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New Webinar: Inattention, Hyperactivity and Impulsivity in At-Risk Children: Differential Diagnosis of ADHD in Speech Language Pathology

 Inattentiveness, hyperactivity, and impulsivity are the most common presenting behavioral problems in at-risk children. This workshop will describe select speech language causes of hyperactivity and inattentiveness in children beyond the ADHD diagnosis, including traumatic brain injury, auditory processing disorders, severe language disorders, as well as social pragmatic language deficits.It will review case examples to illustrate the importance of differential diagnosis. Implications for assessment as well as the need for relevant referrals will be discussed.

When: Thursday, January 17, 2013, 4-5 p.m. ET

Where: Your computer*

Presenter: Tatyana Elleseff, MA, CCC-SLP

Cost: FREE

Who Should Attend: Anyone interested in discussing behavioral problems in at-risk children.

How: Register Here

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Understanding the risks of social pragmatic deficits in post institutionalized internationally adopted (IA) children.

Image may contain: 1 person, textThis article was originally published in December 24, 2012 issue of Advance for Speech Language Pathologists and Audiologists under the title: “Adoption & Pragmatic Problems” (pp 6-9) 

Photo credits: Leonid Khavin

Cover Model: Bella Critelli

According to U.S. State Department, 233,934 children were adopted internationally between 1999-2011, with a majority 76 percent (or approximately 177,316) of these children being under 3 years of age.

To date a number of studies have come out about various aspects of these children’s language development, including but not limited to, rate of new language acquisition, patterns of typical vs. atypical language acquisition, as well as long-term language outcomes post-institutionalization.

While significant variability was found with respect to language gains and outcomes of internationally adopted children, a number of researchers found a correlation between age of adoption and language outcomes, namely, children adopted at younger ages (under 3 years of age) seem to present with better language/academic outcomes in the long-term vs. children adopted at older ages.1,2,3,4

Indeed, it certainly stands to reason that the less time children spend in an institutional environment, the better off they are in all areas of functioning (cognitive, emotional, linguistic, social, etc.). The longer the child stays in an institutional environment, the greater is the risk of greater delays, including a speech and language delay.

However, children adopted at younger ages, may also present with significant delays in select areas of functioning, many years post-adoption. Continue reading Understanding the risks of social pragmatic deficits in post institutionalized internationally adopted (IA) children.

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ASHA Community Spotlight

I just got an email that I’ll be profiled on ASHA Community Page for the next month or so. So click on the link to find out why I participate in ASHA’s Professional Community.

Here are some ways in which I participate:

I contribute to forum discussions including those which pertain to Special Interest Groups 1, 14, and 16.

I share materials with members and post them in various ASHA Libraries.

I am an ASHA S.T.E.P Mentor.

I also intermittently contribute blog posts to ASHAsphere, the official blog of the American Speech Language and Hearing Association.

If you are a certified speech language pathologist I highly recommend ASHA Community Participation as as part of your professional growth.

If you haven’t done it yet, try it!

I guarantee you’ll like it!

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“Appdapting” Flashcard Apps to Address Social Skills

I have to admit, I don’t really like flashcards. I especially don’t like it when parents or SLPs use flashcards to drill vocabulary in toddlers and preschoolers, much less school aged children. I feel that it produces very limited learnability and generalization. I am personally a proponent of thematic language learning, since it allows me to take a handful of words/concepts and reinforce them in a number of different ways. The clients still get the benefit of information repetition, much like one would get during a typical flashcard drill.  However, they are also getting much more.  Thematic language learning allows the client to increase word comprehension, make connections to real life scenarios,  develop abstract thinking skills, as well as to transfer and generalize knowledge (Morrow, Pressley, Smith, &  Smith, 1997; Ramey, 1995).

However, even though I dislike flashcards, I still don’t necessarily want to give up using them completely, especially because nowadays many different type of image based language flashcards can be found for free as both printables as well as Iphone/Ipad apps.  Consequently, I decided to pick a free flashcard app and adapt it or rather  “appdapt” it (coined by “The Speech Guy”, Jeremy Legaspi, the “Appdapt Guru”) in a meaningful and functional way for my students.

After looking over and rejecting a number of contenders, without a clear plan of action in mind,  I stumbled upon a free app, ABA Flash Cards – Actions by kindergarten.com, which is designed to target verb labeling in ASD children.   When I saw this app, I immediately knew how I wanted to appdapt it.  I especially liked the fact that the app is made for both Ipad and Iphone. Here’s why.

My primary setting is an out of district day school inside a partial psychiatric hospital.  So in my line of work I  frequently do therapy with students just coming out from  “chill out rooms” and “calm down areas”.  This is definitely not the time when I want to bring or use a lot of materials in the session, since in a moment’s notice the session’s atmosphere can change from calm and productive into volatile and complicated.  I also didn’t  want to use a bulky Ipad in sessions with relatively new children on the caseload, since it usually takes a few sessions of careful observations and interaction to learn what makes them “tick”. Consequently, I was looking for an app which could ideally be downloaded onto not just the Ipad but also the Iphone. I reasoned that in unexpected  situations I could simply put the phone into my pocket, unlike the Ipad, which in crisis situations can easily become a target or a missile.

Given the fact that many children with psychiatric disorders present with significant social pragmatic language deficits (Hyter, 2003; Hyter et al 2001; Cohen et al., 1998; Bryan, 1991; Goldman, 1987 ), which is certainly the case for the children on my caseload, I planned on adapting this app to target my students’ pragmatic language development, social problem solving skills as well as perspective taking abilities.

So here are just a few examples of how I appdapted the cards.  First, I turned off the sound, since the visual images were what I was going after.  Then I separated the cards into several categories and formulated some sample questions and scenarios that I was going to ask/pose to the students:

Making Inferences (re: People, Locations and Actions)

iPhone Screenshot 2

What do you think the girl is thinking about?

How do you know what she is thinking?

How do you think she is feeling?

How can you tell?

Where do you think she is?

How do you know?

 

Multiple Interpretations of Actions and Settings: 

iPhone Screenshot 3

 

What do you think the girl is doing?

What else could she be doing?

 

 

 

 

 

boyflowerHow does the boy feel about the flower?

Give me a different explanation of how else can he possibly feel?

 

 

 

 

Who are the boys in the picture? (relationship)

Who else could they be?

What do you think the boy in a blue shirt is whispering to the boy in a red shirt?

What else could he be saying?

How do you know?

 

Supporting Empathy/Sympathy and Developing Peer Relatedness:

How does this child feel?

Why do you think he is crying?

What can you ask him/tell him to make things better?

 

 

 

 

The girl is laughing because someone did something nice for her?

What do you think they did?

 

 

 

 

 

Interpreting Ambiguous Situations:

girlrunning

 

What is the girl doing?

Who do you think is the woman in the picture?

How do you know?

How does she feel about what the girl is doing?

How do you know?

My goal was to help the students how to correctly interpret facial features, body language, and context clues in order to teach them how to appropriately justify their responses. I also wanted to demonstrate to them that many times the situations in which we find ourselves in or the scenes that we are confronted with on daily basis  could be interpreted in multiple ways. Moreover, I wanted to teach how appropriately speak to, console, praise, or compliment others in order to improve their ability to relate to peers. Finally, I wanted to provide them with an opportunity to improve their perspective taking abilities so they could comprehend and verbally demonstrate  that other people could have feelings, beliefs and desires different from theirs.

Since I knew that many of my students had significant difficulties with even such simple tasks as labeling and identifying feelings, I also wanted to make sure that the students got multiple opportunities to describe a variety of emotions that they saw in the images, beyond offering the rudimentary labels of “happy”, “mad”, “sad”, so I took pictures of Emotions Word Bank as well as Emotion Color Wheel courtesy of the Do2Learn website, to store in my phone, in order to provide them with extra support.

                

The above allowed me not only to provide them with visual and written illustrations but also to teach them synonyms and antonyms of relevant words.  Finally, per my psychotherapist colleagues request,  I also compiled a list of vocabulary terms reflecting additional internal states besides emotions (happy, mad) and emotional behaviors (laughing, crying, frowning). These included words related to:  Cognition (know, think, remember, guess), Perception (see, hear, watch, feel), and Desire (want, need, wish), (Dodd, 2012) so my students could optimally benefit not just from language related therapy services but also their individual psychotherapy sessions as well.

I’ve only just began trialing the usage of this app with the students but I have to admit, even though its still the early days, so far things have been working pretty well. Looks like there’s hope for flashcards after all!

References:

———Bryan, T. (1991). Social problems and learning disabilities. In B. Y. L. Wong (Ed.), Learning about learning disabilities (pp. 195-229). San Diego, CA: Academic Press.

—Cohen, N. & Barwick, M. (1996) Comorbidity of Language and Social-Emotional Disorders: Comparison of Psychiatric Outpatients and Their Siblings. Journal of Clinical Child Psychology, 25(2), 192-200.

Goldman, L. G. (1987). Social implications of learning disorders. Reading, Writing and Learning Disabilities, 3, 119-130.

—Hyter, Y. D., et al (2001). Pragmatic language intervention for children with language and emotional/behavioral disorders. Communication Disorders Quarterly, 23(1), 4–16.

Hyter, Y. D. (2003). Language intervention  for children with emotional or behavioral disorders. Behavioral  Disorders, 29, 65–76.

Morrow, L. M., Pressley, M., Smith, J.K., & Smith, M. (1997). The effect of a literature-based program integrated into literacy and science instruction with children from diverse background. Reading Research Quarterly, 32(1), 54-76.

Petersen, D. B., Dodd, J & Finestack, L. H (2012, Oct 9) Narrative Assessment and Intervention: Live Chat. Sponsored by SIG 1: Language Learning and Education. http://www.asha.org/events/live/10-09-2012-narrative-assessment-and-intervention/

Ramey, E. K. (1995). An integrated approach to language arts instruction. The Reading Teacher, 48(5), 418-419.

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Stimulating Language Abilities of Internationally Adopted Children: Fun with Ready-Made Fall and Halloween Bingo

  There are many fun language based activities parents can do at home with their newly (and not so newly) internationally adopted  preschool and school aged children in the fall. One of my personal favorites is bingo. Boggles World, an online ESL teacher resource actually has a number of ready made materials, flashcards, and worksheets which can be adapted for such purposes. For example, their Fall and Halloween Bingo comes with both call out cards and a 3×3 and a 4×4 (as well as 3×3) card generator/boards. Clicking the refresh button will generate as many cards as you need, so the supply is endless! You can copy and paste the entire bingo board into a word document resize it and then print it out on reinforced paper or just laminate it.

Fall vocabulary words includecorn, crops, farmer, scarecrow, apples, acorns, oak leaf, maple leaves, ginkgo leaves, grapes, mushrooms, salmon, geese, squirrel, jacket, turkey, Jack-O’-Lantern, rake, pumpkins, harvest moon, hay, chestnuts, crow, and sparrow

Halloween vocabulary words includewitch, ghost, skeleton, skull, spider, owl, Jack-O’-Lantern, devil, cobweb, graveyard, clown, pirate, robot, superhero, mummy, vampire, bat, black cat, trick or treaters, alien, werewolf

Now the fun begins!

Some suggested activities:

Practice Vocabulary Labeling: Label the words for newly adopted IA children and get them to say the words after you.

Practice Simple Sentences: Make up simple sentences such as A spider lives in a cobweb or  A squirrel is eating an acorn.

Practice Rhyming:  what rhymes with cat/bat/ trick/leaf/ rake/moon?

For those children who are having articulation (speech) difficulties practice saying  words with select sounds (/ch/, /sh/, /l/, etc) to improve their  intelligibility (pronunciation)

Practice Categorization Skills: Name some fall words, Halloween words, name some popular halloween costumes, name some popular fall activities, etc

Practice naming Associations: what goes with a witch (broom), what goes with a squirrel (acorn), etc

Practice expanding vocabulary by providing Attributes (object characteristics):  Take a noun-word (thing) such as “squirrel” and answer some questions about it: what is it? what does it do? where do you find it? what are its parts? What color/shape is it? does it make any sounds? what goes with it.  Here’s one example, (I see a pumpkin. It’s a fruit/vegetable that you can plant, grow and eat. You find it on a farm. It’s round and orange and is the size of a ball. Inside the pumpkin are seeds. You can carve it and make a jack o lantern out of it).

Practice expanding language by providing relevant  Definitions: Tell me what a skeleton is. Tell me what a scarecrow is.

Practice improving their Problem Solving abilities by naming Similarities and Differences among semantically related items: How are pumpkin and apple alike? How are they different?

Help them understand that many words can have more than one meaning and  explain Multiple Meaning words to them:   A bat, witch, clown, can mean _____ and also mean _________

So join in the fun and start playing today! 

Resources:

Bogglesworld Halloween Bingo Board and Cards http://bogglesworldesl.com/halloweenbingo.htm

Bogglesworld Fall Bingo Board and Cards http://bogglesworldesl.com/autumn_bingo.htm

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Rutgers 31 Annual Let’s Talk Adoption Conference

Tatyana ElleseffCo-presenting 2 sessions at the Rutgers 31 Annual Let’s Talk Adoption Conference on November 3, 2012. Rutgers 31 Annual Let’s Talk Adoption Conference

1:45-2:45pm

24. “Inattentiveness and Hyperactivity in Adopted and Foster Care Children;; Not All ADHD is Bouncing Off the Walls” [AF, ED, FP, HC, MP, PA, SW-­2] Inattentiveness, hyperactivity, and impulsivity are the most common behavioral problems in adopted and foster care children. The effectiveness of any preventative and/or therapeutic intervention greatly depends on accurate diagnosis of the underlying issue. A general pediatrician and a speech/language pathologist, both specializing in adoption/foster care as well as in educational issues, will discuss the multi-­faceted problem in the ‘at-­risk’ population, children and their caregivers. Special emphasis will be made on major medical, developmental, educational, and/or mental health causes of hyperactivity and inattentiveness in children and teenagers beyond the ADHD diagnosis, including FASD, PTSD, traumatic brain injury, and other entities. Alla Gordina, MD, FAAP and Tatyana Elleseff, MA CCC-­SLP (1 CEH)

3:00-4:00pm

33. “Sobering Thoughts on Attitudes Towards Fetal Alcohol Spectrum Disorders” [AF, ED, FP, HC, MP, PA, SW-­4] The group of Fetal Alcohol Spectrum Disorders, affecting up to 10% of adopted and foster care children, is the single most common preventable cause of mental retardation in the United States. Yet it is one of the least diagnosed and worst managed conditions by medical, mental health and educational professionals. A general pediatrician and a speech/language pathologist, both specializing in adoption/foster care as well as in educational issues, will discuss the approaches to evaluation and management of individuals affected by Fetal Alcohol Spectrum Disorders, as well as recommendations on local resources and advocacy strategies. Alla Gordina, MD, FAAP and Tatyana Elleseff, MA CCC-­SLP (1 CEH)

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The Value of Multidisciplinary Collaboration and Follow -up among International Adoption Professionals: A Speech Pathologist’s Perspective

As a speech language pathologist who works with internationally adopted children, I often encounter difficult cases on which I require multidisciplinary collaboration from other professionals such as pediatricians, neurologists, psychologists, occupational therapists and other related specialists. However, over the years of working with this unique population, I have noted that among adoption professionals and adoptive parents this practice is not as popular, as I would like it to be, despite evidence based practice recommendations (Catlett & Halper, 1992; Ellingson, 2002; Hwa-Froelich, Pettinelli, & Jones, 2006; Tzenalis & Sotiriadou, 2010). Oftentimes, medical professionals may initially examine a child post adoption, recommend a related service (e.g., “you child needs speech therapy”) but will not follow up with the related service provider regarding the child’s progress or lack of thereof.  Of course the same goes the other way, I have also encountered cases where a related services provider (e.g., OT, ST) had made clinically relevant observations and did not find it “important” to follow up with relevant medical professional/s regarding the findings.  I’ve also encountered numerous adoptive parents who did not follow through on specific recommendations regarding related services provision (speech or occupational therapy services) or psychiatric/neurological referrals.

Consequently, for the purpose of this article I would like to demonstrate to both adoptive parents and professionals two case examples in which multidisciplinary and parental collaboration was key to confirming specific relevant to social and academic functioning diagnoses, which then in turn supported the provision of relevant services for the children in question, to help them function appropriately.

Last year a received a private referral to perform a speech-language evaluation on a preschooler, 8 months post adoption.  He had previously underwent a post adoption assessment at a prominent hospital in my area,  where a neurologist had noted his small head circumference and significantly reduced language abilities and made a general referral for the child to be evaluated by a speech pathologist but did not emphasize the importance of follow-up to the adoptive parent.  Fast forward 8 months later, this child was still presenting with significant language delay as well as behavioral outbursts, when he was reluctantly brought in for an assessment by his parent based on a recommendation of a privately seen psychotherapist.

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. I still documented my findings and referred him for a second opinion due to 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 difficulties.  This time around the second opinion consultations “paid off”, and yielded a diagnosis of Fetal Alcohol Spectrum Disorder, which allowed this child to be placed in preschool disabled classroom as well as to receive appropriate accommodations and related services to improve his language abilities and social emotional functioning.

While many professionals might consider this a successful conclusion to this story I would like to point out that this child presented with significant unrecognized and unaddressed deficits for 8 months post adoption due to lack of consistent collaboration and follow through in his case. Had the collaborative process been more cohesive this child could have been receiving relevant and necessary services since adoption, and could have feasibly improved his abilities by the time 8 months had passed.  

Here’s another case example in which the collaborative process was equally important.  A number of months ago during presentation preparation with two of my colleagues, a pediatrician and a clinical social worker, the conversation turned to progress of our mutual clients.   At that point I expressed frustration with halting and inconsistent progress of one of my clients, who was receiving weekly private speech therapy from me as well as private tutoring three times a week, and whose issues with attention and cognition persisted, despite the absence of a particular diagnosis (e.g., ASD).

After, I shared my concerns with my colleagues; the pediatrician stated that she has long been concerned with the presence of café au lait spots on this child’s skin and has sent him out for blood work but have not heard anything from his parents since. Though the pediatrician was not stating her suspicious explicitly, café au lait spots on the skin are often indicative of neurofibromatosis, a neurocutaneous syndrome that leads to benign tumor growths in various parts of the body, can affect the brain, spinal cord, nerves, skin, and other body systems as well as cause cognitive deficits and learning disabilities that affect appropriate knowledge acquisition and retention.  In this situation, it was very important to make sure that the parent was “on the same page” as the other professionals and followed through on their recommendations, in order to coordinate appropriate services and supports for this child both privately and through his school.

I use these examples to emphasize the value and importance of working as part of a team to treat the “whole” child.  Those adoption professionals who specialize in working with children on the spectrum are most familiar with being part of a team, since they are just one of many professionals such as behaviorists, OT’s, psychologists or neurologists who are working with a child.  Being part of a team is also a much more acceptable practice when a child is treated in a hospital or a rehab setting and presents with a complex disorder (e.g., has a genetic syndrome, etc).

However, in the field of adoptive services, even outside of specialty settings (hospital/rehab) we are frequently confronted with clients who stump our thinking processes, and who require the team approach.  Yet oftentimes that creates a significant challenge for many professionals isolated in private practice.  Being part of a team when one is sole practitioner is a much more difficult feat, especially when select adoptive professionals are just striking out on their own for the first time.

Yet, both interdisciplinary and multidisciplinary teamwork is oftentimes so crucial in our field. Working as part of a team allows us to collectively pursue common goals, combine our selective expertise, initiate a discussion to solve difficult problems, as well as to have professional lifelines when working on difficult cases.   Different providers (neurologist, SLP, OT, psychotherapist) see different symptoms as well as different aspects of the patient’s disorder. Consequently, different providers bring different perspectives to the table, which ultimately positively contributes to the treatment of the whole child.

So how can we develop productive professional relationships with other service providers which go beyond the initial referral? I’ll be the first one to admit that it is not an easy accomplishment especially which it comes to physicians such as psychiatrists, neurologists, geneticists, or developmental pediatricians.  I can tell you that while some of my professional relationships came easy, others took years to attain and refine.

When I first started working with internationally adopted children in private practice, in a fairly short period of time I ended up having a number of clients with complex diagnoses and no one to refer them to.  What complicated matters further was that some parents did not bring their child to pediatrician specializing in adoptions post arrival (the child just saw a regular pediatrician), but simply brought their child to me when the child’s most “visible issues” speech language deficits, became evident. I had to be the one to initiate the referral process to suggest to their parents relevant medical adoption professionals, which needed to be visited in order to figure out why their children were having such complex language difficulties (among other symptoms) in the first place.

Consequently, I’ve compiled some suggestions for adoption professionals on how to initiate and maintain professional relationships with other relevant adoption providers. Adoptive parents can also benefit from these, since it can help them to initiate the process of obtaining appropriate services for their adopted child.

Start by doing a little reconnaissance.  Become a member of select adoption forums, poke around for advice in support groups, subscribe to relevant adoption publications, network with adoption professionals on LinkedIn,  ask around locally based colleagues, talk to other client’s parents who already did the necessary legwork, or find out whether there are any good international adoption programs/professionals in the local area hospitals.  Personally, when word of mouth failed to do the trick, I turned to “Google” to provide me with desired results.  Surprisingly, simply typing in a string search containing the words adoption as well as “best _______ (profession) in _____ (name of state)” frequently did the trick and allowed me to locate relevant professionals, after browsing through the multitude of web reviews.

Of course depending on the length of client treatment, you will have different relationships with different adoption professionals.   You may collaborate for years with some (e.g., pediatricians, psychiatrists), and only infrequently speak with select specialists (geneticist, otolaryngologist, pediatric ophthalmologist).

Typically, when I refer a client for additional testing or consultation, in my referral letter, I request to receive the results in writing, asking the adoption professional to also include relevant recommendations (if needed). Oftentimes, I also try to set some time to discuss the findings in a phone call in case I have any additional questions or concerns. Of course, I also send out to others, relevant information from my end (progress reports, evaluations) so all of professionals on a specific case will have a more comprehensive profile of the client’s disorder/deficit.

After all, ST’s, OT’s and PT’s are not the only ones who are dependent on information from doctors in order to do our work better. There are times when physicians need information from related professionals in order to move further in treatment such as order specific tests. For example, just recently a pediatrician used my therapy progress report in conjunction with another provider’s, to order an MRI on our mutual recently adopted client.  The pediatrician had significant concerns over client’s development and presenting symptomatology, and needed to gather additional reports supporting her cause for concern in order to justify her course of action (ordering an MRI) to the HMO.

As mentioned previously there are numerous benefits to teamwork including the fact that it allows for appreciation of other disciplines, creation of functional goals for the child,  integration of interventions as well as “brings together diverse knowledge and skills and can result in quicker decision making” (Catlett & Halper, 1992).

Given the above, I highly recommend that adoptive parents and professionals attempt to coordinate care and maintain relationships throughout the duration of the child’s treatment.  This will improve decision making, allow the professionals to address the child’s deficits in a holistic manner, an even potentially expedite the child’s length of stay in therapies.

References:

  • Catlett, C & Halper, A (1992) Team Approaches: Working Together to Improve Quality. ASHA: Quality Improvement Digest.http://www.asha.org/uploadedFiles/aud/TeamApproaches.pdf
  • Ellingson, L (2002) Communication, Collaboration, and Teamwork among Health Care Professionals. Communication Research Trends 21(3) 1-43.
  • Hwa-Froelich, D. A., Pettinelli, J. D., & Jones, S. (2006). Multidisciplinary Collaboration  with Internationally Adopted Children. Perspectives on Communication  Disorders in Culturally and Linguistically Diverse Populations, 13(3), 8-16.
  • Matsuo, H. Hwa-Froelich, D. A., Pettinelli, J. D., Pryor, C., & Sessions, L. (2006).   Constructing Shared Realities: Multidisciplinary Collaboration of Internationally   Adopted Children’s Clinic. Presentation at the Second International Congress of  Qualitative Inquiry, Urbana-Champaign, IL.
  • National Institute of Neurological Disorders and Stroke (NINDS) Neurofibromatosis Information Page http://www.ninds.nih.gov/disorders/neurofibromatosis/neurofibromatosis.htm
  • Pettinelli, D. J., Matsuo, H., & Hwa-Froelich, D. A. (2006). Supervision in   multidisciplinary collaboration. Presentation at the Missouri Family Therapy   Conference, St. Louis, MO.
  • Tzenalis, A & Sotiriadou, C (2010) Health Promotion as Multi-Professional and Multi-Disciplinary Work.  International Journal of Caring Sciences 3(2)49-55
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Upcoming Presentations: Narrative Assessments of Preschool and School Aged Children

On October 24th 2012, I will be presenting at the Morris County Speech Hearing Association in Whippany, NJ on the importance of Narrative Assessments of Preschool and School Aged Children.  See MCSHA’s August 2012 Newsletter regarding registration details.

Learning Objectives:

Participants will be able to

•Explain the impact of narrative difficulties on language development and academic performance
•Discuss stages of narrative development in preschool and school aged children
•List formal and informal instruments that can be used to elicit narratives in children of various ages
•Identify specific elements of narrative assessment
•Formulate measurable goals and objectives targeting narrative skills for IEP reports
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Fun and Educational Summer Board Games: Recommendations for SLPs and Parents

 

children-playingAccording to the New York Times Article which summarized the results of Johns Hopkins University study: A  TYPICAL STUDENT WILL LOSE ABOUT ONE  MONTH OF LEARNING OVER THE SUMMER  TIME.

More troubling is that it disproportionately affects low-income students: they lose two months of reading skills, while their higher-income peers — whose parents can send them to enriching camps, take them on educational vacations and surround them with books during the summer — make slight gains.”  To continue: “the study of students in Baltimore found that about two-thirds of the achievement gap between lower- and higher-income ninth graders could be explained by summer learning loss during the elementary school years.”

BUMMER!

But then again it is summer and kids do want to have fun!

So with the recent heatwaves across the country, how about combining fun with learning on those sweltering summer days when lazing at the pool or going outside may not be the best option.

Let’s take a look at the few common and readily available  board games, which can be used to improve various language abilities: including vocabulary knowledge, problem solving, questioning, storytelling as well as other language related 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., basic concepts) to more complicated (e.,. attributes). This game is great for several players of different age groups, since younger children or 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 you help the non readers with the cards. It’s great for encouraging children to become both better at describing and at listening. You may want to allow the children to select the word they want to describe in order to boost their confidence in own abilities. 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.

Games the facilitate asking questions: 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.

Game that facilitates Story Telling as well as Perspective Taking:   Fib or Not (ages 10+) 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.

Games that improve verbal reasoning and problem solving abilities: 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 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.

Now that you know which games to play and why, how about you give it a try.

Have fun playing!

References:

Smink, J (2011) This is Your Brain on Summer. New York Times: The Opinion Pages. http://www.nytimes.com/2011/07/28/opinion/28smink.html?_r=1

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Adventures in Word-Finding or is Their Language Comprehension Really THAT Bad?

This summer I am taking an on-line course on word-finding with Dr. Diane German, and I must say, in addition to all the valuable information I have learned so far, this course has given me a brand new outlook on how to judge the language comprehension abilities of my clients with word finding difficulties.  It all started with a simple task, to determine the language comprehension abilities of my client with word finding deficits.  Based on available evidence I’ve collected over the period of time I’ve been working with him, I had determined that his comprehension was moderately impaired. I was then asked by Dr. German what language tasks I had used to make that determination?  She also pointed out that many of the formal language comprehension tasks I’ve listed in my report required an oral response.

That question really got me thinking. The truth of the matter is that many formal tests and informal assessments that probe language comprehension abilities rely on learners oral responses. But as it had been pointed out to me, what of our clients with impaired oral skills or significant word retrieval deficits? Most of the time we judge their language comprehension based on the quality of the oral responses they produce, and if their answers are not to our satisfaction, we make sweeping judgments regarding their comprehension abilities, which as Dr. German rightfully pointed out “is the kiss of death” for learners with word finding difficulties and could potentially result in “a spiral of failure”.

Now, in the case of this particular client in question, his language comprehension abilities were truly moderately impaired. I knew that because I tested him by showing him pictures of situations and asked him questions, which did not rely on oral responses but on him selecting the correct answer from a series of pictures and written sentences.

However, had I not performed the above tasks and simply relied on the “language comprehension” subtests from popular standardized tests alone, I would not have had a defensible answer and would have had to admit that I had no clue whether his language comprehension was truly as impaired as I had described.

Following that discussion I decided to take a “fresh look” at the other expressively impaired clients on my caseload but first I needed to figure out which tasks truly assessed my clients’ language comprehension abilities. I didn’t just want to assess their listening skills and vocabulary knowledge (some of the more “easily” assessed non-verbal skills). I wanted to know whether their memory, problem solving skills, figurative language, perspective taking abilities or knowledge of multiple meaning words were actually better than I had originally judged.

Thus, I set out to compile language comprehension materials (formal or informal), which could be used to assess various aspects of language comprehension (multiple meaning words, problem solving abilities, etc) without relying on the child’s ability to produce verbal responses.  However, this task turned out to be far more difficult than I had originally anticipated. For example, when I took a closer look at one of the more popular standardized tests available to me, such as the CELF-4, I realized that there were only two subtests on the first record form 5-8 years (“Concepts and Following Directions” and “Sentence Structure”) and 3 subtests on the second form 9-21 years (“Concepts & Following Directions”, “Sentence Assembly”, and “Semantic Relationships”) that relied on the listener’s ability to point to pictures or use written visuals to answer questions. Moreover, two of the subtests on the second record form (Sentence Assembly”, and “Semantic Relationships”) still required verbal responses.  All other subtests testing “listening comprehension abilities” relied purely on oral responses for correct score determination.

As I reviewed other popular tests (TOLD, CASL, OWLS, etc) I quickly realized that few of these tests’ subtests actually satisfied the above requirement.  Moreover, tests that actually did considerably rely on nonverbal responses (e.g., pointing) such as the Test for Auditory Comprehension of Language-3 (TACL-3) or the Test of Language Competence- Expanded Ed (TLC-Expanded Ed), were unfortunately not accessible to me at my place of work (although I did manage briefly to borrow both tests to assess some clients).

So, I decided to adapt some of the existing tests as well as create a few of my own materials to target language comprehension abilities in various areas.  Surprisingly, it wasn’t as difficult as I imagined it to be, though some tasks did require more creativity than others.

The easiest of course were the assessment of receptive vocabulary for nouns, verbs, and adjectives which was accomplished via standardized testing and story comprehension for which I created picture answers for the younger children and written multiple choice responses for the older children. Assessment of synonyms and antonyms was also doable. I again printed out the relevant pictures and then presented them students.  For example, to assess synonym knowledge the student was shown a relevant picture and asked to match it with another similar meaning word:  “show me another word for “trail” (requires the student to point to a picture depicting “path”) or “show me another word for “flame” (requires the student to point to a picture depicting “fire”). For recognition of antonyms, the student was presented with pictures of both synonyms and antonyms and told: “show me the opposite of child” or “show me the opposite of happy” and so on.

To assess the student’s understanding of “Multiple Meanings” I borrowed the sentences from the Language Processing Test-3 Elementary (LPT-3E), and printed out a few pictures from the internet. So instead of asking the student to explain what “Rose” means in the following sentences:  “Ask Rose to call me”, or “The sun rose over the mountains”, I asked the student to select and point to a corresponding picture from a group of visually related multiple meaning items.  For some children, I also increased the complexity by presenting to them pictures which required attention to details in order to answer the question correctly (e.g., differentiating between boy and girl for the first picture or between actual sunrise and sun peeking through the clouds for the second picture).   Similarly, to assess their problem solving abilities I again printed out pictures to go with select verbal reasoning questions: “Point to what you would do if …”; “Point to how you would solve the following situation…?”

I do have to admit that one of the more challenging subtests to adapt was the “Recalling Sentences” task.  For that I ended up creating similar sounding sentences and asked the child to select the appropriate response given visual multiple choice answers (e.g., point to which sentence did I just say? “The tractor was followed by the bus?” “The bus was followed by the tractor?” “The tractor was followed by the bicycle.”

Again, the point of this exercise was not to prove that the learners’ comprehension skills were indeed impaired but rather to assess whether their comprehension was as significantly impaired as was originally judged. Well the truth of the matter was that most of the children I’ve reassessed using the “pure” auditory comprehension tasks ended up doing much better on these tasks than on those which required verbal responses.

To illustrate, here is a recent case example. I was working with one student on strengthening his knowledge of geography related core vocabulary words (names of the continents and the major bodies of water surrounding them).  This boy had profound difficulty recalling the words even with maximal phonemic cues, after multiple sessions of drill instruction.   Typically after he was shown a specific continent and asked to name it he produced a semantically related response (“South America” for “North America”, “Arctic” for “Antarctica”, etc), which appeared to indicate that his “knowledge” of the words was impaired or at least highly inconsistent.  However, when the verbal naming task was completely eliminated and he was asked to show the examiner specifically named continents and bodies of water on a map (e.g., “Show me Europe”; “Show me Atlantic Ocean”, etc) he was able to do so with 90% accuracy over 3 trials indicating that he did have fairly solid knowledge of where each continent was located visually on a map.

Consequently, as Dr. German has rightly pointed out, when making judgment calls regarding language comprehension abilities of complex clients with severe or at least fairly involved expressive language difficulties, it is very important that SLP’s use tasks that require non verbal responses to questions (e.g., pointing, selecting a picture out of a group, etc), in order not to underestimate these children’s “true” comprehension abilities.

References and Resources:

German, D. J. (2009, Feb. 10). Child Word Finding: Student Voices Enlighten Us. The ASHA Leader, 14 (2), 10-13.

German, D.J. (2005) Word-Finding Intervention Program, Second Edition (WFIP-2)  Austin Texas: Pro.Ed

German, D.J. (2001) It’s on the Tip of My Tongue, Word Finding Strategies to Remember Names and Words You Often Forget.  Word Finding Materials, Inc.

Dr. German’s Word Finding Website: http://www.wordfinding.com/