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The risk of social-emotional deficits in language-impaired young children

In recent years there has been an increase in infants, toddlers and preschoolers diagnosed with significant social-emotional and/or behavioral problems.  An estimated 10% to 15% of birth-5 year-old population experience serious social-emotional problems which significantly impact their functioning and development in the areas of language, behavior, cognition and school-readiness (Brauner & Stephens, 2006). Continue reading The risk of social-emotional deficits in language-impaired young children

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Tips Corner: Creating Opportunities for Spontaneous and Functional Communication

In today’s guest post,  Natalie Romanchukevich advises readers on how to create opportunities to expand children’s spontaneous communication skills.

Helping young children build speech- language skills is an exciting job that both caregivers and educators try to do every second of the day.  We spend so much time giving our children directions to follow, asking them a ton of questions, and modeling words and phrases to shape them into eloquent communicators.

What I find we do NOT do enough, sometimes, is hold back on our never ending “models” of what or how to say things, questions, and directions, instead of allowing our children initiate and engage with us.  Greenspan refers to these initiations as opening circles of communication (Weirder & Greenspan “Engaging Autism”, 2006).

Speech- language development can be thought of as having three interacting and equally important domains- Form ,Content, and Use (Lahey, 1988).

Form refers to the grammatical correctness of our words and sentences (eat vs. eat+ ing).

Content is what the we are essentially communicating- the meaning of our words and sentences.

Use (also known as pragmatics) refers to the function of our words or for what purpose we are using them.

The communicative functions that slowly emerge and characterize communication over the course of language acquisition in vary in typically developing young children.  Children communicate to greet others, comment on objects/actions, request desired objects, request assistance, protest, deny (a statement), ask questions, regulate others (e.g. “blow!”, “open!”), entertain, and narrate events.

In order for children to be able to express these functions, aside from the intent to communicate, there must also be opportunities to express ideas, wants, needs.  For example, why would Timmy request for an object (nonverbally or verbally) if the caregiver hands everything to the child at the slightest sign of a tantrum.  Why ask a “where?” question if every toy or beloved object is comfortably in sight?  Why ask for help if the caregiver readily assists the child with all activities.  The educators describe it as assuming the child’s needs.

Of course we do it out of love and care for the child, and, let’s be honest, sometimes, to save time.  However, it is important with both typical and delayed children to be mindful of what (form, content, use) we model, when (timing is crucial in teaching) we model it, how (facial expression, tone of voice, etc) we model it, and why (is it developmentally important to teach it now?) we model it at this very moment.

Just as it is important for kids to comprehend concepts, follow directions, and understand the different wh- questions, it is also paramount that your child is able to initiate communication.  After all, communication is the ability to express ideas, thoughts, and wants, not just understand those expressed by others.  Answering questions and following commands is not initiating.  Language that is elicited by us- is not spontaneous.

To use language spontaneously, effortlessly and creatively, children need opportunities to practice the skill, to experience taking the lead.  In order for our children to get there, we must first offer models of how to initiate communication and do so appropriately.  We can then create opportunities for the child to speak up.

The most basic strategies you can use to encourage spontaneous initiations (whether nonverbal or verbal) may seem seem initially as counterintuitive.  I mean what is the point to introducing attractive new toys or displaying a yummy snack and then putting it away? Yet it is exactly that action which may very much encourage your child to run after you with gestures or words.  Even then, you may still choose to play “dumb” and be “unsure” as to what it is your child wants.  Does s/he want that bag with new toy or snack “opened?” and “out?”

If the child is nonverbal, his use of gestures to regulate your actions to get the desired item out and open may be the child’s initial step toward sound imitation.  If you are working on getting the child to request help (not just objects), here is your opportunity to model “help” if the child can’t open the item independently.  On a side note, I often hear educators model “help me please!” when the child is clearly at a single word level.  This is not a developmental way of teaching.   Yes, it is nice to hear a full sentence but your child may not be ready for it.

While playing with your child and actively commenting on your joint play, you may find it productive to suddenly become quiet and cease all attempts to ask questions.   This often works beautifully in my therapy sessions; usually, after I have engaged the child into some sort of cooperative and enjoyable play! But it takes a conscious effort and self-control on the part of the adult, since we are so used to engaging in this adult- directed (telling the child what to do as opposed to letting him/her lead and you follow) approach to teaching.

However, once you are able to contain your speech and actions (I promise you it is possible), you may be surprised to hear some immediate or delayed imitations of words/ phrases as well as spontaneous meaningful language.  The language produced, to me, is an indication that the child wants more of the experience- more language enriched play.  Use this opportunity to expand on what s/he is already saying.

Here, timing is really important as you want to imitate back everything your child is doing.  This is another way to communicate with your child.  Build on your child’s language to further describe the objects or people in play without using long sentences.  So, allowing nothing to happen for a few minutes at a time may just be the push to help your child come out with some form of communication.

In addition, stopping a novel activity or toy exploration at the very height of your child’s excitement also works well with many children.  You don’t have to be  confrontational about it, “if you don’t imitate my word/ phrase I just won’t give it back to  you”.  make sure to create these “obstructions”, as Greenspan refers to them, in a friendly, playful and positive manner.  Obstructions or fabricated “problems” are also a big part of social-cognitive and constructivist theories of language learning.

The idea behind these “obstructions” is that the children are forced to problem solve and use resources (language being one of them!) so they can get what they want.  Allowing your child to problem solve is critical to overall cognitive development that affects and shapes speech and language. Presenting your child with developmentally appropriate activities that involve thinking and figuring out of how to get X is an invaluable strategy that I always use with all of my children.

In sum, stop access to items that are already loved, tape up containers, close boxes and jars with favorite snack and toys, give your child all but ONE important item that is needed to complete an activity (glue, scissors), give your child the “wrong” item, or offer the “wrong” solution to the problem.  All of these “problems” will push the kid to think and figure out what to do next.  This, in turn, facilitates spontaneous language use.

Letting go of control and just allowing for things to spill, break, or simply not follow the predictable comfortable routine, too, elicits a ton of speech- language and fun communication.  These are the most teachable moments as our children experience all the new words and concepts first hand.  Perhaps, this is why many children learn “dirty” or “wet” attributes before they learn their colors.  These concepts are more easily learned because they are experiential and bring about relevant words to describe these personally relevant and emotional experiences.  Cleaning up and taking turns arranging things back in place is super educational too as our children need to learn responsibility and helping others.

Moreover, exposing children to objects that are completely novel and foreign (but safe!) may help elicit an attempt to ask a question “what this?” because the child wants to know.  The motivation is there.  Now s/he needs language to get the answer from you.  Some children may use a word with a rising intonation, which too is a question form, just not grammatically mature one.  For example, “Hat?” is as much of a question as “Is that a hat?!”.  If all your child is capable of verbalizing is “wow”, then you can go ahead and model “what IS that?” question a few times.  Of course, you want to pair it up with an exaggerated expression of surprise and excitement in your voice.

To sum up, do not be afraid to experiment, get “messy”, stay silent, entice, intrigue and just wait for a few minutes to see what your child will do.  Yes, we want to teach our children to attend, sit down for a structured activity, and identify objects, shapes, colors, and actions; but these adult- directed activities do not allow for self- expression or spontaneous language use.  You also want to follow your child’s natural interests and inclinations as this is frequently a way into their world.  If you show interest in your friend’s ideas and you let him/her speak, will they not want to bond with you even more? Will they not want to communicate with you?

Creative and talented teachers are those who can use unconventional materials presented in unexpected ways while targeting all the skills that must be learned!  Learning to manipulate the environment to get the most out of your child’s skills can be difficult but indescribably rewarding.

References:

  1. Lahey, M. (1988). Language disorders and Language Development.
  2. Greenspan, S. & Weider, S. (2006). Engaging Autism: Using the Floortime approach to help children related, communicate, and think.
  3. Wetherby, A. & Prizant, B. (1990). Communication and Symbolic Behavior Scales. ChicagoIL: Applied Symblix. 

nrslp

Natalie Romanchukevich has a MS in Communication Sciences and Disorders from Long Island University (LIU) as well as Bilingual (Russian/English) Certification, which allows her to practice speech- language pathology in both Russian and English. Following graduation, Natalie has been working with both monolingual and bilingual 0- 5 population in New York City, and has been an active advocate for preschoolers with disabilities in her present setting.  Natalie’s clinical interests and experience have been focused on  early childhood speech- language delays and disorders including speech disorders (e.g., Articulation, Childhood Apraxia of Speech (CAS), Pervasive Developmental Disorders, Autistic Spectrum Disorders,  Auditory Processing Disorders, Specific Language Impairment (SLI), as well as Feeding Disorders. Presently she is working on developing her private practice in Brooklyn, NY.

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

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

Changing Trends in International Adoption:

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

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

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

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

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

So what is the difference between DI and an SLP?

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

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

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

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

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

What does this all mean to parents?

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

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

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

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

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

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

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

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

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

(from  Service Guidelines for Speech Therapy in Early Intervention)   

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

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

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

Useful Resources:

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Improving Social Skills of Language Impaired Children

social kids

Many children on our caseloads have social pragmatic language goals aimed at improving their social emotional functioning in a variety of settings.  In therapy we often target our clients ability to engage in interpersonal negotiations, interpret ambiguous facial expressions, as well as appropriately relate to peers.

However, oftentimes finding appropriate and relevant real-life photos is a challenge for busy clinicians. That is why I created the “Social Pragmatic Language Activity Pack“.

This 30 page social pragmatic photo/question set is intended for children ages 6 and older. It is organized in a hierarchy of complexity ranging from basic social scenarios to more abstract and socially ambiguous situations.  Some photos contain additional short stories with questions that focus on auditory memory, processing, and comprehension.

There are on average 10-20 questions per each photo, and each photo takes up one page.  While some scenarios may be suitable for younger children, most are suitable for children ages 8-9 and older. Select scenarios containing abstract concepts may be suitable only for upper elementary or middle school aged students.   These sets are suitable for both individual therapy sessions as well as group work. Depending on the student’s abilities and extent of deficits, one set (one page) may take up to 30 minutes to complete.

Areas covered by the questions:

  1. Recognizing Emotional Reactions
  2. Explaining Facial Expressions
  3. Making Predictions
  4. Making Inferences (re: people, locations, thoughts, feelings, and actions)
  5. Multiple Interpretations (of actions and settings)
  6. Interpersonal Negotiations
  7. Sympathy/Empathy
  8. Peer Relatedness (Support)
  9. Interpreting Ambiguous Situations
  10. Problem Solving
  11. Determining Solutions
  12. Determining Causes
  13. Determining Perspectives
  14. Social Judgment
  15. Safety Rules

So don’t delay and grab your set today. You can find it HERE in my online store.

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Guest Post: Simple Activities to Help Your Child with Language Impairment

If your child has been identified as having a language impairment, there are simple activities you can do at home that facilitate language development. These activities work in conjunction with your child’s formal therapy sessions and the activities he or she may participate in at school, either in the classroom or in an adjunct therapy session.

Such activities have three characteristics:

  • They are fun.

Therapy is almost always more effective for small children if it’s fun. Observe the therapist and note that almost all of the activities during the session are based around something that your child already likes to do.

  • They are part of “ordinary” interactions.

While formal therapy sessions are important, the activities at home don’t need to resemble therapy. Instead, they should be built into the normal course of everyday interactions to facilitate language skills naturally.

  • They build receptive language and vocabulary.

As you help your child develop language at home, the process becomes a natural part of your day together. Instead of being singled out as “language impaired,” your child is a loved and “normal” part of your family, and building his or her language skills becomes something that you do with your child just as you would with anyone. In addition, the interaction as you work together to strengthens your bond as you communicate.

Some simple activities to help your child include:

  • Reading aloud

Every child loves to be read a bedtime story; it’s a special time to snuggle with Mom or Dad and to hear a favorite story, again and again. Children find this repetition comforting; it also helps build both receptive and communicative language because as they learn the familiar words – both what they mean and how to say them – they can repeat them as you read the story together. This is perhaps the most perfect activity to help your child because you can do it every day. In fact, your child will look forward to it and probably even demand that it be done.

  • Telling stories, repeating rhymes, and asking your child to “complete the sentence”

Nursery rhymes and familiar stories are additional fun ways to expose your child to both communicative and receptive language. These activities develop language skills in a playful and non-stressful manner. For example, as your child develops familiarity with a rhyme, story, etc., simply pause at the end of a phrase and have him or her complete it.

  • Singing and listening to songs

Music is a wonderful facilitator of language too, and great to include in activities to help your child with language impairment issues. Spend some time each day singing together or listening to songs while driving, for example.

  • Playing the game, “What comes next?”

The “alphabet song” is a good example of how to play the game, “What comes next?” with your child. Since this song helps most children learn the alphabet, begin by singing the song together, and then as your child learns the alphabet, drop out so he or she sings the next letters alone.

“What comes next?” can also be played with days of the week, months of the year, counting, and more. The beauty of “What comes next?” is its applicability to anything language-based. Customize it to suit your child’s likes and dislikes, and it never gets boring.

  • Providing appropriate language modeling

Among the best activities to help your child is modeling correct language during conversations. Your child will watch, learn, and ultimately respond correctly, with gentle prompting at first.

About the author:

Erica L. Fener, Ph.D., is Vice President, Strategic Growth at Progressus Therapy, a leading provider of school-based therapy and early intervention services.

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Language Processing Deficits (LPD) Checklist for School Aged Children

Need a Language Processing Deficits Checklist for School Aged Children

You can find it in my online store HERE

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

Checklist Categories:

  • Listening Skills and Short Term Memory
  • Verbal Expression
  • Emergent Reading/Phonological Awareness
  • General Organizational Abilities
  • Social-Emotional Functioning
  • Behavior
  • Supplemental* Caregiver/Teacher Data Collection Form
  • Select assessments sensitive to Auditory Processing Deficits
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New Product: Speech Language Assessment of Older Internationally Adopted Children

IAToday  I am very excited to introduce to you my brand new product which has been long in the making.  “Speech Language Assessment of Older Internationally Adopted Children”. In the past I have written a number of articles and blog posts as well as done a number of  presentations on related topics. I finally decided that it’s a great time to put it all together and created this 65 slide presentation which succinctly explains how to assess speech language abilities of older Internationally Adopted (IA) Children.

Presentation Summary

—Institutionalization affects every child’s speech-language development. Signs of delay can be obvious or obscure; show immediately or years later. This presentation will review the latest literature regarding the language abilities of post-institutionalized children adopted at older ages. It will discuss language development of older children post-adoption, explain the difference between conversational and cognitive language competencies, offer pre-adoption recommendations, address select pre-assessment preparations as well as to provide recommendations on best assessment practices for these children. Continue reading New Product: Speech Language Assessment of Older Internationally Adopted Children
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Guest Post: 10 Common Causes of Pediatric Speech and Language Problems

Many young children develop speech skills within a wide range of time and with different capabilities. However, by a certain point, most children have begun to learn how to speak and communicate effectively. Of course, when parents notice that their child isn’t keeping up with other children, they worry. While most children develop appropriately given enough time, some children do experience issues with speech-language development.

Delays in speech development are caused by a variety of reasons, so it is important to understand what these potential causes are, as well as why a thorough, professional evaluation may be needed for some children. Too often parents, relatives, neighbors, and school officials believe they know for sure that something is off, but in fact, their guesses may be dead wrong. Instead, accurate diagnosis of speech-language problems requires a thorough evaluation by trained professionals and includes testing of both speech-language and hearing to determine the root cause of any potential problems. Continue reading Guest Post: 10 Common Causes of Pediatric Speech and Language Problems

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Hurray for Book Companions: What will the pig want next?

Is there anything more fun then literature based speech language intervention?

Rhetorical question of course, but seriously how much fun is it?  Even the simplest books are jam-packed with a variety of language concepts, “wh” questions, target vocabulary, prepositions of location, and much, much more.

Of course, it’s always a bonus when I manage to create or obtain a book companion as a complement to the story, so the clients benefit the most from the activity.  I also find book companions particularly useful when it comes to passing out the homework activities to the parents, many of whom require a little guidance regarding how to work at home with their children in order to increase carryover and ultimately reduce the child’s overall time in therapy. This is why I jumped at the opportunity to review one of Denise’s (Speech Language Pirates Blog) several book companions: “If you give a Pig a Pancake.” Continue reading Hurray for Book Companions: What will the pig want next?