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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/

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The reviews are in: Improving Social Skills in Children with Psychiatric Disturbances

 

 

 

 

 

Today I did a webinar on

Improving Social Skills in Children with Psychiatric Disturbances

click below for the initial reviews of my live webinar

http://www.speechpathology.com/slp-ceus/course/autism-asd-social-emotional-improving-social-skills-in-children-5414

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or read below:
Average Rating 5 stars
well organized, gave a few examples of what presenter actually has used herself and/or put into practice
Her power point was clear and she was easy to listen to. I appreciated the corresponding resources very much.
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Good review of strategies.
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Information was well organized and clearly presented
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Good info…wish it would have been more specific to certain populations (ADHD)
Well organized and informative.
It was very organized and easy to follow. She was incredibly informative and provided abundant resources!
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practical/fuctional information to use in therapy
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Extremely clear handout and great resource recommendations for therapy.
I appreciated her thoroughness in taking us from theory to therapy to materials and resources.
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The information was given in a logical sequential order with data and some materials to use during therapy.
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good content and presentation
The course content and presentation were informative, concise, and well organized.
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Improving Social Skills in Children With Psychiatric Disturbances Speechpathology.com Webinar

Will be presenting a webinar via speechpathology.com on July 2nd 2012 at 12pm EDT entitled

Improving Social Skills in Children with Psychiatric Disturbances

Course Abstract

This course is aimed at increasing the participants’ knowledge regarding the role of SLPs in the treatment of social pragmatic language disorders of school-age children with psychiatric impairments. It will review social pragmatic treatment approaches which can be used for children with psychiatric impairments, explain the functions of common challenging behaviors, as well as list a number of proactive behavioral intervention approaches professionals can implement to decrease challenging behaviors and increase compliance and cooperation in therapy sessions.

Course Objectives

  • After this course, participants will be able to identify social pragmatic deficit areas of children with psychiatric impairments.
  • After this course, participants will be able to describe components and targets of successful social skills treatments.
  • After this course, participants will be able to list common challenging behavior types and explain proactive behavior strategies used to prevent inappropriate behaviors from occurring.
  • After this course, participants will be able to describe social pragmatic treatment approaches that can be used for children with psychiatric impairments.
  • After this course, participants will be able to identify materials that can be used to address relevant social pragmatic treatment goals.
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Dinner with Friends or the Value of Interdisciplinary Collaboration and Follow Up

Several months ago I had dinner with two of my colleagues, a pediatrician and a clinical social worker, to iron out the details of our upcoming conference presentation. As time went by we managed to discuss every topic under the sun, yet still the subject of our presentation was sadly not on the agenda. Exhausted from working at the hospital a full day and seeing private clients afterwards, I was getting distinctly antsy as the hand clock kept climbing closer to midnight.

The conversation began to feel more productive when we started to touch base on our mutual clients.   Mostly they wanted to hear from me, since they both share an office suite and I was the only one located off-site. So, even though we all individually frequently conferred via phone regarding clients, that was the first time all three of us got together in the same room to discuss them. Quickly, I rattled off each of my clients’ progress in therapy, until I got to D, and paused.  Oh, don’t get me wrong I am very proud of my work with D, whom I’ve been working with for several years, and who went from being limitedly verbal, severely echolalic, and “autistic like” at the age of 4-5 to fluent complex sentence speaker, fledgling problem solver, and a little charmer by the age of 6-5. Yet something was still bothering me regarding D’s performance that I couldn’t put my finger on. Despite the absence of a particular diagnosis (e.g., ASD) and significant gains, his issues with attention and cognition persisted, and his progress was still halting and inconsistent, even with rigorous language therapy and supplementary academic instruction at home 4 times a week.

In my desperation I have already considered and mentally rejected a number of referrals (“No it doesn’t seem to be a psychiatric issue”, “Yes he can benefit from a neurological but should I refer him to a psychological assessment first, could it be an IQ issue?” I pondered out loud as I shared my concerns with my colleagues.  Both of them haven’t seen him for about 6 months so the clinical social worker immediately whipped out his chart busily looking for appropriate information, while the pediatrician started to frown, searching her memory for an “appropriate entry.”  “Wait a second”, she said, “when I last saw him, during his physical exam I saw brown café au lait spots on his skin that I didn’t like at all, so I referred mom to get some blood work done but I haven’t heard from her since that time. Since you see her every week, can you please ask her to call me ASAP so I could remind her to do the blood test, as the information you are telling me makes it even more imperative that she follow up with the lab work.”

Right away, I became alert.  Though the pediatrician was not stating her suspicious explicitly, through years of working with medical professionals I was familiar with the implications of what café au lait spots can potentially represent and that is neurofibromatosis. It is a neurocutaneous syndrome that leads to benign tumor growths in various parts of the body and can affect the brain, spinal cord, nerves, skin, and other body systems.  In additional to all the medical implications of this syndrome (e.g., tumors becoming cancerous), it can also cause cognitive deficits and subsequent learning disabilities that affect appropriate knowledge acquisition and retention.

To me the situation was clear, no matter what the outcome, as the only team professional in contact with the parent at the time, it was my job to counsel the parent that she get in touch with the pediatrician so she can successfully pursue the recommended course of action.  It may not have been the position I wanted to be in but unfortunately I knew that if this matter was left unpursued, I was left with a whole host of unanswered questions regarding further treatment options for this child.

I use the above example to emphasize the value and importance of working as part of a team to treat the “whole” child.  Therapists specializing 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., is medically fragile, has a genetic syndrome, etc).

However, in our field, even outside of specialty settings (hospital/rehab) we are frequently confronted with speech or language disordered clients who stump our thinking processes, and who require the team approach (including the involvement of specialized medical professionals).  Yet oftentimes that creates a significant challenge for many clinicians who are working contractually (through an agency) in school settings or in private practice.  Being part of a team when one is contractor or a sole practitioner in a private practice is a much more difficult feat, especially when the clinicians are just striking out on their own for the first time.

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) 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.

Interestingly, many private speech language practitioners have wide referral networks (e.g., pediatricians, OT’s, PT’s and others who refer clients to them) yet when asked regarding frequency of contact with respect to conferences/discussions about the progress of specific clients, many clinicians draw a blank.

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.

In my hospital setting I work as part of a team. However, when I first started out 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 that in contrast to them being referred to me by a pediatrician, these clients came to me first, since their most “visible issues” at the time were speech language deficits. I had to be the one to initiate the referral process to suggest to their parents relevant medical 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.

So here are a few suggestions on how to initiate and maintain professional relationships with medical service providers.

Start with doing a little research.  You have worked hard to build your practice and your clients deserve the best, so locate the best medical service providers in your area. In the past I’ve had some excellent recommendations from locally based colleagues who were active on the ASHA discussion forums, other client’s parents who already did the necessary legwork, or hospital based colleagues who recommended peers in private practice. Several times I actually liked the initial medical reports I’ve received on a client so much – that I’ve referred other clients to the same doctor.

When word of mouth fails to do the trick, I turn to “Google” to provide me with desired results.  Surprisingly, simply typing in “best _______in _____(name of state)” frequently does the trick and allows 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 medical providers.   I have collaborated for years with some (e.g., pediatrician, psychiatrist), and only infrequently spoken with others (geneticist, otolaryngologist, pediatric ophthalmologist).

Typically, when I refer a client for additional testing or consultation, in my referral letter to the physician, I request to receive the results in writing, asking the physician 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 the physician (and other providers working with the child) the information from my end (progress reports, evaluations) so all of us can 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 us 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 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, it is important that speech language pathologists help to coordinate care and maintain relationships with other medical and related professionals who are treating the child.  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 therapy.

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

National Institute of Neurological Disorders and Stroke (NINDS) Neurofibromatosis Information Page http://www.ninds.nih.gov/disorders/neurofibromatosis/neurofibromatosis.htm

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Multicultural Considerations in Assessment of Play

As speech language pathologist part of my job is to play! Since play assessment is a routine part of speech language evaluations for preschool and early school-aged children, I often find myself on the carpet in my office racing cars, making sure that all the “Little People” get their turn on the toy Ferris Wheel, and “cooking” elaborate  meals in complete absence of electrical appliances.  In fact, I’ve heard the phrase “I want toy” so many times that I actually began to worry that I might accidentally use it in polite company myself.

The benefits of play are well known and cataloged. Play allows children to use creativity and develop imagination. It facilitates cognition, physical and emotional development, language, and literacy.  Play is great!  However, not every culture values play as much as the Westerners do.

Cultural values affect how children play. Thus play interactions vary significantly across cultures. For instance, many Asian cultures prize education over play, so in these cultures children may engage in educational play activities vs. pretend play activities. To illustrate, Farver and colleagues have found that Korean preschool children engaged in greater parallel play (vs. pretend play), initiated play less frequently, as well as had less frequent social play episodes in contrast to Anglo-American peers. (Farver, Kim & Lee, 1995; Farver and Shinn 1997)

To continue, cultures focused on individualism stress independence and self-reliance.  In such cultures, babies and toddlers are taught to be self sufficient when it comes to sleeping, feeding, dressing, grooming and playing from a very early age. (Schulze, Harwood, and Schoelmerich, 2001) Consequently, in these cultures parents would generally support and encourage child initiated and directed play. However, in many Latin American cultures, parents expect their children to master self-care abilities and function independently at later ages.  Play in these cultures may be more parent directed vs. child directed.   These children may receive more explicit directives from their caregivers with respect to how to act and speak and be more physically positioned or restrained during play. (Harwood, Schoelmerich, & Schulze, 2000)

In Western culture, early choice making is praised and encouraged.  In contrast, traditional collective cultures encourage child obedience and respect over independence (Johnston & Wong, 2002).  Choice making may not be as encouraged since it might seem like it’s giving the child too much power.  It would not be uncommon for a child to be given a toy to play with which is deemed suitable for him/her, instead of being asked to choose.   The children in these cultures may not be encouraged to narrate on their actions during play but expected to play quietly with their toy.  Furthermore, if the parents do not consider play as an activity beneficial to their child’s cognitive and emotional development, but treat it as a leisure activity that helps pass the time, they may not ask the child questions regarding what he/she are doing and will not expect the child to narrate on their actions during play.

Consequently, in our assessments, it is very important to keep in mind that children’s play is affected by a number of variables including: cultural values, family relationships, child rearing practices, toy familiarity as well as developmental expectations (Hwa-Froelich, 2004).  As such, in order to conduct balanced and objective play assessments, we as clinicians need to find a few moments in our busy schedules to interview the caregivers regarding their views on child rearing practices and play interactions, so we could objectively interpret our assessment findings (e.g.,  is it delay/disorder or lack of  exposure and task unfamiliarity).

References:

  •  Farver, J. M., Kim, Y. K., & Lee, Y. (1995). Cultural differences in Korean- and Anglo-American preschoolers’ social interaction and play behaviors. Child Development, 66, 1088- 1099.
  • Farver, J. M., & Shinn, Y. L. (1997). Social pretend play in Korean- and Anglo- American pre-schoolers. Child Development,68 (3), 544-556.
  • Johnston, J.R., & Wong, M.-Y. A. (2002). Cultural differences in beliefs and practices concerning talk to children . Journal of Speech, Language, and Hearing Research, 45 (5), 916-926
  • Harwood, R. L., & Schoelmerich, A and Schulze, P. A. (2000) Homogeneity and heterogeneity in cultural belief systems. New Directions for Child and Adolescent Development 87,  41-57
  • Hwa-Froelich, D. A. (2004). Play Assessment for Children from Culturally and Linguistically Diverse Backgrounds. Perspectives on Language, Learning and Education and on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations, 11(2), 6-10.
  • Hwa-Froelich, D. A., & Vigil, D. C. (2004). Three aspects of cultural influence on communication: A literature review. Communication Disorders Quarterly, 25(3),110-118.
  • Schulze, P. A., Harwood, R. L., & Schoelmerich, A. (2001). Feeding practices and expectations among middle-class Anglo and Puerto Rican mothers of 12-month-old infants. Journal of Cross-Cultural Psychology, 32(4), 397–406.