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How to select the right speech language pathologist for your adopted child?

May 112009

How to select the right speech language pathologist for your adopted child?

You have decided to consult a private speech language pathologist because of concerns over your adopted child’s developing speech and language. But how do you choose the right one? There are many speech therapists out there and not all of them are alike in experience and skills. On top of it all, you are also looking for a bilingual therapist, one who is not only proficient in your child’s native language but is also knowledgeable regarding the speech and language issues of international adoptees. That is not an easy decision to make, especially for many parents who until now have not had any direct contact with a speech language pathologist.
Not to worry, below is a list of simple guidelines designed to assist you in the right therapist selection.

Let’s begin with something basic: educational and professional credentials. A speech language pathologist must possess a Master’s Degree (or its equivalent) from a reputable academic institution of higher learning. They must also have a Certificate of Clinical Competence from the American Speech Language Hearing Association as well as an appropriate licensure from the state in which they maintain their practice. Additionally, it is highly recommended that they have Bilingual Certification as it indicates that they have completed the necessary academic coursework and are proficient in the issues surrounding normal and disordered speech-language acquisition of bilingual children in dual languages.

Now we are ready to proceed to experience. Here its gets a little tricky. The traditional approach: “I want the therapist with a gazillion years of experience” is just not going to be all that useful. It can’t be just any experience; it has to be the right experience! After all do you really want a therapist with 30 years of experience in exclusively treating articulation deficits when your child needs help with feeding and swallowing or with developing augmentative/alternative communication?

It is important to choose a therapist who has a rich and varied experience from multiple settings, total years of experience may not be as important as the qualitative value of that experience. A good therapist has probably spent a considerable portion of his/her time in a variety of settings from schools and early intervention agencies to hospitals and rehabilitation clinics. As the result of working in these diverse environments that therapist is much more likely to come up with innovative ideas and solutions to your child’s problems as opposed to just using the same old remediation strategies that they have learned way back then. It is also a good idea to inquire regarding the areas of specialization of the therapist in order to find out whether he/she has successfully treated children with similar problems to your child’s.

Typically, private speech language pathologists who maintain some type of pediatric hospital affiliation (e.g. per diem or part-time employees) are up to date regarding the current methodologies, which they apply to practice on daily basis. The reasons for that are twofold:

Speech departments in hospitals deal with diverse caseloads, with patients ranging in ages, diagnoses (some of which can be quite unusual), and levels of severity. In an average inpatient department staff SLP’s are expected to carry caseloads of 12-16 patients per day.
In order to keep up with the caseload diversity and with the latest treatment trends, hospitals require these SLP’s to actively take professional development courses in order to provide their patients with the best quality of care.
This brings us to another important consideration: professional development. To maintain their state licensure and national certification all therapists are required to take professional education courses in order to stay up to date with all the relevant research and new treatments developed in our field. The minimum requirement is to accumulate 30 professional education hours every 3 years whether by attending courses in person, taking them online through qualified providers, or by conducting workshops and presenting at conferences. Professional development provides the speech therapists with an opportunity to use evidence based techniques supported and tested by research to treat a variety of communication disorders. Consequently, when selecting your therapist it is important to find out just how up to date are they on the current treatment methods and methodologies pertaining to your child speech and language deficits. You can always find out this information by politely questioning the therapist regarding their background and “resume highlights.”

It is also important to find out whether you understand and agree with the therapist’s methods and approaches. For example, if your child is a toddler, it probably does not make sense for him/her to spend most sessions doing worksheets and drills when he/she needs to be engaged in play based, child centered therapy. Don’t be intimidated by the therapist’s credentials and your lack of knowledge, if something they said doesn’t make sense, ask follow up questions and/or look up pertinent information online. While you should not use the internet to diagnose your child’s problems, it can be used as a valuable learning tool to look up information and to share ideas with other parents who experience similar difficulties.

Now that we have specified general selection criteria, let’s talk about how to initiate your search for the right SLP. The best way is again to go online. Start your search by going to the ASHA website and clicking on the ‘Find Professional Button’ located in the top of the page and then follow the instructions on the screen. Fill out your search criteria carefully but don’t be too specific. For example, don’t look for a Russian speaking SLP in Blue Creek, California as you will probably not find one. Instead try typing in the first 3 digits of your zipcode or your state of residence (if it’s small enough) and don’t forget to specify the language of the practitioner. That will get you the optimum results.

Once you have located several candidates, you can narrow down the search by trying to learn something about them online. Google the clinician’s name (or the name of their practice) to see whether they have their own website, have written any articles or have been profiled by any organizations. To make sure that your practitioner’s licensure is up to date, visit your state’s speech language accreditation website and type in the last name of the professional. Typically, a window will pop up listing the therapists’ names alphabetically, find the one you are looking for and check if their license is active. Finally, armed with your research, create a list of questions that you might have for the practitioners and start making phone calls. Find out all the pertinent information and don’t forget to ask about rates which may differ depending on what services the practitioner is providing.

Please note that many private practitioners refuse to deal with insurance companies directly due to the hassle of multiclient billing as well as extended wait for reimbursement. They will instead provide you with a letter for your insurance company, containing the necessary diagnosis and treatment codes, incurred fees as well as a brief description of services provided, and will expect you to apply for reimbursement on your own.

Now that we have gone over the selection process in some detail, please keep in mind that you can always learn more information on this and any other speech pathology related topic by visiting the ASHA website and clicking on the ‘Public’ tab located at the top of the screen.

Best of luck in your search and happy hunting!

Useful websites:
Find a Professional SLP on the ASHA website: http://www.asha.org/proserv/
State Contacts & Licensure Requirements: http://www.asha.org/about/legislation-advocacy/state/

Functional Strategies for Improving the Language Abilities of Your Adopted School-Age Child

internationally adopted children, language stimulation, preschoolers, Smart Speech Therapy Article No Responses »

Feb 202009

Functional Strategies for Improving the Language Abilities of Your Adopted School-Age Child.

While most internationally adopted children catch up to their peers in language development somewhat quickly, not all internationally adopted children demonstrate equal progress by the time they reach school age. Below are some suggestions on how parents can facilitate their school age child’s language skills and improve their language abilities via fun interactive games that the whole family can enjoy and benefit from.

There are several language functions important for academic success. Typically this hierarchy develops from the most basic to the most complex, with the earliest stages beginning long before the child reaches school age. These functions include the ability to: seek information, inform, compare, order, classify, analyze, infer, justify/persuade, solve problems, synthesize, and evaluate. For some children those abilities come naturally while for others – a creative push in the right direction might just do the trick. Luckily, there are plenty of children’s games on the market that address the above skills in a fun and functional way, oftentimes without the child even realizing that they are doing work.

One of the earliest and important areas of language development is vocabulary knowledge. Good vocabulary skills are essential for communication of thoughts and ideas, interaction with peers, as well as meeting the demands of the classroom. As academic demands increase the importance of good vocabulary comes prominently into play. Vocabulary hierarchy ranges from a simple ability of labeling (providing a name for people, actions and objects) to the advanced descriptions (using attributes, functions, and learned concepts to depict an object/item in a cohesive manner). As children’s vocabulary increases from basic labeling to using sophisticated descriptions it goes through several other important stages outlined below:

• Concept Knowledge – the ability to comprehend and identify qualitative (e.g., same–different, big– little, hot-cold), quantitative (e.g., few-many, more-less), temporal (e.g., before-after, next, first, last), or spatial (e.g., in-on, under-over) concepts
• Associations – knowledge of how words are semantically related/linked (e.g., knowing why a spoon and a knife go together)
• Categorization/Classification – the ability to identify items within a category (divergent naming) and provide labels for groups/classes of objects (convergent naming)

The following are just a few selected examples of available games (a more complete list will be provided at the end of this article) that should help facilitate the development of vocabulary language skills:
A to Z Jr- a game of early categorizations is recommended for players 5 – 10 years of age, but can be used with older children depending on their knowledge base. The object of the game is to cover all letters on your letter board by calling out words in specific categories before the timer runs out. This game can be used to increase word finding abilities in children with weak language skills as the categories range from simple (e.g., colors) to more complicated (e.,. animals with stripes). This game is great for several players of different age groups (e.g., older siblings), since children with weaker knowledge and language skills can answer simpler questions and learn the answers to the harder questions as other players get their turn.

Tribond Jr – is another great game which purpose is to determine how 3 seemingly random items are related to one another. Good for older children 7-12 years of age it’s also great for problem solving and reasoning as some of the answers are not so straight forward (e.g., what do the clock, orange and circle have in common? Psst…they are all round)

Password Jr-is a great game to develop the skills of description. In the game you guess passwords based on the one word clues. This game is designed to play with children ages 7 years and older as long as the parents help the non readers with the cards. It’s great for encouraging children to become both better at describing and at listening. Parents are encouraged to allow their kids to select the word they want to describe in order to boost their confidence in own abilities. Parents are also encouraged to provide visual cheat sheets (listing ways we can describe something such as: what does it do, where does it go, how can we use it etc) to the child as they will be much more likely to provide more complete descriptions of the target words given visual cues.

Blurt – a game for children 10 and up is a game that works on a simple premise. Blurt out as many answers as you can in order to guess what the word is. Blurt provides ready-made definitions that you read off to players so they could start guessing what the word is. Players and teams use squares on the board strategically to advance by competing in various definition challenges that increase language opportunities.

However, vocabulary knowledge alone does not determine academic success. There are other equally valuable language skills which are important as well. One of them is asking and answering questions. Being able to ask and answer questions is an integral part of academic success.

Asking questions is one of the main ways that children obtain knowledge about the world beyond their immediate experience. Children who are unable to ask questions are at a disadvantage when it comes to following directions or understanding difficult concepts since they are unable to request repetition and clarification from speakers. Moreover, the inability to answer questions effectively is an indication that the child will not be understood well by others. Being able to answer concrete and abstract questions is another necessary requirement for success in school. Games such as Guess Who (age 6+), Guess Where (age 6+), and Mystery Garden (age 4+) are great for encouraging students to ask relevant questions in order to be the first to win the game. They are also terrific for encouraging reasoning skills. Questions have to be thought through carefully in order to be the first one to win the game.

Another important ability in the language learning hierarchy is story telling. Being able to tell good stories is a difficult task for many children, even those without language impairment. Consequently, one way of learning to become a good story teller is through the usage of visual cues such as picture cards, or games. When children are very young speech therapists often work on improving their story telling abilities using props such as a variety of toys or puppets. As they get older they transition to picture cards or wordless story books with the final step being spontaneously produced stories with no visual support. One of such games is Fib or Not (ages 10+). The game encourages the players to fool other players by either telling an outlandish true story or a truly believable made up story. For the players who are listening to the story, the objective is to correctly guess if the story teller is fibbing or being truthful. Players advance by fooling the other players or by guessing correctly.

As children grow older, they are required to do more and more tasks that focus on their verbal reasoning and problem solving abilities. If your child’s problem solving skills are on the weaker side consider using events from storybooks that illustrate problems. Talk aloud about the problem and offer a list of choices if your child is having difficulties figuring out the answers. Have your child talk through the process of how they arrived to their conclusions and offer suggestions and guidance along the way. The two popular games that work on improving verbal reasoning and problem solving abilities are: 30 Second Mysteries (ages 8-12) and 20 Questions for Kids (ages 7+).

In 30 Second Mysteries kids need to use critical thinking and deductive reasoning in order to solve mysteriously sounding cases of everyday events. Each clue read aloud reveals more about the mystery and the trick is to solve it given the fewest number of clues in order to gain the most points. In 20 Questions for Kids, a classic guessing game of people, places, and things, children need to generate original questions in order to obtain information. Here again, each clue read aloud reveals more about the secret identity and the trick is to solve it given the fewest number of clues.

A good way of implementing the above games in action is during family fun night. Select a game that focuses on one or more elements that you feel your child needs to work on and then involve your entire family in a game playing activity so the child does not feel that they are being isolated for “work”. For children who are younger or with weaker vocabularies, modify the rules to help to simplify the demands of the game, or play in a team so that the child doesn’t feel overwhelmed. Feel free to provide your own cues and prompts in order to achieve maximum success with all gaming activities.

Now that we have gone over the game description and selection process in some detail, please keep in mind that you can always learn more about children’s games by simply going to a popular internet websites such as Amazon and reading product descriptions in order to figure out whether specific game is right fit for your child.

As always, parents are advised to consult with related professionals (speech and language therapists, psychologists, etc) if they have any serious concerns regarding their child’s communication skills. Early detection and treatment are critical to the process of successful speech and language development not just in early childhood but also during school age, adolescence, and even early adulthood.

Best of luck and have fun playing!

List of Selected Games:
• 20 Questions for Kids
• 30 Second Mysteries
• A to Z Jr.
• Blurt
• Fib or Not
• Guess Where?
• Guess Who?
• Last Word
• Loaded Questions
• Mystery Garden
• Outburst
• Password Junior
• Tribond Junior

Creating a learning rich environment to facilitate language development in adopted preschoolers.

internationally adopted children, language stimulation, resource websites, Smart Speech Therapy Article No Responses »

Feb 152009

Creating a learning rich environment to facilitate language development in adopted preschoolers.

Tatyana Elleseff MA CCC-SLP

Bringing your newly adopted child home after an often difficult and lengthy adoption process can be both exciting and intimidating for parents. On the one hand there is relief; the child you were waiting for so long is finally yours. On the other hand, this is frequently a starting point of many new worries, especially if adoptive parents do not share a common language with their newly adopted child. What is more, a significant number of adopted children over three years of age are drastically delayed in their native language development. This is often due to the harsh realities of institutional care, which is characterized by neglect, lack of stimulation, inadequate learning setting and many other factors which may negatively impact language development. Coupled with this, is adopted child’s trauma of being uprooted from all that is familiar. As a result, the new parents may find themselves facing a child who simply refuses to speak in any language. This reluctance to speak can last anywhere from a few days to a few months. If you find yourself in this situation, don’t despair. There are a few relatively simple strategies to facilitate a child’s language development, whether you are attempting to reinforce child’s Russian or teaching the child English. All that is required are some patience and perseverance.For starters, set up a learning environment in the play room. Purchase inexpensive language rich toys that are fun and educational at the same time. For example, many wooden peg puzzles have sounds (e.g. Melissa and Doug brand) and are great for teaching some essential language ranging from foods and animals to transportation and clothes. Additionally, portable “Create-A-Scene Magnetic Play Sets” (e.g. Smethport brand) are great for imaginative language rich play during which children can make endless combination of fun scenes and comment on their creations. With numerous different play sets to choose from, including fairy tales and nursery rhymes, its a great way to facilitate language through child centered, commentary laden play (a child creates scenes and an adult comments on them while setting up multiple opportunities for the child to imitate and respond).Other toys great for language development are early games such as Bingo. Bingo games can be purchased, found free online (e.g. http://bogglesworldesl.com/) or even made using special websites (e.g. dltk-kids). They are great for developing many basic skills such as knowledge about body parts, recognizing everyday sounds, learning rhyming words, learning sight words or matching vowels during fun interactive play that targets language comprehension and expression.Furthermore, simple play sets such as doll houses, car garages, or enchanted castles can serve as great tools for language development. They can be used for teaching and eliciting new language forms through repetition, for following multistep directions (“put daddy in the kitchen, mommy on the porch, and the baby in the bathtub”) as well as for developing your child’s imagination and cognitive skills through play.Of course we mustn’t forget books. Book reading can be an art form. It can teach much or it can teach very little as we have learned from a seminal study by Shirley Brice Heath entitled “What no bed time story means”, which explored patterns of book reading to preschoolers in a cluster of mainstream school-oriented neighborhoods of a city in the southeastern region in the United States. In a nutshell, the study postulated that bedtime stories are a crucial part of a child’s early education and the way they are read to children can determine their success in school. When purchasing books (checking out from the library or printing/reading online see useful websites) for preschoolers one needs to take into the consideration both the illustrations and the content. While board books are appropriate for toddlers, older children (2.6+) can handle paper pages and will be particularly interested in ‘lift the flap’ or ‘pop up’ illustrations. Books for preschoolers must contain “learnability”- possess repetition, focus on basic concepts (e.g. up/down, big/small, good/bad etc), use rhyming text in order to develop the child’s comprehension and vocabulary as well as to prepare them for independent book reading in the future.

When reading books with your preschool child your focus should be not just on asking the child to simply identify the pictures in the book. You should also ask concrete “wh” questions (i.e. what, where, when) as well as via more abstract ‘why’ and ‘how’ questions. These techniques will help you improve your child’s comprehension development. Good story reading involves comparing and contrasting (e.g. objects/people/animals) making predictions and inferences about what going to happen in the story line, asking the child to problem solve the situation for the character (e.g. what do you think he must do to…?), state his/her likes and dislikes about the story characters as well as describe (narrate back) their view of events taking place in the story.

Additionally, listening as well as singing and dancing along with simple children’s songs develops comprehension of words through actions and expression of language through vocalizations. This is especially valuable because the activity places low demand (singing along is less demanding than directly imitating adults) on a child who is already significantly ‘stressed’ due to his inability/decreased ability to speak.

All toys/activities can be used to facilitate speech and language; one just must be creative in their uses. Parents don’t need to purchase costly toys in order to facilitate language development (all abovementioned toys and manipulatives can be found for a fraction of its retail price on different sites online as well as in discount stores such as Amazing Savings, Daffy’s and many others). However, appropriate selection and use of toys can make a difference in the rate of language adaptation and use.

As always, parents are advised to consult with related professionals (speech and language therapists, psychologists, etc) if they have any concerns regarding their child’s developing communication skills. Early detection and treatment are critical to the process of successful speech and language development.

References:
Heath, S. B (1982) What no bedtime story means: Narrative skills at home and school. Language in Society, vol. 11 pp. 49-76.

Some Useful Websites:
www.beyondplay.com

http://www.superdairyboy.com/Toys/magnetic_playsets.html

http://www.educationaltoysplanet.com/

http://www.melissaanddoug.com/shop.phtml

http://www.dltk-cards.com/bingo/

http://bogglesworldesl.com/

http://www.childrensbooksforever.com/index.html

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