Category: Assessment

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Guest Post: The Importance of Hearing Testing in Children

Today two of my guest bloggers Drs. Stella Fulman and Zhanneta Shapiro explain the importance of pediatric hearing tests beyond the newborn screenings.

The importance of hearing testing isn’t widely understood by many parents. Parents may schedule appointments with an opthamologist or a dentist for their children at regular intervals – but never think to similarly schedule a hearing test with an audiologist. We think perhaps that if a child responds to our voice in a room of our homes that their hearing must be fine. Jokingly we think that if they don’t respond to the calls for dinner that they should have their hearing checked – but rarely follow up on this. Continue reading Guest Post: The Importance of Hearing Testing in Children

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Working with Russian-speaking clients: implications for speech-language assessment

United States boasts an impressive Russian-speaking population.  Numerous Russian-Americans live in various parts of the country with large concentrations in states such as New York, New Jersey, Pennsylvania, Ohio, Washington, Oregon, Illinois, California, and Florida, with smaller numbers found in most of the remaining states. According to the 2010 United States Census the number of Russian speakers was 854,955, which made Russian the 12th most spoken language in the country (link to statistics). Continue reading Working with Russian-speaking clients: implications for speech-language assessment

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Bilingual Therapy Resources Linky Party!

bilingual therapy resources link upThe Dabbling Speechie is having a bilingual therapy resources Linky Party so I decided to join in and write a few posts on what I am using and referencing when it comes to assessment and treatment of bilingual and multicultural children.

First up I’d like to tell you a little bit about the post I wrote and materials I created for this purpose.

A few months ago I did a post on Integrating aspects of multiculturalism into group language therapy sessions where I offered some suggestions on how to integrate multiculturalism into your group therapy sessions, which included books, activities and websites.

Below are a few products I’ve created for bilingual/multicultural assessment and treatment purposes:

I also created specific products relevant to comprehensive data collection and narrative assessment of multicultural children

  • General Assessment and Treatment Start-Up Bundle
    • This product bundle contains 5 downloads for general speech language assessment and treatment planning and includes:
      1. Speech Language Assessment Checklist for a Preschool Child
      2. Speech Language Assessment Checklist for a School-Aged Child
      3. Creating a Functional Therapy Plan: Therapy Goals & SOAP Note Documentation
      4. Selecting Clinical Materials for Pediatric Therapy
      5. Recognizing Speech-Language delay in school age-children: a tutorial for teachers
  • The Checklists Bundle
    • This product contains 4 checklists relevant to screening and assessment in speech language pathology
      1. Speech Language Assessment Checklist for a Preschool Child
      2. Speech Language Assessment Checklist for a School-Aged Child
      3. Auditory Processing Deficits (APD) Checklist for School Aged Children
      4. Social Pragmatic Deficits Checklist for School Aged Children
  • Narrative Assessment Bundle
    • This product contains ontains 3 downloads relevant to narrative assessment
      1. Narrative Assessments of Preschool and School Aged Children
      2. Understanding Complex Sentences
      3. Vocabulary Development: Working with Disadvantaged Populations

What materials are you using to assess your bilingual/multicultural students?

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What parents need to know about speech-language assessment of older internationally adopted children

This post is based on Elleseff, T (2013) Changing Trends in International Adoption: Implications for Speech-Language Pathologists. Perspectives on Global Issues in Communication Sciences and Related Disorders, 3: 45-53

Changing Trends in International Adoption:

In recent years the changing trends in international adoption revealed a shift in international adoption demographics which includes more preschool and school-aged children being sent for adoption vs. infants and toddlers (Selman, 2012a; 2010) as well as a significant increase in special needs adoptions from Eastern European countries as well as from China (Selman, 2010; 2012a). Continue reading What parents need to know about speech-language assessment of older internationally adopted children

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DI or SP: Why it’s important to know who is treating your child in Early Intervention

Recently on the American Speech Language Hearing Association Early Intervention forum there was a discussion about the shift in several states pertaining to provision of language services to children in the early intervention system.  Latest trend seems to be that a developmental interventionists (DI) or early childhood educators are now taking over in providing language intervention services instead of speech language pathologists.

A number of parents reported to SLPs that they were told by select DIs  that “they work on same goals as speech therapists”.  One parent, whose child received speech therapy privately with me and via EI kept referring to a DI’s as an SLP, during our conversation. This really confused me during my coordination of services phone call with the DI, since I was using terminology the DI was unfamiliar with.

Consequently, since a number of parents have asked me about the difference between DIs and SLPs I decided to write a post on this topic.

So what is the difference between DI and an SLP?

DI or a developmental interventionist is an early childhood education teacher.  In order to provide EI services a DI needs to have an undergraduate bachelor’s degree in a related health, human service, or education field. They also need a certificate in Early Childhood Education OR at least six (6) credits in infant or early childhood development and/or special education coursework.

A DI’s job is to create learning activities that promote the child’s acquisition of skills in a variety of developmental areas. DI therapists do not address one specific area of functioning but instead try to promote all skills including: cognition, language and communication, social-emotional functioning and behavior, gross and fine motor skills as well as self-help skills via play based interactions as well as environmental modifications. In other words a DIs are a bit like a jacks of all trades and they focus on a little bit of everything.

SLP or a Speech Language Pathologist is an ancillary health professional. In order to provide EI services, in the state of NJ for example, an SLP needs to have a Masters Degree in Speech Language Pathology or Communication Disorders as well as a State License (and in most cases a certification from ASHA, our national association).

Unlike DIs, pediatric SLPs focus on and have an in-depth specialization in improving children’s communication skills (e.g., speech, language, alternative augmentative communication, etc.). SLPs undergo rigorous training including multiple internships at both undergraduate (BA) and graduate (MA) levels as well as complete a clinical fellowship year prior to receiving relevant licenses and certifications. SLPs are also required to obtain a certain number of professional education hours every year after graduation in order to maintain their license and certifications.  Many of them undergo highly specialized trainings and take courses on specialized techniques of speech and language elicitation in order to work with children with severe speech language disorders secondary to a variety of complex medical, neurological and/or genetic diagnoses.

As you can see from the above, even though at first glance it may look like DIs and SLPs do similar work, DIs DON’T have nearly the same level of expertise and training possessed by the SLPs, needed to address TRUE speech-language delays and disorders in children.

What does this all mean to parents?

That depends on why parents/caregivers are seeking early intervention services in the first place. If they are concerned about their child’s speech language development then they definitely want to ensure the following:

  1. The child undergoes a speech language assessment with a qualified speech language pathologist and
  2. If speech language therapy is recommended, the child receives it from a qualified speech language pathologist

So if a professional other than an SLP assesses the child than it cannot be called a speech language assessment.

Similarly, if a related professional (e.g., DI) is providing services, they are NOT providing “speech language therapy” services.

They are also NOT providing the ‘SAME‘ level of services as a speech-language pathologist does.

Consequently, if speech language services are recommended for the child and those recommendations are documented in the child’s Individualized Family Service Plan (IFSP) then these services MUST be provided by a speech language pathologist, otherwise it is a direct violation of the child’s IFSP under the IDEA: Part C.

So how can parents ensure their child receives appropriate services from the get-go?

  • Find out in advance before the assessment who are the professionals (from which disciplines) coming to evaluate your child
    • If you have requested a speech-language evaluation due to concerns over your child’s speech language abilities and the SLP is not scheduled to assess, find out the reason for it and determine whether that reason makes sense to you
  • Ask questions during the assessment regarding the child’s performance/future recommendations
  • Make sure that an IFSP meeting is scheduled 45 days after the initial referral if the child is found eligible
  • Find out in advance which professionals will be attending your child’s IFSP meeting
  • Find out if any reports will be available to you prior to the meeting
    • If yes, carefully review the assessment report to ensure that you understand and agree with the findings
    • If no, make sure you have an adequate period of time to review all documentation prior to signing it and if need to request time to review reports
  • If an SLP assessed your child but therapy services are not recommended find out the reason for services denial in order to determine whether you have grounds for appeal (child’s delay was not substantial enough to merit services. vs. lack of SLP availability to provide intervention services)
  • If speech-language therapy services are recommended ensure that therapy initiation occurs in a timely manner after the initial IFSP meeting and that all missed sessions (by an SLP) are made-up in a timely manner as well

EI Service Provision in the State of New Jersey: DI vs. SLP 

(from  Service Guidelines for Speech Therapy in Early Intervention)   

The following are the circumstances in which a DI will be assigned to work with the child instead of an SLP (vs. in conjunction with) in the state of NJ (rules are similar in many other states)

  • If a child, under 28 months of age, presents with a “late-talker profile” (pg 27)
  • If child with speech-language delays  also has delayed prelinguistic skills (e.g., joint attention, turn-taking, etc), the DI will work with the child first to establish them  (pg 29)
  • If a child under 28 months has expressive language delay only and has intact cognition, receptive language, and motor skills
  • If the child has a cognitive delay commensurate with a receptive and expressive delay (p 30)
  • If a child has a hearing impairment and no other developmental delays, DI services will be provided while  information is being obtained and medical intervention is being provided (pg 31)

Understanding who is providing services and the rationale behind why these services are being provided is the first important step in quality early intervention service provision for young children with language delays and disorders.  So make sure that you know, who is treating your child!

Useful Resources:

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Introduction to the “Need to Know” Disorders in Speech Language Pathology

In a few weeks the school semester will begin and many speech language pathologists will be heading back to school to resume their duties. Seasoned professionals, newly minted clinical fellows, and eager graduate students will embark on assessment and treatment of children with a variety of communication disorders. In the course of the next school year they will encounter, assess, and treat children with a number of diagnoses which result in accompanying speech language deficits. Many of these diagnoses will be familiar, a number will be new, some complex, yet others will be less known or controversial. Continue reading Introduction to the “Need to Know” Disorders in Speech Language Pathology

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Forms for Back to School Assessment Preparation

Back to school time is just around the corner and if your job is anything like mine then you are getting ready to perform a number of speech language screenings and assessments after the kids get back to school in September.  In order to optimize the assessment process I’ve created a number of checklists and forms for my (and your convenience). They allow for quick and efficient determination of whether the preschool/school age monolingual/bilingual student in question requires any speech language services including: screening, assessment, future follow-up, or on-going monitoring. Please note that for bilingual students it is recommended that parents mark whether the child presents with deficits in one language or in both on the checklists (e.g., mark R, E, or B – Russian, English or both).

  • R  difficulty following 3+step directions containing concepts of time or location (before/after/to the left)
  • E  difficulty understanding basic concepts in the classroom
  • B  difficulty responding appropriately to simple questions (who/what/where/when)

Speech Language Assessment Checklist For A Preschool Child is a 9 page guide created to assist speech language pathologists in the decision making process of how to select assessment instruments and prioritize assessment for preschool children 3:00-5:11 years of age. The goal is to eliminate administration of unnecessary or irrelevant tests and focus on the administration of instruments directly targeting the areas of difficulty that the child presents with.

It contains:

  • Page 1 Title
  • Page 2 Directions
  • Pages 3-5 Checklist
  • Pages 6 Suggested Speech-Language Test Selection for Preschool Children
  • Page 7  Select Language Testing Battery Suggestions
  •  Page 8-9 Supplemental Caregiver/Teacher Data Collection Form

Checklist Target Areas:

  1. Receptive Language
  2. Memory, Attention and Sequencing
  3. Expressive Language
  4. Speech
  5. Voice
  6. Resonance
  7. Phonological Awareness
  8. Problem Solving
  9. Pragmatic Language
  10. Social Emotional Development
  11. Executive Functions

Speech Language Assessment Checklist For A School-Aged Child is a 12 page guide created to assist speech language pathologists in the decision making process of how to select assessment instruments and prioritize assessment for school age children. The goal is to eliminate administration of unnecessary or irrelevant tests and focus on the administration of instruments directly targeting the areas of difficulty that the child presents with.

It contains:

  • Page 1 Title
  • Page 2 Directions
  • Pages 3-6 Checklist
  • Pages 7-8 Suggested Speech-Language Test Selection for School-Aged Children
  • Page 9  Select Language Testing Battery Suggestions
  •  Page 10-12 Supplemental Caregiver/Teacher Data Collection Form

Checklist Target Areas:

  1. Receptive Language
  2. Memory, Attention and Sequencing
  3. Expressive Language
  4. Vocabulary
  5. Narrative
  6. Speech
  7. Voice
  8. Resonance
  9. Phonological Awareness
  10. Problem Solving
  11. Pragmatic Language
  12. Social Emotional Development
  13. Executive Functions

Auditory Processing Deficits Checklist for School Aged Children was created to assist speech language pathologists (SLPs) with figuring out whether the student presents with auditory processing deficits which require further follow up (e.g., screening, comprehensive assessment). The SLP should provide this form to both teacher and caregiver/s to fill out to ensure that the deficit areas are consistent across all settings and people.

Checklist Categories:

  • Listening Skills and Short Term Memory
  • Verbal Expression
  • Emergent Reading/Phonological Awareness

  • General Organizational Abilities

  • Social Emotional Functioning
  • Behavior
  • Supplemental* Caregiver/Teacher Data Collection Form
  • Select assessments sensitive to Auditory Processing Deficits

Social Pragmatic Deficits Checklist for School Aged Children was created to assist speech language pathologists (SLPs) with figuring out whether the student presents with social pragmatic language deficits which require further follow up (e.g., assessment). The SLP should provide this form to both teacher and caregiver/s to fill out to ensure that the deficit areas are consistent across all settings and people.

Checklist Categories:

  • Listening/Processing
  • Verbal Expression
  • Problem Solving
  • Pragmatic Language Skills
  • Social Emotional Development
  • Behavior
  • Supplemental* Caregiver/Teacher Data Collection Form
  • Select assessments sensitive to Social Pragmatic Deficits

You can find these products by clicking on the individual links above. You can also find many other educational products relevant to assessment and treatment in speech language pathology in my online store by clicking HERE.

Happy and successful new school year everyone!

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FASD and Background History Collection: Asking the Right Questions

Note: This article was originally published in August 2013 Issue of Adoption Today Magazine (pp. 32-35).   

Sometime ago, I interviewed the grandmother of an at-risk 11 year old child in kinship care, whose language abilities I have been asked to assess in order to determine whether he required speech-language therapy services.  The child was attending an outpatient school program in a psychiatric hospital where I worked and his psychiatrist was significantly concerned regarding his listening comprehension abilities as well as social pragmatic skills. Continue reading FASD and Background History Collection: Asking the Right Questions

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SLPs Blogging About Research: August Edition -FASD

This month I am joining the ranks of bloggers who are blogging about research related to the field of speech pathology.  Click here for more details.

Today I will be reviewing a recently published article in The Journal of Neuroscience  on the topic of brain development in children with Fetal Alcohol Spectrum Disorders (FASD), one of my areas of specialty in speech pathology.

Title: Longitudinal MRI Reveals Altered Trajectory of Brain Development during Childhood and Adolescence in Fetal Alcohol Spectrum Disorder

Purpose: Canadian researchers performed advanced MRI brain scans of 17 children with FASD between 5 and 15 years of age and compared them to the scans of 27 children without FASD. Each participant underwent 2-3 scans and each scan took place 2-4 years apart. The multiple scan component over a period of time is what made this research study so unique because no other FASD related study had done it before.

Aim of the study: To better understand how brain abnormalities evolve during key developmental periods of behavioral and cognitive progression via longitudinal examination of within-subject changes in white brain matter (Diffusion Tensor Imaging – DTI) ) in FASD during childhood and adolescence.

Subjects: Experimental subjects had a variety of FASD diagnoses which included fetal alcohol syndrome (FAS), partial FAS (pFAS), static encephalopathy alcohol exposed (SE:AE), neurobehavioral disorder alcohol exposed (NBD:AE), as well as alcohol related neurobehavioral disorder (ARND). Given the small study size the researchers combined all sub diagnoses into one FASD group for statistical analysis.

In addition to the imaging studies, FASD subjects underwent about ∼1.5 h of cognitive testing at each scan, administered by a trained research assistant. The test battery included:

  • Woodcock Johnson Quantitative Concepts 18A&B (mathematics)
  • Woodcock Reading Mastery Test-Revised (WRMT-R) Word ID
  • Comprehensive Expressive and Receptive Vocabulary Test (CREVT)
  • Working Memory Test Battery for Children (WMTB-C)
  • Behavior Rating Inventory of Executive Function (BRIEF) parent form
  • NEPSYI/II (auditory attention and response set; memory for names, narrative memory; arrows).

9/17 participants in the FASD group were also administered the Wide Range Intelligence Test (WRIT) at scan 2.

Control subjects were screened for psychiatric and neurological impairments. Their caregivers were also contacted retrospectively and asked to estimate in utero alcohol exposure for their child. Of the 21 control subject caregivers who were reached, 14/21 reported no exposure, 2/21 unknown, and 5/21 reported minimal alcohol exposure (range: 1–3 drinks; average of two drinks total during pregnancy). Control subjects did not undergo a full battery of cognitive testing, but were administered WRMT-R Word ID at each scan.

Summary of results: The FASD group performed significantly below the controls on most of the academic, cognitive, and executive function measures  despite average IQ scores in 53% of the FASD sample. According to one of the coauthors, Sarah Treit,  “longitudinal increases in raw cognitive scores (albeit without changes in age-corrected standard scores) suggest that the FASD group made cognitive gains at a typical rate with age, while still performing below average”. For those of us who work with this population these findings are very typical.

Imaging studies revealed that over time subjects in the control group presented with marked increases in brain volume and white matter – growth which was lacking in subjects with FASD. Furthermore, children with FASD who demonstrated the greatest changes in white matter development (on scans) also made the greatest reading gains. Children with the most severe FASD showed the greatest diffusion changes in white matter brain wiring and less overall brain volume.

Implications: “This study suggests alcohol-induced injury with FASD isn’t static – those with FASD have altered brain development, they aren’t developing at the same rate as those without the disorder.” So not only does the brain altering damage exists in children with FASD at birth, but it also continues to negatively affect brain development through childhood and at least through adolescence.

Given these findings, it is very important for SLPs to perform detailed and comprehensive language assessments and engage in targeted treatment planning for these children in order to provide them with specialized individualized services which are based on their rate of development.

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Dear Neurodevelopmental Pediatrician: Please Don’t Do That!

Recently I got yet another one of the dreaded phone calls which went a little something like this:

Parent: Hi, I am looking for a speech therapist for my son, who uses PROMPT to treat Childhood Apraxia of Speech (CAS). Are you PROMPT certified?

Me: I am PROMPT trained and I do treat motor speech disorders but perhaps you can first tell me a little bit about your child? What is his age? What type of speech difficulties does he have? Who diagnosed him and recommended the treatment.

Parent: He is turning 3. He was diagnosed by a neurodevelopmental pediatrician a few weeks ago. She recommended speech therapy 4 times a week for 30 minutes sessions, using PROMPT.

Me: And what did the speech therapy evaluation reveal?

Parent: We did not do a speech therapy evaluation yet.

Sadly I get these type of phone calls at least once a month. Frantic parents of toddlers aged 18 months to 3+ years of age call to inquire regarding the availability of PROMPT therapy based exclusively on the diagnosis of the neurodevelopmental pediatrician. In all cases I am told that the neurodevelopmental pediatrician specified speech language diagnosis, method of treatment, and therapy frequency, ALBEIT in a complete absence of a comprehensive speech language evaluation and/or past speech language therapy treatments.

The conversation that follows is often an uncomfortable one. I listen to the parental description of the child’s presenting symptoms and explain to the parents that a comprehensive speech language assessment by a certified speech language pathologist is needed prior to initiation of any therapy services. I also explain to the parents that depending on the child’s age and the assessment findings CAS may or may not be substantiated since there are a number of speech sound disorders which may have symptoms similar to CAS.

Following my ‘spiel’, the parents typically react in a number of ways. Some get offended that I dared to question the judgement of a highly qualified medical professional. Others hurriedly thank me for my time and resoundingly hang up the phone. Yet a number of parents will stay on the line, actually listen to what  I have to say and ask me detailed questions.  Some of them will even become clients and have their children undergo a speech language evaluation.  Still a number of them will find out that  their child never even had CAS! Past misdiagnoses ranged from ASD  (CAS was mistaken due to the presence of imprecise speech and excessive jargon related utterances) to severe phonological disorder to dysarthria secondary to CP.  Thus, prior to performing a detailed speech language evaluation  on the child I had no way of knowing whether the child truly presented with CAS symptoms.

Before I continue I’d like to provide a rudimentary definition of CAS.  Since its identification years ago it has been argued whether CAS is linguistic or motoric in nature with the latest consensus being that CAS is a disorder which disrupts speech motor control and creates difficulty with volitional, intelligible speech production.  Latest research also shows that in addition to having difficulty forming words and sentences at the speech level, children with CAS also experience difficulty in the areas of receptive and expressive language, in other words,  “pure” apraxia of speech is rare (Hammer, 2007).

This condition NEEDS to be  diagnosed by a speech language pathologist! Not only that, due to the disorder’s complexity it is strongly recommended that if parents suspect CAS they should take their child for an assessment with an SLP specializing in assessment and treatment of motor speech disorders. Here’s why.

  • CAS has a number of overlapping symptoms with other speech sound disorders (e.g., severe phonological disorder, dysarthria, etc).
  • Symptoms which may initially appear as CAS may change during the course of intervention by the time the child is older (e.g., 3 years of age) which is why diagnosing toddlers under 3 years of age is very problematic and the use of  “suspected” or “working” diagnosis is recommended (Davis & Velleman, 2000) in order to avoid misdiagnosis
  • Diagnosis of CAS is also problematic due to the fact that there are no valid or reliable standardized assessments sensitive to CAS  (McCauley & Strand, 2008). However, a new instrument Dynamic Evaluation of Motor Speech Skill (DEMSS) (Strand et al, 2013) is showing promise with respect to differential diagnosis of severe speech impairments in children
  • Thus for children with less severe impairments SLPs need to design tasks to assess the child’s:
    • Automatic vs. volitional control
    • Simple vs. complex speech
    • Consistency of productions on repetitions of same word
    • Vowel productions
    • Imitation abilities
    • Prosody
    • Phonetic inventory BEFORE and AFTER intervention
    •  Types and levels of cueing the child is presently stimulable to
      • in order to determine where the breakdown is taking place (Caspari, 2012)

These are just some of the reasons why specialization in CAS is needed and why it is IMPOSSIBLE to make a reliable CAS diagnosis by  simply observing the child for a length of time, from a brief physical exam, and from extensive parental interviews (e.g., a typical neurodevelopmental appointment).

In fact, leading CAS experts state that you DON’t need a neurologist in order to confirm the CAS diagnosis (Hammer, 2007).

Furthermore, “NO SINGLE PROGRAM WORKS FOR ALL CHILDREN WITH APRAXIA!!” (Hammer, 2007). Hence SLPs NEED to individualize not only their approach with each child but also switch approaches with the same child when needed it in order to continue making therapy gains. Given the above the PROMPT approach may not even be applicable to some children.

It goes without saying that MANY developmental pediatricians will NOT do this!

But for those who do, I implore you – if you observe that a young child is having difficulty producing speech, please refer the child for a speech language assessment first. Please specify to the parents your concerns (e.g., restricted sound repertoire for the child’s age, difficulty sequencing sounds to make words, etc) BUT NOT the diagnosis, therapy frequency, as well as therapy approaches.  Allow the assessing speech language pathologist to make these recommendations in order to ensure that the child receives the best possible targeted intervention for his/her disorder.

For more information please visit the Childhood Apraxia of Speech Association of North America (CASANA) website or visit the ASHA website to find a professional specializing in the diagnosis and treatment of CAS near you.

References:

  1. Caspari, S (2012)  Beyond Picture Cards! Practical Assessment and Treatment Methods for Children with Apraxia of Speech. Session presented for New Jersey Speech Language Hearing Association Convention, Long Branch, NJ
  2. Davis, B., & Velleman, S. L. (2000). Differential diagnosis and treatment of developmental apraxia of speech in infants and toddlers. Infant-Toddler Intervention: The Transdisciplinary Journal, 10, 177–192.
  3. Hammer, D (2007) Childhood Apraxia of Speech: Evaluation and Therapy Challenges. Retrieved from http://www.maxshouse.com.au/documents/CAS%20conference%20day%201%20.ppt.
  4. McCauley RJ, Strand EA. (2008). A Review of Standardized Tests of Nonverbal Oral and Speech Motor Performance in Children. American Journal of Speech-Language Pathology, 17,81-91.
  5.  Strand, E, McCauley, R, Weigand, S, Stoeckel, R & Baas, B (2013) A Motor Speech Assessment for Children with Severe Speech Disorders: Reliability and Validity Evidence. Journal of Speech Language and Hearing Research, vol 56; 505-520.