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Creating A Learning Rich Environment for Language Delayed Preschoolers

Today I’m excited to introduce a new product: “Creating A Learning Rich Environment for Language Delayed Preschoolers“.  —This 40 page presentation provides suggestions to parents regarding how to facilitate further language development in language delayed/impaired preschoolers at home in conjunction with existing outpatient, school, or private practice based speech language services. It details implementation strategies as well as lists useful materials, books, and websites of interest.

It is intended to be of interest to both parents and speech language professionals (especially clinical fellows and graduates speech pathology students or any other SLPs switching populations) and not just during the summer months. SLPs can provide it to the parents of their cleints instead of creating their own materials. This will not only save a significant amount of time but also provide a concrete step-by-step outline which explains to the parents how to engage children in particular activities from bedtime book reading to story formulation with magnetic puzzles.

Product Content:

  • The importance of daily routines
  • The importance of following the child’s lead
  • Strategies for expanding the child’s language
    • —Self-Talk
    • —Parallel Talk
    • —Expansions
    • —Extensions
    • —Questioning
    • —Use of Praise
  • A Word About Rewards
  • How to Begin
  • How to Arrange the environment
  • Who is directing the show?
  • Strategies for facilitating attention
  • Providing Reinforcement
  • Core vocabulary for listening and expression
  • A word on teaching vocabulary order
  • Teaching Basic Concepts
  • Let’s Sing and Dance
  • Popular toys for young language impaired preschoolers (3-4 years old)
  • Playsets
  • The Versatility of Bingo (older preschoolers)
  • Books, Books, Books
  • Book reading can be an art form
  • Using Specific Story Prompts
  • Focus on Story Characters and Setting
  • Story Sequencing
  • More Complex Book Interactions
  • Teaching vocabulary of feelings and emotions
  • Select favorite authors perfect for Pre-K
  • Finding Intervention Materials Online The Easy Way
  • Free Arts and Crafts Activities Anyone?
  • Helpful Resources

Are you a caregiver, an SLP or a related professional? DOES THIS SOUND LIKE SOMETHING YOU CAN USE? if so you can find it HERE in my online store.

Useful Smart Speech Therapy Resources:

References:
Heath, S. B (1982) What no bedtime story means: Narrative skills at home and school. Language in Society, vol. 11 pp. 49-76.

Useful Websites:
http://www.beyondplay.com
http://www.superdairyboy.com/Toys/magnetic_playsets.html
http://www.educationaltoysplanet.com/
http://www.melissaanddoug.com/shop.phtml
http://www.dltk-cards.com/bingo/
http://bogglesworldesl.com/
http://www.childrensbooksforever.com/index.html

 

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Have you Worked on Morphological Awareness Lately?

Last year an esteemed colleague, Dr. Roseberry-McKibbin posed this question in our Bilingual SLPs Facebook Group:  “Is anyone working on morphological awareness in therapy with ELLs (English Language Learners) with language disorders?”

Her question got me thinking: “How much time do I spend on treating morphological awareness in therapy with monolingual and bilingual language disordered clients?” The answer did not make me happy!

So what is morphological awareness and why is it important to address when treating monolingual and bilingual  language impaired students?

Morphemes are the smallest units of language that carry meaning. They can be free (stand alone words such as ‘fair’, ‘toy’, or ‘pretty’) or bound (containing prefixes and suffixes that change word meanings – ‘unfair’ or ‘prettier’).

Morphological awareness refers to a ‘‘conscious awareness of the morphemic structure of words and the ability to reflect on and manipulate that structure’’ (Carlisle, 1995, p. 194). Also referred to as “the study of word structure” (Carlisle, 2004), it is an ability to recognize, understand, and use affixes or word parts (prefixes, suffixes, etc) that “carry significance” when speaking as well as during reading tasks. It is a hugely important skill for building vocabulary, reading fluency and comprehension as well as spelling (Apel & Lawrence, 2011; Carlisle, 2000; Binder & Borecki, 2007; Green, 2009). 

So why is teaching morphological awareness important? Let’s take a look at some research.

Goodwin and Ahn (2010) found morphological awareness instruction to be particularly effective for children with speech, language, and/or literacy deficits. After reviewing 22 studies Bowers et al. (2010) found the most lasting effect of morphological instruction was on readers in early elementary school who struggled with literacy.

Morphological awareness instruction mediates and facilitates vocabulary acquisition leading to improved reading comprehension abilities (Bowers & Kirby, 2010; Carlisle, 2003, 2010; Guo, Roehrig, & Williams, 2011; Tong, Deacon, Kirby, Cain, & Parilla, 2011).

Unfortunately as important morphological instruction is for vocabulary building, reading fluency, reading comprehension, and spelling, it is often overlooked during the school years until it’s way too late. For example, traditionally morphological instruction only beings in late middle school or high school but research actually found that in order to be effective one should actually begin teaching it as early as first grade (Apel & Lawrence, 2011).

So now that we know that we need to target morphological instruction very early in children with language deficits, let’s talk a little bit regarding how morphological awareness can be assessed in language impaired learners.

When it comes to standardized testing, both the Test of Language Development: Intermediate – Fourth Edition (TOLD-I:4) and the Test of Adolescent and Adult Language–Fourth Edition (TOAL-4) have subtests which assess morphology as well as word derivations. However if you do not own either of these tests you can easily create non-standardized tasks to assess  morphological awareness.

Apel, Diehm, & Apel (2013) recommend multiple measures which include:  phonological awareness tasks, word level reading tasks, as well as reading comprehension tasks.

Below are direct examples of tasks from their study:

MATs

One can test morphological awareness via production or decomposition tasks. In a production task a student is asked to supply a missing word, given the root morpheme (e.g., ‘‘Sing. He is a great _____.’’ Correct response: singer).  A decomposition task asks the student to identify the correct root of a given derivation or inflection. (e.g., ‘‘Walker. How slow can she _____?’’ Correct response: walk).

Another way to test morphological awareness is through completing analogy tasks since it involves both  decomposition and production components (provide a missing word based on the presented pattern—crawl: crawled:: fly: ______ (flew).

Still another way to test morphological awareness with older students is through deconstruction tasks: Tell me what ____ word means? How do you know? (The student must explain the meaning of individual morphemes).

Finding the affix: Does the word ______ have smaller parts?

So what are the components of effective morphological instruction you might ask?

Below is an example of a ‘Morphological Awareness Intervention With Kindergarteners and First and Second Grade Students From Low SES Homes’ performed by Apel & Diehm, 2013:

Apel and Diem 2011

Here are more ways in which this can be accomplished with older children:

  • Find the root word in a longer word
  • Fix the affix (an additional element placed at the beginning or end of a root, stem, or word, or in the body of a word, to modify its meaning)
    • Affixes at the beginning of words are called “prefixes”
    • Affixes at the end of words are called “suffixes
  • Word sorts to recognize word families based on morphology or orthography
  • Explicit instruction of syllable types to recognize orthographical patterns
  • Word manipulation through blending and segmenting morphemes to further solidify patterns

Now that you know about the importance of morphological awareness, will you be incorporating it into your speech language sessions? I’d love to know!

Until then, Happy Speeching!

References:

  • Apel, K., & Diehm, E. (2013). Morphological awareness intervention with kindergarteners and first and second grade students from low SES homes: A small efficacy study. Journal of Learning Disabilities.
  • Apel, K., & Lawrence, J. (2011). Contributions of morphological awareness skills to word-level reading and spelling in first-grade children with and without speech sound disorder. Journal of Speech, Language & Hearing Research, 54, 1312–1327.
  • Apel, K., Brimo, D., Diehm, E., & Apel, L. (2013). Morphological awareness intervention with kindergarteners and first and second grade students from low SES homes: A feasibility study. Language, Speech, and Hearing Services in Schools, 44, 161-173.
  • Binder, K. & Borecki, C. (2007). The use of phonological, orthographic, and contextualinformation during reading: a comparison of adults who are learning to read and skilled adult readers. Reading and Writing, 21, 843-858.
  • Bowers, P.N., Kirby, J.R., Deacon, H.S. (2010). The effects of morphological instruction on literacy skills: A systematic review of the literature. Review of Educational Research, 80, 144-179.
  • Carlisle, J. F. (1995). Morphological awareness and early reading achievement. In L. B. Feldman (Ed.), Morphological aspects of language processing (pp. 189–209). Hillsdale, NJ: Erlbaum.
  • Carlisle, J. F. (2000). Awareness of the structure and meaning of morphologically complex words: Impact on reading. Reading and Writing: An Interdisciplinary Journal,12,169-190.
  • Carlisle, J. F. (2004). Morphological processes that influence learning to read. In C. A. Stone, E. R. Silliman, B. J. Ehren, & K. Apel (Eds.), Handbook of language and literacy. NY: Guilford Press.
  • Carlisle, J. F. (2010). An integrative review of the effects of instruction in morphological awareness on literacy achievement. Reading Research Quarterly, 45(4), 464-487.
  • Goodwin, A.P. & Ahn, S. (2010). Annals of Dyslexia, 60, 183-208.
  • Green, L. (2009). Morphology and literacy: Getting our heads in the game. Language, Speech, and Hearing Services in the schools, 40, 283-285.
  • Green, L., & Wolter, J.A. (2011, November). Morphological Awareness Intervention: Techniques for Promoting Language and Literacy Success. A symposium presentation at the annual American Speech Language Hearing Association, San Diego, CA.
  • Guo, Y., Roehrig, A. D., & Williams, R. S. (2011). The relation of morphological awareness and syntactic awareness to adults’ reading comprehension: Is vocabulary knowledge a mediating variable? Journal of Literacy Research, 43, 159-183.
  • Tong, X., Deacon, S. H., Kirby, J. R., Cain, K., & Parrila, R. (2011). Morphological awareness: A key to understanding poor reading comprehension in English. Journal of Educational Psychology103 (3), 523-534.
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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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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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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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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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Who Doesn’t Like Keiko Kasza? A Book Companion Review and Double Giveaway

badger cover

Those of you who follow me, know that I LOVE book companions.  I think that they are a great way of supplementing children’s literature in a meaningful and enriching ways. I also love certain children’s authors and Keiko Kasza just happens to be on the top of that list.

Her books just have so much to offer! Bright engaging illustrations, sophisticated vocabulary words, lots of humor and irony, you name it. That is why I was so excited to do a material swap with Kathy Grover from Speech All the Time. Kathy is currently reviewing my Language Difference vs. language Disorder” packet on assessment and treatment of bilingual and multicultural children, and I am reviewing her “Badger’s Fancy Meal” by Keiko Kasza book companion packet.

Let me start off by noting that the packet contains complete lesson plans and activities for 4 sessions. This is very detailed for a companion packet since most of them are not designed to be that comprehensive. It’s also a feature which definitely makes Kathy’s companion packet stand out from the crowd.

The beauty of the packet is that you can use the lessons as is, especially if you are a grad student or a CFY who is just starting out in our profession and needs a bit more structure and guidance.

You could also make the lessons shorter to suit the needs of your students. Whichever way you decide to go Kathy does recommend that the activities be presented in order since they build upon each other.

Now lets proceed to the packet contents:

Activities include:

  • Animal Facts
  • Vocabulary Words
  • Context Clues
  • Craft Activity
  • Game with Game Cards focused on answering “wh” questions related specifically to the story (awesome thematic activity)
  • Sequencing Activity

Using the above material you can use the packet in innumerable ways!

You can teach new information, predicting and inferencing skills, new vocabulary, synonyms, antonyms, multiple meaning words and idioms. You can build oral narratives and story retelling skills.

If you are working with a group of students you can put up a play in which kids play different story characters and have to act out the book. And of course you can always use the game to focus on comprehension of -wh questions to reinforce vocabulary and story knowledge.

This great companion has so much to offer and you can find it for a mere $4.75 in Kathy’s TPT Store.

As I mentioned previously Kathy is currently reviewing my Language Difference vs. language Disorder packet on her Blog.

So we decided to do a Raflecopter giveaway of these products on our respective blogs! She’ll be giving away her  Badger’s Fancy Meal packet on her Blog. while I’ll be giving away my  Language Difference vs. language Disorder packet  on mine.

SO DON’T FORGET TO ENTER BOTH GIVEAWAYS TO MAXIMIZE YOUR CHANCES TO WIN BOTH Prizes!
a Rafflecopter giveaway

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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?

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It’s all about RtI!

Today I am excited to review one of the latest products from Busy Bee Speech “Common Core Standards-Based RtI Packet for Language“.

So what is RtI or Response to Intervention?

Developed as an alternative to the ability–achievement “discrepancy model,” which requires children to show a discrepancy between their IQ and standardized tests/grades, RtI is a method of academic intervention aimed to provide early, systematic assistance to children who are having difficulty learning in order to prevent academic failure via the provision of early school based intervention, frequent progress measurement, and increasingly intensive research-based instructional interventions for children who continue to have difficulty learning.

In contrast to a number of schools in my state (New Jersey), RTI or Response to Intervention is currently not utilized in my unique setting (outpatient specialized school in a psychiatric hospital). Continue reading It’s all about RtI!

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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: