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Back to School SLP Efficiency Bundles™

September is practically here and many speech language pathologists (SLPs) are looking to efficiently prepare for assessing and treating a variety of clients on their caseloads.

With that in mind, a few years ago I created SLP Efficiency Bundles™, which are materials highly useful for SLPs working with pediatric clients. These materials are organized by areas of focus for efficient and effective screening, assessment, and treatment of speech and language disorders.

A.  General Assessment and Treatment Start-Up Bundle contains 5 downloads for general speech language assessment and treatment planning and includes:

  1. Speech Language Assessment Checklist for a Preschool Child
  2. Speech Language Assessment Checklist for a School-Aged Child
  3. Creating a Functional Therapy Plan: Therapy Goals & SOAP Note Documentation
  4. Selecting Clinical Materials for Pediatric Therapy
  5. Types and Levels of Cues and Prompts in  Speech Language Therapy

B. The Checklists Bundle contains 7 checklists relevant to screening and assessment in speech language pathology

  1. Speech Language Assessment Checklist for a Preschool Child 3:00-6:11 years of age
  2. Speech Language Assessment Checklist for a School-Aged Child 7:00-11:11 years of age
  3. Speech Language Assessment Checklist for Adolescents 12-18 years of age
  4. Language Processing Deficits (LPD) Checklist for School Aged Children 7:00-11:11 years of age
  5. Language Processing Deficits (LPD) Checklist for Preschool Children 3:00-6:11 years of age
  6. Social Pragmatic Deficits Checklist for School Aged Children 7:00-11:11 years of age
  7. Social Pragmatic Deficits Checklist for Preschool Children 3:00-6:11 years of age

C. Social Pragmatic Assessment and Treatment Bundle  contains 6 downloads for social pragmatic assessment and treatment planning (from 18 months through school age) and includes:

  1. Recognizing the Warning Signs of Social Emotional Difficulties in Language Impaired Toddlers and Preschoolers
  2. Behavior Management Strategies for Speech Language Pathologists
  3. Social Pragmatic Deficits Checklist for School Aged Children
  4. Social Pragmatic Deficits Checklist for Preschool Children
  5. Assessing Social Pragmatic Skills of School Aged Children
  6. Treatment of Social Pragmatic Deficits in School Aged Children

D. Multicultural Assessment and Treatment Bundle contains 2 downloads relevant to assessment and treatment of bilingual/multicultural children

  1. Language Difference vs. Language Disorder:  Assessment  & Intervention Strategies for SLPs Working with Bilingual Children
  2. Impact of Cultural and Linguistic Variables On Speech-Language Services

E. Narrative Assessment Bundle contains 3 downloads relevant to narrative assessment

  1. Narrative Assessments of Preschool and School Aged Children
  2. Understanding Complex Sentences
  3. Vocabulary Development: Working with Disadvantaged Populations

F. Fetal Alcohol Spectrum Disorders Assessment and Treatment Bundle contains 3 downloads relevant to FASD assessment  and treatment

  1. Orofacial Observations of At-Risk Children
  2. Fetal Alcohol Spectrum Disorder: An Overview of Deficits
  3. Speech Language Assessment and Treatment of Children With Alcohol Related Disorders

G. Psychiatric Disorders Bundle contains 7 downloads relevant to language  assessment  and treatment in psychiatrically impaired children

  1. Recognizing the Warning Signs of Social Emotional Difficulties in Language Impaired Toddlers and Preschoolers
  2. Social Pragmatic Deficits Checklist for School Aged Children
  3. Social Pragmatic Deficits Checklist for Preschool Children
  4. Assessing Social Skills in Children with Psychiatric Disturbances
  5. Improving Social Skills of Children with Psychiatric Disturbances
  6. Behavior Management Strategies for Speech Language Pathologists
  7. Differential Diagnosis Of ADHD In Speech Language Pathology

You can find these bundles on SALE in my online store by clicking on the individual bundle links above. You can also purchase these products individually in my online store by clicking HERE.

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Adolescent Assessments in Action: Informal Reading Evaluation

Image result for adolescentsIn the past several years, due to an influx of adolescent students with language and learning difficulties on my caseload, I have begun to research in depth aspects of adolescent language development, assessment, and intervention.

While a number of standardized assessments are available to test various components of adolescent language from syntax and semantics to problem-solving and social communication, etc. in my experience with this age group, frequently, the informal assessments (vs. the standardized tests)which do a far better job of teasing out language difficulties in adolescents.

Today I wanted to write about the importance of performing an informal reading assessment as part of select* adolescent language and literacy evaluations.

There are a number of standardized tests on the market, which presently assess reading. However, not all of them by far are as functional as many clinicians would like them to be. To illustrate, one popular reading assessment is the Gray Oral Reading Tests-5 (GORT-5).  It assesses the student’s rate, accuracy, fluency, and comprehension abilities. While it’s a useful test to possess in one’s assessment toolbox, it is not without its limitations. In my experience assessing adolescent students with literacy deficits, many can pass this test with average scores, yet still present with pervasive reading comprehension difficulties in the school setting. As such, as part of the assessment process, I like to administer informal reading assessments to students who pass the standardized reading tests (e.g., GORT-5),  in order to ensure that the student does not possess any reading deficits at the grade  text level.

So how do I informally assess reading abilities of struggling adolescent learners?

First, I select one-page long grade level/below grade level text. I ask the student in question to read that text, and time the first minute of their reading in order to analyze the oral reading fluency or words correctly read per minute (wcpm).

Content Reading: ScienceFor this purpose, I often use the books from the Continental Press series entitled: Reading Comprehension for Social Studies & Science.   Texts for grades 5 – 7 of the series are perfect for assessment of struggling adolescent readers. In some cases using a below grade level text allows me to starkly illustrate the extent of the student’s reading difficulties. Below is an example of one of such informal rading assessments in action.

INFORMAL READING ASSESSMENT: 8th Grade Male   

Content Reading: Social ScienceAn informal reading assessment was administered to TS, a 15-5-year-old male, on a supplementary basis in order to further analyze his reading abilities. Given the fact that TS was reported to present with grade-level reading difficulties, the examiner gave TS a 7th-grade text by Continental Press. TS was asked to read aloud the 7 paragraph long text, and then answer factual and inferential questions, summarize the presented information, define select context embedded vocabulary words as well as draw conclusions based on the presented text. (Please note that in order to protect the client’s privacy some portions of the below assessment questions and responses were changed to be deliberately vague).

Image result for reading fluency componentsReading Fluency: TS’s reading fluency (automaticity, prosody, accuracy and speed, expression, intonation, and phrasing) during the reading task was marked by monotone vocal quality, awkward word stress, imprecise articulatory contacts, false-starts, self–revisions, awkward mid-sentential pauses, limited pausing for punctuation, as well as  misreadings and word substitutions, all of which resulted in an impaired reading prosody.

With respect to specific errors, TS was observed to occasionally add word fillers to text (e.g., and, a, etc.), change morphological endings of select words (e.g., read /elasticity/ as /elastic/, etc.) as well as substitute similar looking words (e.g., from/for; those/these, etc.) during reading.  He occasionally placed stress on the first vs. second syllable in disyllabic words, which resulted in distorted word productions (e.g., products, residual, upward, etc.), as well as inserted extra words into text (e.g., read: “until pressure inside the earth starts to build again” as “until pressure inside the earth starts to build up again”). He also began reading a number of his sentences with false starts (e.g., started reading the word “drinking” as ‘drunk’, etc.) and as a result was observed to make a number of self-corrections during reading.

During reading TS demonstrated adequate tracking movements for text scanning as well as use of context to aid his decoding.  For example, TS was observed to read the phonetic spelling of select unfamiliar words in parenthesis (e.g., equilibrium) and then read them correctly in subsequent sentences. However, he exhibited limited use of metalinguistic strategies and did not always self-correct misread words; dispute the fact that they did not always make sense in the context of the read sentences.

TS’s oral reading rate during today’s reading was judged to be reduced for his age/grade levels. An average 8th grader is expected to have an oral reading rate between 145 and 160 words per minute. In contrast, TS was only able to read 114 words per minute. However, it is important to note that recent research on reading fluency has indicated that as early as by 4th grade reading faster than 90 wcpm will not generate increases in comprehension for struggling readers.  Consequently, TS’s current reading rate of off 114 words per minute was judged to be adequate for reading purposes. Furthermore, given the fact that TS’s reading comprehension is already compromised at this rate (see below for further details) rather than making a recommendation to increase his reading rate further, it is instead recommended that intervention focuses on slowing TS’s rate via relevant strategies as well as improving his reading comprehension abilities. Strategies should focus on increasing his opportunities to learn domain knowledge via use of informational texts; purposeful selection of texts to promote knowledge acquisition and gain of expertise in different domains; teaching morphemic as well as semantic feature analyses (to expand upon already robust vocabulary), increasing discourse and critical thinking with respect to informational text, as well as use of graphic organizers to teach text structure and conceptual frameworks.

Verbal Text Summary: TS’s text summary following his reading was very abbreviated, simplified, and confusing. When asked: “What was this text about?” Rather than stating the main idea, TS nonspecifically provided several vague details and was unable to elaborate further. When asked: “Do you think you can summarize this story for me from beginning to the end?” TS produced the two disjointed statements, which did not adequately address the presented question When asked: What is the main idea of this text.” TS vaguely responded: “Science,” which was the broad topic rather than the main idea of the story.

Image result for vocabularyText Vocabulary Comprehension:

After that, TS was asked a number of questions regarding story vocabulary.  The first word presented to him was “equilibrium”.  When asked: “What does ‘equilibrium’ mean?” TS first incorrectly responded: “temperature”. Then when prompted: “Anything else?” TS correctly replied: “balance.” He was then asked to provide some examples of how nature leans towards equilibrium from the story. TS nonspecifically produced: “Ah, gravity.” When asked to explain how gravity contributes to the process of equilibrium TS again nonspecifically replied: “gravity is part of the planet”, and could not elaborate further. TS was then asked to define another word from the text provided to him in a sentence: “Scientists believe that this is residual heat remaining from the beginnings of the solar system.” What is the meaning of the word: “residual?” TS correctly identified: “remaining.” Then the examiner asked him to define the term found in the last paragraph of the text: “What is thermal equilibrium?” TS nonspecifically responded: “a balance of temperature”, and was unable to elaborate further.

Image result for reading comprehensionReading Comprehension (with/out text access):

TS was also asked to respond to a number of factual text questions without the benefit of visual support. However, he presented with significant difficulty recalling text details. TS was asked: When asked, “Why did this story mention ____? What did they have to do with ____?” TS responded nonspecifically, “______.” When prompted to tell more, TS produced a rambling response which did not adequately address the presented question. When asked: “Why did the text talk about bungee jumpers? How are they connected to it?” TS stated, “I am ah, not sure really.” 

Finally, TS was provided with a brief worksheet which accompanied the text and asked to complete it given the benefit of written support. While TS’s performance on this task was better, he still achieved only 66% accuracy and was only able to answer 4 out of 6 questions correctly. On this task, TS presented with difficulty identifying the main idea of the third paragraph, even after being provided with multiple choice answers. He also presented with difficulty correctly responding to the question pertaining to the meaning of the last paragraph.

Image result for impressionsImpressions: Informal below grade-level reading comprehension assessment reading revealed that TS presents with a number of reading related difficulties.   TS’s reading fluency was marked by monotone vocal quality, awkward word stress, imprecise articulatory contacts, false-starts, self–revisions, awkward mid-sentential pauses, limited pausing for punctuation, as well as misreadings and word substitutions, all of which resulted in an impaired reading prosody. TS’s understanding as well as his verbal summary of the presented text was immature for his age and was characterized by impaired gestalt processing of information resulting in an ineffective and confusing summarization.  While TS’s text-based vocabulary knowledge was deemed to be grossly adequate for his age, his reading comprehension abilities were judged to be impaired for his age. Therapeutic intervention is strongly recommended to improve TS’s reading abilities. (See Impressions and Recommendations sections for further details).

There you have it! This is just one of many different types of informal reading assessments, which I occasionally conduct with adolescents who attain average scores on reading fluency and reading comprehension tests such as the GORT-5 or the Test of Reading Comprehension -4 (TORC-4), but still present with pervasive reading difficulties working with grade level text.

You can find more information on the topic of adolescent assessments (including other comprehensive informal write-up examples) in this recently developed product entitled: Assessment of Adolescents with Language and Literacy Impairments in Speech Language Pathology currently available in my online store.

What about you? What type of informal tasks and materials are you using to assess your adolescent students’ reading abilities and why do you like using them?

Helpful Smart Speech Therapy Adolescent Assessment Resources:

 

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The Importance of Narrative Assessments in Speech Language Pathology (Revised)

Image result for narrativeA few years ago I wrote a guest post on the importance of assessing narratives for another blog. Below is a revised version of that post containing the updates with respect to the assessment of narratives.

As SLPs we routinely administer a variety of testing batteries in order to assess our students’ speech-language abilities. Grammar, syntax, vocabulary, and sentence formulation get frequent and thorough attention. But how about narrative production? Does it get its fair share of attention when the clinicians are looking to determine the extent of the child’s language deficits? I was so curious about what the clinicians across the country were doing that in 2013, I created a survey and posted a link to it in several SLP-related FB groups.  I wanted to find out how many SLPs were performing narrative assessments, in which settings, and with which populations.  From those who were performing these assessments, I wanted to know what type of assessments were they using and how they were recording and documenting their findings.   Since the purpose of this survey was non-research based (I wasn’t planning on submitting a research manuscript with my findings), I only analyzed the first 100 responses (the rest were very similar in nature) which came my way, in order to get the general flavor of current trends among clinicians, when it came to narrative assessments. Here’s a brief overview of my [limited] findings. Continue reading The Importance of Narrative Assessments in Speech Language Pathology (Revised)

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Improving Executive Function Skills of Language Impaired Students with Hedbanz

Image result for hedbanzThose of you who have previously read my blog know that I rarely use children’s games to address language goals.  However, over the summer I have been working on improving executive function abilities (EFs) of some of the language impaired students on my caseload. As such, I found select children’s games to be highly beneficial for improving language-based executive function abilities.

For those of you who are only vaguely familiar with this concept, executive functions are higher level cognitive processes involved in the inhibition of thought, action, and emotion, which located in the prefrontal cortex of the frontal lobe of the brain. The development of executive functions begins in early infancy; but it can be easily disrupted by a number of adverse environmental and organic experiences (e.g., psychosocial deprivation, trauma).  Furthermore, research in this area indicates that the children with language impairments present with executive function weaknesses which require remediation.

Image result for executive functions brain

EF components include working memory, inhibitory control, planning, and set-shifting.

  • Working memory
    • Ability to store and manipulate information in mind over brief periods of time
  • Inhibitory control
    • Suppressing responses that are not relevant to the task
  • Set-shifting
    • Ability to shift behavior in response to changes in tasks or environment

Simply put, EFs contribute to the child’s ability to sustain attention, ignore distractions, and succeed in academic settings. By now some of you must be wondering: “So what does Hedbanz have to do with any of it?”

Well, Hedbanz is a quick-paced multiplayer  (2-6 people) game of “What Am I?” for children ages 7 and up.  Players get 3 chips and wear a “picture card” in their headband. They need to ask questions in rapid succession to figure out what they are. “Am I fruit?” “Am I a dessert?” “Am I sports equipment?” When they figure it out, they get rid of a chip. The first player to get rid of all three chips wins.

The game sounds deceptively simple. Yet if any SLPs or parents have ever played that game with their language impaired students/children as they would be quick to note how extraordinarily difficult it is for the children to figure out what their card is. Interestingly, in my clinical experience, I’ve noticed that it’s not just moderately language impaired children who present with difficulty playing this game. Even my bright, average intelligence teens, who have passed vocabulary and semantic flexibility testing (such as the WORD Test 2-Adolescent or the  Vocabulary Awareness subtest of the Test of Integrated Language and Literacy ) significantly struggle with their language organization when playing this game.

So what makes Hedbanz so challenging for language impaired students? Primarily, it’s the involvement and coordination of the multiple executive functions during the game. In order to play Hedbanz effectively and effortlessly, the following EF involvement is needed:

  • Task Initiation
    • Students with executive function impairments will often “freeze up” and as a result may have difficulty initiating the asking of questions in the game because many will not know what kind of questions to ask, even after extensive explanations and elaborations by the therapist.
  • Organization
    • Students with executive function impairments will present with difficulty organizing their questions by meaningful categories and as a result will frequently lose their track of thought in the game.
  • Working Memory
    • This executive function requires the student to keep key information in mind as well as keep track of whatever questions they have already asked.
  • Flexible Thinking
    • This executive function requires the student to consider a situation from multiple angles in order to figure out the quickest and most effective way of arriving at a solution. During the game, students may present with difficulty flexibly generating enough organizational categories in order to be effective participants.
  • Impulse Control
    • Many students with difficulties in this area may blurt out an inappropriate category or in an appropriate question without thinking it through first.
      • They may also present with difficulty set-shifting. To illustrate, one of my 13-year-old students with ASD, kept repeating the same question when it was his turn, despite the fact that he was informed by myself as well as other players of the answer previously.
  • Emotional Control
    • This executive function will help students with keeping their emotions in check when the game becomes too frustrating. Many students of difficulties in this area will begin reacting behaviorally when things don’t go their way and they are unable to figure out what their card is quickly enough. As a result, they may have difficulty mentally regrouping and reorganizing their questions when something goes wrong in the game.
  • Self-Monitoring
    • This executive function allows the students to figure out how well or how poorly they are doing in the game. Students with poor insight into own abilities may present with difficulty understanding that they are doing poorly and may require explicit instruction in order to change their question types.
  • Planning and Prioritizing
    • Students with poor abilities in this area will present with difficulty prioritizing their questions during the game.

Image result for executive functionsConsequently, all of the above executive functions can be addressed via language-based goals.  However, before I cover that, I’d like to review some of my session procedures first.

Typically, long before game initiation, I use the cards from the game to prep the students by teaching them how to categorize and classify presented information so they effectively and efficiently play the game.

Rather than using the “tip cards”, I explain to the students how to categorize information effectively.

This, in turn, becomes a great opportunity for teaching students relevant vocabulary words, which can be extended far beyond playing the game.

I begin the session by explaining to the students that pretty much everything can be roughly divided into two categories animate (living) or inanimate (nonliving) things. I explain that humans, animals, as well as plants belong to the category of living things, while everything else belongs to the category of inanimate objects. I further divide the category of inanimate things into naturally existing and man-made items. I explain to the students that the naturally existing category includes bodies of water, landmarks, as well as things in space (moon, stars, sky, sun, etc.). In contrast, things constructed in factories or made by people would be example of man-made objects (e.g., building, aircraft, etc.)

When I’m confident that the students understand my general explanations, we move on to discuss further refinement of these broad categories. If a student determines that their card belongs to the category of living things, we discuss how from there the student can further determine whether they are an animal, a plant, or a human. If a student determined that their card belongs to the animal category, we discuss how we can narrow down the options of figuring out what animal is depicted on their card by asking questions regarding their habitat (“Am I a jungle animal?”), and classification (“Am I a reptile?”). From there, discussion of attributes prominently comes into play. We discuss shapes, sizes, colors, accessories, etc., until the student is able to confidently figure out which animal is depicted on their card.

In contrast, if the student’s card belongs to the inanimate category of man-made objects, we further subcategorize the information by the object’s location (“Am I found outside or inside?”; “Am I found in ___ room of the house?”, etc.), utility (“Can I be used for ___?”), as well as attributes (e.g., size, shape, color, etc.)

Thus, in addition to improving the students’ semantic flexibility skills (production of definitions, synonyms, attributes, etc.) the game teaches the students to organize and compartmentalize information in order to effectively and efficiently arrive at a conclusion in the most time expedient fashion.

Now, we are ready to discuss what type of EF language-based goals, SLPs can target by simply playing this game.

1. Initiation: Student will initiate questioning during an activity in __ number of instances per 30-minute session given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

2. Planning: Given a specific routine, student will verbally state the order of steps needed to complete it with __% accuracy given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

3. Working Memory: Student will repeat clinician provided verbal instructions pertaining to the presented activity, prior to its initiation, with 80% accuracy  given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

4. Flexible Thinking: Following a training by the clinician, student will generate at least __ questions needed for task completion (e.g., winning the game) with __% accuracy given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

5. Organization: Student will use predetermined written/visual cues during an activity to assist self with organization of information (e.g., questions to ask) with __% accuracy given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

6. Impulse Control: During the presented activity the student will curb blurting out inappropriate responses (by silently counting to 3 prior to providing his response) in __ number of instances per 30 minute session given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

7. Emotional Control: When upset, student will verbalize his/her frustration (vs. behavioral activing out) in __ number of instances per 30 minute session given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

8. Self-Monitoring:  Following the completion of an activity (e.g., game) student will provide insight into own strengths and weaknesses during the activity (recap) by verbally naming the instances in which s/he did well, and instances in which s/he struggled with __% accuracy given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

There you have it. This one simple game doesn’t just target a plethora of typical expressive language goals. It can effectively target and improve language-based executive function goals as well. Considering the fact that it sells for approximately $12 on Amazon.com, that’s a pretty useful therapy material to have in one’s clinical tool repertoire. For fancier versions, clinicians can use “Jeepers Peepers” photo card sets sold by Super Duper Inc. Strapped for cash, due to highly limited budget? You can find plenty of free materials online if you simply input “Hedbanz cards” in your search query on Google. So have a little fun in therapy, while your students learn something valuable in the process and play Hedbanz today!

Related Smart Speech Therapy Resources:

 

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Treatment of Children with “APD”: What SLPs Need to Know

Free stock photo of people, woman, cute, playingIn recent years there has been an increase in research on the subject of diagnosis and treatment of Auditory Processing Disorders (APD), formerly known as Central Auditory Processing Disorders or CAPD.

More and more studies in the fields of audiology and speech-language pathology began confirming the lack of validity of APD as a standalone (or useful) diagnosis. To illustrate, in June 2015, the American Journal of Audiology published an article by David DeBonis entitled: “It Is Time to Rethink Central Auditory Processing Disorder Protocols for School-Aged Children.” In this article, DeBonis pointed out numerous inconsistencies involved in APD testing and concluded that “routine use of APD test protocols cannot be supported” and that [APD] “intervention needs to be contextualized and functional” (DeBonis, 2015, p. 124)

Image result for time to rethink quotesFurthermore, in April 2017, an article entitled: “AAA (2010) CAPD clinical practice guidelines: need for an update” (also written by DeBonnis) concluded that the “AAA CAPD guidance document will need to be updated and re-conceptualised in order to provide meaningful guidance for clinicians” due to the fact that the “AAA document … does not reflect the current literature, fails to help clinicians understand for whom auditory processing testing and intervention would be most useful, includes contradictory suggestions which reduce clarity and appears to avoid conclusions that might cast the CAPD construct in a negative light. It also does not include input from diverse affected groups. All of these reduce the document’s credibility.” 

Image result for systematic reviewIn April 2016, de Wit and colleagues published a systematic review in the Journal of Speech, Language, and Hearing ResearchThey reviewed research studies which described the characteristics of APD in children to determine whether these characteristics merited a label of a distinct clinical disorder vs. being representative of other disorders.  After a search of 6 databases, they chose 48 studies which satisfied appropriate inclusion criteria. Unfortunately, they unearthed only one study with strong methodological quality. Even more disappointing was that the children in these studies presented with incredibly diverse symptomology. The authors concluded that “The listening difficulties of children with APD may be a consequence of cognitive, language, and attention issues rather than bottom-up auditory processing” (de Wit et al., 2016, p. 384).  In other words, none of the reviewed studies had conclusively proven that APD was a distinct clinical disorder.  Instead, these studies showed that the children diagnosed with APD exhibited language-based deficits. In other words, the diagnosis of APD did not reveal any new information regarding the child beyond the fact that s/he is in great need of a comprehensive language assessment in order to determine which language-based interventions s/he would optimally benefit from.

Now, it is important to reiterate that students diagnosed with “APD” present with legitimate symptomology (e.g., difficulty processing language, difficulty organizing narratives, difficulty decoding text, etc.). However, all the research to date indicates that these symptoms are indicative of broader language-based deficits, which require targeted language/literacy-based interventions rather than recommendations for specific prescriptive programs (e.g., CAPDOTS, Fast ForWord, etc.) or mere in-school accommodations.

Image result for dig deeper quotesUnfortunately, on numerous occasions when the students do receive the diagnosis of APDthe testing does not “dig further,” which leads to many of them not receiving appropriate comprehensive language-literacy assessments.  Furthermore, APD then becomes the “primary” diagnosis for the student, which places SLPs in situations in which they must address inappropriate therapeutic targets based on an audiologist’s recommendations.  Even worse, in many of these situations, the diagnosis of APD limits the provision of appropriate language-based services to the student.

Since the APD controversy has been going on for years with no end in sight despite the mounting evidence pointing to the lack of its validity, we know that SLPs will continue to have students on their caseloads diagnosed with APD. Thus, the aim of today’s post is to offer some constructive suggestions for SLPs who are asked to assess and treat students with “confirmed” or suspected APD.

The first suggestion comes directly from Dr. Alan Kamhi, who states: “Do not assume that a child who has been diagnosed with APD needs to be treated any differently than children who have been diagnosed with language and learning disabilities” (Kamhi, 2011, p. 270).  In other words, if one carefully analyzes the child’s so-called processing issues, one will quickly realize that those issues are not related to the processing of auditory input  (auditory domain) since the child is not processing tones, hoots, or clicks, etc. but rather has difficulty processing speech and language (language domain).

If a student with confirmed or suspected APD is referred to an SLP, it is important, to begin with formal and informal assessments of language and literacy knowledge and skills. (details HERE)   SLPs need to “consider non-auditory reasons for listening and comprehension difficulties, such as limitations in working memory, language knowledge, conceptual abilities, attention, and motivation (Kamhi & Wallach, 2012).

Image result for language goalsAfter performing a comprehensive assessment, SLPs need to formulate language goals based on determined areas of weaknesses. Please note that a systematic review by Fey and colleagues (2011) found no compelling evidence that auditory interventions provided any unique benefit to auditory, language, or academic outcomes for children with diagnoses of (C)APD or language disorder. As such it’s important to avoid formulating goals focused on targeting isolated processing abilities like auditory discrimination, auditory sequencing, recognizing speech in noise, etc., because these processing abilities have not been shown to improve language and literacy skills (Fey et al., 2011; Kamhi, 2011).

Instead, SLPs need to target we need to focus on the language underpinnings of the above skills and turn them into language and literacy goals. For example, if the child has difficulty recognizing speech in noise, improve the child’s knowledge and access to specific vocabulary words.  This will help the child detect the word when the auditory information is degraded.  Child presents with phonemic awareness deficits? Figure out where in the hierarchy of phonemic awareness their strengths and weaknesses lie and formulate goals based on the remaining areas in need of mastery.  Received a description of the child’s deficits from the audiologist in an accompanying report? Turn them into language goals as well!  Turn “prosodic deficits” or difficulty understanding the intent of verbal messages into “listening for details and main ideas in stories” goals.   In other words, figure out the language correlate to the ‘auditory processing’ deficit and replace it.

Image result for quackeryIt is easy to understand the appeal of using dubious practices which promise a quick fix for our student’s “APD deficits” instead of labor-intensive language therapy sessions. But one must also keep something else in mind as well:   Acquiring higher order language abilities takes a significant period of time, especially for those students whose skills and abilities are significantly below age-matched peers.

APD Summary 

  1. There is still no compelling evidence that APD is a stand-alone diagnosis with clear diagnostic criteria.
  2. There is still no compelling evidence that auditory deficits are a “significant risk factor for  language or academic performance.”
  3. There is still no compelling evidence that “auditory interventions provide any unique benefit to auditory, language, or academic outcomes” (Hazan, Messaoud-Galusi, Rosan, Nouwens, & Shakespeare, 2009; Watson & Kidd, 2009).
  4. APD deficits are language based deficits which accompany a host of developmental conditions ranging from developmental language disorders to learning disabilities, etc.
  5. SLPs should perform comprehensive language and literacy assessments of children diagnosed with APD.
  6. SLPs should target   literacy goals.
  7. SLPS should be wary of any goals or recommendations which focus on remediation of isolated skills such as: “auditory discrimination, auditory sequencing, phonological memory, working memory, or rapid serial naming” since studies have definitively confirmed their lack of effectiveness (Fey et al., 2011).
  8. SLPs should be wary of any prescriptive programs offering APD “interventions” and instead focus on improving children’s abilities for functional communication including listening, speaking, reading, and writing (see Wallach, 2014: Improving Clinical Practice: A School-Age and School-Based Perspective).  This article  “presents a conceptual framework for intervention at school-age levels” and discusses “advanced levels of language that move beyond preschool and early elementary grade goals and objectives with a focus on comprehension and meta-abilities.”

There you have it!  Students diagnosed with APD are best served by targeting the language and literacy problems that are affecting their performance in school. 

Related Posts:

 

 

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Is it a Difference or a Disorder? Free Resources for SLPs Working with Bilingual and Multicultural Children

Image result for bilingualFor bilingual and monolingual SLPs working with bilingual and multicultural children, the question of: “Is it a difference or a disorder?” arises on a daily basis as they attempt to navigate the myriad of difficulties they encounter in their attempts at appropriate diagnosis of speech, language, and literacy disorders.

For that purpose, I’ve recently created a Checklist for Identification of Speech-Language Disorders in Bilingual and Multicultural Children. Its aim is to assist Speech Language Pathologists (SLPs) and Teachers in the decision-making process of how to appropriately identify bilingual/multicultural children who present with speech-language delay/deficits (vs. a language difference), for the purpose of initiating a formal speech-language-literacy evaluation. The goal is to ensure that educational professionals are appropriately identifying bilingual children for assessment and service provision due to legitimate speech language deficits/concerns, and are not over-identifying students because they speak multiple languages or because they come from low socioeconomic backgrounds. It is very important to understand that true language impairment in bilingual children will be evident in both languages from early childhood onwards, and thus will adversely affect the learning of both languages.

However, today the aim of today’s post is not on the above product but rather on the free bilingual and multicultural resources available to SLPs online in their quest of differentiating between a language difference from a language disorder in bilingual and multicultural children.

Let’s start with an excellent free infographic entitled from the Hola BlogMyth vs. Fact: Bilingual Language Development” which was created by Kelly Ibanez, MS CCC-SLP to help dispel bilingual myths and encourage practices that promote multilingualism.  Clinicians can download it and refer to it themselves, share it with other health and/or educational professionals as well as show it to parents of their clients.

Let us now move on to the typical phonological development of English speaking children. After all, in order to compare other languages to English, SLPs need to be well versed in the acquisition of speech sounds in the English language. Children’s speech acquisitiondeveloped by Sharynne McLeod, Ph.D., of Charles Sturt University, is one such resource. It contains a compilation of data on typical speech development for English speaking children, which is organized according to children’s ages to reflect a typical developmental sequence.

Next up, is a great archive which contains phonetic inventories of the various language spoken around the world for contrastive analysis purposes. The same website also contains a speech accent archive. Native and non-native speakers of English were recorded reading the same English paragraph for teaching and research purposes. It is meant to be used by professionals who are interested in comparing the accents of different English speakers.

Image result for charles sturt universityNow let’s talk about one of my favorite websites, MULTILINGUAL CHILDREN’S SPEECH, also developed by Dr. Mcleod of Charles Stuart University. It contains an AMAZING plethora of resources on bilingual speech development and assessment. To illustrate, its Speech Acquisition Data includes A list of over 200 speech acquisition studies. It also contains a HUGE archive on Speech Assessments in NUMEROUS LANGUAGES as well as select assessment reviews. Finally, the website also lists in detail how aspects of speech (e.g., consonants, vowels, syllables, tones) differ between languages.

The Leader’s Project Website is another highly informative source of FREE information on bilingual assessments, intervention, and FREE CEUS.

Now, I’d like to list some resources regarding language transfer errors.

Image result for errorsThis chart from Cengage Learning contains a nice, concise Language Guide to Transfer Errors. While it is aimed at multilingual/ESL writers, the information contained on the site is highly applicable to multilingual speakers as well.

You can also find a bonus transfer chart HERE. It contains information on specific structures such as articles, nouns, verbs, pronouns, adverbs, adjectives, word order, questions, commands, and negatives on pages 1-6 and phonemes on pages 7-8.

A final bonus chart entitled: Teacher’s Resource Guide of Language Transfer Issues for English Language Learners containing information on grammar and phonics for 10 different languages can be found HERE.  

Similarly, this 16-page handout: Language Transfers: The Interaction Between English and Students’ Primary Languages also contains information on phonics and grammar transfers for Spanish, Cantonese, Vietnamese, Hmong Korean, and Khmer languages.

Image result for russian languageFor SLPs working with Russian-speaking children the following links pertinent to assessment, intervention and language transference may be helpful:

  1. Working with Russian-speaking clients: implications for speech-language assessment 
  2. Strategies in the acquisition of segments and syllables in Russian-speaking children
  3. Language Development of Bilingual Russian/ English Speaking Children Living in the United States: A Review of the Literature
  4. The acquisition of syllable structure by Russian-speaking children with SLI

There you have it! FREE bilingual/multicultural SLP resources compiled for you conveniently in one place. And since there are much more FREE GEMS online, I’d love it if you guys contributed to and expanded this modest list by posting links and title descriptions in the comments section below for others to benefit from!

Together we can deliver the most up to date evidence-based assessment and intervention to bilingual and multicultural students that we serve!

Helpful Bilingual Smart Speech Therapy Resources:

  1. Checklist for Identification of Speech-Language Disorders in Bilingual and Multicultural Children
  2. Multicultural Assessment Bundle
  3. Best Practices in Bilingual Literacy Assessments and Interventions
  4. Dynamic Assessment of Bilingual and Multicultural Learners in Speech-Language Pathology
  5. Practical Strategies for Monolingual SLPs Assessing and Treating Bilingual Children
  6. Language Difference vs. Language Disorder: Assessment & Intervention Strategies for SLPs Working with Bilingual Children
  7. Impact of Cultural and Linguistic Variables On Speech-Language Services
  8. Assessment of sound and syllable imitation in Russian-speaking infants and toddlers
  9. Russian Articulation Screener 
  10. Creating Translanguaging Classrooms and Therapy Rooms

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A Focus on Literacy

Image result for literacyIn recent months, I have been focusing more and more on speaking engagements as well as the development of products with an explicit focus on assessment and intervention of literacy in speech-language pathology. Today I’d like to introduce 4 of my recently developed products pertinent to assessment and treatment of literacy in speech-language pathology.

First up is the Comprehensive Assessment and Treatment of Literacy Disorders in Speech-Language Pathology

which describes how speech-language pathologists can effectively assess and treat children with literacy disorders, (reading, spelling, and writing deficits including dyslexia) from preschool through adolescence.  It explains the impact of language disorders on literacy development, lists formal and informal assessment instruments and procedures, as well as describes the importance of assessing higher order language skills for literacy purposes. It reviews components of effective reading instruction including phonological awareness, orthographic knowledge, vocabulary awareness,  morphological awareness, as well as reading fluency and comprehension. Finally, it provides recommendations on how components of effective reading instruction can be cohesively integrated into speech-language therapy sessions in order to improve literacy abilities of children with language disorders and learning disabilities.

from wordless books to readingNext up is a product entitled From Wordless Picture Books to Reading Instruction: Effective Strategies for SLPs Working with Intellectually Impaired StudentsThis product discusses how to address the development of critical thinking skills through a variety of picture books utilizing the framework outlined in Bloom’s Taxonomy: Cognitive Domain which encompasses the categories of knowledge, comprehension, application, analysis, synthesis, and evaluation in children with intellectual impairments. It shares a number of similarities with the above product as it also reviews components of effective reading instruction for children with language and intellectual disabilities as well as provides recommendations on how to integrate reading instruction effectively into speech-language therapy sessions.

Improving critical thinking via picture booksThe product Improving Critical Thinking Skills via Picture Books in Children with Language Disorders is also available for sale on its own with a focus on only teaching critical thinking skills via the use of picture books.

Best Practices in Bilingual LiteracyFinally,   my last product Best Practices in Bilingual Literacy Assessments and Interventions focuses on how bilingual speech-language pathologists (SLPs) can effectively assess and intervene with simultaneously bilingual and multicultural children (with stronger academic English language skills) diagnosed with linguistically-based literacy impairments. Topics include components of effective literacy assessments for simultaneously bilingual children (with stronger English abilities), best instructional literacy practices, translanguaging support strategies, critical questions relevant to the provision of effective interventions, as well as use of accommodations, modifications and compensatory strategies for improvement of bilingual students’ performance in social and academic settings.

You can find these and other products in my online store (HERE).

Helpful Smart Speech Therapy Resources:

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C/APD Update: New Developments on an Old Controversy

In the past two years, I wrote a series of research-based posts (HERE and HERE) regarding the validity of (Central) Auditory Processing Disorder (C/APD) as a standalone diagnosis as well as questioned the utility of it for classification purposes in the school setting.

Once again I want to reiterate that I was in no way disputing the legitimate symptoms (e.g., difficulty processing language, difficulty organizing narratives, difficulty decoding text, etc.), which the students diagnosed with “CAPD” were presenting with.

Rather, I was citing research to indicate that these symptoms were indicative of broader linguistic-based deficits, which required targeted linguistic/literacy-based interventions rather than recommendations for specific prescriptive programs (e.g., CAPDOTS, Fast ForWord, etc.),  or mere accommodations.

I was also significantly concerned that overfocus on the diagnosis of (C)APD tended to obscure REAL, language-based deficits in children and forced SLPs to address erroneous therapeutic targets based on AuD recommendations or restricted them to a receipt of mere accommodations rather than rightful therapeutic remediation.

Today I wanted to update you regarding new developments, which took place since my last blog post was written 1.5 years ago, regarding the validity of “C/APD” diagnosis.

In April 2016, de Wit and colleagues published a systematic review in the Journal of Speech, Language, and Hearing Research. Their purpose was to review research studies describing the characteristics of APD in children and determine whether these characteristics merited a label of a distinct clinical disorder vs. being representative of other disorders.  After they searched 6 databases they chose 48 studies which satisfied appropriate inclusion criteria. Unfortunately, only 1 study had strong methodological quality and what’s even more disappointing, the children in their studies were very dissimilar and presented with incredibly diverse symptomology. The authors concluded that: “the listening difficulties of children with APD may be a consequence of cognitive, language, and attention issues rather than bottom-up auditory processing.”

In other words, because APD is not a distinct clinical disorder, a diagnosis of APD would not contribute anything to the child’s functioning beyond showing that the child is experiencing linguistically based deficits, which bear further investigation.

To continue, you may remember that in my first CAPD post I extensively cited a tutorial written by Dr. David DeBonis, who is an AuD. In his article, he pointed out numerous inconsistencies involved in CAPD testing and concluded that “routine use of CAPD test protocols cannot be supported” and that [CAPD] “intervention needs to be contextualized and functional.”

In July 2016, Iliadou, Sirimanna, & Bamiou published an article: “CAPD Is Classified in ICD-10 as H93.25 and Hearing Evaluation—Not Screening—Should Be Implemented in Children With Verified Communication and/or Listening Deficits” protesting DeBonis’s claim that CAPD is not a unique clinical entity and as such should not be included in any disease classification system.  They stated that DeBonis omitted the fact that “CAPD is included in the U.S. version of the International Statistical Classification of Diseases and Related Health Problems–10th Revision (ICD-10) under the code H93.25” (p. 368). They also listed what they believed to be a number of article omissions, which they claimed biased DeBonis’s tutorial’s conclusions.

The authors claimed that DeBonis provided a limited definition of CAPD based only on ASHA’s Technical report vs. other sources such as American Academy of Audiology (2010), British Society of Audiology Position Statement (2011), and Canadian Guidelines on Auditory Processing Disorder in Children and Adults: Assessment Intervention (2012).  (p. 368)

The also authors claimed that DeBonis did not adequately define the term “traditional testing” and failed to provide several key references for select claims.  They disagreed with DeBonis’s linkage of certain digit tests, as well as his “lumping” of studies which included children with suspected and diagnosed APD into the same category. (p. 368-9)  They also objected to the fact that he “oversimplified” results of positive gains of select computer-based interventions for APD, and that in his summary section he listed only selected studies pertinent to the topic of intelligence and auditory processing skills. (p. 369).

Their main objection, however, had to do with the section of DeBonis’s article that contained “recommended assessment and intervention process for children with listening and communication difficulties in the classroom”.  They expressed concerns with his recommendations on the grounds that he failed to provide published research to support that this was the optimal way to provide intervention. The authors concluded their article by stating that due to the above-mentioned omissions they felt that DeBonis’s tutorial “show(ed) unacceptable bias” (p. 370).

In response to the Iliadou, Sirimanna, & Bamiou, 2016 concerns, DeBonis issued his own response article shortly thereafter (DeBonis, 2016). Firstly, he pointed out that when his tutorial was released in June 2015 the ICD-10 was not yet in effect (it was enacted Oct 1, 2015). As such his statement was factually accurate.

Secondly, he also made a very important point regarding the C/APD construct validity, namely that it fails to satisfy the Sydenham–Guttentag criteria as a distinct clinical entity (Vermiglio, 2014). Namely, despite attempts at diagnostic uniformity, CAPD remains ambiguously defined, with testing failing to “represent a homogenous patient group.” (p. 906).

For those who are unfamiliar with this terminology (as per direct quote from Dr. Vermiglio’s presentation): “The Sydenham-Guttentag Criteria for the Clinical Entity Proposed by Vermiglio (accepted 2014, JAAA) is as follows:

  1. The clinical entity must possess an unambiguous definition (Sydenham, 1676; FDA, 2000)
  2. It must represent a homogeneous patient group (Sydenham, 1676; Guttentag, 1949, 1950; FDA, 2000)
  3. It must represent a perceived limitation (Guttentag, 1949)
  4. It must facilitate diagnosis and intervention (Sydenham, 1676; Guttentag, 1949; FDA, 2000)

Thirdly, DeBonis addressed Iliadou, Sirimanna, & Bamiou, 2016 concerns that he did not use the most recent definition of APD by pointing out that he was most qualified to discuss the US system and its definitions of CAPD, as well as that “the U.S. guidelines, despite their limitations and age, continue to have a major impact on the approach to auditory processing disorders worldwide” (p.372). He also elucidated that: the AAA’s (2010) definition of CAPD is “not so much built on previous definitions but rather has continued to rely on them” and as such does not constitute a “more recent” source of CAPD definitions. (p.372)

DeBonis next addressed the claim that he did not adequately define the term “traditional testing”. He stated that he defined it on pg. 125 of his tutorial and that information on it was taken directly from the AAA (2010) document. He then explained how it is “aligned with bottom-up aspects of the auditory system” by citing numerous references (see p. 372 for further details).  After that, he addressed Iliadou, Sirimanna, & Bamiou, 2016 claim that he failed to provide references by pointing out the relevant citation in his article, which they failed to see.

Next, he proceeded to address their concerns “regarding the interaction between cognition and auditory processing” by reiterating that auditory processing testing is “not so pure” and is affected by constructs such as memory, executive function skills, etc. He also referenced the findings of  Beck, Clarke and Moore (2016)  that “most currently used tests of APD are tests of language and attention…lack sensitivity and specificity” (p. 27).

The next point addressed by DeBonis was the use of studies which included children with suspected vs. confirmed APD. He agreed that “one cannot make inferences about one population from another” but added that the data from the article in question “provided insight into the important role of attention and memory in children who are poor listeners” and that “such listeners represent the population [which] should be [AuD’s] focus.” (p.373)

From there on, DeBonis moved on to address Iliadou, Sirimanna, & Bamiou, 2016 claims that he “oversimplified” the results of one CBAT study dealing with effects of computer-based interventions for APD. He responded that the authors of that review themselves stated that: “the evidence for improving phonological awareness is “initial”.

Consequently, “improvements in auditory processing—without subsequent changes in the very critical tasks of reading and language—certainly do not represent an endorsement for the auditory training techniques that were studied.” (p.373)

Here, DeBonis also raised concerns regarding the overall concept of treatment effectiveness, stating that it should not be based on “improved performance on behavioral tests of auditory processing or electrophysiological measures” but ratheron improvements on complex listening and academic tasks“. (p.373) As such,

  1. “This limited definition of effectiveness leads to statements about the impact of certain interventions that can be misinterpreted at best and possibly misleading.”
  2. “Such a definition of effectiveness is unlikely to be satisfying to working clinicians or parents of children with communication difficulties who hope to see changes in day-to-day communication and academic abilities.” (p.373)

Then, DeBonis addressed Iliadou, Sirimanna, & Bamiou, 2016 concerns regarding the omission of an article supporting CAPD and intelligence as separate entities. He reiterated that the aim of his tutorial was to note that “performance on commonly used tests of auditory processing is highly influenced by a number of cognitive and linguistic factors” rather than to “do an overview of research in support of and in opposition to the construct”. (p.373)

Subsequently, DeBonis addressed the Iliadou, Sirimanna, & Bamiou, 2016 claim that he did not provide research to support his proposed testing protocol, as well as that he made a figure error. He conceded that the authors were correct with respect to the figure error (the information provided in the figure was not sufficient). However, he pointed out that the purpose of his tutorial was to “to review the literature related to ongoing concerns about the use of the CAPD construct in school-aged children and to propose an alternative assessment/intervention procedure that moves away from testing “auditory processing” and moves toward identifying and supporting students who have listening challenges”. As such, while the effectiveness of his model is being tested, it makes sense to “use of questionnaires and speech-in-noise tests with very strong psychometric characteristics” and thoroughly assess these children’s “language and cognitive skills to reduce the chance of misdiagnosis”  in order to provide functional interventions (p.373).

Finally, Debonis addressed the Iliadou, Sirimanna, & Bamiou, 2016 accusation that his tutorial contained “unacceptable bias”. He pointed out that “the reviewers of this [his 2015 article article] did not agree” and that since the time of that article’s publication “readers and other colleagues have viewed it as a vehicle for important thought about how best to help children who have listening difficulties.” (p. 374)

Having read the above information, many of you by now must be wondering: “Why is the research on APD as a valid stand alone diagnosis continues to be published at regular intervals?”

To explain the above phenomenon, I will use several excerpts from an excellent presentation by Kamhi, A, Vermiglio, A, & Wallach, G (2016), which I attended during the 2016 ASHA Convention in Philadephia, PA.

It has been suggested that the above has to do with: “The bias of the CAPD Convention Committee that reviews submissions.” Namely, “The committee only accepts submissions consistent with the traditional view of (C)APD espoused by Bellis, Chermak and others who wrote the ASHA (2005) position statement on CAPD.”

Kamhi Vermiglio, and Wallach (2016) supported this claim by pointing out that when Dr. Vermiglio attempted to submit his findings on the nature of “C/APD” for the 2015 ASHA Convention, “the committee did not accept Vermiglio’s submission” but instead accepted the following seminar: “APD – It Exists! Differential Diagnosis & Remediation” and allocated for it “a prominent location in the program planner.”

Indeed, during the 2016 ASHA convention alone, there was a host of 1 and 2-hour pro-APD sessions such as: “Yes, You CANS! Adding Therapy for Specific CAPDs to an IEP“, “Perspectives on the Assessment & Treatment of Individuals With Central Auditory Processing Disorder (CAPD)“, as well asThe Buffalo Model for CAPD: Looking Back & Forward, in addition to a host of posters and technical reports attempting to validate this diagnosis despite mounting evidence refuting that very fact. Yet only one session, “Never-Ending Controversies With CAPD: What Thinking SLPs & Audiologists Know” presented by Kamhi, Vermiglio, & Wallach (two SLPs and one AuD) and accepted by a non-AuD committee, discussed the current controversies raging in the fields of speech pathology and audiology pertaining to “C/APD”. 

In 2016, Diane Paul, the Director of Clinical Issues in Speech-Language Pathology at ASHA  had asked Kamhi, Vermiglio, and Wallach “to offer comments on the outline of audiology and SLP roles in assessing and treating CAPD”.  According to Kamhi, et al, 2016, the outline did not mention any of controversies in assessment and diagnosis documented by numerous authors dating as far as 2009. It also did not “mention the lack of evidence on the efficacy of auditory interventions documented in the systematic review by Fey et al. (2011) and DeBonis (2015).”

At this juncture, it’s important to start thinking regarding possible incentives a professional might have to continue performing APD testing and making prescriptive program recommendations despite all the existing evidence refuting the validity and utility of APD diagnosis for children presenting with listening difficulties.

Conclusions:

  • There is still no compelling evidence that APD is a stand-alone diagnosis with clear diagnostic criteria
  • There is still no compelling evidence that auditory deficits are a “significant risk factor for  language or academic performance”
  • There is still no compelling evidence that “auditory interventions provide any unique benefit to auditory, language, or academic outcomes” (Hazan, Messaoud-Galusi, Rosan, Nouwens, & Shakespeare, 2009; Watson & Kidd, 2009)
  • APD deficits are linguistically based deficits which accompany a host of developmental conditions ranging from developmental language disorders to learning disabilities, etc.
  • SLPs should continue comprehensively assessing children diagnosed with “C/APD” to determine the scope of their linguistic deficits
  • SLPs should continue formulating language goals to  determine linguistic areas of weaknesses
  • SLPS should be wary of any goals or recommendations which focus on remediation of isolated skills such as: “auditory discrimination, auditory sequencing, phonological memory, working memory, or rapid serial naming” since studies have definitively confirmed their lack of effectiveness (Fey, et al, 2011)
  • SLPs should be wary of any prescriptive programs offering C/APD “interventions”
  • SLPs should focus on improving children’s abilities for functional communication including listening, speaking, reading, and writing
    • Please see excellent article written by Dr. Wallach in 2014 entitled: Improving Clinical Practice: A School-Age and School-Based Perspective. It “presents a conceptual framework for intervention at school-age levels” and discusses “advanced levels of language that move beyond preschool and early elementary grade goals and objectives with a focus on comprehension and meta-abilities.”

So there you have it, sadly, despite research and logic, the controversy is very much alive! Except I am seeing some new developments!

I see SLPs, newly-minted and seasoned alike, steadily voicing their concerns regarding the symptomology they are documenting in children diagnosed with so-called “CAPD” as being purely auditory in nature.

I see more and more SLPs supporting research evidence and science by voicing their concerns regarding the numerous diagnostic markers of ‘CAPD’ which do not make sense to them by stating “Wait a second – that can’t be right!”.

I see more and more SLPs documenting the lack of progress children make after being prescribed isolated FM systems or computer programs which claim to treat “APD symptomology” (without provision of therapy services).  I see more and more SLPs beginning to understand the lack of usefulness of this diagnosis, who switch to using language-based interventions to teach children to listen, speak, read and write and to generalize these abilities to both social and academic settings.

I see more and more SLPs beginning to understand the lack of usefulness of this diagnosis, who switch to using language-based interventions to teach children to listen, speak, read and write and to generalize these abilities to both social and academic settings.

So I definitely do see hope on the horizon!

References:

(arranged in chronological order of citation in the blog post):

Related Posts:

 

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New Product Giveaway: Comprehensive Literacy Checklist For School-Aged Children

I wanted to start the new year right by giving away a few copies of a new checklist I recently created entitled: “Comprehensive Literacy Checklist For School-Aged Children“.

It was created to assist Speech Language Pathologists (SLPs) in the decision-making process of how to identify deficit areas and select assessment instruments to prioritize a literacy assessment for school aged children.

The goal is to eliminate administration of unnecessary or irrelevant tests and focus on the administration of instruments directly targeting the specific areas of difficulty that the student presents with.

*For the purpose of this product, the term “literacy checklist” rather than “dyslexia checklist” is used throughout this document to refer to any deficits in the areas of reading, writing, and spelling that the child may present with in order to identify any possible difficulties the child may present with, in the areas of literacy as well as language.

This checklist can be used for multiple purposes.

1. To identify areas of deficits the child presents with for targeted assessment purposes

2. To highlight areas of strengths (rather than deficits only) the child presents with pre or post intervention

3. To highlight residual deficits for intervention purpose in children already receiving therapy services without further reassessment

Checklist Contents:

  • Page 1 Title
  • Page 2 Directions
  • Pages 3-9 Checklist
  • Page 10 Select Tests of Reading, Spelling, and Writing for School-Aged Children
  • Pages 11-12 Helpful Smart Speech Therapy Materials

Checklist Areas:

  1. AT RISK FAMILY HISTORY
  2. AT RISK DEVELOPMENTAL HISTORY
  3. BEHAVIORAL MANIFESTATIONS 
  4. LEARNING DEFICITS   
    1. Memory for Sequences
    2. Vocabulary Knowledge
    3. Narrative Production
    4. Phonological Awareness
    5. Phonics
    6. Morphological Awareness
    7. Reading Fluency
    8. Reading Comprehension
    9. Spelling
    10. Writing Conventions
    11. Writing Composition 
    12. Handwriting

You can find this product in my online store HERE.

Would you like to check it out in action? I’ll be giving away two copies of the checklist in a Rafflecopter Giveaway to two winners.  So enter today to win your own copy!

a Rafflecopter giveaway

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How Early can “Dyslexia” be Diagnosed in Children?

Image result for dyslexiaIn recent years there has been a substantial rise in awareness pertaining to reading disorders in young school-aged children. Consequently, more and more parents and professionals are asking questions regarding how early can “dyslexia” be diagnosed in children.

In order to adequately answer this question it is important to understand the trajectory of development of literacy disorders in children.

Image result for ida dyslexiaAccording to the definition set forth by the International Dyslexia Association“Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.”

Thus, despite the significant controversy over the use of the label “dyslexia”, as being ‘unscientific and conceptually problematic’, the above definition affirms the fact that it is undisputedly a linguistically based disability.   While it is true that merely using the term “dyslexia” does not automatically evoke our understanding of what type of specific reading-related deficits the child is experiencing, which prevents him/her from reading effectively, it does alert us right away to the fact that a reading disability exists.

In this post, rather than utilizing the term “dyslexia”, I will use a more broad term “literacy deficits” to refer to children who develop trouble reading, writing, and spelling.

Image result for genetic inheritanceSo who exactly are those children? Well, with respect to genetic inheritance, children with immediate and/or extended family members who have in the past received diagnoses such as “dyslexia”, “reading disability”, “learning disability” or who had experienced special education placements during school years are significantly more at risk of developing literacy based deficits than children with no history of above problems in the family.

Unfortunately, the situation is further complicated by the fact that some children with no recognizable family history of learning disabilities, may be at risk for future literacy deficits if they display a pattern of linguistic difficulties during early development (e.g., delayed developmental milestones).

Below is the approximate hierarchy of language development in young children:

  • Exploration of the environment (early socio-emotional development)
  • Play (continuation of socio-emotional development)
  • Receptive Language
    • Comprehension of  words, phrases, sentences, stories
  • Expressive Language
    • Speaking single words, phrases, sentences, engaging in conversations, producing stories
  • Social Emotional Development (Pragmatics) continues to be refined and becomes more sophisticated
  • 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 fact is that if the child experiences any deficits in the foundational language areas such as listening and speaking, s/he will most certainly experience difficulties in more complex areas of language: reading, writing, and spelling.

So now that we know that children with a history of language delay/disorder are at a significant risk of having the disorder turn into a learning disability when they’re older, let’s talk about how early can these children be assessed in order to better plan their future literacy based interventions for optimal functional outcomes.

The first scenario is a more obvious one.  If a child has a documented history of language impairments and is receiving services from a very early age (e.g., early intervention, preschool, etc.) then given what we know about the connection between language disorders and learning disabilities, professionals can begin administering phonological awareness/emergent reading interventions during the early preschool years in order to optimally facilitate the child’s literacy outcomes.

Image result for detective clipartNow our second scenario is not so clear-cut. In our second scenario, the child may have never been identified as having language difficulties during toddlerhood or even early preschool years. However, as the child grows older (e.g., 4-5 years of age) his/her parents may be noticing some subtle difficulties such as difficulty remembering nursery rhymes and songs, trouble remembering the letters of the alphabet, trouble recognizing simple rhyming words, etc.  A such, even without a pertinent family history of literacy disabilities it may be important for a child to undergo an early literacy assessment in order to determine whether intervention is warranted.

Now let’s talk about various assessment options available for preschool children with suspected literacy deficits.  Firstly, if the child has never received a language assessment it is paramount that the child’s language abilities in the areas of listening comprehension, verbal expression, problem-solving and social communication be assessed prior to assessment of literacy  to ensure that the child does not present with any unrecognized/previously undetected deficits in any of the above areas.  This is done in order to ensure optimal intervention outcomes as failure to address gaps/deficits in foundational language areas may significantly impede any potential literacy gains even when the child is provided with optimal literacy based interventions (click HERE to view my post discussing select speech-language tests for preschool children 2-6 years of age).

Now that we’ve covered some basics let us move on to discuss how early can select literacy tests be administered.  Luckily, there are a number of tests pertaining to literacy which can be administered to children as young as 3:6 years of age.

Image result for asa pearsonTo illustrate: The Auditory Skills Assessment (ASA) can be administered to children 3:6—6:11 years of age. Present controversy over CAPD notwithstanding, it does assess important areas related to early phonological awareness development including nonsense word repetition, phonemic blending, as well as rhyming.  Similarly, the Test of Auditory Processing Skills-3 (TAPS-3) begins at 4 years of age and covers several areas pertaining to phonological awareness including auditory discrimination of words, phonological segmentation, as well as phonological blending abilities.

Image result for ctoppHowever, for a thorough phonological awareness assessment for children that age (4+) nothing beats the Comprehensive Test of Phonological Processing-2 —(CTOPP-2), which assesses such areas as:

  • Phonological Segmentation
  • Blending Words
  • Sound Matching
  • Initial, Medial and Final Phoneme Isolation
  • Blending Nonwords*
  • Segmenting Nonwords*
  • Memory for Digits
  • Nonword Repetition*
  • Rapid Digit Naming 
  • Rapid Letter Naming 
  • Rapid Color Naming 
  • Rapid Object Naming 

(—Assesses the ability to manipulate real and *nonsense words)

(—Assesses word fluency skills via a host of rapid naming tasks)

Image result for Emerging Literacy & Language Assessment®For children 4:6 years of age and older the  Emerging Literacy & Language Assessment (ELLA) deserves a mention. It assesses the following literacy related abilities:

  • Section 1 – Phonological Awareness and Flexibility assesses rhyming (awareness and production), initial sound identification, blending and segmenting sounds, words, and syllables, and deleting and substituting sounds in the initial and final positions of words.
  • Section 2 – Sign and Symbol Recognition and Interpretation assesses environmental symbol identification, letter-symbol identification, word reference association, and reading comprehension for one to three sentences.
  • Section 3 – Memory, Retrieval, and Automaticity assesses rapid naming, word associations (name items that start with the “S” sound), and story retell (includes three story levels based on the child’s age).

For children between 5:0-9:11 years of age, —The Phonological Awareness Test 2 (PAT 2) will assess the following areas:Product Image

  • —Rhyming:  Discrimination and Production—identify rhyming pairs and provide a rhyming word
  • —Segmentation:  Sentences, Syllables, and Phonemes—dividing by words, syllables and phonemes
  • —Isolation:  Initial, Final, Medial—identify sound position in words
  • —Deletion:  Compound Words, Syllables, and Phonemes—manipulate root words, syllables, and phonemes in words
  • —Substitution With Manipulatives—isolate a phoneme in a word, then change it to another phoneme to form a new word
  • —Blending:  Syllables and Phonemes—blend units of sound together to form words
  • —Graphemes—assess knowledge of sound/symbol correspondence for consonants, vowels, consonant blends, consonant digraphs, r-controlled vowels, vowel digraphs, and diphthongs
  • —Decoding—assess  general knowledge of sound/symbol correspondence to blend sounds into nonsense words
  • —Invented Spelling (optional)—write words to dictation to show encoding ability

Furthermore, starting from 5 years of age the —Rapid Automatized Naming and Rapid Alternating Stimulus Test RAN/RAS  tests can be administered in order to assess the child’s word fluency skills.  Decreased word fluency is a significant indicator of reading deficits, which is why this ability is very important to test.

—In addition to the above assessments, there are several tests of early reading and writing abilities which are available for younger children with suspected literacy deficits

TERA-3: Test of Early Reading Ability–Third EditionThe  Test of Early Reading Ability–Third Edition (TERA-3) assesses  the emergent reading abilities of children starting from 3:6 years of age. Similarly, the Test of Early Written Language, Third Edition (TEWL-3) assesses  the emergent writing abilities of children starting from 4:0 years of age.

So there you have it! Now you know that if needed children as young 3:6 years of age can undergo early literacy assessments in order to determine their potential risk of developing literacy deficits when older.

Of course, due to the precociously young age of the children, it is important for examiners to exercise significant caution when it comes to interpretation of standardized testing results. It is a well-documented fact that standardized tests present with numerous limitations when it comes to identification of children with language and literacy disorders.

As such, due to the children’s young age there will be a number of instances when testing may reveal “false negative results” (show that there are no deficits when deficits still exist).  Consequently, in such cases, it is important to carefully monitor the child’s school performance in order to perform a literacy reassessment (if needed) when the child is older and his/her difficulties may be more apparent (click HERE to view my 4-part post discussing Components of Comprehensive Dyslexia Testing for further details).

Finally, it is very important to reiterate that children presenting with language and literacy deficits will not outgrow these deficits on their own. While there may be periods of “illusory recovery” when it looks like children with early language disorders have caught up with their peers, such “spurts” are typically followed by a “post-spurt plateau” (Sun & Wallach, 2014). This is because due to the ongoing challenges 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” (Sun & Wallach, 2014).  That is why it is crucial that we identify language and literacy deficits in children at a very early age in order to ensure their optimal educational outcomes.

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