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Assessing Social Communication Abilities of School-Aged Children

Recently, I’ve published an article in SIG 16 Perspectives on School Based Issues discussing the importance of social communication assessments of school aged children 2-18 years of age. Below I would like to summarize article highlights.

First, I summarize the effect of social communication on academic abilities and review the notion of the “academic impact”. Then, I go over important changes in terminology and definitions as well as explain the “anatomy of social communication”.

Next I suggest a sample social communication skill hierarchy to adequately determine assessment needs (assess only those abilities suspected of deficits and exclude the skills the student has already mastered).

After that I go over pre-assessment considerations as well as review standardized testing and its limitations from 3-18 years of age.

Finally I review a host of informal social communication procedures and address their utility.

What is the away message?

When evaluating social communication, clinicians need to use multiple assessment tasks to create a balanced assessment. We need to chose testing instruments that will help us formulate clear goals.  We also need to add descriptive portions to our reports in order to “personalize” the student’s deficit areas. Our assessments need to be functional and meaningful for the student. This means determining the student’s strengths and not just weaknesses as a starting point of intervention initiation.

Is this an article which you might find interesting? If so, you can access full article HERE free of charge.

Helpful Smart Speech Resources Related to Assessment and Treatment of Social Communication 

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SLP Efficiency Bundles™ for Graduating Speech Language Pathologists

Graduation time is rapidly approaching and many graduate speech language pathology students are getting ready to begin their first days in the workforce. When it comes to juggling caseloads and managing schedules, time is money and efficiency is the key to success. Consequently,  a few years ago I created  SLP Efficiency Bundles™, which are materials highly useful for Graduate SLPs working with pediatric clients. These materials are organized by areas of focus for efficient and effective screening, assessment, and treatment of speech and language disorders.   Continue reading SLP Efficiency Bundles™ for Graduating Speech Language Pathologists

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What if Its More Than Just “Misbehaving”?

Frequently,  I see a variation of the following scenario on  many speech and language forums.

The SLP is seeing a client with speech and/or language deficits  through early intervention,  in the schools, or in private practice, who is having some kind of behavioral issues.

Some  issues  are described as mild such as  calling out, hyperactivity, impulsivity, or inattention, while others are more severe  and include  refusal, noncompliance, or aggression  such as kicking, biting,  or punching.

An array of advice from well-meaning professionals immediately follows.  Some behaviors may be labeled as “normal” due to the child’s age (toddler),  others may be “partially excused” due to a DSM-5  diagnosis (e.g., ASD).   Recommendations for reinforcement charts (not grounded in evidence) may be suggested. A call for other professionals to deal with the behaviors is frequently made (“in my setting the ______ (insert relevant professional here) deals with these behaviors and I don’t have to be involved”). Specific judgments on the child may be pronounced: “There is nothing wrong with him/her, they’re just acting out to get what they want.” Some drastic recommendations could be made: “Maybe you should stop therapy until the child’s behaviors are stabilized”.

However, several crucial factors often get overlooked. First, a system to figure out why particular set of behaviors takes place and second, whether these behaviors may be manifestations of non-behaviorally based difficulties such as medical issues, or overt/subtle linguistically based deficits.

So what are some reasons kids may present with behavioral deficits? Obviously, there could be numerous reasons: some benign while others serious, ranging from lack of structure and understanding of expectations to manifestations of psychiatric illnesses and genetic syndromes. Oftentimes the underlying issues are incredibly difficult to recognize without a differential diagnosis. In other words, we cannot claim that the child’s difficulties are “just behavior” if we have not appropriately ruled out other causes which may be contributing to the “behavior”.

Here are some possible steps which can ensure appropriate identification of the source of the child’s behavioral difficulties in cases of hidden underlying language disorders (after of course relevant learning, genetic, medical, and psychiatric issues have been ruled out).

Let’s begin by answering a few simple questions. Was a thorough language evaluation with an emphasis on the child’s social pragmatic language abilities been completed? And by thorough, I am not referring to general language tests but to a variety of formal and informal social pragmatic language testing (read more HERE).

Please note that none of the general language tests such as the Preschool Language Scale-5 (PLS-5), Comprehensive Assessment of Spoken Language (CASL-2), the Test of Language Development-4 (TOLD-4) or even the Clinical Evaluation of Language Fundamentals Tests (CELF-P2)/ (CELF-5) tap into the child’s social language competence because they do NOT directly test the child’s social language skills (e.g., CELF-5 assesses them via a parental/teachers questionnaire).  Thus, many children can attain average scores on these tests yet still present with pervasive social language deficits. That is why it’s very important to thoroughly assess social pragmatic language abilities of all children  (no matter what their age is) presenting with behavioral deficits.

                 

But let’s say that the social pragmatic language abilities have been assessed and the child was found/not found to be eligible for services, meanwhile their behavioral deficits persist, what do we do now?

The first step in establishing a behavior management system is determining the function of challenging behaviors, since we need to understand why the behavior is occurring and what is triggering it (Chandler & Dahlquist, 2006)

We can begin by performing some basic data collection with a child of any age (even with toddlers) to determine behavior functions or reasons for specific behaviors. Here are just a few limited examples:

  • Seeking Attention/Reward
  • Seeking Sensory Stimulation
  • Seeking Control

Most behavior functions typically tend to be positively, negatively or automatically reinforced (Bobrow, 2002). For example, in cases of positive reinforcement, the child may exhibit challenging behaviors to obtain desirable items such as toys, games, attention, etc. If the parent/teacher inadvertently supplies the child with the desired item, they are reinforcing inappropriate behaviors positively and in a way strengthening the child’s desire to repeat the experience over and over again, since it had positively worked for them before.

In contrast, negative reinforcement takes place when the child exhibits challenging behaviors to escape a negative situation and gets his way. For example, the child is being disruptive in classroom/therapy because the tasks are too challenging and is ‘rewarded’ when therapy is discontinued early or when the classroom teacher asks an aide to take the child for a walk.

Finally, automatic reinforcements occur when certain behaviors such as repetitive movements or self-injury produce an enjoyable sensation for the child, which he then repeats again to recreate the sensation.

In order to determine what reinforces the child’s challenging behaviors, we must perform repeated observations and take data on the following:

  • —Antecedent or what triggered the child’s behavior?
    • —What was happening immediately before behavior occurred?
  • —Behavior
    • —What type of challenging behavior/s took place as a result?
  • —Response/Consequence
    • —How did you respond to behavior when it took place?

Here are just a few antecedent examples:

  • —Therapist requested that child work on task
  • —Child bored w/t task
  • —Favorite task/activity taken away
  • —Child could not obtain desired object/activity

In order to figure them out we need to collect data, prior to appropriately addressing them. After the data is collected the goals need to be prioritized based urgency/seriousness.  We can also use modification techniques aimed at managing interfering behaviors.  These techniques include modifications of: physical space, session structure, session materials as well as child’s behavior. As we are implementing these modifications we need to keep in mind the child’s maintaining factors or factors which contribute to the maintenance of the problem (Klein & Moses, 1999). These include: cognitive, sensorimotor, psychosocial and linguistic deficits. 

We also need to choose our reward system wisely, since the most effective systems which facilitate positive change actually utilize intrinsic rewards (pride in self for own accomplishments) (Kohn, 2001).  We need to teach the child positive replacement behaviors  to replace the use of negative ones, with an emphasis on self-talk, critical thinking, as well as talking about the problem vs. acting out behaviorally.

Of course it is very important that we utilize a team based approach and involve all the professionals involved in the child’s care including the child’s parents in order to ensure smooth and consistent carryover across all settings. Consistency is definitely a huge part of all behavior plans as it optimizes intervention results and achieves the desired therapy outcomes.

So the next time the client on your caseload is acting out don’t be so hasty in judging their behavior, when you have no idea regarding the reasons for it. Troubleshoot using appropriate and relevant steps in order to figure out what is REALLY going on and then attempt to change the situation in a team-based, systematic way.

For more detailed information on the topic of social pragmatic language assessment and behavior management in speech pathology see if the following Smart Speech Therapy LLC products could be of use:

 

References: 

  1. Bobrow, A. (2002). Problem behaviors in the classroom: What they mean and how to help. Functional Behavioral Assessment, 7 (2), 1–6.
  2. Chandler, L.K., & Dahlquist, C.M. Functional assessment: strategies to prevent and remediate challenging behavior in school settings (2nd ed.). Upper Saddle River, New Jersey: Pearson Education, Inc.
  3. —Klein, H., & Moses, N. (1999). Intervention planning for children with communication disorders: A guide to the clinical practicum and professional practice. (2nd Ed.). Boston, MA.: Allyn & Bacon.
  4. —Kohn, A. (2001, Sept). Five reasons to stop saying “good job!’. Young Children. Retrieved from http://www.alfiekohn.org/parenting/gj.htm
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Creating Successful Team Collaboration: Behavior Management in the Schools

In March 2014, ASHA SIG 16 Perspectives on School Based Issues, I’ve written an article on how SLPs can collaborate with other school based professionals to successfully work with children exhibiting challenging behaviors secondary to psychiatric diagnoses and emotional and behavioral disturbances. In this post I would like to summarize the key points of my article as well as offer helpful professional resources on this topic. Continue reading Creating Successful Team Collaboration: Behavior Management in the Schools

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Recognizing the Warning Signs of Social Emotional Difficulties in Language Impaired Toddlers and Preschoolers

emd toddlersToday I am exited to tell you about the new product I created in honor of Better Speech and Hearing Month. 

It is a 45 slide presentation created for speech language pathologists to explain the connection between late language development and the risk of social emotional disturbances in young children 18 months- 6 years of age.

Learning Objectives:

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In case you missed it: How to Successfully Address Client’s Inattention, Impulsivity, and Hyperactivity in Therapy Sessions

Last week I did a guest post for The Speech Bubble Blog. In case you missed it,  below are my recommendations on how to address aspects of inattention, hyperactivity, and impulsivity in your therapy sessions.

In recent years, with the ‘back to district trend’ sweeping our schools, more and more speech language pathologists find themselves working with children who present with behavioral deficits in conjunction with speech-language delays and impairments. A significant portion of work with these children in therapy involves successful management of a number of behavioral difficulties, which often interfere with successful objective completion and goal attainment. Continue reading In case you missed it: How to Successfully Address Client’s Inattention, Impulsivity, and Hyperactivity in Therapy Sessions

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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.

This 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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“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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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.