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Smart Speech Therapy Black Friday Sale!

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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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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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What do Narratives and Pediatric Psychiatric Impairments Have in Common?

High comorbidity between language and psychiatric disorders has been well documented (Beitchman, Cohen, Konstantaras, & Tannock, 1996; Cohen, Barwick, Horodezky, Vallence, & Im, 1998; Toppelberg & Shapiro, 2000). However, a lesser known fact is that there’s also a significant under-diagnosis of language impairments in children with psychiatric disorders.

In late 90’s, a study by Cohen, Barwick, Horodezky, Vallance, & Im (1998) found that 40% of children between the ages of 7 and 14 referred solely for psychiatric problems had a language impairment that had not been previously suspected.

Several decades later not much has changed. Hollo, Wehby, & Oliver (2014) did a meta-analysis of 22 studies, which reported results of language assessments in children with emotional and behavioral disturbances, EBD, with no prior history of language impairment (LI). They found that more than 80% of these children displayed below average language performance on standardized assessments (1–2 SD below the mean on a single measure) and 46.5% of these children qualified for criteria of moderate-severe LI (>2 SD below the mean on a single measure).

The above illustrates that children with psychiatric impairments often spend years “under the radar” without the recognition from medical and educational professionals that they present with difficulty adequately comprehending and expressing language. This is particularly damaging because good language development is critically important in order for psychotherapy and cognitive-behavioral therapies to be effective for the child. Without relevant speech-language intervention services, psychotherapy referrals are rendered virtually useless, since those children who lack adequate linguistic abilities would not make meaningful therapeutic gains even after spending years in psychotherapy.

Narrative abilities are “highly relevant for the child psychiatry population as means for both psychotherapeutic evaluation (Emde, Wolf, & Oppenheim, 2003) and intervention (Angus & McLeod, 2004; Chaika, 2000; Gardner, 1993)”.  That is why it is crucial that language impairments be “identified, taken into account, and remediated (Losh & Capps, 2003)” (Pearce, et al, 2014, p. 245).

Over a two-year period, Pearce and colleagues (2014) assessed 48 children, 6–12 years old who were admitted: “for a four-week diagnostic period to the Child Psychiatry Inpatient Unit in a children’s hospital”. The children selected for the study had a minimum IQ of 85, had passed a hearing test and did not present with any acute psychotic symptoms (e.g., delusions, hallucinations, etc.). The children were administered the core subtests of The Clinical Evaluation of Language Fundamentals–4 (CELF-4) as well as the Test of Narrative Language (TNL).

Study results found that:

  1. “The mean scores for less complex core language production and comprehension were in the average range”, whereas the mean narrative-production scores on the TNL were in the clinical range. In other words: “These children perhaps had acquired foundational language skills sufficient for functional communication and produced verbal output at a rate and complexity not noticeably different from their peers, particularly with the overlay of social or emotional disturbance, yet had impaired discourse skills difficult to detect in the typical psychiatric interview, psychotherapy session, or classroom setting” (Pearce, et al, 2014, p. 253).
  2. The study also found a significant correlation between narratives and social skills (but not between core language and social skills). That is because, in contrast to general language tests, which assess basic constructs such as vocabulary and grammar and often require single word responses, storytelling involves a number of higher order skills such as sequencing, emotion processing, perspective taking, pragmatic presupposition, gauging the listener’s level of interest, etc., which children with psychiatric impairments understandably lack.
  3. Consequently, the authors concluded that: “More than half the children in our complex population not previously diagnosed with language impairment were identified as having impaired language when higher-level discourse skills, measured by narrative ability, were tested in addition to core language abilities.”(Pearce, et al, 2014, p. 257)

Additionally, it is important to note that the above study utilized two fairly basic language measures and was still able to attain very significant results. It is strongly speculated that if the study was conducted in the present and utilized a general language test such as the Test of Integrated Language and Literacy the results would have been even more dramatic and the impairment would have extended to language abilities as well as narratives.

So the takeaway messages are as follows:

  1. Do not assume that children who present with challenging behaviors are merely “acting out” and present with intact language abilities. Assess them in order to confirm/rule out a language disorder (and make a relevant psychiatric referral if needed).
  2. Do not assume that children with emotional and behavioral disturbances are ONLY behaviorally/psychiatrically impaired and have average language abilities. Consequently, perform necessary testing in order to confirm/rule out the presence of concomitant language disorder.
  3. General language tests such do NOT directly test children’s narrative abilities or social language skills. Thus, many children can attain average scores on these tests yet still present with pervasive higher order language deficits, so more sensitive testing IS NEEDED
  4. Don’t ascribe linguistic deficits to externalizing symptomology (e.g., impulsivity, anxiety, inattention, challenging behaviors, etc.)  when the cause of it may in actuality be an undiagnosed language impairment. Perform a thorough assessment of higher-order linguistic abilities to ensure that the child receives the best possible care in order to optimally function in social and academic settings.

Helpful Resources:

References:

  • Angus, L. E., & McLeod, J. (Eds.) (2004). The handbook of narrative and psychotherapy. London, UK: Sage Publications
  • Beitchman, J., Cohen, N., Konstantareas, M., & Tannock, R. (Eds.) (1996). Language, learning and behaviour disorders: Developmental, biological and clinical perspectives. Cambridge, NY: Cambridge University Press.
  • Chaika, E. (2000). Linguistics, pragmatics and psychotherapy. London, UK: Whurr Publishers
  • Cohen, N., Barwick, M., Horodezky, N., Vallance, D., & Im, N. (1998). Language, achievement, and cognitive processing in psychiatrically disturbed children with previously identified and unsuspected language impairments. Journal of Child Psychology and Psychiatry, 39, 865–877.
  • Cohen, N., & Horodezky, N. (1998). Prevalence of language impairments in psychiatrically referred children at different ages: Preschool to adolescence [Letter to the editor]. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 461–262.
  • Emde, R., Wolf, D., & Oppenheim, D. (Eds.) (2003). Revealing the inner worlds of young children—The MacArthur story stem battery. New York, NY: Oxford University Press.
  • Gardner, R. (1993). Storytelling in psychotherapy with children. London, UK: Jason Aronson.
  • Hollo, A., Wehby, J. H., & Oliver, R. O.  (2014). Unsuspected language deficits in children with emotional and behavioral disorders: A meta-analysis. Exceptional Children, Vol. 80, No. 2, pp. 169-186.
  • Losh, M., & Capps, L. (2003). Narrative ability in high-functioning children with autism or Asperger’s syndrome. Journal of Autism and Developmental Disorders, 33, 239–251.
  • Pearce, P. et al. (2014). Use of narratives to assess language disorders in an inpatient pediatric psychiatric population. Clin Child Psychol Psychiatry, 19(2) 244-259.
  • Toppelberg, C., & Shapiro, T. (2000). Language disorders: A 10-year research update review. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 143–152.
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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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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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Components of Comprehensive Dyslexia Testing: Part I- Introduction and Language Testing

With the passing of dyslexia laws in the state of New Jersey in 2014, there has been an increased focus on reading disabilities and dyslexia particularly in the area of effective assessment and remediation. More and more parents and health related professionals are looking to understand the components of effective dyslexia testing and who is qualified to perform it. So I decided to write a multi-part series regarding the components of comprehensive dyslexia testing in order to assist parents and professionals to better understand the steps of the testing process (Infographic courtesy of TES Resources).

In this particular post I would like to accomplish two things: dispel several common myths regarding dyslexia testing as well as discuss the first step of SLP based testing which is a language assessment.

Myth 1: Dyslexia can be diagnosed based on a single test!

DYSLEXIA CANNOT BE CONFIRMED BY THE ADMINISTRATION OF ONE SPECIFIC TEST. A comprehensive battery of tests from multiple professionals including neuropsychologists, psychologists, learning specialists, speech language pathologists and even occupational therapists needs to actually be administered in order to confirm the presence of reading based disabilities.

Myth 2: A doctor can diagnose dyslexia!

A doctor does not have adequate training to diagnose learning disabilities, the same way as a doctor cannot diagnose speech and language problems. Both lie squarely outside of their scope of practice! A doctor can listen to parental concerns and suggest an appropriate plan of action (recommend relevant assessments)  but they couldn’t possibly diagnose dyslexia which is made on the basis of team assessments.

Myth 3: Speech Pathologists cannot perform dyslexia testing!

SPEECH LANGUAGE PATHOLOGISTS TRAINED IN IDENTIFICATION OF READING AND WRITING DISORDERS ARE FULLY QUALIFIED TO PERFORM SIGNIFICANT PORTIONS OF DYSLEXIA BATTERY.

So what are the dyslexia battery components?

Prior to initiating an actual face to face assessment with the child, we need to take down a thorough case history (example HERE) in order to determine any pre-existing risk factors. Dyslexia risk factors may include (but are not limited to):

  • History of language and learning difficulties in the family
  • History of language delay (impaired memory,  attention, grammar, syntax, sentence repetition ability, etc) as well as
  • History of impaired phonological awareness skills (difficulty remembering children’s songs, recognizing and making rhymes, confusing words that sound alike,  etc).

After that we need to perform language testing to determine whether the child presents with any deficits in that area. Please note that while children with language impairments are at significant risk for dyslexia not all children with dyslexia present with language impairments. In other words, the child may be cleared by language testing but still present with significant reading disability, which is why comprehensive language testing is only the first step in the dyslexia assessment battery.

LANGUAGE TESTING

Here we are looking to assess the child’s listening comprehension. processing skills, and verbal expression in the form of conversational and narrative competencies. Oral language is the prerequisite to reading and writing.   So a single vocabulary test, a grammar completion task, or even a sentence formulation activity is simply not going to count as a part of a comprehensive assessment.

In children without obvious linguistic deficits such as limited vocabulary, difficulty following directions, or grammatical/syntactic errors (which of course you’ll need to test) I like to use the following tasks, which are sensitive to language impairment:

Listening Comprehension (with a verbal response component)

  • Here it is important to assess the student’s ability to listen to short passages and answer a variety of story related questions vs. passively point at 1 of 4 pictures depicting a particular sentence structure (e.g., Point to the picture which shows: “The duck was following the girl”). I personally like to use the Listening Comprehension Tests for this task but any number of subtests from other tests have similar components.

Semantic Flexibility

  • Here it is important to assess the student’s vocabulary ability via manipulation of words to create synonyms, antonyms, multiple meaning words, definitions, etc. For this task I like to use the WORD Tests (3-Elementary and 2-Adolescent).

Narrative Production:

  • A hugely important part of a language assessment is an informal spontaneously produced narrative sample, which summarizes a book or a movie.  Just one few minute narrative sample can yield information on the following:
  • Sequencing Ability
  • Working Memory
  • Grammar
  • Vocabulary
  • Pragmatics and perspective taking
  • —Story grammar (Stein & Glenn, 1979)

Usually I don’t like to use any standardized testing for assessment of this skill but use the parameters from the materials I created myself based on existing narrative research (click HERE).

Social Pragmatic Language

  • Given my line of work (school in an outpatient psychiatric setting), no testing is complete without some for of social pragmatic language assessment in order to determine whether the student presents with hidden social skill deficits. It is important to note that I’ve seen time and time again students acing the general language testing only to bomb on the social pragmatic tasks which is why this should be a mandatory part of every language test in my eyes. Here, a variety of choices exists. For quick results I typically tends to use the Social Language Development Tests as well as portions of the Social Thinking Dynamic Assessment Protocol®.

Not sure what type of linguistic deficits your student is displaying? Grab a relevant checklist and ask the student’s teacher and parent fill it out (click HERE to see types of available checklists)

So there you have it! The first installment on comprehensive dyslexia testing is complete.

READ part II which discusses components of Phonological Awareness and Word Fluency testing HERE

Read part III of this series which discusses components of Reading Fluency and Reading Comprehension testing HERE.

Helpful Links

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Review: Kindergarten Language Benchmark Assessment (KLBA)

Recently I had an opportunity to use the Kindergarten Language Benchmark Assessment published by Speech Language Literacy Lab with a classroom of kindergarten students 5-6 years of age.  The KLBA is the screening and progress monitoring tool which tracks the development of appropriate early language skills and helps support the RTI model.

KLBA+test

This tool is comprised of four sections: auditory comprehension, following directions, categories and  narrative language, which are correlated to future reading success and academic competence. It is intended for monolingual and bilingual kindergarten children 5 to 6 years of age. It yields a raw score for each skill area and requires a very short administration time (around 5-7 minutes) .

The kit was created by Naomi R. Konikoff, MS, CCC-SLP and Jennifer Preschern, MA, CCC-SLP. It includes an administration manual, testing book, and 25 protocols.  Each protocol allows for 3 administrations (Winter, Spring, Fall) to monitor language growth in kindergarten students over a period of a school year.

Subtest description:

Auditory Comprehension subtest assesses the students’ ability to respond to -wh-questions based on short stories 3-4 sentences in length

Following Directions subtest assesses the students’ ability to follow 1-2 step directions.

Categories subtest assesses the student’s ability to receptively identify the similarities between 2 out of 3 presented items and then coherently verbalize their connection

Narrative Language subtest assesses the students’s ability to produce simple stories in order to determine their use of relevant story grammar elements.

KLBA 1

While there are a number of uses for this tool (RTI, to reduce over-identification of Limited English Proficiency students, evaluation of effectiveness of early language instruction, etc.),  since I’ve had it for a fairly limited time I used it as a screening instrument in order to determine whether a full comprehensive language testing was needed for the kindergarten children who were currently not mandated language services.

To confirm its reliability I also used it with children with known language impairment on my caseload, to determine how sensitive it was to detecting already existing language impairments.

The KLBA had indeed proven to be a reliable screening tool with the children I had tested. It cleared the children with typically developing language abilities (as per teachers reports and personal observations). In contrast when used with language impaired students on my caseload, KLBA had reliably identified their areas of weaknesses.  Children with language impairments were able to do quite well on several KLBA subtests due to the fact that they had already been receiving language therapy services. However, they invariably did poorly on the following subtests: expressive categorization and narrative production, which research has identified as being most sensitive to language impairment.

KLBA 2

Given the research behind the KLBA I find it to be another useful tool in my material repertoire. For more information on KLBA check out Speech Language Literacy LabTo purchase KLBA from their site click HERE. 

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Bear Wants More Product Swap and Giveaway

Today I am doing a product swap and giveaway with Whitney Smith, the author of the Let’s Talk blog, who’s created a book companion packet to the popular children’s book: Bear Wants More by Karma Wilson.  Those of you who are familiar with my prior posts know that I am a big fan of Karma Wilson’s Bear Books, which is why I was so excited to review Whitney’s  comprehensive product, which in addition t0 having  story related concepts and vocabulary also contains information on the different food groups, types of food, healthy eating, as well as seasons. Continue reading Bear Wants More Product Swap and Giveaway