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SLPs Blogging About Research: August Edition -FASD

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Trivia Night Answers and Winners

Thank you all who participated in yesterday’s Trivia Night!

Below you’ll find answers to round’s questions as well as the names of winners for each round.

Round 1: Early Child Development

1. Name at least 3 characteristics of child directed speech

These include: motherese, repetition, modeling speech, simple syntax, slowing rate, using a higher pitch as well as using an exaggerated intonation pattern.

2. What is the critical period hypothesis? It is a time period during which language acquisition takes place

3. Name at least 3 functions of communicative behavior during infancy

These include: obtaining attention, seeking approval, seeking assistance, seeking attachment just to name a few

4. Name 2 types of echolalia: Immediate and Delayed

5.  What is jargon and up until what age is it appropriate in children?  Jargon is not true speech but rather pre-linguistic “nonsensical” vocalizations which involve adult-like stress and intonation patterns.  Jargon usually begins to occur around 10-11 months of age in children and can typically last up until about 18 months of age give or take depending on the individual development rate of the child in question. 

Round 2: Internationally Adopted Children 

1. As related to internationally adopted (IA) children, what does the acronym CLM stand for and what does it mean?

CLM stands for Cognitive Language Mastery. It is the 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 typically 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.

2. ”The pattern of language acquisition in internationally adopted children is often referred to as a second first language acquisition” (Scott et al., 2011). Why? Because the first language (which is typically delayed and limited to begin with due to adverse effects of institutionalization) becomes completely obsolete as English is learned. So they end up learning L2 literally from scratch. 

3. Why CAN’T we treat Internationally Adopted children as bilingual speakers? Because they are typically adopted by parents who do not speak their birth language as a result of which they experience rapid birth language attrition and forget their birth language very rapidly.  

4. IA children may present with “normal” language abilities but still display significant difficulties in this area of functioning cognitive-academic and or social pragmatic communication (acceptable responses)

5.  Finish the following sentence: 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)

Round 3: Fetal Alcohol Spectrum Disorders

1. FASD is an umbrella term for the range of effects that can occur due to maternal alcohol consumption during pregnancy which may create physical, cognitive, behavioral, as well as learning/language deficits. It is NOT a clinical diagnosis. Please list at least 3 CURRENT terms under the FASD umbrella (see http://depts.washington.edu/fasdpn/htmls/fasd-fas.htm for details)

  • —Fetal Alcohol Syndrome (FAS) 
  • —Partial FAS 
  • ———Static Encephalopathy (alcohol exposed)
  • Neurobehavioral Disorder (alcohol exposed)

2. Name at least 3 characteristics of infants/toddlers with alcohol related deficits

  • — —May show failure to thrive
  • Increased sensitivity to sensory stimuli 
  • —Delayed speech/language milestones
  • Decreased muscle tone and poor muscle coordination 
  • —Poor self regulation

3. Since behavioral problems become more pronounced during the school years, many researchers found that the primary deficit of school aged children with FASD is in the area of (acceptable responses below)

  • —Daily Functioning Skills
  • —Self-regulation difficulties
  • —Problem Solving Issues
  • —Social/emotional problems

4. Finish the following sentence: adolescents with FASD have significant —DIFFICULTY LEARNING FROM Experience 

5. Why is early detection of alcohol related deficits important? Because it can lead to 

  • —Early and Appropriate Service Delivery
  • —Improved Adaptability
  • —Improved Functioning
  • Improved Outcomes

AND NOW THE WINNERS:

Round 1: Kristin Yanchuleff Simmons      
Round 2: Christina Pillar Cook 
Round 3: Kristin Yanchuleff Simmons 
 
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SLP Trivia Night: Round Three

1. FASD is an umbrella term for the range of effects that can occur due to maternal alcohol consumption during pregnancy which may create physical, cognitive, behavioral, as well as learning/language deficits. It is NOT a clinical diagnosis. Please list at least 3 CURRENT terms under the FASD umbrella.

2. Name at least 3 characteristics of infants/toddlers with alcohol related deficits.

3. Since behavioral problems become more pronounced during the school years, many researchers found that the primary deficit of school aged children with FASD is in the area of ____________

4. Finish the following sentence: adolescents with FASD have significant —DIFFICULTY LEARNING FROM _______

5. Why is early detection of alcohol related deficits important?

Place your responses under this blog post and number each response for clarity.

The first person to get all answers correct will have their choice of product from my online store.

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Tuesday July 30th is Trivia Night!

This Tuesday is my turn to host SLP Trivia Night. Created by Kristine of Simply Speech (graphic by Carrie of  Carrie’s Speech Corner),  Trivia Night involves different SLP Bloggers hosting a night of trivia SLP related questions on their respective Facebook pages.  Jen of Speech Universe did it on July 16, Jocelyn of Ms. Jocelyn Speech did it on July 23rd and now it’s my turn.

Tomorrow (Tuesday, July 30th) I will be hosting this event on my Facebook Page at 9:00 p.m EST.  I am going to have three different rounds at

1. 9:00 pm: First round is on Early Child Development

2. 9:15 pm: Second round is on Internationally Adopted (IA)  Children

3. 9:30 pm: Third round is on Fetal Alcohol Spectrum Disorders (FASD)

Each round will consist of 5 questions on each of the above topics. Each set of questions will be posted on my blog with a link provided on my Facebook Page.

Contestants will be asked to answer ALL 5 questions under the blog entry for a chance to win.

In each round the first person to get all 5 questions correct will have their choice of products from my online store.  I hope to see you all there for SLP Trivia Night!

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Introduction to Fetal Alcohol Spectrum Disorders (FASD)

FASD introI have been making a lot of materials lately in order to disseminate information on a variety of helpful topics including insurance coverage for speech language services, improving feeding abilities in picky eaters, the importance of oro-facial observations during speech- language assessments  and so on. I’ve also created an “introduction” series, which offers presentations on popular topics of interest, such as Auditory Processing Disorders (APD) and Social Pragmatic Language Disorders (click on the name to get to the link to the product).

Today I am excited to tell you about my new product: Introduction to Fetal Alcohol Spectrum Disorders (FASD): What Caregivers and Professionals Need to Know Continue reading Introduction to Fetal Alcohol Spectrum Disorders (FASD)

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

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

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

Learning Objectives:

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New Webinar: Fetal Alcohol Spectrum Disorder: An Overview of Deficits

Course Abstract

This course will provide an overview for speech-language pathologists regarding how alcohol consumption during pregnancy affects the structure and function of a child’s developing brain. It will also describe symptoms of alcohol-related speech/language deficits in children of varying ages from infancy through adolescence, as well as list challenges with reliable identification and diagnosis of alcohol-related deficits.

Course Learning Outcomes

  • After this course, participants will be able to list the terms associated with fetal alcohol spectrum disorders (FASD).
  • After this course, participants will be able to explain FASD-related diagnostic challenges.
  • After this course, participants will be able to describe how prenatal alcohol abuse can change the structure and function of the developing brain.
  • After this course, participants will be able to describe symptoms of alcohol- related speech/language deficits in children of varying ages.

Time-ordered Agenda

0-10 Minutes Overview of alcohol-related disorders and relevant statistics
10-40 Minutes Overview of changes in brain structure and function related to alcohol damage
40-55 Minutes Overview of alcohol-related symptomatology in children of varying ages
55-60 Minutes  Conclusion; Q & A

Course Details

Monday, January 28, 2013 at 12:00 pm EST via SpeechPathology.com

Course Fee:

Subscription Based ($99 per year)

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Improving Social Skills in Children With Psychiatric Disturbances Speechpathology.com Webinar

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

Improving Social Skills in Children with Psychiatric Disturbances

Course Abstract

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

Course Objectives

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