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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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Assessing Social Communication Abilities of School-Aged Children

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

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

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

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

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

What is the away message?

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

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

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

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Special Education Disputes and Comprehensive Language Testing: What Parents, Attorneys, and Advocates Need to Know

Image result for evaluationSeveral years after I started my private speech pathology practice, I began performing comprehensive independent speech and language evaluations (IEEs).

For those of you who may be hearing the term IEE for the first time, an Independent Educational Evaluation is “an evaluation conducted by a qualified examiner who is not employed by the public agency responsible for the education of the child in question.” 34 C.F.R. 300.503. IEE’s can evaluate a broad range of functioning outside of cognitive or academic performance and may include neurological, occupational, speech language, or any other type of evaluations  as long as they bear direct impact on the child’s educational performance.

Independent evaluations can be performed for a wide variety of reasons, including but not limited to:

  • To determine the student’s present level of functioning
  • To determine whether the student presents with hidden, previously undiscovered deficits (e.g., executive function, social communication, etc.)
  • To determine whether the student’s educational classification requires a change
  • To determine if the student requires additional, previously not provided, related services (e.g., language therapy, etc.) or an increase in related services
  • To determine whether a student might benefit from an application of a particular therapy technique or program (e.g, Orton-Gillingham)
  • To determine whether a student with a severe impairment (e.g., severe emotional and behavioral disturbances, genetic syndrome, significant intellectual disability, etc.) is a good candidate for an out of district specialized school

Why can’t similar assessments be performed in school settings?

There are several reasons for that.

Why are IEE’s Needed?

The answer to that is simple:  “To strengthen the role of parents in the educational decision-making process.” According to one Disability Rights site: “Many disagreements between parents and school staff concerning IEP services and placement involve, at some stage, the interpretation of evaluation findings and recommendations. When disagreements occur, the Independent Educational Evaluation (IEE) is one option lawmakers make available to parents, to help answer questions about appropriate special education services and placement“.

Indeed, many of the clients who retain my services also retain the services of educational advocates as well as special education lawyers.  Many of them work on determining appropriate level of services as well as an out of district placement for the children with a variety of special education needs. However, one interesting reoccurring phenomenon I’ve noted over the years is that only a small percentage of special education lawyers, educational advocates, and even parents believed that children with autism spectrum disorders, genetic syndromes, social pragmatic deficits, emotional disturbances, or reading disabilities required a comprehensive language evaluation/reevaluation prior to determining an appropriate out of district placement or an in-district change of service provision.

So today I would like to make a case, in favor of comprehensive independent language evaluations being a routine component of every special education dispute involving a child with impaired academic performance. I will do so through the illustration of past case scenarios that clearly show that comprehensive independent language evaluations do matter, even when it doesn’t look like they may be needed.

Case A: “He is just a weak student”.

Several years ago I was contacted by a parent of a 12 year old boy, who was concerned with his son’s continuously failing academic performance. The child had not qualified for an IEP but was receiving 504 plan in school setting and was reported to significantly struggle due to continuous increase of academic demands with each passing school year.  An in-district language evaluation had been preformed several years prior. It showed that the student’s general language abilities were in the low average range of functioning due to which he did not qualify for speech language services in school setting. However, based on the review of available records it very quickly became apparent that many of the academic areas in which the student struggled (e.g., reading comprehension, social pragmatic ability, critical thinking skills, etc)  were simply not assessed by the general language testing. I had suggested to the parent a comprehensive language evaluation and explained to him on what grounds I was recommending this course of action.  That comprehensive 4 hour assessment broken into several testing sessions revealed that the student presented with severe receptive, expressive, problem solving and social pragmatic language deficits, as well as moderate executive function deficits, which required therapeutic intervention.

Prior to that assessment the parent, reinforced by the feedback from his child’s educational staff believed his son to be an unmotivated student who failed to apply himself in school setting.  However, after the completion of that assessment, the parent clearly understood that it wasn’t his child’s lack of motivation which was impeding his academic performance but rather a true learning disability was making it very difficult for his son to learn without the necessary related services and support. Several months after the appropriate related services were made available to the child in school setting on the basis of the performed IEE, the parent reported significant progress in his child academic performance.

Case B: “She’s just not learning because of her behavior, so there’s nothing we can do”.  

This case involved a six year old girl who presented with a severe speech – language disorder and behavioral deficits in school setting secondary to an intellectual disability of an unspecified origin.

In contrast to Case A scenario, this child had received a variety of assessments and therapies since a very early age; however, her parents were becoming significantly concerned regarding her regression of academic functioning in school setting and felt that a more specialized out of district program with a focus on multiple disabilities would be better suitable to her needs. Unfortunately the school disagreed with them and believed that she could be successfully educated in an in-district setting (despite evidence to the contrary).  Interestingly, an in-depth comprehensive speech language assessment had never been performed on this child because her functioning was considered to be “too low” for such an assessment.

Comprehensive assessment of this little girl’s abilities revealed that via an application of a variety of behavioral management techniques (of non-ABA origin), and highly structured language input, she was indeed capable of significantly better performance then she had exhibited in school setting.  It stood to reason that if she were placed in a specialized school setting composed of educational professionals who were trained in dealing with her complex behavioral and communication needs, her performance would continue to steadily improve.  Indeed, six months following a transfer in schools her parents reported a “drastic” change pertaining to a significant reduction in challenging behavioral manifestations as well as significant increase in her linguistic output.

Case C: “Your child can only learn so much because of his genetic syndrome”.  

This case scenario does not technically involve just one child but rather three different male students between 9 and 11 years of age with several ‘common’ genetic syndromes: Down, Fragile X, and Klinefelter.  All three were different ages, came from completely different school districts, and were seen by me in different calendar years.

However, all three boys had one thing in common, because of their genetic syndromes, which were marked by varying degrees of intellectual disability as well as speech language weaknesses, their parents were collectively told that there could be very little done for them with regards to expanding their expressive language as well as literacy development.

Similarly to the above scenarios, none of the children had undergone comprehensive language testing to determine their strengths, weaknesses, and learning styles. Comprehensive assessment of each student revealed that each had the potential to improve their expressive abilities to speak in compound and complex sentences. Dynamic assessment of literacy also revealed that it was possible to teach each of them how to read.

Following the respective assessments, some of these students had became my private clients, while others’s parents have periodically written to me, detailing their children’s successes over the years.  Each parent had conveyed to me how “life-changing”a comprehensive IEE was to their child.

Case D: “Their behavior is just out of control”

The final case scenario I would like to discuss today involves several students with an educational classification of “Emotionally Disturbed” (pg 71).  Those of you who are familiar with my blog and my work know that my main area of specialty is working with school age students with psychiatric impairments and emotional behavioral disturbances.  There are a number of reasons why I work with this challenging pediatric population. One very important reason is that these students continue to be grossly underserved in school setting. Over the years I have written a variety of articles and blog posts citing a number of research studies, which found that a significant number of students with psychiatric impairments and emotional behavioral disturbances present with undiagnosed linguistic impairments (especially in the area of social communication), which adversely impact their school-based performance.

Here, we are not talking about two or three students rather we’re talking about the numbers in the double digits of students with psychiatric impairments and emotional disturbances, who did not receive appropriate therapies in their respective school settings.

The majority of these students were divided into two distinct categories. In the first category, students began to manifest moderate-to-severe speech language deficits from a very early age. They were classified in preschool and began receiving speech language therapy. However by early elementary age their general language abilities were found to be within the average range of functioning and their language therapies were discontinued.   Unfortunately since general language testing does not assess all categories of linguistic functioning such as critical thinking, executive functions, social communication etc., these students continued to present with hidden linguistic impairments, which continued to adversely impact their behavior.

Students in the second category also began displaying emotional and behavioral challenges from a very early age. However, in contrast to the students in the first category the initial language testing found their general language abilities to be within the average range of functioning. As a result these students never received any language-based therapies and similar to the students in the first category, their hidden linguistic impairments continued to adversely impact their behavior.

Students in both categories ended up following a very similar pattern of behavior. Their behavioral challenges in the school continued to escalate. These were followed by a series of suspensions, out of district placements, myriad of psychiatric and neuropsychological evaluations, until many were placed on home instruction. The one vital element missing from all of these students’ case records were comprehensive language evaluations with an emphasis on assessing their critical thinking, executive functions and social communication abilities. Their worsening patterns of functioning were viewed as “severe misbehaving” without anyone suspecting that their hidden language deficits were a huge contributing factor to their maladaptive behaviors in school setting.

Conclusion:

So there you have it!  As promised, I’ve used four vastly different scenarios that show you the importance of comprehensive language evaluations in situations where it was not so readily apparent that they were needed.  I hope that parents and professionals alike will find this post helpful in reconsidering the need for comprehensive independent evaluations for students presenting with impaired academic performance.

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Improving Emotional Intelligence of Children with Social Communication Disorders

Our ability to recognize our own and other people’s emotions, distinguish between and correctly identify different feelings, as well as use that information to guide our thinking and behavior is called Emotional Intelligence (EI) (Salovey, et al, 2008).

EI encompasses dual areas of: emotion understanding, which is an awareness and comprehension of one’s and others emotions (Harris, 2008) and emotion regulation, which are internal and external strategies people use to regulate emotions (Thompson, 1994).

Many students with social communication challenges experience problems with all aspects of EI, including the perception, comprehension, and regulation of emotions (Brinton & Fujiki, 2012).

A number of recent studies have found that children with language impairments also present with impaired emotional intelligence including impaired perception of facial expressions (Spackman, Fujiki, Brinton, Nelson, & Allen, 2005), prosodic emotions (Fujiki, Spackman, Brinton, & Illig, 2008) as well as abstract emotion comprehension (Ford & Milosky, 2003).

Children with impaired emotional intelligence will experience numerous difficulties during social interactions due to their difficulty interpreting emotional cues of others (Cloward, 2012).  These may include but not be limited to active participation in cooperative activities, as well as full/competent interactions during group tasks (Brinton, Fujiki, & Powell, 1997)

Many students with social pragmatic deficits and language impairments are taught to recognize emotional states as part of their therapy goals. However, the provided experience frequently does not go beyond the recognition of the requisite “happy”, “mad”, “sad” emotions. At times, I even see written blurbs from others therapists, which state that “the student has mastered the goals of emotion recognition”.  However, when probed further it appears that the student had merely mastered the basic spectrum of simple emotional states, which places the student at a distinct disadvantage  as compared to typically developing peers who are capable of recognition and awareness of a myriad of complex emotional states.

03well_eyes-tmagArticle

That is why I developed a product to target abstract emotional states comprehension in children with language impairments and social communication disorders. “Gauging Moods and Interpreting Abstract Emotional States: A Perspective Taking Activity Packet” is a social pragmatic photo/question set,  intended for children 7+ years of age, who present with difficulty recognizing abstract emotional states of others (beyond the “happy, mad, sad” option) as well as appropriately gauging their moods.

Many sets contain additional short stories with questions that focus on making inferencing, critical thinking as well as interpersonal negotiation skills.  Select sets require the students to create their own stories with a focus on the reasons why the person in the photograph might be feeling what s/he are feeling.

There are on average 12-15 questions per each photo.  Each page contains a photograph of a person feeling a particular emotion. After the student is presented with the photograph, they are asked a number of questions pertaining to the recognition of the person’s emotions, mood, the reason behind the emotion they are experiencing as well as what they could be potentially thinking at the moment.  Students are also asked to act out the depicted emotion they use of mirror.

Activities also include naming or finding (in a thesaurus or online) the synonyms and antonyms of a particular word in order to increase students’ vocabulary knowledge. A comprehensive two page “emotions word bank” is included in the last two pages of the packet to assist the students with the synonym/antonym selection, in the absence of a thesaurus or online access.

Students are also asked to use a target word in a complex sentence containing an adverbial (pre-chosen for them) as well as to identify a particular word or phrase associated with the photo or the described story situation.

Since many students with social pragmatic language deficits present with difficulty determining a person’s age (and prefer to relate to either younger or older individuals who are perceived to be “less judgmental of their difficulties”), this concept is also explicitly targeted in the packet.

This activity is suitable for both individual therapy sessions as well as group work.  In addition to its social pragmatic component is also intended to increase vocabulary knowledge and use as well as sentence length of children with language impairments.

Intended Audiences:

  • Clients with Language Impairments
  • Clients with Social Pragmatic Language Difficulties
  • Clients with Executive Function Difficulties
  • Clients with Psychiatric Impairments
    • ODD, ADHD, MD, Anxiety, Depression, etc.
  • Clients with Autism Spectrum Disorders
  • Clients with Nonverbal Learning Disability
  • Clients with Fetal Alcohol Spectrum Disorders
  • Adult and pediatric post-Traumatic Brain Injury (TBI) clients
  • Clients with right-side CVA Damage

Areas covered in this packet:

  1. Gauging Age (based on visual support and pre-existing knowledge)
  2. Gauging Moods (based on visual clues and context)
  3. Explaining Facial Expressions
  4. Making Social Predictions and Inferences (re: people’s emotions)
  5. Assuming First Person Perspectives
  6. Understanding Sympathy
  7. Vocabulary Knowledge and Use (pertaining to the concept of Emotional Intelligence)
  8. Semantic Flexibility (production of synonyms and antonyms)
  9. Complex Sentence Production
  10. Expression of Emotional Reactions
  11. Problem Solving Social Situations
  12. Friendship Management and Peer Relatedness

This activity is suitable for both individual therapy sessions as well as group work.  In addition to its social pragmatic component is also intended to increase vocabulary knowledge and use as well as sentence length of children with language impairments. You can find it in my online store (HERE).

Helpful Smart Speech Resources:

References:

  1. Brinton, B., Fujiki, M., & Powell, J. M. (1997). The ability of children with language impairment to manipulate topic in a structured task. Language, Speech and Hearing Services in Schools, 28, 3-11.
  2. Brinton B., & Fujiki, M. (2012). Social and affective factors in children with language impairment. Implications for literacy learning. In C. A. Stone, E. R. Silliman, B. J. Ehren, & K. Apel (Eds.), Handbook of language and literacy: Development and disorders (2nd Ed.). New York, NY: Guilford.
  3. Cloward, R. (2012). The milk jug project: Expression of emotion in children with language impairment and autism spectrum disorder (Unpublished honor’s thesis). Brigham Young University, Provo, Utah.
  4. Ford, J., & Milosky, L. (2003). Inferring emotional reactions in social situations: Differences in children with language impairment. Journal of Speech, Language, and Hearing Research, 46(1), 21-30.
  5. Fujiki, M., Spackman, M. P., Brinton, B., & Illig, T. (2008). Ability of children with language impairment to understand emotion conveyed by prosody in a narrative passage. International Journal of Language & Communication Disorders, 43(3), 330-345
  6. Harris, P. L. (2008). Children’s understanding of emotion. In M. Lewis, J. M. Haviland-Jones, & L. Feldman Barrett, (Eds.), Handbook of emotions (3rd ed., pp. 320–331). New York, NY: Guilford Press.
  7. Salovey, P., Detweiler-Bedell, B. T., Detweiler-Bedell, J. B., & Mayer, J. D. (2008). Emotional intelligence. In M. Lewis, J. M. Haviland-Jones, & L. Feldman Barrett (Eds.), Handbook of Emotions (3rd ed., pp. 533-547). New York, NY: Guilford Press.
  8. Spackman, M. P., Fujiki, M., Brinton, B., Nelson, D., & Allen, J. (2005). The ability of children with language impairment to recognize emotion conveyed by facial expression and music. Communication Disorders Quarterly, 26(3), 131-143.
  9. Thompson, R. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59(2-3), 25-52

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SLP Efficiency Bundles™ for Graduating Speech Language Pathologists

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

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What if Its More Than Just “Misbehaving”?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Here are just a few antecedent examples:

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

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

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

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

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

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

 

References: 

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

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I frequently get  emails,  phone calls,  and questions from parents and professionals  regarding academic functioning of internationally adopted post institutionalized children.  Unfortunately despite the fact that  there is  a  fairly large body of research  on this topic  there still continue to be numerous misconceptions regarding how these children’s needs should be addressed  in academic settings.

Perhaps  one of the most serious and damaging misconceptions is that internationally adopted children are bilingual/multicultural children with Limited English Proficiency who need to be treated as ESL speakers. This erroneous belief often leads to denial or mismanagement of appropriate level of services for these children not only with respect to their  language processing and verbal expression but also their social pragmatic language abilities.

Even after researchers published a number of articles on this topic, many psychologists, teachers and speech language pathologists still don’t know that internationally adopted children rapidly lose their little birth language literally months post their adoption by English-speaking parents/families. Gindis (2005) found that children adopted between 4-7 years of age lose expressive birth language abilities within 2-3 months and receptive abilities within 3-6 months post- adoption. This process is further expedited in children under 4, whose language is delayed or impaired at the time of adoption (Gindis, 2008).    Even school-aged children of 10-12 years of age who were able to read and write in their birth language,  rapidly lose  their comprehension and expression of birth language  within their first year post adoption,  if adopted by English-speaking parents who are unable to support their birth language.

 So how does this translate into appropriate provision of speech language services you may ask?   To begin with,  I often see posts on the ASHA forums  or in Facebook speech pathology and special education groups seeking assistance with finding interpreters fluent in various exotic languages.  However, unless the child is “fresh off the boat” (several months post arrival to US)  schools shouldn’t be feverishly trying to locate interpreters to assist with testing in the child’s birth language.  They will not be able to obtain any viable results especially if the child had been residing in the United States for several years.

So if the post-institutionalized, internationally  adopted child is still struggling with academics  several years post adoption,  one should not immediately jump to the conclusion that this is an “ESL” issue,  but get relevant professionals (e.g., speech pathologists, psychologists) to perform thorough testing in order to determine whether it’s the lack of foundational abilities due to institutionalization which is adversely impacting the child’s academic abilities.

Furthermore, ESL itself is often not applicable as an educational method to internationally adopted children.  Here’s why:

Let’s literally take the first definition of ESL which pops-up on Google when you put in a query: “What is ESL?”  “English as a Second Language (ESL) is an instructional program for students whose dominant language is not English. The purpose of the program is to increase the English language proficiency of eligible students so they can attain academic standards and achieve success in the classroom.”

Here is our first problem.  These students don’t have a dominant language.   They are typically adopted by parents who do not speak their birth language and that are unable to support them in their birth language. So upon arrival to US, IA children will typically acquire English via the subtractive model of language acquisition (birth language is replaced and eliminated by English), which is a direct contrast to bilingual children, many of whom learn via the additive model (adding English to the birth language (Gindis, 2005). As a result, of subtractive language acquisition IA children experience very rapid birth language attrition (loss) post-adoption (Gindis, 2003; Glennen, 2009).   Thus they will literally undergo what some researchers have called: “second-first language acquisition” (Scott et al., 2011)  and their first language will “become completely obsolete as English is learned” (Nelson, 2012, p. 2). 

This brings us to our second problem: the question of “eligibility”.  Historically, ESL programs have been designed to assist children of immigrant families  acquire academic readiness skills.  This methodology is based on the fact that skills from first language was ultimately transfer to the  second language.  However, since post-institutionalized children don’t technically have a “first language”  and  their home language is English,  how could they technically be eligible for ESL services? Furthermore,  because of frequent lack of basic foundational skills in the birth language  internationally adopted post-institutionalized children will not benefit the same way from ESL instruction the same way bilingual children of immigrant families do.  So instead of focusing on these children’s questionable eligibility for ESL services  it is important to perform detailed review of their pre-adoption records in order to determine birth language deficits and consider eligibility for  speech language services with the emphasis on improving  these children’s  foundational skills.

If the child’s pre-adoption records specifically state that s/he has birth language delay then it should be taken seriously (Gindis, 1999) since language delays in the birth language transfer and affect the new language (McLaughlin, Gesi, & Osani, 1995). These delays will not “go away” without appropriate interventions.  “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)

Now that we have discussed the issue of ESL services, lets touch upon social pragmatic language abilities of internationally adopted children.  Here’s how erroneous beliefs can contribute to mismanagement of appropriate services in this area.

Different cultures have different pragmatic conventions,  therefore we are taught to be very careful when labeling  certain behaviors  of children from other cultures as atypical, just because they are not consistent with the conventions and behaviors of children from the mainstream culture. Here’s a recent example. A mainstream American parent consulted an SLP regarding the inappropriate social pragmatic skills of her teenaged daughter adopted almost a decade ago from Southeast Asia. The SLP was under the  impression that  some of the child’s deficits  were due to multicultural differences and had to do with the customs and traditions of the child’s country of origin. She was considering  advising the parent regarding requesting  an evaluation by a SLP who spoke the child’s birth language.

Here are two problems with the above scenario.  Firstly,  any internationally adopted post-institutionalized child who was adopted by American parents who were not part of the culture from which the child was adopted, the child will quickly become acculturated  and  immersed in the American culture.  These children “need functional English for survival”, and thus have a powerful incentive to acquire English (Gindis, 2005; p. 299).   consequently, any unusual or atypical behaviors they exhibit in social interactions and in academic setting with other individuals cannot be  attributed to customs and traditions of another culture.

Secondly,  It is very important to understand that  institutionalization and orphanage care have been closely linked to increase in mental health disorders  and psychiatric impairments.   As a result, internationally adopted children have a high incidence of social pragmatic deficits as compared to non-adopted peers as well as post-institutionalized children adopted at younger ages, (under 3).    Given this, if parents present with concerns regarding their internationally adopted post-institutionalized children’s social pragmatic and behavioral functioning it is very important not to  jump to erroneous conclusion pertaining to these children’s birth countries but rather preform comprehensive evaluations in order to determine whether these children can be assisted further in the realm of social pragmatic functioning in a variety of settings.

In order to develop a clear picture regarding appropriate service delivery for IA children, school based professionals need to educate themselves regarding the fundamental differences between development and learning trajectories of internationally adopted children and multicultural/bilingual children. Children, who struggle academically, after years of adequate schooling exposure, do not deserve a “wait and see” approach. They should start receiving appropriate intervention as soon as possible (Hough & Kaczmarek, 2011; Scott & Roberts, 2007).

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Review of Social Language Development Test Adolescent: What SLPs Need to Know

Product ImageA few weeks ago I reviewed the  Social Language Development Test Elementary  (SLDTE) and today I am reviewing the  Social Language Development Test Adolescent  (SLDTA) currently available from PRO-ED.

Basic overview

Release date: 2010
Age Range: 12-18
Authors:Linda Bowers, Rosemary Huisingh, Carolyn LoGiudice
Publisher: Linguisystems (PRO-ED as of 2014)

The Social Language Development Test: Adolescent (SLDT-A) assesses adolescent students’ social language competence. The test addresses the students ability to take on someone else’s perspective, make correct inferences, interpret social language, state and justify logical solutions to social problems, engage in appropriate social interactions, as well as interpret ironic statements.

The Making Inferences subtest of the SLDT-A assesses students’ ability to infer what someone in the picture is thinking as well as state what visual cues aided him/her in the making of that inference.

The first question asks the student to pretend to be a person in the photo and then to tell what the person is thinking by responding as a direct quote. The quote must be relevant to the person’s situation and the emotional expression portrayed in the photo.The second question asks the student to identify the relevant visual clues that he used to make the inference.

Targeted Skills include:

  1. detection of nonverbal and context clues
  2. assuming the perspective of a specific person
  3. inferring what the person is thinking and expressing the person’s thought
  4. stating the visual cues that aided with response production

A score of 1 or 0 is assigned to each response, based on relevancy and quality. However, in contrast to the SLDTE student must give a correct response to both questions to achieve a score of 1.

Errors can result due to limited use of direct quotes (needed for correct responses to indicate empathy/attention to task), poor interpretation of provided visual clues (attended to irrelevant visuals) as well as vague, imprecise, and associated responses.

The Interpreting Social Language subtest of the SLDT-A assesses students’ ability to demonstrate actions (including gestures and postures), tell a reason or use for an action, think and talk about language and interpret figurative language including idioms.

A score of 1 or 0 is assigned to each response, based on relevancy and quality. Student must give a correct response to both questions to achieve a score of 1.

Targeted Skills:

  1. Ability to demonstrate actions such as gestures and postures
  2. Ability to explain appropriate reasons or use for actions
  3. Ability to think and talk about language
  4.  Ability to interpret figurative language (e.g., idioms)

Errors can result due to vague, imprecise (off-target), or associated responses as well as lack of responses. Errors can result due to lack of knowledge of correct nonverbal gestures to convey meaning of messages.  Finally errors can result due to literal interpretations of idiomatic
expressions.

The Problem Solving subtest of the SLDT-A assesses students’ ability to offer a logical solution to a problem and explain why that would be a good way to solve the problem.

To receive a score of 1, the student has to provide an appropriate solution with relevant justification. A score of 0 is given if any of the responses to either question were incorrect or inappropriate.

Targeted Skills:

  1. Taking perspectives of other people in various social situations
  2. Attending to and correctly interpreting social cues
  3. Quickly and efficiently determining best outcomes
  4. Coming up with effective solutions to social problems
  5. Effective conflict negotiation

Errors can result due to illogical or irrelevant responses, restatement of the problem, rude solutions, or poor solution justifications.

The Social Interaction subtest of the SLDT-A assesses students’ ability to socially interact with others.

A score of 1 is given for an appropriate response that supports the situation. A score of 0 is given for negative, unsupportive, or passive responses as well as for ignoring the situation, or doing nothing.

Targeted Skills:

  1. Provision of appropriate, supportive responses
  2. Knowing when to ignore the situation

Errors can result due to inappropriate responses that were negative, unsupportive or illogical.

The Interpreting Ironic Statements subtest of the SLDT-A assesses sudents’ ability to recognize sarcasm and interpret ironic statements.

To get a score of 1, the student must give a response that shows s/he understands that the speaker is being sarcastic and is saying the opposite of what s/he means.  A score of 0 is given if the response is literal and ignores the irony of the situation.

Errors can result due to consistent provision of literal idiom meanings indicating lack of
understanding of the speaker’s intentions as well as “missing” the context of the situation. errors also can result due the the student identifying that the speaker is being sarcastic but being unable to explain the reason behind the speaker’s sarcasm (elaboration).

For example, one student was presented with a story of a brother and a sister who extensively labored over a complicated recipe. When their mother asked them about how it came out, the sister responded to their mother’s query: “Oh, it was a piece of cake”. The student was then asked: What did she mean?” Instead of responding that the girl was being sarcastic because the recipe was very difficult, student responded: “easy.”  When presented with a story of a boy who refused to help his sister fold laundry under the pretext that he was “digesting his food”, he was then told by her, “Yeah, I can see you have your hands full.” the student was asked: “What did she mean?” student provided a literal response and stated: “he was busy.”

goal-setting

The following goals can be generated based on the performance on this test:

  • Long Term Goals: Student will improve social pragmatic language skills in order to effectively communicate with a variety of listeners/speakers in all social and academic contexts
  • Short Term Goals
  1. Student will improve his/her ability to  make inferences based on social scenarios
  2. Student will improve his/her interpretation of facial expressions, body language, and gestures
  3. Student will improve his/her ability to interpret social language (demonstrate appropriate gestures and postures, use appropriate reasons for actions, interpret figurative language)
  4. Student will his/her ability to provide multiple interpretations of presented social situations
  5. Student will improve his/her ability to improve social interactions with peers and staff (provide appropriate supportive responses; ignore situations when doing nothing is the best option, etc)
  6. Student will improve his/her ability to  interpret abstract language (e.g., understand common idioms, understand speaker’s beliefs, judge speaker’s attitude, recognize sarcasm, interpret irony, etc)

Caution

A word of caution regarding testing eligibility: 

I would also not administer this test to the following adolescent populations:

  • Students with social pragmatic impairments secondary to intellectual disabilities (IQ <70)
  • Students with severe forms of Autism Spectrum Disorders
  • Students with severe language impairment and limited vocabulary inventories
  • English Language Learners (ELL) with suspected social pragmatic deficits 
  • Students from low SES backgrounds with suspected pragmatic deficits 

—I would not administer this test to Culturally and Linguistically Diverse (CLD)  students due to significantly increased potential for linguistic and cultural bias, which may result in test answers being marked incorrect due to the following:

  • Lack of relevant vocabulary knowledge will affect performance 
  • Lack of exposure to certain cultural and social experiences related to low SES status or lack of formal school instruction
    • How many of such students would know know the meaning of the word “sneer”?
    • —How many can actually show it?
  • Life experiences that the child simply hasn’t encountered yet
    • Has an —entire subtest devoted to idioms
  • —Select topics may be inappropriate for younger children
    • —Dieting
    • —Dating—
  • —Culturally biased when it comes to certain questions regarding friendship and personal values
    • —Individual vs. cooperative culture differences

What I like about this test: 

  • I like the fact that unlike the  CELF-5:M,  the test is composed of open-ended questions instead of offering orally/visually based multiple choice format as it is far more authentic in its representation of real world experiences
  • I really like how the select subtests (Making Inferences) require a response to both questions in order for the responder to achieve credit on the total subtest

Overall, when you carefully review what’s available in the area of assessment of social pragmatic abilities of adolescents this is an important test to have in your assessment toolkit as it provides very useful information for social pragmatic language treatment goal purposes.

Have YOU purchased SLDTA yet? If so how do you like using it? Post your comments, impressions and questions below.

Helpful Resources Related to Social Pragmatic Language Overview, Assessment  and Remediation:

Disclaimer: The views expressed in this post are the personal opinion of the author. The author is not affiliated with PRO-ED or Linguisystems in any way and was not provided by them with any complimentary products or compensation for the review of this product. 

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Review of Social Language Development Test Elementary: What SLPs Need to Know

sldtelAs the awareness of social pragmatic language disorders continues to grow, more and more speech language pathologists are asking questions regarding various sources of social pragmatic language testing.  Today I am reviewing one such test entitled:  Social Language Development Test Elementary  (SLDTE) currently available from PRO-ED.

Basic overview

Release date: 2008
Age Range: 6:00-11:11
Authors:Linda Bowers, Rosemary Huisingh, Carolyn LoGiudice
Publisher: Linguisystems (PRO-ED as of 2014)

This test assesses the students’ social language competence and addresses their ability to take on someone else’s perspective, make correct inferences, negotiate conflicts with peers, be flexible in interpreting situations and supporting friends diplomatically. 

The test is composed of 4 subtests, of which the first two subtests are subdivided into 2 and 3 tasks respectively.

The Making Inferences subtest (composed of 2 tasks) of the SLDT-E is administered to assess student will’s ability to infer what someone in the picture is thinking (task a) as well as state the visual cues that aided the student in the making of that inference (task b). 

On task /a/ errors can result due to student’s difficulty correctly assuming first person perspective (e.g., “Pretend you are this person. What are you thinking?”) and infering (guessing) what someone in the picture was thinking. Errors can also result due to vague, associated and unrelated responses which do not take into account the person’s context (surroundings) as well as emotions expressed by their body language.   

On task /b/ errors can result due to the student’s inability to coherently verbalize his/her responses which may result in the offer of vague, associated, or unrelated answers to presented questions, which do not take into account facial expressions and body language but instead may focus on people’s feelings, or on the items located in the vicinity of the person in the picture. 

student-think-bubble-clipart-thought-girl-color

The Interpersonal Negotiation subtest (composed of 3 tasks) of the SLDT-E is administered to assess the student’s ability to resolve personal conflicts in the absence of visual stimuli.  Student is asked to state the problem (task a) from first person perspective (e.g., pretend the problem is happening with you and a friend), propose an appropriate solution (task b), as well as explain why the solution she was proposing was a good solution (task c).

On task /a/ errors can result due to the student’s difficulty recognizing that a problem exists in the presented scenarios. Errors can also result due to the student’s difficulty stating a problem from a first person perspective, as a result of which they may initiate their responses with reference to other people vs. self (e.g., “They can’t watch both shows”; “The other one doesn’t want to walk”, etc.). Errors also can also result due to the student’s attempt to provide a solution to the presented problem without acknowledging that a problem exists. Here’s an example of how one student responded on this subtest. When presented with: “You and your friend found a stray kitten in the woods. You each want to keep the kitten as a pet. What is the problem?” A responded: “They can’t keep it.”  When presented with:  You and your friend are at an afterschool center. You both want to play a computer game that is played by one person, but there’s only one computer. What is the problem?” A responded: “You have to play something else.”

On task /b/ errors can result due to provision of inappropriate, irrelevant, or ineffective solutions, which lack arrival to a mutual decision based on dialog.  

On task /c/ errors can result due to vague and inappropriate explanations as to why the solution proposed was a good solution.  

The Multiple Interpretations subtest assesses the student’s flexible thinking ability via the provision of two unrelated but plausible interpretations of what is happening in a photo. Here errors can result due to an inability to provide two different ideas regarding what is happening in the pictures. As a result the student may provide vague, irrelevant, or odd interpretations, which do not truly reflect the depictions in the photos. 

The Supporting Peers subtest assesses student’s ability to take the perspective of a person involved in a situation with a friend and state a supportive reaction to a friend’s situation (to provide a “white lie” rather than hurt the person’s feelings).  Errors on this subtest may result due to the student’s difficulty appropriately complementing, criticizing, or talking with peers.  Thus students who as a rule tend to be excessively blunt, tactless, or ‘thoughtless’ regarding the effect their words may have on others will do poorly on this subtest.   However, there could be situations when a high score on this subtest may also be a cause for concern (see the details on why that is HERE). That is because simply repeating the phrase “I like your ____” over and over again without putting much thinking into their response will earn the responder an average subtest score according to the SLDT-E subtest scoring guidelines.   However, such performance will not be reflective of true subtest competence and needs to be interpreted with significant caution

goal-setting

The following goals can be generated based on the performance on this test:

Long Term Goals: Student will improve social pragmatic language competence in order to effectively communicate with a variety of listeners/speakers in all conversational and academic contexts

Short Term Goals

  • Student will improve ability to  make inferences based on social scenarios
  • Student will improve ability to interpret facial expressions, body language, and gestures
  • Student will improve ability to recognize conflicts from a variety of perspectives (e.g., first person, mutual, etc.)
  • Student will improve ability to  resolve personal conflicts using effective solutions relevant to presented scenarios
  • Student will improve ability  to effectively  justify solutions to presented situational conflicts
  • Student will ability to provide multiple interpretations of presented social situations
  • Student will provide effective responses to appropriately support peers in social situations
  • Student will improve ability to engage in perspective taking (e.g., the ability to infer mental states of others and interpret their knowledge, intentions, beliefs, desires, etc.)

Caution

A word of caution regarding testing eligibility: 

I would also not administer this test to the following populations:

  • Students with social pragmatic impairments secondary to intellectual disabilities (IQ <70)
  • Students with severe forms of Autism Spectrum Disorders
  • Students with severe language impairment and limited vocabulary inventories
  • English Language Learners (ELL) with suspected social pragmatic deficits 
  • Students from low SES backgrounds with suspected pragmatic deficits 

—I would not administer this test to Culturally and Linguistically Diverse (CLD)  students due to significantly increased potential for linguistic and cultural bias, which may result in test answers being marked incorrect due to the following:

  • Lack of relevant vocabulary knowledge
  • Lack of exposure to certain cultural and social experiences related to low SES status or lack of formal school instruction
  • Life experiences that the child simply hasn’t encountered yet
    • For example the format of the Multiple Interpretations subtest may be confusing to students unfamiliar with being “tested” in this manner (asked to provide two completely different reasons for what is happening ina particular photo)

What I like about this test: 

  • I like the fact that the test begins at 6 years of age, so unlike some other related tests such as the CELF-5:M, which begins at 9 years of age or the informal  Social Thinking Dynamic Assessment Protocol® which can be used when the child is approximately 8 years of age, you can detect social pragmatic language deficits much earlier and initiate early intervention in order to optimize social language gains.
  • I like the fact that the test asks open-ended questions instead of offering orally/visually based multiple choice format as it is far more authentic in its representation of real-world experiences
  • I really like how the select subtests are further subdivided into tasks in order to better determine the students’ error breakdown

Overall, when you carefully review what’s available in the area of assessment of social pragmatic abilities this is an important test to have in your assessment toolkit as it provides very useful information for social pragmatic language treatment goal purposes.

Have YOU purchased SLDTE yet? If so how do you like using it?Post your comments, impressions and questions below.

NEW: Need an SLDTE Template Report? Find it HERE

Helpful Resources Related to Social Pragmatic Language Overview, Assessment  and Remediation:

 Disclaimer: The views expressed in this post are the personal opinion of the author. The author is not affiliated with PRO-ED or Linguisystems in any way and was not provided by them with any complimentary products or compensation for the review of this product. 

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What is ND-PAE and how is it Related to FASD?

The DSM-5 was released in May 2013 and with it came a revision of criteria for the diagnosis and classification of many psychiatric disorders.  Among them a new proposed criteria was included relevant to alcohol related deficits in children, which is Neurobehavioral Disorder Associated  With Prenatal Alcohol Exposure (ND-PAE) (DSM-5, pgs 798-801). This proposed criteria was included in order to better serve the complex mental health needs of individuals diagnosed with alcohol related deficits, which the previous diagnosis of 760.71 – Alcohol affecting fetus or newborn via placenta or breast milk was unable to adequately capture.   Continue reading What is ND-PAE and how is it Related to FASD?