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Speech, Language, and Literacy Fun with Karma Wilson’s “Bear” Books

In my previous posts, I’ve shared my thoughts about picture books being an excellent source of materials for assessment and treatment purposes. They can serve as narrative elicitation aids for children of various ages and intellectual abilities, ranging from pre-K through fourth grade.  They are also incredibly effective treatment aids for addressing a variety of speech, language, and literacy goals that extend far beyond narrative production.

In the past, I’ve shared several posts regarding how to incorporate both fiction and nonfiction picture books into contextual language intervention sessions, with the most recent posts describing how I incorporate Helen Lester‘s as well as Julia Cook‘s picture books into therapy sessions.

Today I wanted to share how I implement books by Karma Wilson into my treatment sessions with preschool, kindergarten aged, as well as early elementary aged children.

Though these books are intended for younger children (3-8 years; pre-K-3rd grade), older children (~10 years of age) with significant language and learning difficulties and/or intellectual disabilities can significantly benefit from reading/listening to them and enjoy working with them as well.

Much like Helen Lester’s books, Karma Wilson’s books possess tremendous versatility with respect to what goals can be targeted via their use.

Themes:

  • Ms. Wilson’s books are terrific for discussing a variety of seasonal events and happenings.
    • Bear Feels Sick’, ‘Bear Feels Scared’ and ‘Bear Says Thanks‘ take place in the fall.
    • Bear Can’t Sleep’, ‘Bear Stays Up’, and ‘Bear Snores On‘ take place in the winter.
    • Bear’s New Friend’ and Bear’s Loose Tooth‘ take place in the Spring and Summer.
  • They are great for discussing illness and visits to the dentist (‘Bear Feels Sick’ and Bear’s Loose Tooth’), hibernation ( ‘Bear Snores On‘), holidays such as Thanksgiving and Christmas (‘Bear Says Thanks‘ and ‘Bear Stays Up‘).
  • They are also great for select social themes such as feeling frightened and making new friends (‘Bear Feels Scared’ and ‘Bear’s New Friend’).
  • Finally, ‘Bear Wants More‘ is great for working on nutrition as well as on making healthy food choices, in addition to reviewing a variety of food groups as well as food categories.

Speech Production: Bear books are terrific for the production of a variety of sounds in words in sentences including /r/ in all books, /s/ (‘Bear Feels Sick’, ‘Bear Feels Scared’), /th/ (‘Bear Says Thanks‘ ), etc.

Language: There are numerous language goals that could be formulated based on Karma Wilson’s books including answering concrete and abstract listening comprehension questions, defining story-embedded vocabulary words, producing word associations, synonyms, antonyms, and multiple-meaning words (semantic awareness), formulating compound and complex sentences (syntax), answering predicting and inferencing questions (critical thinking), gauging moods and identifying emotional reactions of characters (social communication), assuming characters’ perspectives and frame of reference (social cognition, theory of mind, etc.), identifying main ideas in text (Gestalt processing) and much, much more.

  • Select Highlights:Vocabulary: For the ages/grades that there’ve written for (3-8 years; pre-K-3rd grade), Ms. Wilson’s books are laden with a wealth of sophisticated vocabulary words such as vale, crooked, trail, lumbers, prowl, howl, spooks, wails, dimmer, squeaks, lair, roam, perch, prepare, trembles, longs, flounce, squawk, cluster, etc. (From the ‘Bear Feels Scared’ book)
  • Social Communication: ‘Bear’s New Friend’, ‘Bear’s Loose Tooth’, and ‘Bear Says Thanks’ are especially terrific for addressing a variety of social themes such as rules of politeness, making new friends (and accepting them for who they are), as well as helping out friends in difficult circumstances.

Literacy: Similar to the above, numerous literacy goals can be formulated based on these books. These include but are not limited to, goals targeting phonological (e.g., rhyming words, counting syllables in words, etc.) and phonemic awareness, phonics, reading fluency and comprehension, spelling, as well as the composition of written responses to story questions.

  • Select Highlights:
    • Phonics: Students can practice reading words containing a variety of syllable shapes as well as decode low-frequency words containing a variety of consonantal clusters (From the ‘Bear Feels Sick’ book: achy, autumn, stuffed, sneezes, heap, wheezes, whiffs, mutters, mumbles, moans, broth, squeezes, whispers, cloth, gopher, coax, herbs, smidgen, fuss, fret, etc. 
    • Morphology: There’s a terrific opportunity to introduce a discussion on simple affixes when using Ms. Wilson’s books to discuss how for example, select suffixes (e.g., –s, -ly, ‘ed, etc.) can change root words.  (From the ‘Bear Stays Up’ book: soundly, stays, gathered, etc.) 
    • Spelling: There is a terrific opportunity for children to practice spelling numerous spelling patterns to solidify their spelling abilities. From the ‘Bear’s New Friend’ book:  -00-, -ee-, -ea-,-oo-, -oe-, -ou-, -le, -ff-, -mm-, -tt-, etc.

As mentioned in previous posts, when working with picture books, I typically spend numerous sessions working with the same book. That is because research indicates that language disordered children require 36 exposures  (as compared with 12 exposures for typically developing children) to learn new words via interactive book reading (Storkel et al, 2016). As such, I discuss vocabulary words before, during, and after the book reading, by asking the children to both repeatedly define and then use selected words in sentences so the students can solidify their knowledge of these words.

I also spent quite a bit of time on macrostructure, particularly on the identification and definitions of story grammar elements as well as having the student match the story grammar picture cards to various portions of the book.

When working with picture books, here are some verbal prompts that I provide to the students with a focus on story Characters and Setting

  • Who are the characters in this story?
  • Where is the setting in this story?
  • Are there multiple settings in this story?
  • What are some emotions the characters experience throughout this story?
  • When did they experience these emotions in the story?
  • How do you think this character is feeling when ____?
    • Why?
    • How do you know?
  • What do you think this character is thinking?
    • Why?
    • How do you know?
  • What are some actions the characters performed throughout the story?
  • What were the results of some of those actions?

Here is a sampling of verbal prompts I provide to the students with a focus on story Sequencing 

  • What happened at the beginning of the story?
    • What words can we use to start a story?
  • What happened next?
  • What happened after that?
  • What happened last?
  • How do we end a story?
  • What was the problem in the story?
  • Was there more than one problem?
    • What happened?
    • Who solved it?
    • How did s/he solve it?
  • Was there adventure in the story?
    • If yes, how did it start and end?

Here is a sampling of verbal prompts I provide to the students with a focus on Critical Thinking Image result for bear says thanks

  • How are these two characters alike/different? (compare/contrast)
  • What do you think will happen next? (predicting)
  •  Why/How do you think ___ happened (inferencing)
  • Why shouldn’t you, couldn’t s/he ____ ? (answering negative questions)
  • What do you thing s/he must do to ______? (problem-solving)
  • How would you solve his problem? (determining solutions)
  • Why is your solution ______ a good solution? (providing justifications)

Here is a small sampling of verbal prompts I provide to the students with a focus on Social Communication and Social Cognition 

  • How would you feel if ____?
  • What is his/her mood at ____ point in the story?
    • How do you know?
  • What is his/her reaction to the ____?
    • How do you know?
  • How does it make you feel that s/he are _____?
  • Can you tell me two completely different results of this character’s actions?
  • What could you say to this character to make him/her feel better?
    • Why?
  • What would you think if?

At times, I also use select Free TPT resources to supplement my sessions with book-related visuals as related materials.

There you have it! Just a few of the reasons why I really like using Karma Wilson’s books for language and literacy treatment purposes with younger children. How about you? Do you use any of her books for treatment purposes? If yes, comment below which ones you use and why do you use them?

References:

Helpful Related Smart Speech Therapy Resources: 

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Why “good grades” do not automatically rule out “adverse educational impact”

Image result for good grades?As a speech-language pathologist (SLP) working with school-age children, I frequently assess students whose language and literacy abilities adversely impact their academic functioning.   For the parents of school-aged children with suspected language and literacy deficits as well as for the SLPs tasked with screening and evaluating them, the concept of ‘academic impact’ comes up on daily basis. In fact, not a day goes by when I do not see a variation of the following question: “Is there evidence of academic impact?”, being discussed in a variety of Facebook groups dedicated to speech pathology issues.

At first glance, the issue of academic impact appears to be rather straightforward. For example, many SLPs will readily assert that if a child is receiving good grades (A’s and B’s) in the school setting and is not exhibiting any “significant” maladaptive and challenging behaviors, then there is no evidence of adverse academic impact, and screening/evaluation/intervention services are unnecessary.

Unfortunately, things are not as “crystal clear” as they appear. That is because of the relative subjectivity pertaining to the grading practices of the students’ work in the school setting. Now, before you accuse me of inventing a problem where there is none, please hear me out.

In this post, I would like to illustrate how the subjectivity of grading practices can obfuscate the issue of academic impact to such an extent that students with significant language and learning needs may not be identified as being in need of help until it’s far too late – if identified at all.

Related imageLet’s begin with reading, an incredibly complex and deeply misunderstood process, especially in settings which do not utilize scientifically informed practices (e.g., synthetic phonics) when teaching young children to read.  When it comes to the teaching and assessment of reading, it is an absolute Wild West out there! And no one is more familiar with it, than parents of reading impaired children.

One of the first things these parents notice about their children in the early grades is that their reading abilities are highly inconsistent and are not commensurate with those of their peers.  These parents will notice that it takes their kids an extraordinary amount of time to master the alphabetic principle (remember the letters of the alphabet, match letters to sounds, etc.). They will notice that their children have an extraordinarily difficult time blending simple three letter words involving initial and final consonants with a medial vowel (e.g., “nob”). They will complain that their children display inconsistent knowledge of “sight words” from day to day, as well as misread and skip words when reading.

Here is the problem though, unless objective measures are used to test their children’s phonemic awareness and phonics abilities, there is a very strong possibility that these issues will persist well into upper elementary years, completely unnoticed in the school system, given the subjectivity involved in assessing reading mastery.

Indeed, numerous studies highlight the lack of efficacy of build-in assessments in programs such as Fountas and Pinnell, Reading Recovery, as well as the utility of utilizing Running Records, for reading assessment purposes.  My clinical observations of struggling readers in a variety of school settings, as part of the independent evaluation process, certainly support and corroborate available research on the subject. Namely, in many educational disputes, there’s a significant mismatch between teacher claims “S/he is reading at grade level as per (insert subjective method here)”  and observed student’s abilities (child is functionally illiterate) during reading tasks in the classroom. 

Related imageNow, let’s move on to discuss the subjectivity of the weekly spelling test. A number of scientific studies on this subject have shown that spelling instruction needs to be direct, explicit and systematic in order to be effective for struggling learners. When teaching spelling, best instruction practices involve consistently addressing and grouping words according to specific spelling patterns rather than teaching random “grade level” or topically related words. However, in the vast majority of instances, the weekly spelling test continues to consist of random words which are expected to be memorized by students. As a result of these memorization practices, numerous students will attain high marks on spelling tests but will be absolutely unable to correctly spell these words in a variety of writing assignments even a week later.

Image result for children taking a testThe practice of teaching to the test is certainly not restricted to spelling.  I have also seen similar practices pertaining to the subjects of science and social studies, whereas children are provided with specific handouts pertaining to a particular topic to memorize for the test. While this allows these children to perform well on such tests, unfortunately, their topic knowledge remains minimal to nonexistent given the fact that the memorized information will be long forgotten in a period of just a few weeks, if not sooner.

Similarly, science projects and social studies book reports may not even be necessarily completed by the children themselves. Many parents of struggling learners will readily acknowledge the mammoth work they had contributed to such projects just so their children could attain good marks which were worth a significant percentage of the overall class grade.

Many parents of struggling learners will also readily admit their significant involvement in the homework process and how stressful and frustrating it is on the students. They report spending numerous hours each day explaining information, their children’s tears of frustration and rage, significant tantrum behavior, and in some extreme cases even visits to a hospital, subsequent to accidental injuries stemming from challenging behaviors.

Finally, the subjectivity of grading written assignments is another important factor that needs to be explicitly acknowledged. Many parents and professionals tasked with the evaluation of the students’ spontaneous written work will readily confirm that oftentimes the grades some struggling learners receive on written assignments appear to be almost ridiculously overinflated.  Despite seemingly clear rubrics provided to the students explaining the breakdown of points for a particular written composition, many students end up receiving much higher marks than they deserve.  I myself have observed this phenomenon firsthand by reviewing the written work of my clients in private practice following parental complaints of grade inflation.

Related imageWe’re talking essays, blatantly lacking in coherence and cohesion, peppered with run-on and fragmented sentences, lacking subject-verb agreement, and full of grammatical errors, given A- and B+ grades, when the grading rubrics which came with the assignment, clearly indicate that the work is at the best deserving of a C- or a D+ grade.

These are just some of the many reasons why students of all ages with very noticeable language and learning needs, may end up being denied much-needed language and literacy assessments to determine the extent of their difficulties in order to receive targeted assistance.

Further complicating this issue is the fact that even when these students are finally tested in the school setting, due to the relative “mildness”  of their deficits,  coupled with the use of general (vs. targeted), often psychometrically weak tests, a lack of or under-identification of their deficit areas often occurs.

So what can parents and professionals do with this information? For starters, all are encouraged to examine the available information through a critical lens, albeit in different ways. Parents are encouraged to collect the samples of the child’s work (independent writing and spelling, audio samples of their reading, etc.) highlighting the discrepancies between the grades they receive and their actual abilities. They should absolutely request child study team assessments and if they are unsatisfied with the results of those tests they can seek out independent evaluations pertaining to the child’s areas of concern.

Image result for high sensitivity high specificitySimilarly, SLPs are encouraged to review their testing practices to ensure that they accurately reflect the students’ deficit areas. They are also strongly encouraged to review the psychometric properties of the tests they are using to better understand the sensitivity and specificity of these instruments with respect to the appropriate identification of language disorders. Finally, SLPs are strongly encouraged to familiarize themselves with the language and literacy expectations of older students and utilize clinical assessment procedures which reflect more sensitive assessment practices.

Image result for falling dominoesSo the next time someone has concerns regarding the language and literacy abilities of students with seemingly good grades, do not be so hasty in dismissing their worries due to a “lack of academic impact”. Depending on the setting and testing in question,  that impact may be far greater than we know!

Helpful Related Posts: 

  1. Special Education Disputes and Comprehensive Language Testing: What Parents, Attorneys, and Advocates Need to Know
  2. What Makes an Independent Speech-Language-Literacy Evaluation a GOOD Evaluation?
  3. What Research Shows About the Functional Relevance of Standardized Language Tests
  4. Part II: Components of Comprehensive Dyslexia Testing – Phonological Awareness and Word Fluency Assessment
  5. On the Limitations of Using Vocabulary Tests with School-Aged Students
  6. It’s All Due to …Language: How Subtle Symptoms Can Cause Serious Academic Deficits
  7. Dear Reading Specialist, May I Ask You a Few Questions?
  8. Help, My Student has a Huge Score Discrepancy Between Tests and I Don’t Know Why?
  9.  The Reign of the Problematic PLS-5 and the Rise of the Hyperintelligent Potato
  10. Components of Qualitative Writing Assessments: What Exactly are We Trying to Measure?

 

 

 

 

 

 

 

 

 

 

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Editable Report Template and Tutorial for the Test of Integrated Language and Literacy

Today I am introducing my newest report template for the Test of Integrated Language and Literacy.

This 16-page fully editable report template discusses the testing results and includes the following components:

  • Table of testing results
  • Recommendations for using severity ratings of percentile ranks
  • Recommendations of which information to include in the background history section of the report
  • Teacher Interview Samples for Adolescent and Elementary Aged Students
  • Classroom Observations Sample
  • Adaptive behavior section sample
  • Assessment findings
    • All subtests descriptions
    • Extensive descriptions of how to analyze error patterns on all subtests
    • Descriptions of how to analyze scenarios when a student obtains average performance but it contradicts academic functioning.
    • Elaborations regarding specific subtests, weaknesses on which are not as apparent or straightforward (e.g., Nonword Repetition, Following Directions, etc.)
    • Recommendations for supplemental testing when the performance on select subtests (e.g., Social Communication) is within the average range despite glaring weaknesses
    • Extensive error descriptions that can be found on the Reading Fluency subtest
    • Extensive footnotes with clarifying information
    • Links to a variety of TILLS FREE tutorials created by the authors
    • Impressions section formulation
    • Possible ICD-10 diagnoses that can result based on TILLS assessment
    • Accommodations Section
    • Adaptive Recommendations Section
    • Maintaining Factors Section
    • Suggested Therapy Long and Short Term Goals Sampler for
      • Listening Comprehension
      • Oral Communication
      • Social Communication
      • Phonological Awareness
      • Phonics
      • Reading Fluency
      • Reading Comprehension
      • Spelling
      • Writing Conventions
      • Writing Composition
      • Reward System and Rationale
      • Expected duration of treatment
      • Prognosis
      • Therapy Discharge Recommendations

You can access it HERE in my online store.  My review of the TILLS is available HERE 

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What Makes an Independent Speech-Language-Literacy Evaluation a GOOD Evaluation?

Image result for Independent Educational EvaluationThree years ago I wrote a blog post entitled: “Special Education Disputes and Comprehensive Language Testing: What Parents, Attorneys, and Advocates Need to Know“. In it, I used  4 very different scenarios to illustrate the importance of comprehensive language evaluations for children with subtle language and learning needs.  Today I would like to expound more on that post in order to explain, what actually constitutes a good independent comprehensive assessment.

Independent evaluations, whether educational, psychological, speech and language, etc., are typically performed with a particular purpose in mind. That purpose is not to simply document the student’s strengths and needs but also to explicitly advise on solid goals and objectives or a strong treatment plan so the child could improve abilities in the affected areas of functioning.

Image result for all children can learnFor example, psychological evaluations do not simply determine the child’s full-scale IQ. Depending on the breakdown of the child’s scores, they help educators with planning for the child’s educational needs. To illustrate, let’s say that an IQ testing determined that the child is functioning in the below average range with significantly lower scores in the areas of working memory and processing speed.  Given this information professionals working with the child in the classroom and in the therapy room can plan accordingly in terms of designing an appropriate intervention which takes into the consideration the child’s cognitive challenges.

Image result for functionalSimilarly, let’s say an educational/learning testing had determined that the child exhibits difficulties in the areas of phonics, word reading, reading fluency, etc.   Such information is hugely helpful in assisting the child to receive additional reading intervention services with a focus on improving the affected areas of difficulty.

In other words, it is not nearly enough to state in the body of the report, what is wrong with the child, rather it is important to make functional recommendations on what can be done with a child in order to make the child better.

Now here it is very important to understand that accommodations and modifications, while extremely helpful for all children with learning needs, are simply not going to be as functional as actual targeted intervention goals in the affected areas, be it reading, writing, listening comprehension, etc.

Independent evaluations need to make concrete recommendation suggestions regarding best remediation practices for the child. They need to contain goals that other professionals can follow. Without this component, independent evaluations have highly limited value. Here is an example which illustrates a limited value of one such report.

Several years ago I was asked to do a comprehensive language and literacy evaluation on a fifth-grade student who was functionally illiterate. The student had already underway and a comprehensive neuropsychological evaluation, which surprisingly enough did not draw any conclusion regarding the student’s abilities.

The neuropsychologist found that the student had an average IQ and learning difficulties across the board in numerous tested areas. Because of these findings, the neuropsychologist chose to ‘blame’ the student’s deficits on ADHD and stated that he is unable to diagnose a student with a learning disability because there were no score discrepancies on educational testing (not a scientifically backed argument).

Image result for valueNow, what is the value of such an assessment? This child’s parents have spent thousands of dollars on this assessment but in the end, they had absolutely nothing to show for it! The assessment had literally found nothing useful because the submission of such an assessment to the school setting would not have resulted in an altered and beneficial program placement for this child.

So what are the components of a good comprehensive independent evaluation? For the purpose of this particular question, I’ll stick to the subject of language and literacy evaluations, which are in my purview.

Here are the sections I include in a typical independent comprehensive language and literacy report for school-age clients. Make sure to click on the multicolored/highlighted words to learn more details via relevant past posts pertaining to this topic.

Formal Testing Results

  • This section includes the tables of all the standardized testing administered to the child

Background Information

  • This section comprehensively discusses the child’s history to date. It summarizes in meticulous detail prenatal perinatal and postnatal histories, developmental milestones acquisition, relevant medical and psychiatric histories, as well as a compilation of information regarding all previous assessments and interventions to date. This is particularly important for cases involving a change in school placement. After all, if the child had received extensive interventions in a particular school setting which were found to be ineffective to date, it is a strong indication that a different school placement may be warranted.

School Visit

  • This section is hugely important for the determination of the child’s functioning in school setting. It documents an observation one hour in length, preformed to determine whether the child is receiving free and appropriate education in school setting (whether the child is appropriately receiving relevant therapies/schooling).
    • School Visit Impressions
      • All school visits need to include a report section which discusses the observers impressions of the program, as well as their suitability to the child’s educational needs.

Adaptive Behavior

  • This section documents the child’s social communication abilities as displayed throughout testing. Was the child calm or distractible, but did the child display any socially awkward behaviors, did the child display any refusal behaviors, was there any odd conversational exchanges, did it take the child too long to answer questions, with the child displaying any word finding difficulties when speaking? All of these observations are documented in that section as a precursor to both formal as well as clinical social communication testing (see below)

Peripheral Oral Motor Exam

  • Here any orofacial anomalies get documented if needed

Voice, Fluency, Resonance and Prosody

  • This section discusses any deviations in the above, and/or documents the presence of typical functioning as commensurate with age.

Articulation and Phonology

  • Here I document the presence of typical or atypical speech patterns

Auditory Function

  • This is a section which discusses previous audiological findings, history of hearing deficits (if present), as well as overall impressions of child’s hearing throughout the assessment.

Methods of Assessment

Testing Protocols 

  • A list of all the formal tests used during the assessment

Language Processing and Listening Comprehension:

  • Detailed findings of both formal and clinical testing pertaining to the child’s ability to process and comprehend language

Expressive Language and Metalinguistic Abilities:

  • Detailed findings of both formal and clinical testing pertaining to the child’s ability to verbally express self via the effective/ineffective ability to manipulate words and sentences

Discourse Analysis

  • Detailed findings of clinical testing pertaining to the child’s ability to produce age level narratives

Problem Solving, Critical Thinking, and Verbal Reasoning:

  • This section documents formal testing results of problem-solving testing

Social Communication Abilities

Reading Assessment

  • This extensive section includes the details of both formal as well as clinical reading testing including information on the child’s phonemic awareness abilities, decoding abilities, reading fluency and reading comprehension, summarization of read information, etc.

Written Assessment

  • This section contains results of formal and clinical writing assessments including spelling as well as writing composition

IMPRESSIONS

  • At this juncture I am ready to summarize the results of my assessment findings in detail. Here I discuss the severity of the impairment as well as list the areas in which deficits have been noted.

ICD-10 Diagnoses

  • Here I list relevant to the assessment diagnoses which were revealed by the conclusion of testing

CLASSROOM PLACEMENT RECOMMENDATIONS:

  • If necessary, this section discusses recommendations for alternative classroom placement. Here I include information regarding the class size, what additional therapies the child may need to receive, the need for additional classification/services, etc.

Instructional Accommodations to Improve Information Processing

  • Here I discuss my observations pertaining to accommodations which may be beneficial to the child in the school setting

ACCOMMODATIONS VS. REMEDIATION:

  • Here, I discuss the importance of providing direct remediation services versus mere accommodations and modifications alone

Knowledge Retention Recommendations:

  • This section may also be merited at times especially with severely impaired children who may not be able to process information presented to them in longer sentences

Adaptive Recommendations:

  • This section requires what adaptive modifications with respect to the child’s physical space, session materials, etc. may be needed in order for the child to succeed

Maintaining Factors (factors contributing to the maintenance of linguistic deficits)Image result for worse

  • Cognitive
  • Sensorimotor
  • Psychosocial
  • Linguistic

SUGGESTED THERAPY GOALS

  • As mentioned before this is a hugely important section which details the students long term as well as short-term goals which were derived based on the presence of deficit areas as documented throughout the assessment report

Reward system and rationale:

  • This may be a particularly important section for students with the greater degree of impairment as here we may be able to document what type of reward/reinforcements (intrinsic/extrinsic) work to for the student to motivate him/her to complete the assessment
  • If possible, an internal and social system of reward for targeted skill achievement (fostering, intrinsic motivation to take pride in own accomplishments) is strongly recommended

Goal Termination

  • Here I discuss the expectations for goal termination. I typically recommend a contingency of 90% or above accuracy marker over a period of 3 consecutive sessions

Expected duration of treatment

  • While it is often impossible to predict the duration of treatment, certain educated guesses may be taken to determine therapy length. This is frequently determined based on how rapidly the student progresses in therapy, the extent of parental involvement as evidenced or homework as well as carryover activities and exercises at home, any additional private therapy services as well as any additional school therapy services and support (e.g., reading instruction)

Image result for prognosisPrognosis

  • Here, once again depending on the extent of severity of the students deficits, a statement of prognosis may be made (e.g., “Good but cautious due to the above maintaining factors”)

Therapy Discharge:

  • Contingent on a successful reassessment of target deficit areas.

Appendices

  • This is a section where I provide any pertinent to the assessment documents such as the results of the prescriptive spelling test (e.g., SPELL-2) or a synopsis of a particular narrative (e.g., Dr. De Soto by William Steig) so that assessment readers could compare the student’s narrative production with expected production

So now that you know, what sections I include in my independent comprehensive language and literacy evaluations, I’d love to know if there are other sections/areas that you including yours? Post your thoughts and suggestions in the comments section below

Related Posts:

  1. Special Education Disputes and Comprehensive Language Testing: What Parents, Attorneys, and Advocates Need to Know
  2. On the Limitations of Using Vocabulary Tests with School-Aged Students
  3. Updated: What Does “Their Social Skills Are Just Fine” Really Means When it Comes to Children with Language Impairment
  4. Why Developmental History Matters: On the Importance of Background Information in Speech-Language Assessments
  5. The Importance of Narrative Assessments in Speech-Language Pathology (Revised)
  6. Analyzing Discourse Abilities of Adolescents via Peer Conflict Resolution (PCR) tasks
  7. What do Auditory Memory Deficits Indicate in the Presence of Average General Language Scores?
  8. Analyzing Narratives of School-Aged Children
  9. Adolescent Assessments in Action: Informal Reading Evaluation
  10. Dear Reading Specialist, May I Ask You a Few Questions? 
  11. Test Review of CELF-5 Metalinguistics: What SLPs Need to Know
  12. Do Our Therapy Goals Make Sense or How to Create Functional Language Intervention Targets
  13. Social Communication and Describing Skills: What is the Connection? 
  14. Recommendations for Assessing Language Abilities of Verbal Children with Down Syndrome (DS)
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Speech, Language, & Literacy Disorders in School Aged Children with Psychiatric Impairments

Recently I did a presentation for Rutgers University on the subject of  “Speech, Language, & Literacy Disorders in School-Aged Children with Psychiatric Impairments“. The learning objectives for this presentation were as follows:  

  • Explain the comorbidity between language impairments and psychiatric disturbances of school-aged children
  • Describe language and literacy deficits of school-aged children with psychiatric impairments
  • List warning signs of language and literacy deficits in school-aged children that warrant a referral to speech-language pathologists for a potential assessment

It focused on the fact that health professionals need to be aware of a significant comorbidity between psychiatric impairments and language disorders, in order to appropriately refer relevant children for potential assessment and treatment services to improve their social and academic outcomes.

This presentation was video recorded and can be accessed in its entirety below as we as on Youtube. You can also access the handouts which accompany the video HERE

References:

  • Angus, L. E., & McLeod, J. (Eds.) (2004). The handbook of narrative and psychotherapy. London, UK: Sage Publications
  • Aram, D.M., Ekelman, B.E., & Nation, J.E. (1984). Preschoolers with language disorders: 10 years later. Journal of Speech and Hearing Research, 27, 232-244.
  • Baltaxe,  C.  A. M., & Simmons,  J.  Q. (1988b).  Pragmatic deficits in  emotionally  disturbed  children  and  adolescents.  In  R. Schiefelbusch & L. Lloyd  (Eds.), Language perspectives (2nd ed.,  pp. 223-253).  Austin, TX: Pro-Ed.
  • Baker,  L.,  & Cantwell,  D. P. (1987b).  A prospective psychiatric  follow-up  of children  with  speech/language  disorders. Journal of the American Academy  of Child and Adolescent Psychiatry, 26, 546-553.
  • 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.
  • Benner, G.J., Nelson, R., & Epstein, M.H. (2002). Language skills of children with EBD: a literature review-emotional and behavioral disorders- statistical data included. Journal of Emotional and Behavioral Disorders, 10, 43-59.
  • Bishop, D. V., & Baird, G. (2001). Parent and teacher report of pragmatic aspects of communication: Use of the Children’s Communication Checklist in a clinical setting. Developmental Medicine & Child Neurology, 43(12), 809–818.
  • Brosnan, M.J. et al. (2004) Gestalt processing in autism: failure to process perceptual relationships and the implications for contextual understanding. The Journal of Child Psychology and Psychiatry, 45, 459–469
  • Bryan, T. (1991). Social problems and learning disabilities. In B. Y. L. Wong (Ed.), Learning about learning disabilities (pp. 195-229). San Diego, CA: Academic Press.
  • Cohen, N. & Barwick, M. (1996) Comorbidity of Language and Social-Emotional Disorders: Comparison of Psychiatric Outpatients and Their Siblings. Journal of Clinical Child Psychology, 25(2), 192-200.
  • 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.
  • —Gallagher, T. M. (1999). Interrelationships  among children’s language, behavior,  and emotional problems. Topics in  Language Disorders, 19, 1–15.
  • Gardner, R. (1993). Storytelling in psychotherapy with children. London, UK: Jason Aronson.
  • —Gilmour J, et al (2004). Social communication deficits in conduct disorder: a clinical and community study. J Child Psychol Psychiatry45: 967– 78.
  • Goldman, L. G. (1987). Social implications of learning disorders. Reading, Writing and Learning Disabilities, 3, 119-130.
  • —Gurney, D., Gersten, R., Dimino, J. & Carnine, D. (1990). Story grammar: Effective literature instruction for high school students with learning disabilities. Journal of Learning Disabilities, 23, 335-348.
  • Happé, F. G. E. (1994). An Advanced Test of Theory of Mind: Understanding of Story Characters’ Thoughts and Feelings by Able Autistic, Mentally Handicapped and Normal Children and Adults. Journal of Autism and Developmental Disorders, 24, 129-154.
  • Hill, J. W., & Coufal, K. L. (2005). Emotional/behavioral disorders: A retrospective examination of social skills, linguistics, and student outcomes. Communication Disorders Quarterly27(1), 33–46.
  • 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.
  • Hummel, L. J., & Prizant, B. M. (1993) A socioemotional perspective for understanding social difficulties of school-age children with language disorders. Language, Speech, and Hearing Services in Schools, 24, 216–224
  • Hyter, Y. D. (2003). Language intervention  for children with emotional or behavioral disorders. Behavioral  Disorders, 29, 65–76.
  • —Hyter, Y. D., et al (2001). Pragmatic language intervention for children with language and emotional/behavioral disorders. Communication Disorders Quarterly, 23(1), 4–16.—
  • Langton,S et al, (2000) Do the eyes have it? Cues to the direction of social attention. Trends in Cognitive Sciences, 4 (2) 50-59.
  • 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.
  • Nelson, J. R., Benner, G. J., & Cheney, D. (2005).An investigation of the language skills of students with emotional disturbance served in public school settings. Journal of Special Education39, 97–105.
  • 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.—
  • Prizant, B.M., et al. (1990). Communication disorders and emotional/behavioral disorders in children and adolescents. The Journal of Speech and Hearing Disorders, 55, 179-192.
  • —Semrud-Clikeman, M., & Glass, K. (2010).  The Relation of Humor and Child Development: Social, Adaptive, and Emotional Aspects.  Journal of Child Neurology, 25, 1248-1260.
  • Sanger, D., Maag, J. W., & Shapera, N. R. (1994). Language problems among students with emotional and behavioral disorders. Intervention in School and Clinic30(2), 103–108.
  • —Tallal, P., Dukette, D,. and Curtiss, S (1989) Behavioral Emotional Profiles of Preschool language impaired children. Development and Psychopathology (1) 51-67.
  • 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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Smart Speech Therapy Black Friday Sale!

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New Products for the 2017 Academic School Year for SLPs

Image result for back to schoolSeptember is quickly approaching and  school-based speech language pathologists (SLPs) are preparing to go back to work. Many of them are looking to update their arsenal of speech and language materials for the upcoming academic school year.

With that in mind, I wanted to update my readers regarding all the new products I have recently created with a focus on assessment and treatment in speech language pathology.

My most recent product Assessment of Adolescents with Language and Literacy Impairments in Speech Language Pathology  is a 130-slide pdf download which discusses how to effectively select assessment materials in order to conduct comprehensive evaluations of adolescents with suspected language and literacy disorders. It contains embedded links to ALL the books and research articles used in the development of this product.

Effective Reading Instruction Strategies for Intellectually Impaired Students is a 50-slide downloadable presentation in pdf format which describes how speech-language pathologists (SLPs) trained in assessment and intervention of literacy disorders (reading, spelling, and writing) can teach phonological awareness, phonics, as well as reading fluency skills to children with mild-moderate intellectual disabilities. It reviews the research on reading interventions conducted with children with intellectual disabilities, lists components of effective reading instruction as well as explains how to incorporate components of reading instruction into language therapy sessions.

Dysgraphia Checklist for School-Aged Children helps to identify the students’ specific written language deficits who may require further assessment and treatment services to improve their written abilities.

Processing Disorders: Controversial Aspects of Diagnosis and Treatment is a 28-slide downloadable pdf presentation which provides an introduction to processing disorders.  It describes the diversity of ‘APD’ symptoms as well as explains the current controversies pertaining to the validity of the ‘APD’ diagnosis.  It also discusses how the label “processing difficulties” often masks true language and learning deficits in students which require appropriate language and literacy assessment and targeted intervention services.

Checklist for Identification of Speech Language Disorders in Bilingual and Multicultural Children was created to assist Speech Language Pathologists (SLPs) and Teachers in the decision-making process of how to appropriately identify bilingual and 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.

Comprehensive Assessment and Treatment of Literacy Disorders in Speech-Language Pathology is a 125 slide presentation 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.

Improving critical thinking via picture booksImproving Critical Thinking Skills via Picture Books in Children with Language Disorders is a partial 30-slide presentation which discusses effective instructional strategies for teaching language disordered children critical thinking skills via the use of picture books utilizing both the Original (1956) and Revised (2001) Bloom’s Taxonomy: Cognitive Domain which encompasses the (R) categories of remembering, understanding, applying, analyzing, evaluating and creating.

from wordless books to reading From Wordless Picture Books to Reading Instruction: Effective Strategies for SLPs Working with Intellectually Impaired Students is a full 92 slide presentation which 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.

Best Practices in Bilingual LiteracyBest Practices in Bilingual Literacy Assessments and Interventions is a 105 slide presentation which 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.

Comprehensive Literacy Checklist For School-Aged Children 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.

You can find these and other products in my online store (HERE). Wishing all of you a highly successful and rewarding school year!

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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!

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