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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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Teaching “Insight” to students with language, social communication, and executive functions impairments

One common difficulty our “higher functioning” (refers to subjective notion of ‘perceived’ functioning in school setting only) language impaired students with social communication and executive function difficulties present with – is lack of insight into own strengths and weaknesses.

Yet insight is a very important skill, which most typically developing students exhibit without consciously thinking about it. Having insight allows students to review work for errors, compensate for any perceived weaknesses effectively, and succeed with efficient juggling of academic workload.

In contrast, lack of insight in students with language deficits further compounds their difficulties, as they lack realization into own weaknesses and as a result are unable to effectively compensate for them.

That is why I started to explicitly teach the students on my caseload in both psychiatric hospital and private practice the concept of insight.

Now some of you may have some legitimate concerns. You may ask: “How can one teach such an abstract concept to students who are already impaired in their comprehension of language?” The answer to that is – I teach this concept through a series of concrete steps as well as through the introduction of abstract definitions, simplified for the purpose of my sessions into concrete terms.

Furthermore, it is important to understand that the acquisition of “insight” cannot be accomplished in one or even several sessions. Rather after this concept is introduced and the related vocabulary has been ‘internalized’ by the student,  thematic therapy sessions can be used to continue the acquisition of “insight” for months and even years to come.

"The Beginning" Road Sign with dramatic blue sky and clouds.

How do we begin? 

When I first started teaching this concept I used to explain the terminology related to “insight” verbally to students. However, as my own ‘insight’ developed in response to the students’ performance, I created a product to assist them with the acquisition of insight (See HERE).

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

kid-lightbulb-shutterstock_166297358-300×198

This thematic 10 page packet targets the development of “insight” in students with average IQ, 8+ years of age, presenting with social pragmatic and executive function difficulties.

The packet contains 1 page text explaining the concept of insight to students.

It also contains 11 Tier II vocabulary words relevant to the discussion of insight and their simplified definitions. The words were selected based on course curriculum standards for several grade levels (fourth through seventh) due to their wide usage in a variety of subjects (social studies, science, math, etc.)

Language activities in this packet include:

  • Explaining definitions
  • Answering open-ended comprehension questions
  • Sentence construction activity
  • Crossword puzzle
  • Two morphological awareness activities
    • Define prefixes and suffixes
    • Change word meanings by adding prefixes and suffixes to words
  • Self-reflection page in written format contains questions for students to assist them with judging their own strengths and weaknesses related to academic performance

And now a few words regarding the lesson structure

I introduce the concept of “insight” to clients by writing down the word and asking them to identify its parts: ‘in‘ and ‘sight‘. Depending on the student’s level of abilities I either get to the students to explain it to me or explain it myself that it is a compound word made up of two other words.

I then ask the students to interpret what the word could potentially mean. After I hear their responses I either confirm the correct one or end up explaining that this word refers to “looking into one’s brain” for answers related to how well someone understands information.

I have the students read the text located on the first page of my packet going over the concept of insight and some of its associated vocabulary words.  I ask the students to tell me the main idea of each paragraph as well as answer questions regarding supporting text details.

Once I am confident that the students have a fairly good grasp of the presented text I move on to the definitions page. There are actually two definition pages in the lesson: one at the beginning and one at the end of the packet. The first definitions page also contains word meaning and what parts of speech the definitions belong to.  The definition page at the end of the packet contains only the targeted words. It is now the students responsibility to write down the definition of all the vocabulary words and phrases in order for me to see how well they remember the meanings of pertinent words.

The packet also includes comprehension questions, a section on sentence construction several morphological awareness activities, a crossword puzzle and a self-reflection page.

The final activity in the packet requires the student to judge their own work performance during this activity.  I ask students questions such as:

  • How do you think you did on this task?
  • How do you know you did ________?
  • How can you prove to me you understood ________?

If a student responds “I know I did well because I understood everything”, I typically ask them to prove their comprehension to me, verbally. Here the goal is to have the student provide concrete verbal examples supporting their insight of their performance.

 This may include statements such as:

  • I know I did well because you said: “Nice Work!”
  • I know I did well because you didn’t correct me too much
  • I know I did well because you  kept smiling and showed me thumbs up as I was talking

As mentioned above this activity is only the beginning. After I ensure that the students have a decent grasp of this concept I continue working on it indirectly by having the students continuously judge their own performance on a variety of other therapy related activities and assignments.

You can find the complete packet on teaching “insight” in my online store (HERE).  Also, stay tuned for Part II of this series, which will describe how to continue solidifying the concept of “insight” in the context of therapy sessions for students with social pragmatic and executive function deficits.

Helpful Smart Speech Resources:

 

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Thematic Language Intervention with Language Impaired Children Using Nonfiction Texts

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

These book allow for :

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

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

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

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

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

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

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

Helpful Smart Speech Therapy Resources:

References:

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

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

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

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

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

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Is it Language Disorder or Learning Disability? A Tutorial for Parents and Professionals

Recently I read a terrific article written in 2014 by Sun and Wallach entitled: “Language Disorders Are Learning Disabilities: Challenges on the Divergent and Diverse Paths to Language Learning Disability“. I found it to be so valuable that I wanted to summarize some of its key points to my readers because it bears tremendous impact on our understanding of what happens to children with language disorders when they reach school years.

The authors begin the article by introducing a scenario familiar to numerous SLPs. A young child is diagnosed with receptive, expressive  and social pragmatic language deficits as a toddler (2.5 years of age) begins to receive speech language services, which continue through preschool and elementary school until 2nd grade. The child is receiving therapy under the diagnosis of specific language impairment (SLI), which is characterized by difficulties with acquiring language in the absence of any other known disorders. By 2nd grade the child has seemingly “caught up” in the areas of listening comprehension and complex sentence production but is now struggling academically in the areas of reading and writing. Now his teachers are concerned that he has a learning disability, and his bewildered parent asks “Is it true that my child now has another problem on top of his language problem?”

From that scenario the authors skillfully navigate the complex relationship between language disorders and school disability labels to explain that the child does NOT have a new disorder but rather continues to face new challenges presented by his old disorder due to which he is now struggling to meet the growing language demands of the academic curriculum.

Here’s the approximate hierarchy of language development in young children:

  • Exploration of the environment
  • Play
  • Receptive Language
    • Comprehension of  words, phrases, sentences, stories
  • Expressive Language
    • Speaking single words, phrases, sentences, engaging in conversations, producing stories
    • Reading
      • Words, sentences, short stories, chapter books, etc.
      • General topics
      • Domain specific topics (science, social studies, etc)
    • Spelling
    • Writing
      • Words, sentences, short stories, essays

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

The authors continue by explaining the complexity of various labels given to children with language and learning difficulties under the IDEA 2004, DSM-5, as well as “research literature and nonschool clinical settings”. They conclude that: “the use of different labels by different professionals in different contexts should not obscure the commonalities among children with language disorders, no matter what they are called”.

Then they go on to explain that longitudinal (over a period of time) research has revealed numerous difficulties experienced by children with “early language disorders” during school years and in adulthood “in all domains of academic achievement (spelling, reading comprehension, word identification, word attack, calculation)…”. They also point out that many of these children with language disorders were later classified with a learning disability because their “later learning difficulties [took on] the form of problems acquiring higher levels of spoken language comprehension and expression as well as reading and writing”.

The authors also explain the complex process of literacy acquisition as well as discuss the important concept of “illusory recovery“.  They note that there may be  “a time period when the students with early language disorders seem to catch up with their typically developing peers” by undergoing a “spurt” in language learning, which is followed by a “postspurt plateau” because due to their ongoing deficits and an increase in academic demands “many children with early language disorders fail to “outgrow” these difficulties or catch up with their typically developing peers”.

They pointed out that because many of these children “may not show academic or language-related learning difficulties until linguistic and cognitive demands of the task increase and exceed their limited abilities”, SLPs must consider the “underlying deficits that may be masked by early oral language development” and “evaluate a child’s language abilities in all modalities, including preliteracy, literacy, and metalinguistic skills”.

Finally, the authors reiterate that since language is embedded in all parts of the curriculum “intervention choices should be based on students’ ongoing language learning and literacy problems within curricular contexts, regardless of their diagnostic labels”. In other words, SLPs should actively use the students’ curriculum in the intervention process.

In their conclusion the authors summarize the key article points:

  • The diagnostic labels may change but the students linguistic needs stay the same. Thus clinicians need to a) “identify existing language/literacy needs that may have been unidentified previously” and b) provide “relevant and functional interventions that are curriculum-based and literacy-focused”
  • Early language disorders are chronic and tend to follow children through time, manifesting themselves differently based upon an individual’s inherent abilities”. Thus SLPs need to be keenly aware regarding the nature and timing of “illusory recoveries” NOT to be fooled by them.
  • “Definitions of literacy have broadened” so “intervention goals and targeted language learning strategies should change accordingly to guide effective and relevant intervention
  • Majority of learning disabilities are language disorders that have changed over time”.

I hope that you’ve found this article helpful in furthering your understanding of these highly relevant yet often misunderstood labels and that this knowledge will assist you to make better decisions when serving the clients on your caseload.

 References:

Sun, L & Wallach G (2014) Language Disorders Are Learning Disabilities: Challenges on the Divergent and Diverse Paths to Language Learning Disability. Topics in Language Disorders, Vol. 34; (1), pp 25–38.

Helpful Smart Speech Therapy Resources:

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Recommendations for Assessing Language Abilities of Verbal Children with Down Syndrome (DS)

Kid-1Assessment of children with DS syndrome is often complicated due to the wide spectrum of presenting deficits (e.g., significant health issues in conjunction with communication impairment, lack of expressive language, etc) making accurate assessment of their communication a difficult task. In order to provide these children with appropriate therapy services via the design of targeted goals and objectives, we need to create comprehensive assessment procedures that focus on highlighting their communicative strengths and not just their deficits.

Today I’d like to discuss assessment procedures for verbal monolingual and bilingual children with DS 4-9 years of age, since testing instruments as well as assessment procedures for younger as well as older verbal and nonverbal children with DS do differ.

When it comes to dual language use and genetic disorders and developmental disabilities many educational and health care professionals are still under the erroneous assumption that it is better to use one language (English) to communicate with these children at home and at school.  However, studies have shown that not only can children with DS become functionally bilingual they can even become functionally trilingual (Vallar & Papagno, 1993; Woll & Grove, 1996).  It is important to understand that “bilingualism does not change the general profile of language strengths and weaknesses characteristic of DS—most children with DS will have receptive vocabulary strengths and expressive language weaknesses, regardless of whether they are monolingual or bilingual.” (Kay-Raining Bird, 2009, p. 194)

Furthermore, advising a bilingual family to only speak English with a child will cause a number of negative linguistic and psychosocial implications, such as create social isolation from family members who may not speak English well as well as adversely affect parent-child relationships (Portes & Hao, 1998).

Consequently, when preparing to assess linguistic abilities of children with DS we need to first determine whether these children have single or dual language exposure and design assessment procedures accordingly.

Pre-assessment Considerations

It is very important to conduct a parental interview no matter the setting you are performing the assessment in. One of your goals during the interview will be to establish the functional goals the parents’ desire for the child which may not always coincide with the academic expectations of the program in question.

Begin with a detailed case history and review of current records and obtain information about the child’s prenatal, perinatal and postnatal development, medical history as well as the nature of previous assessments and provided related services. Next, obtain a detailed history of the child’s language use by inquiring what languages are spoken by household members and how much time do these people spend with the child?

Choosing Testing Instruments 

A balanced assessment will include a variety of methods, including observations of the child as well as direct interactions in the form of standardized, informal and dynamic assessments. If you will be using standardized assessments (e.g., ROWPVT-4) YOU MUST use descriptive measures vs. standardized scores to describe the child’s functioning. The latter is especially applicable to bilingual children with DS. Consider using the following disclaimer: “The following test/s __________were normed on typically developing English speaking children. Testing materials are not available in standardized form for child’s unique developmental and bilingual/bicultural backgrounds. In accordance with IDEA 2004 (The Individuals with Disabilities Education Act) [20 U.S.C.¤1414(3)],official use of standard scores for this child would be inaccurate and misleading so the results reported are presented in descriptive form.  Raw scores are provided here only for comparison with future performance.”

Selecting Standardized Assessments 

Depending on the child’s age and level of abilities a variety of assessment measures may be applicable to test the child in the areas of Content (vocabulary), Form (grammar/syntax), and Use(pragmatic language).

For children over 3 years of age whose linguistic abilities are just emerging you may wish to use a vocabulary inventory such as the MacArthur-Bates (also available in other languages) as well as provide parents with the Developmental Scale for Children with Down Syndrome to fill out. This will allow you to compare where child with DS features in their development as compared to typically developing peers. For older, more verbal children who are using words, phrases, and/or sentences to express themselves, you may want to use or adapt (see above) one of the following standardized language tests:

Informal Assessment Procedures 

Depending on your setting (hospital vs. school), you may not perform a detailed assessment of the child’s feeding and swallowing skills. However, it is still important to understand that due to low muscle tone, respiratory problems, gastrointestinal disorders and cardiac issues, children with DSoften present with feeding dysfunction which is further exacerbated by concomitant issues such as obesity, GERD, constipation, malnutrition (restricted food group intake lacking in vitamins and minerals), and fatigue. With respect to swallowing, they may experience abnormalities in both the oral and pharyngeal phases of swallow, as well as present with silent aspiration, due to which instrumental assessment (MBS) may be necessary (Frazer & Friedman, 2006).

In contrast to feeding and swallowing the oral-peripheral assessment can be performed in all settings. When performing oral-peripheral exam, you need to carefully describe all structural (anatomical) and functional (physiological) abnormalities (e.g., macroglossia, micrognathia, prognathism, etc).   Note any issues with:

  • —  Dentition (e.g., dental overcrowding, occlusion, etc)
  • —  Tongue/jaw disassociation  (ability to separate tongue from jaw when speaking)
  • —  Mouth Posture (open/closed) and tongue positioning  at rest (protruding/retracted)
  • —  Control of oral secretions
  • —  Lingual and buccal strength, movement (e.g., lingual protrusion, elevation, lateralization, and depression for volitional tasks) and control
  • —  Mandibular (jaw) strength, stability and grading

Take a careful look at the child’s speech. Perform dual speech sampling (if applicable) by considering the child’s phonetic inventory, syllable lengths and shapes as well as articulatory/phonological error patterns.  Make sure to factor in the combined effect of the child’s craniofacial anomalies as well as system wide impairment (disturbances in respiration, voice, articulation, resonance, fluency, and prosody) on conversational intelligibility. Impaired intelligibility is a serious concern for individuals with DS, as it tends to persist throughout life for many of them and significantly interferes with social and vocational pursuits (Kent & Vorperian, 2013)

Don’t forget to assess the child’s voice, fluency, prosody, and resonance. Children with DS may have difficulty maintaining constant airstream for vocal production due to which they may occasionally speak with low vocal volume and breathiness (caused by air loss due to vocal fold hypotonicity). This may be directly targeted in treatment sessions and taught how to compensate for.  When assessing resonance make sure to screen the child for hypernasality which may be due to velopharyngeal insufficiency secondary to hypotonicity as well as rule out hyponasality which may be due to enlarged adenoids (Kent & Vorperian, 2013). Furthermore, since stuttering and cluttering occur in children with DS at rates of 10 to 45%, compared to about 1% in the general population, a detailed analysis of disfluencies may be necessary(Kent & Vorperian, 2013). Finally, due to limitations with perception, imitation, and spontaneous production of prosodic features secondary to motor difficulties, motor coordination issues, and segmental errors that impede effective speech production across multisyllabic sequences, the prosody of individuals with DS will be impaired and might require a separate intervention. (Kent & Vorperian, 2013)

When it comes to auditory function, formal hearing testing and retesting is mandatory due to the fact that many children with DS have high prevalence of conductive and sensorineural hearing loss (Park et al, 2012). So if the child in question is not receiving regular follow-ups from the audiologist, it is very important to make the appropriate referral. Similarly, it is also very important that the child’s visual perception is assessed as well since children with DS frequently experience difficulties with vision acuity as well as visual processing, consequentially a consultation with developmental optometrist may be recommended/needed.

Describe in detail the child’s adaptive behavior and learning style, including their social strengths and weaknesses. Observe the child’s eye contact, affect, attention to task, level of distractibility, and socialization patterns. Document the number of redirections and negotiations the child needed to participate as well as types and level of reinforcement used during testing.

Perform dual language sampling and look at functional vocabulary knowledge and use, grammar measures, sentence length, as well as the child’s pragmatic functions (what is the child using his/her language for: request, reject, comment, etc.) Perform a dynamic assessment to determine the child’s learnability (e.g., how quickly does the child learns and adapts to being taught new concepts?) since “even a minimal mediation in the form of ‘focusing’ improves the receptive language performance of children with DS” (Alony & Kozulin, 2007, p 323)

After all the above sections are completed, it is time to move on to the impressions section of the report.  While it is important to document the weaknesses exposed by the assessment, it is even more important to document the child’s strengths or all the things the child did well, since this will help you to determine the starting treatment point and allow you to formulate relevant treatment goals.

When making recommendations for treatment, especially for bilingual children with DS, make sure to provide a strong rationale for the provision of services in both languages (if applicable) as well as specify the importance of continued support of the first language in the home.

Finally, make sure to provide targeted and measurable [suggested] treatment goals by breaking the targets into measurable parts:

Given ___time period (1 year, 1 progress reporting period, etc), the student will be able to (insert specific goal) with ___accuracy/trials, given ___ level of, given _____type of prompts.

Assessing communication abilities of children with developmental disabilities may not be easy; however, having the appropriate preparation and training will ensure that you will be well prepared to do the job right!  Use multiple tasks and activities to create a balanced assessment, use descriptive measures instead of standard scores to report findings, and most importantly make your assessment functional by making sure that your testing yields relevant diagnostic information which could then be effectively used to provide effective quality treatments for clients with DS!

For comprehensive information on “Comprehensive Assessment of Monolingual and Bilingual Children with Down Syndrome” which discusses how to assess young (birth-early elementary age) verbal and nonverbal monolingual and bilingual children with Down Syndrome (DS) and offers comprehensive examples of write-ups based on real-life clients click HERE.

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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