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Tips on Reducing ‘Summer Learning Loss’ in Children with Language/Literacy Disorders

Related imageThe end of the school year is almost near. Soon many of our clients with language and literacy difficulties will be going on summer vacation and enjoying their time outside of school. However, summer is not all fun and games.  For children with learning needs, this is also a time of “learning loss”, or the loss of academic skills and knowledge over the course of the summer break.  Students diagnosed with language and learning disabilities are at a particularly significant risk of greater learning loss than typically developing students.

 However, there are a number of things that parents can do in an attempt to address this problem. Firstly, consistency is important, so is that there is an opportunity for the students to attend an extended school year it should definitely be taken. Similarly, while all students deserve a hard-earned break, taking an extended break (e.g., two months) from private therapies is not recommended. In the absence of an opportunity to attend an extended school year program, attendance at a summer camp with a good educational component may be the next best option (if financially viable for the parents).

However, in the absence of these options, parents can still do a great deal with the children at home in order to promote learning as well as mitigate the effects of summer learning loss. Consider creating a learning schedule for the week.  Sit down with your child and determine how many minutes a day s/he would be willing to engage in learning.  Rather than doing everything in one day, create a schedule of dates and times when reading, math, as well as science and social studies may be tackled in manageable quantities.

There are a number of fun educational outings for families to embark on in the summer.  While attendance of museums, zoos, or fairs, is often paid, there are still many free events accessible to parents out of which one could potentially create wonderful learning opportunities.

Image result for free admissionDenizens of major cities such as Washington DC or New York have a plethora of free educational events accessible to them. The Washington Mall offers free admission while numerous New York museums offer free admission on selected days of the week. However, a quick search also reveals that many US states, offer wonderful free educational attractions. Here’s a list of major free educational attractions in the state of NJ, which includes an art museum, a living farm, a center for contemporary art, a naval museum, and a 9/11 memorial, just to name a few.  All of these locations could be turned into wonderful learning opportunities replete with novel vocabulary words with science and social study themes.

In addition to these outings is strongly recommended that parents encourage their children to read for pleasure.   There are numerous lists of books available by grade level for the purpose of summer reading.  Furthermore, it is strongly recommended that parents read aloud to their kids, (link to read aloud book recommendations HERE) especially those who are still emergent readers to facilitate vocabulary growth and “introduce young ears to complex and nuanced syntax“.

But it’s not all books and direct learning. A lot of learning can actually be accomplished indirectly via educational summer games as well.   Games such as A to Z Jr, Tribond Jr, Fib or Not, etc., are terrific for working on word finding, verbal reasoning, problem-solving, storytelling, etc. Furthermore, games such as Hedbanz are fantastic for improving executive function skills in the areas of emotional control, self-monitoring, organization, task initiation, etc.

Summer may be a time when learning slows down, but it doesn’t have to stop! Children can still accomplish a great deal of learning through read alouds, educational outings, fun language promoting games, and much, much more!

FOR A PDF HANDOUT FOR PARENTS PLEASE CLICK HERE

References:

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Making Our Interventions Count or What’s Research Got To Do With It?

Two years ago I wrote a blog post entitled: “What’s Memes Got To Do With It?” which summarized key points of Dr. Alan G. Kamhi’s 2004 article: “A Meme’s Eye View of Speech-Language Pathology“. It delved into answering the following question: “Why do some terms, labels, ideas, and constructs [in our field] prevail whereas others fail to gain acceptance?”.

Today I would like to reference another article by Dr. Kamhi written in 2014, entitled “Improving Clinical Practices for Children With Language and Learning Disorders“.

This article was written to address the gaps between research and clinical practice with respect to the implementation of EBP for intervention purposes.

Dr. Kamhi begins the article by posing 10 True or False questions for his readers:

  1. Learning is easier than generalization.
  2. Instruction that is constant and predictable is more effective than instruction that varies the conditions of learning and practice.
  3. Focused stimulation (massed practice) is a more effective teaching strategy than varied stimulation (distributed practice).
  4. The more feedback, the better.
  5. Repeated reading of passages is the best way to learn text information.
  6. More therapy is always better.
  7. The most effective language and literacy interventions target processing limitations rather than knowledge deficits.
  8. Telegraphic utterances (e.g., push ball, mommy sock) should not be provided as input for children with limited language.
  9. Appropriate language goals include increasing levels of mean length of utterance (MLU) and targeting Brown’s (1973) 14 grammatical morphemes.
  10. Sequencing is an important skill for narrative competence.

Guess what? Only statement 8 of the above quiz is True! Every other statement from the above is FALSE!

Now, let’s talk about why that is!

First up is the concept of learning vs. generalization. Here Dr. Kamhi discusses that some clinicians still possess an “outdated behavioral view of learning” in our field, which is not theoretically and clinically useful. He explains that when we are talking about generalization – what children truly have a difficulty with is “transferring narrow limited rules to new situations“. “Children with language and learning problems will have difficulty acquiring broad-based rules and modifying these rules once acquired, and they also will be more vulnerable to performance demands on speech production and comprehension (Kamhi, 1988)” (93). After all, it is not “reasonable to expect children to use language targets consistently after a brief period of intervention” and while we hope that “language intervention [is] designed to lead children with language disorders to acquire broad-based language rules” it is a hugely difficult task to undertake and execute.

Next, Dr. Kamhi addresses the issue of instructional factors, specifically the importance of “varying conditions of instruction and practice“.  Here, he addresses the fact that while contextualized instruction is highly beneficial to learners unless we inject variability and modify various aspects of instruction including context, composition, duration, etc., we ran the risk of limiting our students’ long-term outcomes.

After that, Dr. Kamhi addresses the concept of distributed practice (spacing of intervention) and how important it is for teaching children with language disorders. He points out that a number of recent studies have found that “spacing and distribution of teaching episodes have more of an impact on treatment outcomes than treatment intensity” (94).

He also advocates reducing evaluative feedback to learners to “enhance long-term retention and generalization of motor skills“. While he cites research from studies pertaining to speech production, he adds that language learning could also benefit from this practice as it would reduce conversational disruptions and tunning out on the part of the student.

From there he addresses the limitations of repetition for specific tasks (e.g., text rereading). He emphasizes how important it is for students to recall and retrieve text rather than repeatedly reread it (even without correction), as the latter results in a lack of comprehension/retention of read information.

After that, he discusses treatment intensity. Here he emphasizes the fact that higher dose of instruction will not necessarily result in better therapy outcomes due to the research on the effects of “learning plateaus and threshold effects in language and literacy” (95). We have seen research on this with respect to joint book reading, vocabulary words exposure, etc. As such, at a certain point in time increased intensity may actually result in decreased treatment benefits.

His next point against processing interventions is very near and dear to my heart. Those of you familiar with my blog know that I have devoted a substantial number of posts pertaining to the lack of validity of CAPD diagnosis (as a standalone entity) and urged clinicians to provide language based vs. specific auditory interventions which lack treatment utility. Here, Dr. Kamhi makes a great point that: “Interventions that target processing skills are particularly appealing because they offer the promise of improving language and learning deficits without having to directly target the specific knowledge and skills required to be a proficient speaker, listener, reader, and writer.” (95) The problem is that we have numerous studies on the topic of improvement of isolated skills (e.g., auditory skills, working memory, slow processing, etc.) which clearly indicate lack of effectiveness of these interventions.  As such, “practitioners should be highly skeptical of interventions that promise quick fixes for language and learning disabilities” (96).

Now let us move on to language and particularly the models we provide to our clients to encourage greater verbal output. Research indicates that when clinicians are attempting to expand children’s utterances, they need to provide well-formed language models. Studies show that children select strong input when its surrounded by weaker input (the surrounding weaker syllables make stronger syllables stand out).  As such, clinicians should expand upon/comment on what clients are saying with grammatically complete models vs. telegraphic productions.

From there lets us take a look at Dr. Kamhi’s recommendations for grammar and syntax. Grammatical development goes much further than addressing Brown’s morphemes in therapy and calling it a day. As such, it is important to understand that children with developmental language disorders (DLD) (#DevLang) do not have difficulty acquiring all morphemes. Rather studies have shown that they have difficulty learning grammatical morphemes that reflect tense and agreement  (e.g., third-person singular, past tense, auxiliaries, copulas, etc.). As such, use of measures developed by (e.g., Tense Marker Total & Productivity Score) can yield helpful information regarding which grammatical structures to target in therapy.

With respect to syntax, Dr. Kamhi notes that many clinicians erroneously believe that complex syntax should be targeted when children are much older. The Common Core State Standards do not help this cause further, since according to the CCSS complex syntax should be targeted 2-3 grades, which is far too late. Typically developing children begin developing complex syntax around 2 years of age and begin readily producing it around 3 years of age. As such, clinicians should begin targeting complex syntax in preschool years and not wait until the children have mastered all morphemes and clauses (97)

Finally, Dr. Kamhi wraps up his article by offering suggestions regarding prioritizing intervention goals. Here, he explains that goal prioritization is affected by

  • clinician experience and competencies
  • the degree of collaboration with other professionals
  • type of service delivery model
  • client/student factors

He provides a hypothetical case scenario in which the teaching responsibilities are divvied up between three professionals, with SLP in charge of targeting narrative discourse. Here, he explains that targeting narratives does not involve targeting sequencing abilities. “The ability to understand and recall events in a story or script depends on conceptual understanding of the topic and attentional/memory abilities, not sequencing ability.”  He emphasizes that sequencing is not a distinct cognitive process that requires isolated treatment. Yet many SLPs “continue to believe that  sequencing is a distinct processing skill that needs to be assessed and treated.” (99)

Dr. Kamhi supports the above point by providing an example of two passages. One, which describes a random order of events, and another which follows a logical order of events. He then points out that the randomly ordered story relies exclusively on attention and memory in terms of “sequencing”, while the second story reduces demands on memory due to its logical flow of events. As such, he points out that retelling deficits seemingly related to sequencing, tend to be actually due to “limitations in attention, working memory, and/or conceptual knowledge“. Hence, instead of targeting sequencing abilities in therapy, SLPs should instead use contextualized language intervention to target aspects of narrative development (macro and microstructural elements).

Furthermore, here it is also important to note that the “sequencing fallacy” affects more than just narratives. It is very prevalent in the intervention process in the form of the ubiquitous “following directions” goal/s. Many clinicians readily create this goal for their clients due to their belief that it will result in functional therapeutic language gains. However, when one really begins to deconstruct this goal, one will realize that it involves a number of discrete abilities including: memory, attention, concept knowledge, inferencing, etc.  Consequently, targeting the above goal will not result in any functional gains for the students (their memory abilities will not magically improve as a result of it). Instead, targeting specific language and conceptual goals  (e.g., answering questions, producing complex sentences, etc.) and increasing the students’ overall listening comprehension and verbal expression will result in improvements in the areas of attention, memory, and processing, including their ability to follow complex directions.

There you have it! Ten practical suggestions from Dr. Kamhi ready for immediate implementation! And for more information, I highly recommend reading the other articles in the same clinical forum, all of which possess highly practical and relevant ideas for therapeutic implementation. They include:

References:

Kamhi, A. (2014). Improving clinical practices for children with language and learning disorders.  Language, Speech, and Hearing Services in Schools, 45(2), 92-103

Helpful Social Media Resources:

SLPs for Evidence-Based Practice

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New Products for the 2017 Academic School Year for SLPs

Image result for back to schoolSeptember is quickly approaching and  school-based speech language pathologists (SLPs) are preparing to go back to work. Many of them are looking to update their arsenal of speech and language materials for the upcoming academic school year.

With that in mind, I wanted to update my readers regarding all the new products I have recently created with a focus on assessment and treatment in speech language pathology.

My most recent product Assessment of Adolescents with Language and Literacy Impairments in Speech Language Pathology  is a 130-slide pdf download which discusses how to effectively select assessment materials in order to conduct comprehensive evaluations of adolescents with suspected language and literacy disorders. It contains embedded links to ALL the books and research articles used in the development of this product.

Effective Reading Instruction Strategies for Intellectually Impaired Students is a 50-slide downloadable presentation in pdf format which describes how speech-language pathologists (SLPs) trained in assessment and intervention of literacy disorders (reading, spelling, and writing) can teach phonological awareness, phonics, as well as reading fluency skills to children with mild-moderate intellectual disabilities. It reviews the research on reading interventions conducted with children with intellectual disabilities, lists components of effective reading instruction as well as explains how to incorporate components of reading instruction into language therapy sessions.

Dysgraphia Checklist for School-Aged Children helps to identify the students’ specific written language deficits who may require further assessment and treatment services to improve their written abilities.

Processing Disorders: Controversial Aspects of Diagnosis and Treatment is a 28-slide downloadable pdf presentation which provides an introduction to processing disorders.  It describes the diversity of ‘APD’ symptoms as well as explains the current controversies pertaining to the validity of the ‘APD’ diagnosis.  It also discusses how the label “processing difficulties” often masks true language and learning deficits in students which require appropriate language and literacy assessment and targeted intervention services.

Checklist for Identification of Speech Language Disorders in Bilingual and Multicultural Children was created to assist Speech Language Pathologists (SLPs) and Teachers in the decision-making process of how to appropriately identify bilingual and multicultural children who present with speech-language delay/deficits (vs. a language difference), for the purpose of initiating a formal speech-language-literacy evaluation.  The goal is to ensure that educational professionals are appropriately identifying bilingual children for assessment and service provision due to legitimate speech language deficits/concerns, and are not over-identifying students because they speak multiple languages or because they come from low socioeconomic backgrounds.

Comprehensive Assessment and Treatment of Literacy Disorders in Speech-Language Pathology is a 125 slide presentation which describes how speech-language pathologists can effectively assess and treat children with literacy disorders, (reading, spelling, and writing deficits including dyslexia) from preschool through adolescence.  It explains the impact of language disorders on literacy development, lists formal and informal assessment instruments and procedures, as well as describes the importance of assessing higher order language skills for literacy purposes. It reviews components of effective reading instruction including phonological awareness, orthographic knowledge, vocabulary awareness,  morphological awareness, as well as reading fluency and comprehension. Finally, it provides recommendations on how components of effective reading instruction can be cohesively integrated into speech-language therapy sessions in order to improve literacy abilities of children with language disorders and learning disabilities.

Improving critical thinking via picture booksImproving Critical Thinking Skills via Picture Books in Children with Language Disorders is a partial 30-slide presentation which discusses effective instructional strategies for teaching language disordered children critical thinking skills via the use of picture books utilizing both the Original (1956) and Revised (2001) Bloom’s Taxonomy: Cognitive Domain which encompasses the (R) categories of remembering, understanding, applying, analyzing, evaluating and creating.

from wordless books to reading From Wordless Picture Books to Reading Instruction: Effective Strategies for SLPs Working with Intellectually Impaired Students is a full 92 slide presentation which discusses how to address the development of critical thinking skills through a variety of picture books  utilizing the framework outlined in Bloom’s Taxonomy: Cognitive Domain which encompasses the categories of knowledge, comprehension, application, analysis, synthesis, and evaluation in children with intellectual impairments. It shares a number of similarities with the above product as it also reviews components of effective reading instruction for children with language and intellectual disabilities as well as provides recommendations on how to integrate reading instruction effectively into speech-language therapy sessions.

Best Practices in Bilingual LiteracyBest Practices in Bilingual Literacy Assessments and Interventions is a 105 slide presentation which focuses on how bilingual speech-language pathologists (SLPs) can effectively assess and intervene with simultaneously bilingual and multicultural children (with stronger academic English language skills) diagnosed with linguistically-based literacy impairments. Topics include components of effective literacy assessments for simultaneously bilingual children (with stronger English abilities), best instructional literacy practices, translanguaging support strategies, critical questions relevant to the provision of effective interventions, as well as use of accommodations, modifications and compensatory strategies for improvement of bilingual students’ performance in social and academic settings.

Comprehensive Literacy Checklist For School-Aged Children was created to assist Speech Language Pathologists (SLPs) in the decision-making process of how to identify deficit areas and select assessment instruments to prioritize a literacy assessment for school aged children. The goal is to eliminate administration of unnecessary or irrelevant tests and focus on the administration of instruments directly targeting the specific areas of difficulty that the student presents with.

You can find these and other products in my online store (HERE). Wishing all of you a highly successful and rewarding school year!

Image result for happy school year

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Back to School SLP Efficiency Bundles™

September is practically here and many speech language pathologists (SLPs) are looking to efficiently prepare for assessing and treating a variety of clients on their caseloads.

With that in mind, a few years ago I created SLP Efficiency Bundles™, which are materials highly useful for 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.

A.  General Assessment and Treatment Start-Up 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. Types and Levels of Cues and Prompts in  Speech Language Therapy

B. The Checklists Bundle contains 7 checklists relevant to screening and assessment in speech language pathology

  1. Speech Language Assessment Checklist for a Preschool Child 3:00-6:11 years of age
  2. Speech Language Assessment Checklist for a School-Aged Child 7:00-11:11 years of age
  3. Speech Language Assessment Checklist for Adolescents 12-18 years of age
  4. Language Processing Deficits (LPD) Checklist for School Aged Children 7:00-11:11 years of age
  5. Language Processing Deficits (LPD) Checklist for Preschool Children 3:00-6:11 years of age
  6. Social Pragmatic Deficits Checklist for School Aged Children 7:00-11:11 years of age
  7. Social Pragmatic Deficits Checklist for Preschool Children 3:00-6:11 years of age

C. Social Pragmatic Assessment and Treatment Bundle  contains 6 downloads for social pragmatic assessment and treatment planning (from 18 months through school age) and includes:

  1. Recognizing the Warning Signs of Social Emotional Difficulties in Language Impaired Toddlers and Preschoolers
  2. Behavior Management Strategies for Speech Language Pathologists
  3. Social Pragmatic Deficits Checklist for School Aged Children
  4. Social Pragmatic Deficits Checklist for Preschool Children
  5. Assessing Social Pragmatic Skills of School Aged Children
  6. Treatment of Social Pragmatic Deficits in School Aged Children

D. Multicultural Assessment and Treatment Bundle contains 2 downloads relevant to assessment and treatment of bilingual/multicultural children

  1. Language Difference vs. Language Disorder:  Assessment  & Intervention Strategies for SLPs Working with Bilingual Children
  2. Impact of Cultural and Linguistic Variables On Speech-Language Services

E. Narrative Assessment Bundle contains 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

F. Fetal Alcohol Spectrum Disorders Assessment and Treatment Bundle contains 3 downloads relevant to FASD assessment  and treatment

  1. Orofacial Observations of At-Risk Children
  2. Fetal Alcohol Spectrum Disorder: An Overview of Deficits
  3. Speech Language Assessment and Treatment of Children With Alcohol Related Disorders

G. Psychiatric Disorders Bundle contains 7 downloads relevant to language  assessment  and treatment in psychiatrically impaired children

  1. Recognizing the Warning Signs of Social Emotional Difficulties in Language Impaired Toddlers and Preschoolers
  2. Social Pragmatic Deficits Checklist for School Aged Children
  3. Social Pragmatic Deficits Checklist for Preschool Children
  4. Assessing Social Skills in Children with Psychiatric Disturbances
  5. Improving Social Skills of Children with Psychiatric Disturbances
  6. Behavior Management Strategies for Speech Language Pathologists
  7. Differential Diagnosis Of ADHD In Speech Language Pathology

You can find these bundles on SALE in my online store by clicking on the individual bundle links above. You can also purchase these products individually in my online store by clicking HERE.

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Dear SLPs, Here’s What You Need to Know About Internationally Adopted Children

In the past several years there has been a sharp decline in international adoptions. Whereas in 2004, Americans adopted a record high of 22,989 children from overseas, in 2015, only 5,647 children  (a record low in 30 years) were adopted from abroad by American citizens.

Primary Data Source: Data Source: U.S. State Department Intercountry Adoption Statistics  

Secondary Data Source: Why Did International Adoption Suddenly End?

Despite a sharp decline in adoptions many SLPs still frequently continue to receive internationally adopted (IA) children for assessment as well as treatment – immediately post adoption as well as a number of years post-institutionalization.

In the age of social media, it may be very easy to pose questions and receive instantaneous responses on platforms such as Facebook and Twitter with respect to assessment and treatment recommendations. However, it is very important to understand that many SLPs, who lack direct clinical experience in international adoptions may chime in with inappropriate recommendations with respect to the assessment or treatment of these children.

Consequently, it is important to identify reputable sources of information when it comes to speech-language assessment of internationally adopted children.

There are a number of researchers in both US and abroad who specialize in speech-language abilities of Internationally Adopted children. This list includes (but is by far not limited to) the following authors:

The works of these researchers can be readily accessed in the ASHA Journals or via ResearchGate.

Meanwhile, here are some basic facts regarding internationally adopted children that all SLPs and parents need to know.

Image result for demographicsDemographics:

  • —A greater number of older, preschool and school-aged children and fewer number of infants and toddlers are placed for adoption (Selman, 2012).
  • —Significant increase in special needs adoptions from Eastern European countries (e.g., Ukraine, Kazhakstan, etc.) as well as China.  The vast majority of Internationally Adopted children arrive to the United States with significant physical, linguistic, and cognitive disabilities as well as mental health problems. Consequently, it is important for schools to immediately provide the children with a host of services including speech-language therapy, immediately post-arrival.
  • It is also important to know that in the vast majority of cases the child’s linguistic, cognitive, or mental health deficits may not be documented in the adoption records due to poor record keeping, lack of access to adequate healthcare or often to ensure their “adoptability”. As such, parental interviews and anecdotal evidence become the primary source of information regarding these children’s social and academic functioning in their respective birth countries.

The question of bilingualism: 

  • Internationally Adopted children are NOT bilingual children! In fact, the vast majority of internationally adopted children will very rapidly lose their birth language, in a period of 2-3 months post arrival (Gindis, 2005), since they are most often adopted by parents who do not speak the child’s birth language and as such are unable/unwilling to maintain it.
  • IA children do not need to be placed in ESL classes since they are not bilingual children. Not only are IA children not bilingual, they are also not ‘truly’ monolingual since their first language is lost rather rapidly, while their second language has been gained minimally at the time of loss.
  • IA children need to acquire  Cognitive Language Mastery (CLM) which is language needed for formal academic learning. This includes listening, speaking, reading, and writing about subject area content material including analyzing, synthesizing, judging and evaluating presented information. This level of language learning is essential for a child to succeed in school. CLM takes years and years to master, especially because, IA children did not have the same foundation of knowledge and stimulation as bilingual children in their birth countries.

Image result for assessmentAssessment Parameters: 

  • —IA children’s language abilities should be retested and monitored at regular intervals during the first several years post arrival.  —
  • Glennen (2007) recommends 3 evaluations during the first year post arrival, with annual reevaluations thereafter.  —
  • Hough & Kaczmarek (2011) recommend a reevaluation schedule of 3-4 times a year for a period of two years, post arrival because some IA children continue to present with language-based deficits many years (5+) post-adoption.
  • —If an SLP speaking the child’s first language is available the window of opportunity to assess in the first language is very limited (~2-3 months at most).
  • Similarly, an assessment with an interpreter is recommended immediately post arrival from the birth country for a period of approximately the same time.
  • —If an SLP speaking the child’s first language is not available English-speaking SLP should consider assessing the child in English between 3-6 months post arrival (depending on the child and the situational constraints) in order to determine the speed with which s/he are acquiring English language abilities
    • —Children should be demonstrating rapid language gains in the areas of receptive language, vocabulary as well as articulation (Glennen 2007, 2009)
    • Dynamic assessment is highly recommended
  • It is important to remember that language and literacy deficits are not always very apparent and can manifest during any given period post arrival

Image result for speech therapyTo treat or NOT to Treat?

  • “Any child with a known history of speech and language delays in the sending country should be considered to have true delays or disorders and should receive speech and language services after adoption.” (Glennen, 2009, p.52)
  • —IA children with medical diagnoses, which impact their speech language abilities should be assessed and considered for S-L therapy services as well (Ladage, 2009).

Helpful Links:

  1. 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
  2. Assessing Behaviorally Impaired Students: Why Background History Matters!
  3. Dear School Professionals Please Be Aware of This
  4. What parents need to know about speech-language assessment of older internationally adopted children
  5. Understanding the risks of social pragmatic deficits in post institutionalized internationally adopted (IA) children
  6. Understanding the extent of speech and language delays in older internationally adopted children

References:

  • Gindis, B. (2005). Cognitive, language, and educational issues of children adopted from overseas orphanages. Journal of Cognitive Education and Psychology, 4 (3): 290-315.
  • Glennen, S (2009) Speech and language guidelines for children adopted from abroad at older ages.  Topics in language Disorders 29, 50-64.
  • —Ladage, J. S. (2009). Medical Issues in International Adoption and Their Influence on Language Development. Topics in Language Disorders , 29 (1), 6-17.
  • Selman P. (2012) Global trends in Intercountry Adoption 2000-2010. New York: National Council for Adoption, 2012.
  • Selman P. The global decline of intercountry adoption: What lies ahead?. Social Policy and Society 2012, 11(3), 381-397.

Additional Helpful References:

  • Abrines, N., Barcons, N., Brun, C., Marre, D., Sartini, C., & Fumadó, V. (2012). Comparing ADHD symptom levels in children adopted from Eastern Europe and from other regions: discussing possible factors involved. Children and Youth Services Review, 34 (9) 1903-1908.
  • Balachova, T et al (2010). Changing physicians’ knowledge, skills and attitudes to prevent FASD in Russia: 800. Alcoholism: Clinical & Experimental Research. 34(6) Sup 2:210A.
  • Barcons-Castel, N, Fornieles-Deu,A, & Costas-Moragas, C (2011). International adoption: assessment of adaptive and maladaptive behavior of adopted minors in Spain. The Spanish Journal of Psychology, 14 (1): 123-132.
  • Beverly, B., McGuinness, T., & Blanton, D. (2008). Communication challenges for children adopted from the former Soviet Union. Language, Speech, and Hearing Services in Schools, 39, 1-11.
  • 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.
  • Croft, C et al, (2007). Early adolescent outcomes of institutionally-deprived and nondeprived adoptees: II. Language as a protective factor and a vulnerable outcome. The Journal of Child Psychology and Psychiatry, 48, 31–44.
  • Dalen, M. (2001). School performances among internationally adopted children in Norway. Adoption Quarterly, 5(2), 39-57.
  • Dalen, M. (1995). Learning difficulties among inter-country adopted children. Nordisk pedagogikk, 15 (No. 4), 195-208
  • Davies, J., & Bledsoe, J. (2005). Prenatal alcohol and drug exposures in adoption. Pediatric Clinics of North America, 52, 1369–1393.
  • Desmarais, C., Roeber, B. J., Smith, M. E., & Pollak, S. D. (2012). Sentence comprehension in post-institutionalized school-age children. Journal of Speech, Language, and Hearing Research, 55, 45-54
  • Eigsti, I. M., Weitzman, C., Schuh, J. M., de Marchena, A., & Casey, B. J. (2011). Language and cognitive outcomes in internationally adopted children. Development and Psychopathology, 23, 629-646.
  • Geren, J., Snedeker, J., & Ax, L. (2005). Starting over:  a preliminary study of early lexical and syntactic development in internationally-adopted preschoolers. Seminars in Speech & Language, 26:44-54.
  • Gindis (2008) Abrupt native language loss in international adoptees.  Advance for Speech/Language Pathologists and Audiologists.  18(51): 5.
  • Gindis, B. (2005). Cognitive, language, and educational issues of children adopted from overseas orphanages. Journal of Cognitive Education and Psychology, 4 (3): 290-315. Gindis, B. (1999) Language-related issues for international adoptees and adoptive families. In: T. Tepper, L. Hannon, D. Sandstrom, Eds. “International Adoption: Challenges and Opportunities.” PNPIC, Meadow Lands , PA. , pp. 98-108
  • Glennen, S (2009) Speech and language guidelines for children adopted from abroad at older ages.  Topics in language Disorders 29, 50-64.
  • Glennen, S. (2007) Speech and language in children adopted internationally at older ages. Perspectives on Communication Disorders in Culturally and Linguistically Diverse Populations, 14, 17–20.
  • Glennen, S., & Bright, B. J.  (2005).  Five years later: language in school-age internally adopted children.  Seminars in Speech and Language, 26, 86-101.
  • Glennen, S. & Masters, G. (2002). Typical and atypical language development in infants and toddlers adopted from Eastern Europe. American Journal of Speech-Language Pathology, 44, 417-433
  • Gordina, A (2009) Parent Handout: The Dream Referral, Unpublished Manuscript.
  • Hough, S., & Kaczmarek, L. (2011). Language and reading outcomes in young children adopted from Eastern European orphanages. Journal of Early Intervention, 33, 51-57.
  • Hwa-Froelich, D (2012) Childhood maltreatment and communication development. Perspectives on School-Based Issues,  13: 43-53;
  • Jacobs, E., Miller, L. C., & Tirella, G. (2010).  Developmental and behavioral performance of internationally adopted preschoolers: a pilot study.  Child Psychiatry and Human Development, 41, 15–29.
  • Jenista, J., & Chapman, D. (1987). Medical problems of foreign-born adopted children. American Journal of Diseases of Children, 141, 298–302.
  • Johnson, D. (2000). Long-term medical issues in international adoptees. Pediatric Annals, 29, 234–241.
  • Judge, S. (2003). Developmental recovery and deficit in children adopted from Eastern European orphanages. Child Psychiatry and Human Development, 34, 49–62.
  • Krakow, R. A., & Roberts, J. (2003). Acquisitions of English vocabulary by young Chinese adoptees. Journal of Multilingual Communication Disorders, 1, 169-176
  • Ladage, J. S. (2009). Medical issues in international adoption and their influence on language development. Topics in Language Disorders , 29 (1), 6-17.
  • Loman, M. M., Wiik, K. L., Frenn, K. A., Pollak, S. D., & Gunnar, M. R. (2009). Post-institutionalized children’s development: growth, cognitive, and language outcomes. Journal of Developmental Behavioral Pediatrics, 30, 426–434.
  • McLaughlin, B., Gesi Blanchard, A., & Osanai, Y.  (1995). Assessing language development in bilingual preschool children.  Washington, D.C.: National Clearinghouse for Bilingual Education.
  • Miller, L., Chan, W., Litvinova, A., Rubin, A., Tirella, L., & Cermak, S. (2007). Medical diagnoses and growth of children residing in Russian orphanages. Acta Paediatrica, 96, 1765–1769.
  • Miller, L., Chan, W., Litvinova, A., Rubin, A., Comfort, K., Tirella, L., et al. (2006). Fetal alcohol spectrum disorders in children residing in Russian orphanages: A phenotypic survey. Alcoholism: Clinical and Experimental Research, 30, 531–538.
  • Miller, L. (2005). Preadoption counseling and evaluation of the referral. In L. Miller (Ed.), The Handbook of International Adoption Medicine (pp. 67-86). NewYork: Oxford.
  • Pollock, K. E.  (2005) Early language growth in children adopted from China: preliminary normative data.  Seminars in Speech and Language, 26, 22-32.
  • Roberts, J., Pollock, K., Krakow, R., Price, J., Fulmer, K., & Wang, P. (2005). Language development in preschool-aged children adopted from China. Journal of Speech, Language, and Hearing Research, 48, 93–107.
  • Scott, K.A., Roberts, J.A., & Glennen, S. (2011).  How well children who are internationally do adopted acquire language? A meta-analysis. Journal of Speech, Language and Hearing Research, 54. 1153-69.
  • Scott, K.A., & Roberts, J. (2011). Making evidence-based decisions for children who are internationally adopted. Evidence-Based Practice Briefs. 6(3), 1-16.
  • Scott, K.A., & Roberts, J. (2007) language development of internationally adopted children: the school-age years.  Perspectives on Communication Disorders in Culturally and Linguistically Diverse Populations, 14: 12-17. 
  • Selman P. (2012a) Global trends in intercountry adoption 2000-2010. New York: National Council for Adoption.
  • Selman P (2012b). The rise and fall of intercountry adoption in the 21st centuryIn: Gibbons, J.L., Rotabi, K.S, ed. Intercountry Adoption: Policies, Practices and Outcomes. London: Ashgate Press.
  • Selman, P. (2010) “Intercountry adoption in Europe 1998–2009: patterns, trends and issues,” Adoption & Fostering, 34 (1): 4-19.
  • Silliman, E. R., & Scott, C. M. (2009). Research-based oral language intervention routes to the academic language of literacy: Finding the right road. In S. A. Rosenfield & V. Wise Berninger (Eds.), Implementing evidence-based academic interventions in school (pp. 107–145). New York: Oxford University Press.
  • Tarullo, A. R., Bruce, J., & Gunnar, M. (2007). False belief and emotion understanding in post-institutionalized children. Social Development, 16, 57-78
  • Tarullo, A. & Gunnar, M. R. (2005). Institutional rearing and deficits in social relatedness: Possible mechanisms and processes. Cognitie, Creier, Comportament [Cognition, Brain, Behavior], 9, 329-342.
  • Varavikova, E. A. & Balachova, T. N. (2010). Strategies to implement physician training in FAS prevention as a part of preventive care in primary health settings: P120.Alcoholism: Clinical & Experimental Research. 34(8) Sup 3:119A.
  • Welsh, J. A., & Viana, A. G. (2012). Developmental outcomes of children adopted internationally. Adoption Quarterly, 15, 241-264.
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How Early can “Dyslexia” be Diagnosed in Children?

Image result for dyslexiaIn recent years there has been a substantial rise in awareness pertaining to reading disorders in young school-aged children. Consequently, more and more parents and professionals are asking questions regarding how early can “dyslexia” be diagnosed in children.

In order to adequately answer this question it is important to understand the trajectory of development of literacy disorders in children.

Image result for ida dyslexiaAccording to the definition set forth by the International Dyslexia Association“Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.”

Thus, despite the significant controversy over the use of the label “dyslexia”, as being ‘unscientific and conceptually problematic’, the above definition affirms the fact that it is undisputedly a linguistically based disability.   While it is true that merely using the term “dyslexia” does not automatically evoke our understanding of what type of specific reading-related deficits the child is experiencing, which prevents him/her from reading effectively, it does alert us right away to the fact that a reading disability exists.

In this post, rather than utilizing the term “dyslexia”, I will use a more broad term “literacy deficits” to refer to children who develop trouble reading, writing, and spelling.

Image result for genetic inheritanceSo who exactly are those children? Well, with respect to genetic inheritance, children with immediate and/or extended family members who have in the past received diagnoses such as “dyslexia”, “reading disability”, “learning disability” or who had experienced special education placements during school years are significantly more at risk of developing literacy based deficits than children with no history of above problems in the family.

Unfortunately, the situation is further complicated by the fact that some children with no recognizable family history of learning disabilities, may be at risk for future literacy deficits if they display a pattern of linguistic difficulties during early development (e.g., delayed developmental milestones).

Below is the approximate hierarchy of language development in young children:

  • Exploration of the environment (early socio-emotional development)
  • Play (continuation of socio-emotional development)
  • Receptive Language
    • Comprehension of  words, phrases, sentences, stories
  • Expressive Language
    • Speaking single words, phrases, sentences, engaging in conversations, producing stories
  • Social Emotional Development (Pragmatics) continues to be refined and becomes more sophisticated
  • Reading
    • Words, sentences, short stories, chapter books, etc.
    • General topics
    • Domain specific topics (science, social studies, etc)
  • Spelling
  •  Writing
    • Words, sentences, short stories, essays

The fact is that if the child experiences any deficits in the foundational language areas such as listening and speaking, s/he will most certainly experience difficulties in more complex areas of language: reading, writing, and spelling.

So now that we know that children with a history of language delay/disorder are at a significant risk of having the disorder turn into a learning disability when they’re older, let’s talk about how early can these children be assessed in order to better plan their future literacy based interventions for optimal functional outcomes.

The first scenario is a more obvious one.  If a child has a documented history of language impairments and is receiving services from a very early age (e.g., early intervention, preschool, etc.) then given what we know about the connection between language disorders and learning disabilities, professionals can begin administering phonological awareness/emergent reading interventions during the early preschool years in order to optimally facilitate the child’s literacy outcomes.

Image result for detective clipartNow our second scenario is not so clear-cut. In our second scenario, the child may have never been identified as having language difficulties during toddlerhood or even early preschool years. However, as the child grows older (e.g., 4-5 years of age) his/her parents may be noticing some subtle difficulties such as difficulty remembering nursery rhymes and songs, trouble remembering the letters of the alphabet, trouble recognizing simple rhyming words, etc.  A such, even without a pertinent family history of literacy disabilities it may be important for a child to undergo an early literacy assessment in order to determine whether intervention is warranted.

Now let’s talk about various assessment options available for preschool children with suspected literacy deficits.  Firstly, if the child has never received a language assessment it is paramount that the child’s language abilities in the areas of listening comprehension, verbal expression, problem-solving and social communication be assessed prior to assessment of literacy  to ensure that the child does not present with any unrecognized/previously undetected deficits in any of the above areas.  This is done in order to ensure optimal intervention outcomes as failure to address gaps/deficits in foundational language areas may significantly impede any potential literacy gains even when the child is provided with optimal literacy based interventions (click HERE to view my post discussing select speech-language tests for preschool children 2-6 years of age).

Now that we’ve covered some basics let us move on to discuss how early can select literacy tests be administered.  Luckily, there are a number of tests pertaining to literacy which can be administered to children as young as 3:6 years of age.

Image result for asa pearsonTo illustrate: The Auditory Skills Assessment (ASA) can be administered to children 3:6—6:11 years of age. Present controversy over CAPD notwithstanding, it does assess important areas related to early phonological awareness development including nonsense word repetition, phonemic blending, as well as rhyming.  Similarly, the Test of Auditory Processing Skills-3 (TAPS-3) begins at 4 years of age and covers several areas pertaining to phonological awareness including auditory discrimination of words, phonological segmentation, as well as phonological blending abilities.

Image result for ctoppHowever, for a thorough phonological awareness assessment for children that age (4+) nothing beats the Comprehensive Test of Phonological Processing-2 —(CTOPP-2), which assesses such areas as:

  • Phonological Segmentation
  • Blending Words
  • Sound Matching
  • Initial, Medial and Final Phoneme Isolation
  • Blending Nonwords*
  • Segmenting Nonwords*
  • Memory for Digits
  • Nonword Repetition*
  • Rapid Digit Naming 
  • Rapid Letter Naming 
  • Rapid Color Naming 
  • Rapid Object Naming 

(—Assesses the ability to manipulate real and *nonsense words)

(—Assesses word fluency skills via a host of rapid naming tasks)

Image result for Emerging Literacy & Language Assessment®For children 4:6 years of age and older the  Emerging Literacy & Language Assessment (ELLA) deserves a mention. It assesses the following literacy related abilities:

  • Section 1 – Phonological Awareness and Flexibility assesses rhyming (awareness and production), initial sound identification, blending and segmenting sounds, words, and syllables, and deleting and substituting sounds in the initial and final positions of words.
  • Section 2 – Sign and Symbol Recognition and Interpretation assesses environmental symbol identification, letter-symbol identification, word reference association, and reading comprehension for one to three sentences.
  • Section 3 – Memory, Retrieval, and Automaticity assesses rapid naming, word associations (name items that start with the “S” sound), and story retell (includes three story levels based on the child’s age).

For children between 5:0-9:11 years of age, —The Phonological Awareness Test 2 (PAT 2) will assess the following areas:Product Image

  • —Rhyming:  Discrimination and Production—identify rhyming pairs and provide a rhyming word
  • —Segmentation:  Sentences, Syllables, and Phonemes—dividing by words, syllables and phonemes
  • —Isolation:  Initial, Final, Medial—identify sound position in words
  • —Deletion:  Compound Words, Syllables, and Phonemes—manipulate root words, syllables, and phonemes in words
  • —Substitution With Manipulatives—isolate a phoneme in a word, then change it to another phoneme to form a new word
  • —Blending:  Syllables and Phonemes—blend units of sound together to form words
  • —Graphemes—assess knowledge of sound/symbol correspondence for consonants, vowels, consonant blends, consonant digraphs, r-controlled vowels, vowel digraphs, and diphthongs
  • —Decoding—assess  general knowledge of sound/symbol correspondence to blend sounds into nonsense words
  • —Invented Spelling (optional)—write words to dictation to show encoding ability

Furthermore, starting from 5 years of age the —Rapid Automatized Naming and Rapid Alternating Stimulus Test RAN/RAS  tests can be administered in order to assess the child’s word fluency skills.  Decreased word fluency is a significant indicator of reading deficits, which is why this ability is very important to test.

—In addition to the above assessments, there are several tests of early reading and writing abilities which are available for younger children with suspected literacy deficits

TERA-3: Test of Early Reading Ability–Third EditionThe  Test of Early Reading Ability–Third Edition (TERA-3) assesses  the emergent reading abilities of children starting from 3:6 years of age. Similarly, the Test of Early Written Language, Third Edition (TEWL-3) assesses  the emergent writing abilities of children starting from 4:0 years of age.

So there you have it! Now you know that if needed children as young 3:6 years of age can undergo early literacy assessments in order to determine their potential risk of developing literacy deficits when older.

Of course, due to the precociously young age of the children, it is important for examiners to exercise significant caution when it comes to interpretation of standardized testing results. It is a well-documented fact that standardized tests present with numerous limitations when it comes to identification of children with language and literacy disorders.

As such, due to the children’s young age there will be a number of instances when testing may reveal “false negative results” (show that there are no deficits when deficits still exist).  Consequently, in such cases, it is important to carefully monitor the child’s school performance in order to perform a literacy reassessment (if needed) when the child is older and his/her difficulties may be more apparent (click HERE to view my 4-part post discussing Components of Comprehensive Dyslexia Testing for further details).

Finally, it is very important to reiterate that children presenting with language and literacy deficits will not outgrow these deficits on their own. While there may be periods of “illusory recovery” when it looks like children with early language disorders have caught up with their peers, such “spurts” are typically followed by a “post-spurt plateau” (Sun & Wallach, 2014). This is because due to the ongoing challenges and an increase in academic demands “many children with early language disorders fail to “outgrow” these difficulties or catch up with their typically developing peers” (Sun & Wallach, 2014).  That is why it is crucial that we identify language and literacy deficits in children at a very early age in order to ensure their optimal educational outcomes.

Related Posts:

Helpful Smart Speech Therapy Resources Pertaining to Preschoolers: 

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Why Are My Child’s Test Scores Dropping?

“I just don’t understand,” says a parent bewilderingly, “she’s receiving so many different therapies and tutoring every week, but her scores on educational, speech-language, and psychological testing just keep dropping!”

I hear a variation of this comment far too frequently in both my private practice as well as outpatient school in hospital setting, from parents looking for an explanation regarding the decline of their children’s standardized test scores in both cognitive (IQ) and linguistic domains. That is why today I wanted to take a moment to write this blog post to explain a few reasons behind this phenomenon.

Children with language impairments represent a highly diverse group, which exists along a continuum.   Some children’s deficits may be mild while others far more severe. Some children may receive very little intervention  services and thrive academically, while others can receive inordinate amount of interventions and still very limitedly benefit from them.  To put it in very simplistic terms, the above is due to two significant influences – the interaction between the child’s (1) genetic makeup and (2) environmental factors.

There is a reason why language disorders are considered developmental.   Firstly, these difficulties are apparent from a young age when the child’s language just begins to develop.  Secondly, the trajectory of the child’s language deficits also develops along with the child and can progress/lag based on the child’s genetic predisposition, resiliency, parental input, as well as schooling and academically based interventions.

Let us discuss some of the reasons why standardized testing results may decline for select students who are receiving a variety of support services and interventions.

Ineffective Interventions due to Misdiagnosis 

Sometimes, lack of appropriate/relevant intervention provision may be responsible for it.  Let’s take an example of a misdiagnosis of alcohol related deficits as Autism, which I have frequently encountered in my private practice, when performing second opinion testing and consultations. Unfortunately, the above is not uncommon.  Many children with alcohol-related impairments may present with significant social emotional dysregulation coupled with significant externalizing behavior manifestations.  As a result, without a thorough differential diagnosis they may be frequently diagnosed with ASD and then provided with ABA therapy services for years with little to no benefit.

Ineffective Interventions due to Lack of Comprehensive Testing 

Let us examine another example of a student with average intelligence but poor reading performance.  The student may do well in school up to certain grade but then may begin to flounder academically.  Because only the student’s reading abilities ‘seem’ to be adversely impacted, no comprehensive language and literacy evaluations are performed.   The student may receive undifferentiated extra reading support in school while his scores may continue to drop.

Once the situation ‘gets bad enough’, the student’s language and literacy abilities may be comprehensively assessed.  In a vast majority of situations these type of assessments yield the following results:

  1. The student’s oral language expression as well as higher order language abilities are adversely affected and require targeted language intervention
  2. The undifferentiated reading intervention provided to the student was NOT targeting actual areas of weaknesses

As can be seen from above examples, targeted intervention is hugely important and, in a number of cases, may be responsible  for the student’s declining performance. However, that is not always the case.

What if it was definitively confirmed that the student was indeed diagnosed appropriately and was receiving quality services but still continued to decline academically. What then?

Well, we know that many children with genetic disorders (Down Syndrome, Fragile X, etc.) as well as intellectual disabilities (ID) can make incredibly impressive gains in a variety of developmental areas (e.g., gross/fine motor skills, speech/language, socio-emotional, ADL, etc.)  but their gains will not be on par with peers without these diagnoses.

The situation becomes much more complicated when children without ID (or with mild intellectual deficits) and varying degrees of language impairment, receive effective therapies, work very hard in therapy, yet continue  to be perpetually behind their peers when it comes to making academic gains.  This occurs because of a phenomenon known as Cumulative Cognitive Deficit (CCD).

The Effect of Cumulative Cognitive Deficit (CCD) on Academic Performance 

According to Gindis (2005) CCD “refers to a downward trend in the measured intelligence and/or scholastic achievement of culturally/socially disadvantaged children relative to age-appropriate societal norms and expectations” (p. 304). Gindis further elucidates by quoting Satler (1992): “The theory behind cumulative deficit is that children who are deprived of enriching cognitive experiences during their early years are less able to profit from environmental situations because of a mismatch between their cognitive schemata and the requirements of the new (or advanced) learning situation”  (pp. 575-576).

So who are the children potentially at risk for CCD?

One such group are internationally (and domestically) adopted as well as foster care children.  A number of studies show that due to the early life hardships associated with prenatal trauma (e.g., maternal substance abuse, lack of adequate prenatal care, etc.) as well as postnatal stress (e.g., adverse effect of institutionalization), many of these children have much poorer social and academic outcomes despite being adopted by well-to-do, educated parents who continue to provide them with exceptional care in all aspects of their academic and social development.

Another group, are children with diagnosed/suspected psychiatric impairments and concomitant overt/hidden language deficits. Depending on the degree and persistence of the psychiatric impairment, in addition to having intermittent access to classroom academics and therapy interventions, the quality of their therapy may be affected by the course of their illness. Combined with sporadic nature of interventions this may result in them falling further and further behind their peers with respect to social and academic outcomes.

A third group (as mentioned previously) are children with genetic syndromes, neurodevelopmental disorders (e.g., Autism) and intellectual disabilities. Here, it is very important to explicitly state that children with diagnosed or suspected alcohol related deficits (FASD) are particularly at risk due to the lack of consensus/training  regarding FAS detection/diagnosis. Consequently, these children may evidence a steady ‘decline’ on standardized testing despite exhibiting steady functional gains in therapy.

Brief Standardized Testing Score Tutorial:

When we look at norm-referenced testing results, score interpretation can be quite daunting. For the sake of simplicity,  I’d like to restrict this discussion to two types of scores: raw scores and standard scores.

The raw score is the number of items the child answered correctly on a test or a subtest. However, raw scores need to be interpreted to be meaningful.  For example, a 9 year old student can attain a raw score of 12 on a subtest of a particular test (e.g., Listening Comprehension Test-2 or LCT-2).  Without more information, the raw score has no meaning. If the test consisted of 15 questions, a raw score of 12 would be an average score. Alternatively, if the subtest had 36 questions, a raw score of 12 would be significantly below-average (e.g., Test of Problem Solving-3 or TOPS-3).

Consequently, the raw score needs to be converted to a standard score. Standard scores compare the student’s performance on a test to the performance of other students his/her age.  Many standardized language assessments have a mean of 100 and a standard deviation of 15. Thus, scores between 85 and 115 are considered to be in the average range of functioning.

Now lets discuss testing performance variation across time. Let’s say an 8.6 year old student took the above mentioned LCT-2 and attained poor standard scores on all subtests.   That student qualifies for services and receives them for a period of one year. At that time the LCT-2 is re-administered once again and much to the parents surprise the student’s standard scores appear to be even lower than when he had taken the test as an eight year old (illustration below).

Results of The Listening Comprehension Test -2 (LCT-2): Age: 8:4

Subtests Raw Score Standard Score Percentile Rank Description
Main Idea 5 67 2 Severely Impaired
Details 2 63 1 Severely Impaired
Reasoning 2 69 2 Severely Impaired
Vocabulary 0 Below Norms Below Norms Profoundly Impaired
Understanding Messages 0 <61 <1 Profoundly Impaired
Total Test Score 9 <63 1 Profoundly Impaired

(Mean = 100, Standard Deviation = +/-15)

Results of The Listening Comprehension Test -2 (LCT-2):  Age: 9.6

Subtests Raw Score Standard Score Percentile Rank Description
Main Idea 6 60 0 Severely Impaired
Details 5 66 1 Severely Impaired
Reasoning 3 62 1 Severely Impaired
Vocabulary 4 74 4 Moderately Impaired
Understanding Messages 2 54 0 Profoundly Impaired
Total Test Score 20 <64 1 Profoundly Impaired

(Mean = 100, Standard Deviation = +/-15)

However, if one looks at the raw score column on the far left, one can see that the student as a 9 year old actually answered more questions than as an 8 year old and his total raw test score went up by 11 points.

The above is a perfect illustration of CCD in action. The student was able to answer more questions on the test but because academic, linguistic, and cognitive demands continue to steadily increase with age, this quantitative improvement in performance (increase in total number of questions answered) did not result in qualitative  improvement in performance (increase in standard scores).

In the first part of this series I have introduced the concept of Cumulative Cognitive Deficit and its effect on academic performance. Stay tuned for part II of this series which describes what parents and professionals can do to improve functional performance of students with Cumulative Cognitive Deficit.

References:

  • Bowers, L., Huisingh, R., & LoGiudice, C. (2006). The Listening Comprehension Test-2 (LCT-2). East Moline, IL: LinguiSystems, Inc.
  • Bowers, L., Huisingh, R., & LoGiudice, C. (2005). The Test of Problem Solving 3-Elementary (TOPS-3). East Moline, IL: LinguiSystems.
  • Gindis, B. (2005). Cognitive, language, and educational issues of children adopted from overseas orphanages. Journal of Cognitive Education and Psychology, 4 (3): 290-315.
  • Sattler, J. M. (1992). Assessment of Children. Revised and updated 3rd edition. San Diego: Jerome M. Sattler.
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Parent Consultation Services

Today I’d like to officially introduce a new parent consultation service which I had originally initiated  with a few out-of-state clients through my practice a few years ago.

The idea for this service came after numerous parents contacted me and initiated dialogue via email and phone calls regarding the services/assessments needed for their monolingual/bilingual internationally/domestically adopted or biological children with complex communication needs. Here are some details about it.

Parent consultations is a service provided to clients who live outside Smart Speech Therapy LLC geographical area (e.g., non-new Jersey residents) who are interested in comprehensive specialized in-depth consultations and recommendations regarding what type of follow up speech language services they should be seeking/obtaining in their own geographical area for their children as well as what type of carryover activities they should be doing with their children at home.

Consultations are provided with the focus on the following specialization areas with a focus on comprehensive assessment and intervention recommendations:

  • Language and Literacy 
  • Children with Social Communication (Pragmatic) Disorders
  • Bilingual and Multicultural Children
  • Post-institutionalized Internationally Adopted Children
  • Children with Psychiatric and Emotional Disturbances
  • Children with Fetal Alcohol Spectrum Disorders

The initial consultation length of this service is  1 hour. Clients are asked to forward their child’s records prior to the consultation for review, fill out several relevant intakes and questionnaires, as well as record a short video (3-5 minutes). The instructions regarding video content will be provided to them following session payment.

Upon purchasing a consultation the client will be immediately emailed the necessary paperwork to fill out as well as potential dates and times for the consultation to take place.   Afternoon, Evening and Weekend hours are available for the client’s convenience. In cases of emergencies consultations may be rescheduled at the client’s/Smart Speech Therapy’s mutual convenience.

Refunds are available during a 3 day grace period if a mutually convenient time could not be selected for the consultation. Please note that fees will not be refundable from the time the scheduled consultation begins.

Following the consultation the client has the option of requesting a written detailed consultation report at an additional cost, which is determined based on the therapist’s hourly rate. For further information click HERE. You can also call 917-916-7487 or email [email protected] if you wanted to find out whether this service is right for you.

Below is a past parent consultation testimonial.

International Adoption Consultation Parent Testimonial (11/11/13)

I found Tatyana and Smart Speech Therapy online while searching for information about internationally adopted kids and speech evaluations. We’d already taken our three year old son to a local SLP but were very unsatisfied with her opinion, and we just didn’t know where to turn. Upon finding the articles and blogs written by Tatyana, I felt like I’d finally found someone who understood the language learning process unique to adopted kids, and whose writings could also help me in my meetings with the local school system as I sought special education services for my son.

I could have never predicted then just how much Tatyana and Smart Speech Therapy would help us. I used the online contact form on her website to see if Tatyana could offer us any services or recommendations, even though we are in Virginia and far outside her typical service area. She offered us an in-depth phone consultation that was probably one of the most informative, supportive and helpful phone calls I’ve had in the eight months since adopting my son. Through a series of videos, questionnaires, and emails, she was better able to understand my son’s speech difficulties and background than any of the other sources I’d sought help from. She was able to explain to me, a lay person, exactly what was going on with our son’s speech, comprehension, and learning difficulties in a way that a) added urgency to our situation without causing us to panic, b) provided me with a ton of research-orientated information for our local school system to review, and c) validated all my concerns and gut instincts that had previously been brushed aside by other physicians and professionals who kept telling us to “wait and see”.

After our phone call, we contracted Tatyana to provide us with an in-depth consultation report that we are now using with our local school and child rehab center to get our son the help he needs. Without that report, I don’t think we would have had the access to these services or the backing we needed to get people to seriously listen to us. It’s a terrible place to be in when you think something might be wrong, but you’re not sure and no one around you is listening. Tatyana listened to us, but more importantly, she looked at our son as a specific kid with a specific past and specific needs. We were more than just a number or file to her – and we’ve never even actually met in person! The best move we’ve could’ve made was sending her that email that day. We are so appreciative.

Kristen, P. Charlottesville, VA

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Professional Consultation Services for Speech Language Pathologists

Today I’d like to officially introduce a new professional consultation service for  speech language pathologists (SLPs), which I initiated  with select few clinicians through my practice some time ago.

The idea for this service came after numerous SLPs contacted me and initiated dialogue via email and phone calls regarding cases they were working on or asked for advice on how to initiate assessment or therapy services to new clients with complex communication issues. Here are some details about it.

Professional consultation is a service provided to Speech Language Pathologists (SLPs) seeking specialized in-depth assessment and/or treatment recommendations regarding specific client cases or who are looking to further their professional education in the following specialization areas:

  • Performing Independent Evaluations (IEEs) in Special Education Disputes
  • Comprehensive Early Intervention Assessments of Monolingual and Bilingual Children
  • Speech Language Assessment and Treatment of post-institutionalized Internationally Adopted Children
  • Speech Language Assessment and Treatment of Children with Psychiatric and Emotional Disturbances
  • Speech and Language Assessment and Treatment of Children with Fetal Alcohol Spectrum Disorders
  • Assessment and Management of Social Pragmatic Language Disorders
  • Speech Language Assessment and Treatment of Bilingual and Multicultural Children
  • Speech Language Assessment and Treatment of Severely Cognitively Impaired Clients
  • Speech Language Assessment and Treatment of Children with Genetic Disorders

These professional consultation sessions are conducted via GoTo Meeting and includes video conferencing as well as screen sharing.

The goal of this service is to facilitate the SLPs learning process in the desired specialization area. The initial consultation includes extensive literature, material and resource website recommendations, with the exception of Smart Speech Therapy LLC products, which are available separately for purchase through the online store.

The initial consultation length is 1 hour. SLPs are encouraged to forward de-identified client records prior to the consultation for review. In select cases (and with appropriate permissions) forwarding a short video/audio recording (~7 minutes)  of the client in question is recommended.

Upon purchasing a consultation the client will be immediately emailed potential dates and times for the consultation to take place.   Afternoon, Evening and Weekend hours are available for the client’s convenience. In cases of emergencies consultations may be rescheduled at the client’s/Smart Speech Therapy’s mutual convenience.

While refunds are not available for this type of service, in an unlikely event that the consultation lasts less than 1 hour, leftover time can be banked for future calls without any expiration limits.  Call sessions can be requested as needed and conveyed in advance via email.  For further information click HERE. You can also call 917-916-7487 or email [email protected] if you wanted to find out whether this service is right for you. 

Below is the recent professional consultation testimonial.

Professional Independent Evaluation Consultation Testimonial (8/20/15)

Tatyana,

I just wanted to thank you from the bottom of my heart for the mentorship consultation with you yesterday. I learned a great deal, and appreciated your straight forward approach, and most of all, your scholarly input. You are a thorough professional. This new service that you offer is invaluable for many reasons, one of which is that it buffers the clinical isolation of solo private practice.  I look forward to our next session, about which I will email you in the next week or so. If stars are given, I give you the maximum number of stars possible!    The consultations are pure wonderful!
With gratitude,
Aletta Sinoff Ph.D., CCC-SLP, BCBA-D
Licensed Speech-Language Pathologist
Board Certified Behavior Analyst
Beachwood  OH 44122
Posted on

Thematic Language Intervention with Language Impaired Children Using Nonfiction Texts

FullSizeRender (3)In the past a number of my SLP colleague bloggers (Communication Station, Twin Sisters SLPs, Practical AAC, etc.) wrote posts regarding the use of thematic texts for language intervention purposes. They discussed implementation of fictional texts such as the use of children’s books and fairy tales to target linguistic goals such as vocabulary knowledge in use, sentence formulation, answering WH questions, as well as story recall and production.

Today I would like to supplement those posts with information regarding the implementation of intervention based on thematic nonfiction texts to further improve language abilities of children with language difficulties.

First, here’s why the use of nonfiction texts in language intervention is important. While narrative texts have high familiarity for children due to preexisting, background knowledge, familiar vocabulary, repetitive themes, etc. nonfiction texts are far more difficult to comprehend. It typically contains unknown concepts and vocabulary, which is then used in the text multiple times. Therefore lack of knowledge of these concepts and related vocabulary will result in lack of text comprehension. According to Duke (2013) half of all the primary read-alouds should be informational text. It will allow students to build up knowledge and the necessary academic vocabulary to effectively participate and partake from the curriculum.

So what type of nonfiction materials can be used for language intervention purposes. While there is a rich variety of sources available, I have had great success using Let’s Read and Find Out Stage 1 and 2 Science Series with clients with varying degrees of language impairment.

Here’s are just a few reasons why I like to use this series.

  • They can be implemented by parents and professionals alike for different purposes with equal effectiveness.
  • They can be implemented with children fairly early beginning with preschool on-wards 
  • The can be used with the following pediatric populations:
    • Language Disordered Children
    • Children with learning disabilities and low IQ
    • Children with developmental disorders and genetic syndromes (Fragile X, Down Syndrome, Autism, etc.)
    • Children with Fetal Alcohol Spectrum Disorders
    • Internationally adopted children with language impairment
    • Bilingual children with language impairment
    • Children with dyslexia and reading disabilities
    • Children with psychiatric Impairments
  • The books are readily available online (Barnes & Noble, Amazon, etc.) and in stores.
  • They are relatively inexpensive (individual books cost about $5-6).
  • Parents or professionals who want to continuously use them seasonally can purchase them in bulk at a significantly cheaper price from select distributors (Source: rainbowresource.com)
  • They are highly thematic, contain terrific visual support, and are surprisingly versatile, with information on topics ranging from animal habitats and life cycles to natural disasters and space.
  • They contain subject-relevant vocabulary words that the students are likely to use in the future over and over again (Stahl & Fairbanks, 1986).
  • The words are already pre-grouped in semantic clusters which create schemes (mental representations) for the students (Marzano & Marzano, 1988).

Let’s Read and Find Out Science Level 2 - Weather and Seasons Package | Main Photo (Cover)

For example, the above books on weather and seasons contain information  on:

1. Front Formations
2. Water Cycle
3. High & Low Pressure Systems

Let’s look at the vocabulary words from Flash, Crash, Rumble, and Roll  (see detailed lesson plan HERE). (Source: ReadWorks):

Word: water vapor
Context
: Steam from a hot soup is water vapor.

Word: expands
Context: The hot air expands and pops the balloon.

Word: atmosphere
Context:  The atmosphere is the air that covers the Earth.

Word: forecast
Context: The forecast had a lot to tell us about the storm.

Word: condense
Context: steam in the air condenses to form water drops.

These books are not just great for increasing academic vocabulary knowledge and use. They are great for teaching sequencing skills (e.g., life cycles), critical thinking skills (e.g., What do animals need to do in the winter to survive?), compare and contrast skills (e.g., what is the difference between hatching and molting?) and much, much, more!

So why is use of nonfiction texts important for strengthening vocabulary knowledge and words in language impaired children?

As I noted in my previous post on effective vocabulary instruction (HERE): “teachers with many struggling children often significantly reduce the quality of their own vocabulary unconsciously to ensure understanding(Excerpts from Anita Archer’s Interview with Advance for SLPs).  

The same goes for SLPs and parents. Many of them are under misperception that if they teach complex subject-related words like “metamorphosis” or “vaporization” to children with significant language impairments or developmental disabilities that these students will not understand them and will not benefit from learning them.

However, that is not the case! These students will still significantly benefit from learning these words, it will simply take them longer periods of practice to retain them!

By simplifying our explanations, minimizing verbiage and emphasizing the visuals, the books can be successfully adapted for use with children with severe language impairments.  I have had parents observe my intervention sessions using these books and then successfully use them in the home with their children by reviewing the information and reinforcing newly learned vocabulary knowledge.

Here are just a few examples of prompts I use in treatment with more severely affected language-impaired children:

  • —What do you see in this picture?
  • —This is a _____ Can you say _____
  • What do you know about _____?
  • —What do you think is happening? Why?
  • What do you think they are doing? Why?
  • —Let’s make up a sentence with __________ (this word)
  • —You can say ____ or you can say ______ (teaching synonyms)
  • —What would be the opposite of _______? (teaching antonyms)
  • — Do you know that _____(this word) has 2 meanings
    • —1st meaning
    • —2nd meaning
  • How do ____ and _____ go together?

Here are the questions related to Sequencing of Processes (Life Cycle, Water Cycle, etc.)

  • —What happened first?
  • —What happened second?
  • —What happened next?
  • —What happened after that?
  • —What happened last?

As the child advances his/her skills I attempt to engage them in more complex book interactions—

  • —Compare and contrast items
  • — (e.g. objects/people/animals)
  • —Make predictions and inferences about will happen next?
  • Why is this book important?

“Picture walks” (flipping through the pages) of these books are also surprisingly effective for activation of the student’s background knowledge (what a student already knows about a subject). This is an important prerequisite skill needed for continued acquisition of new knowledge. It is important because  “students who lack sufficient background knowledge or are unable to activate it may struggle to access, participate, and progress through the general curriculum” (Stangman, Hall & Meyer, 2004).

These book allow for :

1.Learning vocabulary words in context embedded texts with high interest visuals

2.Teaching specific content related vocabulary words directly to comprehend classroom-specific work

3.Providing multiple and repetitive exposures of vocabulary words in texts

4. Maximizing multisensory intervention when learning vocabulary to maximize gains (visual, auditory, tactile via related projects, etc.)

To summarize, children with significant language impairment often suffer from the Matthew Effect (—“rich get richer, poor get poorer”), or interactions with the environment exaggerate individual differences over time

Children with good vocabulary knowledge learn more words and gain further knowledge by building of these words

Children with poor vocabulary knowledge learn less words and widen the gap between self and peers over time due to their inability to effectively meet the ever increasing academic effects of the classroom. The vocabulary problems of students who enter school with poorer limited vocabularies only worsen over time (White, Graves & Slater, 1990). We need to provide these children with all the feasible opportunities to narrow this gap and partake from the curriculum in a more similar fashion as typically developing peers. 

Helpful Smart Speech Therapy Resources:

References:

Duke, N. K. (2013). Starting out: Practices to Use in K-3. Educational Leadership, 71, 40-44.

Marzano, R. J., & Marzano, J. (1988). Toward a cognitive theory of commitment and its implications for therapy. Psychotherapy in Private Practice 6(4), 69–81.

Stahl, S. A. & Fairbanks, M. M. “The Effects of Vocabulary Instruction: A Model-based Metaanalysis.” Review of Educational Research 56 (1986): 72-110.

Strangman, N., Hall, T., & Meyer, A. (2004). Background knowledge with UDL. Wakefield, MA: National Center on Accessing the General Curriculum.

White, T. G., Graves, M. F., & Slater W. H. (1990). Growth of reading vocabulary in diverse elementary schools: Decoding and word meaning. Journal of Educational Psychology, 82, 281–290.