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Understanding the risks of social pragmatic deficits in post institutionalized internationally adopted (IA) children.

Image may contain: 1 person, textThis article was originally published in December 24, 2012 issue of Advance for Speech Language Pathologists and Audiologists under the title: “Adoption & Pragmatic Problems” (pp 6-9) 

Photo credits: Leonid Khavin

Cover Model: Bella Critelli

According to U.S. State Department, 233,934 children were adopted internationally between 1999-2011, with a majority 76 percent (or approximately 177,316) of these children being under 3 years of age.

To date a number of studies have come out about various aspects of these children’s language development, including but not limited to, rate of new language acquisition, patterns of typical vs. atypical language acquisition, as well as long-term language outcomes post-institutionalization.

While significant variability was found with respect to language gains and outcomes of internationally adopted children, a number of researchers found a correlation between age of adoption and language outcomes, namely, children adopted at younger ages (under 3 years of age) seem to present with better language/academic outcomes in the long-term vs. children adopted at older ages.1,2,3,4

Indeed, it certainly stands to reason that the less time children spend in an institutional environment, the better off they are in all areas of functioning (cognitive, emotional, linguistic, social, etc.). The longer the child stays in an institutional environment, the greater is the risk of greater delays, including a speech and language delay.

However, children adopted at younger ages, may also present with significant delays in select areas of functioning, many years post-adoption. Continue reading Understanding the risks of social pragmatic deficits in post institutionalized internationally adopted (IA) children.

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Fun and Educational Summer Board Games: Recommendations for SLPs and Parents

 

children-playingAccording to the New York Times Article which summarized the results of Johns Hopkins University study: A  TYPICAL STUDENT WILL LOSE ABOUT ONE  MONTH OF LEARNING OVER THE SUMMER  TIME.

More troubling is that it disproportionately affects low-income students: they lose two months of reading skills, while their higher-income peers — whose parents can send them to enriching camps, take them on educational vacations and surround them with books during the summer — make slight gains.”  To continue: “the study of students in Baltimore found that about two-thirds of the achievement gap between lower- and higher-income ninth graders could be explained by summer learning loss during the elementary school years.”

BUMMER!

But then again it is summer and kids do want to have fun!

So with the recent heatwaves across the country, how about combining fun with learning on those sweltering summer days when lazing at the pool or going outside may not be the best option.

Let’s take a look at the few common and readily available  board games, which can be used to improve various language abilities: including vocabulary knowledge, problem solving, questioning, storytelling as well as other language related skills.

 A to Z Jr– a game of early categorizations is recommended for players 5 – 10 years of age, but can be used with older children depending on their knowledge base. The object of the game is to cover all letters on your letter board by calling out words in specific categories before the timer runs out. This game can be used to increase word finding abilities in children with weak language skills as the categories range from simple (e.g., basic concepts) to more complicated (e.,. attributes). This game is great for several players of different age groups, since younger children or children with weaker knowledge and language skills can answer simpler questions and learn the answers to the harder questions as other players get their turn.

 Tribond Jr – is another great game which purpose is to determine how 3 seemingly random items are related to one another. Good for older children 7-12 years of age it’s also great for problem solving and reasoning as some of the answers are not so straight forward (e.g., what do the clock, orange and circle have in common? Psst…they are all round)

 Password Jr-is a great game to develop the skills of description. In the game you guess passwords based on the one word clues. This game is designed to play with children ages 7 years and older as long as you help the non readers with the cards. It’s great for encouraging children to become both better at describing and at listening. You may want to allow the children to select the word they want to describe in order to boost their confidence in own abilities. Provide visual cheat sheets (listing ways we can describe something such as: what does it do, where does it go, how can we use it etc) to the child as they will be much more likely to provide more complete descriptions of the target words given visual cues.

 Blurt – a game for children 10 and up is a game that works on a simple premise. Blurt out as many answers as you can in order to guess what the word is. Blurt provides ready-made definitions that you read off to players so they could start guessing what the word is. Players and teams use squares on the board strategically to advance by competing in various definition challenges that increase language opportunities.

Games the facilitate asking questions: Guess Who (age 6+),  Guess Where (age 6+), and  Mystery Garden (age 4+) are great for encouraging students to ask relevant questions in order to be the first to win the game. They are also terrific for encouraging reasoning skills. Questions have to be thought through carefully in order to be the first one to win the game.

Game that facilitates Story Telling as well as Perspective Taking:   Fib or Not (ages 10+) encourages the players to fool other players by either telling an outlandish true story or a truly believable made up story. For the players who are listening to the story, the objective is to correctly guess if the story teller is fibbing or being truthful. Players advance by fooling the other players or by guessing correctly.

Games that improve verbal reasoning and problem solving abilities: 30 Second Mysteries (ages 8-12) and 20 Questions for Kids (ages 7+).

In 30 Second Mysteries kids need to use critical thinking and deductive reasoning in order to solve mysteriously sounding cases of everyday events. Each clue read aloud reveals more about the mystery and the trick is to solve it given the fewest number of clues in order to gain the most points.

In 20 Questions for Kids, a guessing game of people, places, and things. Children need to generate original questions in order to obtain information. Here again, each clue read aloud reveals more about the secret identity and the trick is to solve it given the fewest number of clues.

Now that you know which games to play and why, how about you give it a try.

Have fun playing!

References:

Smink, J (2011) This is Your Brain on Summer. New York Times: The Opinion Pages. http://www.nytimes.com/2011/07/28/opinion/28smink.html?_r=1

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Adventures in Word-Finding or is Their Language Comprehension Really THAT Bad?

This summer I am taking an on-line course on word-finding with Dr. Diane German, and I must say, in addition to all the valuable information I have learned so far, this course has given me a brand new outlook on how to judge the language comprehension abilities of my clients with word finding difficulties.  It all started with a simple task, to determine the language comprehension abilities of my client with word finding deficits.  Based on available evidence I’ve collected over the period of time I’ve been working with him, I had determined that his comprehension was moderately impaired. I was then asked by Dr. German what language tasks I had used to make that determination?  She also pointed out that many of the formal language comprehension tasks I’ve listed in my report required an oral response.

That question really got me thinking. The truth of the matter is that many formal tests and informal assessments that probe language comprehension abilities rely on learners oral responses. But as it had been pointed out to me, what of our clients with impaired oral skills or significant word retrieval deficits? Most of the time we judge their language comprehension based on the quality of the oral responses they produce, and if their answers are not to our satisfaction, we make sweeping judgments regarding their comprehension abilities, which as Dr. German rightfully pointed out “is the kiss of death” for learners with word finding difficulties and could potentially result in “a spiral of failure”.

Now, in the case of this particular client in question, his language comprehension abilities were truly moderately impaired. I knew that because I tested him by showing him pictures of situations and asked him questions, which did not rely on oral responses but on him selecting the correct answer from a series of pictures and written sentences.

However, had I not performed the above tasks and simply relied on the “language comprehension” subtests from popular standardized tests alone, I would not have had a defensible answer and would have had to admit that I had no clue whether his language comprehension was truly as impaired as I had described.

Following that discussion I decided to take a “fresh look” at the other expressively impaired clients on my caseload but first I needed to figure out which tasks truly assessed my clients’ language comprehension abilities. I didn’t just want to assess their listening skills and vocabulary knowledge (some of the more “easily” assessed non-verbal skills). I wanted to know whether their memory, problem solving skills, figurative language, perspective taking abilities or knowledge of multiple meaning words were actually better than I had originally judged.

Thus, I set out to compile language comprehension materials (formal or informal), which could be used to assess various aspects of language comprehension (multiple meaning words, problem solving abilities, etc) without relying on the child’s ability to produce verbal responses.  However, this task turned out to be far more difficult than I had originally anticipated. For example, when I took a closer look at one of the more popular standardized tests available to me, such as the CELF-4, I realized that there were only two subtests on the first record form 5-8 years (“Concepts and Following Directions” and “Sentence Structure”) and 3 subtests on the second form 9-21 years (“Concepts & Following Directions”, “Sentence Assembly”, and “Semantic Relationships”) that relied on the listener’s ability to point to pictures or use written visuals to answer questions. Moreover, two of the subtests on the second record form (Sentence Assembly”, and “Semantic Relationships”) still required verbal responses.  All other subtests testing “listening comprehension abilities” relied purely on oral responses for correct score determination.

As I reviewed other popular tests (TOLD, CASL, OWLS, etc) I quickly realized that few of these tests’ subtests actually satisfied the above requirement.  Moreover, tests that actually did considerably rely on nonverbal responses (e.g., pointing) such as the Test for Auditory Comprehension of Language-3 (TACL-3) or the Test of Language Competence- Expanded Ed (TLC-Expanded Ed), were unfortunately not accessible to me at my place of work (although I did manage briefly to borrow both tests to assess some clients).

So, I decided to adapt some of the existing tests as well as create a few of my own materials to target language comprehension abilities in various areas.  Surprisingly, it wasn’t as difficult as I imagined it to be, though some tasks did require more creativity than others.

The easiest of course were the assessment of receptive vocabulary for nouns, verbs, and adjectives which was accomplished via standardized testing and story comprehension for which I created picture answers for the younger children and written multiple choice responses for the older children. Assessment of synonyms and antonyms was also doable. I again printed out the relevant pictures and then presented them students.  For example, to assess synonym knowledge the student was shown a relevant picture and asked to match it with another similar meaning word:  “show me another word for “trail” (requires the student to point to a picture depicting “path”) or “show me another word for “flame” (requires the student to point to a picture depicting “fire”). For recognition of antonyms, the student was presented with pictures of both synonyms and antonyms and told: “show me the opposite of child” or “show me the opposite of happy” and so on.

To assess the student’s understanding of “Multiple Meanings” I borrowed the sentences from the Language Processing Test-3 Elementary (LPT-3E), and printed out a few pictures from the internet. So instead of asking the student to explain what “Rose” means in the following sentences:  “Ask Rose to call me”, or “The sun rose over the mountains”, I asked the student to select and point to a corresponding picture from a group of visually related multiple meaning items.  For some children, I also increased the complexity by presenting to them pictures which required attention to details in order to answer the question correctly (e.g., differentiating between boy and girl for the first picture or between actual sunrise and sun peeking through the clouds for the second picture).   Similarly, to assess their problem solving abilities I again printed out pictures to go with select verbal reasoning questions: “Point to what you would do if …”; “Point to how you would solve the following situation…?”

I do have to admit that one of the more challenging subtests to adapt was the “Recalling Sentences” task.  For that I ended up creating similar sounding sentences and asked the child to select the appropriate response given visual multiple choice answers (e.g., point to which sentence did I just say? “The tractor was followed by the bus?” “The bus was followed by the tractor?” “The tractor was followed by the bicycle.”

Again, the point of this exercise was not to prove that the learners’ comprehension skills were indeed impaired but rather to assess whether their comprehension was as significantly impaired as was originally judged. Well the truth of the matter was that most of the children I’ve reassessed using the “pure” auditory comprehension tasks ended up doing much better on these tasks than on those which required verbal responses.

To illustrate, here is a recent case example. I was working with one student on strengthening his knowledge of geography related core vocabulary words (names of the continents and the major bodies of water surrounding them).  This boy had profound difficulty recalling the words even with maximal phonemic cues, after multiple sessions of drill instruction.   Typically after he was shown a specific continent and asked to name it he produced a semantically related response (“South America” for “North America”, “Arctic” for “Antarctica”, etc), which appeared to indicate that his “knowledge” of the words was impaired or at least highly inconsistent.  However, when the verbal naming task was completely eliminated and he was asked to show the examiner specifically named continents and bodies of water on a map (e.g., “Show me Europe”; “Show me Atlantic Ocean”, etc) he was able to do so with 90% accuracy over 3 trials indicating that he did have fairly solid knowledge of where each continent was located visually on a map.

Consequently, as Dr. German has rightly pointed out, when making judgment calls regarding language comprehension abilities of complex clients with severe or at least fairly involved expressive language difficulties, it is very important that SLP’s use tasks that require non verbal responses to questions (e.g., pointing, selecting a picture out of a group, etc), in order not to underestimate these children’s “true” comprehension abilities.

References and Resources:

German, D. J. (2009, Feb. 10). Child Word Finding: Student Voices Enlighten Us. The ASHA Leader, 14 (2), 10-13.

German, D.J. (2005) Word-Finding Intervention Program, Second Edition (WFIP-2)  Austin Texas: Pro.Ed

German, D.J. (2001) It’s on the Tip of My Tongue, Word Finding Strategies to Remember Names and Words You Often Forget.  Word Finding Materials, Inc.

Dr. German’s Word Finding Website: http://www.wordfinding.com/

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Improving Social Skills in Children With Psychiatric Disturbances Speechpathology.com Webinar

Will be presenting a webinar via speechpathology.com on July 2nd 2012 at 12pm EDT entitled

Improving Social Skills in Children with Psychiatric Disturbances

Course Abstract

This course is aimed at increasing the participants’ knowledge regarding the role of SLPs in the treatment of social pragmatic language disorders of school-age children with psychiatric impairments. It will review social pragmatic treatment approaches which can be used for children with psychiatric impairments, explain the functions of common challenging behaviors, as well as list a number of proactive behavioral intervention approaches professionals can implement to decrease challenging behaviors and increase compliance and cooperation in therapy sessions.

Course Objectives

  • After this course, participants will be able to identify social pragmatic deficit areas of children with psychiatric impairments.
  • After this course, participants will be able to describe components and targets of successful social skills treatments.
  • After this course, participants will be able to list common challenging behavior types and explain proactive behavior strategies used to prevent inappropriate behaviors from occurring.
  • After this course, participants will be able to describe social pragmatic treatment approaches that can be used for children with psychiatric impairments.
  • After this course, participants will be able to identify materials that can be used to address relevant social pragmatic treatment goals.
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The Efficacy of the Lidcombe Program for Stuttering Preschoolers

While the prevalence of stuttering varies according to age groups (preschool, school-age, etc), the incidence of stuttering is reported to be at approximately 5%, with the onset mainly occurring during the preschool years.  Based on the above,  it is estimated that approximately 2.5% of children under 5 years of age stutter (The Stuttering Foundation).

Despite the strides made by the current stuttering research, much confusion and misconceptions exist with respect to the treatment of stuttering in preschoolers. Many clinicians still continue to recommend that the parents ignore the child’s stuttering or use indirect environment modification approaches in the hopes that the child’s stuttering goes away. Further complicating this issue is that oftentimes many preschool children DO spontaneously recover from their stuttering several months post onset.

While oftentimes, it may be prudent to wait a few months to see how the onset of stuttering progresses, waiting too long may be quite problematic.  This is especially true for those children who become increasingly frustrated with their stuttering or those who begin to develop secondary stuttering characteristics (reactions to stuttering such as gaze avoidance, facial grimaces, extraneous body movements, words avoidance, etc).

When it comes to preschool children one intervention approach which has been highly successful to date is The Lidcombe Program. Developed in Australia, the Lidcombe Program is a fluency shaping program, which is highly effective for children 2-6 years of age who stutter.

It’s goal is to eliminate stuttering.  The program focuses on behavioral feedback provided in response to a child’s fluent speech.  However, it’s not the therapist who provides the treatment but the PARENTS. The researchers who developed the program firmly believe that the intervention has to take place in natural environments, and there’s nothing natural regarding the therapist’s office!

Based on theories of operant conditioning, the premise of the program is simple: parents praise stutter free speech and request for correction of stuttered speech.  The Lidcombe focuses on raising the child’s awareness of stuttering and encourages verbal reactions to stutter free speech.

To start, child and parent/s attend therapy sessions once a week.  The therapist teaches the parents the types of verbiage to use with their child in treatment as well as  how to rate their child’s weekly stuttering incidence on a 10-point stuttering severity scale in order to obtain a percent of stuttered syllables (%SS). Parents and therapist compare severity ratings (SR) and discuss discrepancies, if any. Therapist then supervises as parent administers treatment in session. For the rest of the week parents administered treatment in structured home setting in short increments (10 to 15 minutes each) 1 to 2 times per day.  As child’s awareness improves, parents’ switch from structured to unstructured settings in an effort to initiate generalization.

For more information about whether the Lidcombe Program is right for your child, visit their website or contact the speech language professionals specializing in this approach in your area.

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Upcoming New Jersey Speech Language and Hearing Convention 2012 Presentations

Tatyana Elleseff MA CCC-SLP will be giving 2 presentations at the NJSHA 2012 Convention on April 19-20, 2012

1. Presentation Title:     Behavior Management Strategies for School Based Speech Language Pathologists

Time:                         Thursday, April 19                8:15 AM – 10:15 AM

Summary: In recent years more and more school based speech-language pathologists have to work with children who present with behavioral deficits in conjunction to speech-language delays/impairments. A significant portion of work with these children in therapy sessions involves successful management of inappropriate behaviors such as excessive inattention, hyperactivity, aggression, opposition/non-compliance and/or apathy, which interferes with successful objective completion and goal attainment. This workshop will explain what type of common challenging behaviors can manifest in children with select communication, psychiatric, and neurological disorders.  It will outline behavior management strategy hierarchy from most to least intrusive methods for students with differing levels of cognitive functioning (high-average IQ to varying levels of MR). It will list positive proactive behavior management strategies to: prevent inappropriate behaviors from occurring, increase students’ session participation as well as improve compliance and cooperation during therapy sessions.

2. Presentation Title:     Social Pragmatic Assessment of Children Diagnosed with Emotional/Psychiatric Disturbances in the Schools

Time:                         Thursday, April 19              10:45 AM – 12:45 PM

Summary:  The number of children who present with non-spectrum emotional, behavioral, and psychiatric disturbances (oppositional defiant disorder, reactive attachment disorder, mood disorder, etc) has been steadily increasing in recent years. Many of these children attend district schools and due to high incidence of communication issues associated with these conditions, speech language pathologists are frequently included on the team of professionals who treat them.   This workshop is aimed at increasing the participants knowledge regarding aspects of social pragmatic language.  —By the end of the workshop participants will be able to list common pediatric psychiatric diagnoses, explain the impact of psychiatric disturbances on language development of children, summarize the role of SLP in assessment of pragmatic language and social cognitive abilities of school-age children, as well as utilize formal and informal assessment instruments to assess pragmatic language and social cognitive abilities of school age children.

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My new article was published in January 2012 issue of Adoption Today Magazine

My article entitled: Speech Language Strategies for Multisensory Stimulation of Internationally Adopted Children has been published in the January 2012 Issue of Adoption Today Magazine

Summary:  The article introduces the concept of multisensory stimulation and explains its benefits for internationally adopted children of all ages.  It also provides suggestions for parents and professionals on how to implement multisensory strategies in a variety of educational activities in order to stimulate interest, increase task participation as well as facilitate concept retention.

References:

Doman, G & Wilkinson, R (1993) The effects of intense multi-sensory stimulation on coma arousal and recovery. Neuropsychological Rehabilitation. 3 (2): 203-212.

Johnson, D. E et al (1992) The health of children adopted from Romania. Journal of the American Medical Association. 268(24): 3446-3450

Ti, K, Shin YH, & White-Traut, RC (2003), Multisensory intervention improves physical growth and illness rates in Korean orphaned newborn infants. Research in Nursing Health.  26 (6): 424-33.

Milev et al (2008) Multisensory Stimulation for Elderly With Dementia: A 24-Week Single-Blind Randomized Controlled Pilot Study. American Journal of Alzheimer’s Disease and Other Dementias. 23 (4): 372-376.

Tarullo, A & Gunnar, M (2006). Child Maltreatment and Developing HPA Axis. Hormones and Behavior 50, 632-639.

White Traut (1999) Developmental Intervention for Preterm Infants Diagnosed with Periventricular Leukomalacia. Research in Nursing Health.  22: 131-143.

White Traut et al (2009) Salivary Cortisol and Behavioral State Responses of Healthy Newborn Infants to Tactile-Only and Multisensory Interventions. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 38(1): 22–34

 Resources:

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Speech-Language Activity Suggestions for Multisensory Stimulation of At-Risk Children

In recent years the percentage of “at-risk children” has been steadily increasing across pediatric speech-language pathology caseloads.  These include adopted and foster care children, medically fragile children (e.g., failure to thrive), abused and neglected children, children from low socioeconomic backgrounds or any children who for any reason lack the adequate support system to encourage them to function optimally socially, emotionally, intellectually, or physically.

At times speech-language pathologists encounter barriers when working with this population, which include low motivation, inconsistent knowledge retention, as well as halting or labored progress in therapy.

As a speech-language pathologist whose caseload consists entirely of at-children, I have spent countless of hours on attempting to enhance service delivery for my clients. One method that I have found to be highly effective for greater knowledge retention as well as for increasing the kids’ motivation is incorporating multisensory stimulation in speech and language activities.

To date, a number of studies have described the advantages of multisensory stimulation for various at risk populations. For example, in 2003 a study published in Journal of Research in Nursing and Health described the advantages of multisensory stimulation for 2 week old Korean orphans who received auditory, tactile, and visual stimulation twice a day, 5 days a week, for 4 weeks. This resulted in significantly fewer illnesses as well as significant gains in weight, length and head circumference, after the 4-week intervention period and at 6 months of age. Another 2009 study by White Traut and colleagues published in the Journal of Obstetric, Gynecologic, & Neonatal Nursing, found that multi sensory stimulation consisting of auditory, tactile, visual, and vestibular intervention contributed to a reduction of infant stress reactivity (steady decline in cortisol levels).   Moreover, multisensory stimulation is not just beneficial for young children. Other studies found benefits of multisensory stimulation for dementia (Milev et al, 2008) and coma patients (Doman & Wilkinson, 1993), indicating the usefulness of multisensory stimulation for a variety of at risk populations of different age groups.

After reviewing some studies and successfully implementing a number of strategies I wanted to share with you some of my favorite multisensory activities for different age-groups.

Before initiating any activities please remember to obtain parental permissions as well as a clearance from the occupational therapist (if the child is receiving related services), particularly if the child presents with significant sensory issues.  It is also very important to ensure that there are no food allergies, or nutritional restrictions, especially when it comes to working with new and unfamiliar clients on your caseload.

Multisensory stimulation for young children does not have to involve stimulation of all the senses at once. However, there are a number of activities which come quite close, especially when one combines “touch ‘n’ feel” books, musical puzzles as well as paper and edible crafts.

Here’s one of my favorite speech language therapy session activities for children 2-4 years of age. I use a board book called Percival Touch ‘n’ Feel Book to teach insect and animal related vocabulary words as well as talk about adjectives describing textures (furry, smooth, bumpy, sticky, etc).  As I help the children navigate the book, they get to touch the pages and talk about various plant and animals parts such as furry caterpillar dots, shiny flower petals, bumpy frog skin, or sticky spider web.   We also work on appropriately producing multisyllabic words and on combining the words into short sentences, depending of course, on the child’s age, skills, and abilities.   With this activity I often use animal and insect musical puzzles so the children can hear and then imitate select animal and insect noises.

Also, since all of Percival’s friends are garden insects and animals, it’s fairly easy to turn the book characters into paper crafts. Color paper templates are available from free websites such as www.dltk-kids.com, and range in complexity based on the child’s age (e.g., 2+, 3+ etc).  While looking innocuously like simple paper cutouts, in reality these crafts are a linguistic treasure trove and can be used for teaching simple and complex directions (e.g., after you glue the frog’s arm, glue on his foot) as well as prepositional concepts (e.g., glue the eyes on top of the head; glue the mouth below the nose, etc).

So far we have combined the tactile with the auditory and the visual but we are still missing the stimulation of a few other senses such as the olfactory and the gustatory.  For these we need a bit more creativity, and that’s where edible crafts come in (inspired by Janell Cannon’s ‘Crickwing’).  The child and I begin by constructing and gluing together a large paper flower and dabbing it’s petals with various food extracts (almond, vanilla, raspberry, lemon, root beer, banana, cherry, coconut, etc).  Then, using the paper flower as a model, we make an edible flower using various foods.  Pretzel sticks serve as stems, snap peas become leaves while mango, tomato, apple, peach and orange slices can serve as petals.  After our food craft is finished the child (and all other therapy participants) are encouraged to take it apart and eat it.  The edible flower is not just useful to stimulate the visual, tactile, gustatory, and olfactory senses but it also encourages picky eaters to trial new foods with a variety of textures and tastes, as well as serves to develop symbolic play and early abstract thinking skills.

It is also important to emphasize that multisensory activities are not just for younger children; they can be useful for school-age children as well (including middle school and high school aged kids). In the past, I have incorporated multisensory activities into thematic language and vocabulary units for older children (see resources below) while working on the topics such as the senses (e.g., edible tasting plate), nutrition (e.g., edible food pyramid), the human body (e.g., computer games such as whack a bone by anatomy arcade), or even biology (building plant and animal cell structures out of jello and candy). From my personal clinical experience I have noticed that when I utilized the multisensory approach to learning vs. auditory and visual approaches alone (such as paper based or computer based tasks only), the children evidenced greater task participation, were able to understand the material much faster and were still able to recall learned information appropriately several therapy sessions later.

I find multisensory stimulation to be a fun and interactive way to increase the child’s learning potential, decrease stress levels, as well as increase retention of relevant concepts.  Try it and let me know how it works for you!

 References:

·         Doman, G & Wilkinson, R (1993) The effects of intense multi-sensory stimulation on coma arousal and recovery. Neuropsychological Rehabilitation. 3 (2): 203-212.

·         Ti, K, Shin YH, & White-Traut, RC (2003), Multisensory intervention improves physical growth and illness rates in Korean orphaned newborn infants. Research in Nursing Health.  26 (6): 424-33.

·         Milev et al (2008) Multisensory Stimulation for Elderly With Dementia: A 24-Week Single-Blind Randomized Controlled Pilot Study. American Journal of Alzheimer’s Disease and Other Dementias. 23 (4): 372-376.

·         Tarullo, A & Gunnar, M (2006). Child Maltreatment and Developing HPA Axis. Hormones and Behavior 50, 632-639.

  • White Traut (1999) Developmental Intervention for Preterm Infants Diagnosed with Periventricular Leukomalacia. Research in Nursing Health.  22: 131-143.

·         White Traut et al (2009) Salivary Cortisol and Behavioral State Responses of Healthy Newborn Infants to Tactile-Only and Multisensory Interventions. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 38(1): 22–34

 Resources:

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Dept of Children & Families / NJ Task Force on Child Abuse & Neglect Presentation

 

 

 

 

October 21, 2011: East Brunswick NJ

The Department of Children and Families and the New Jersey Task Force on Child Abuse and Neglect  had a  statewide child maltreatment prevention conference today and I had great fun doing today’s presentation:

Differential Diagnosis of Inattention, Hyperactivity and Impulsivity in At-Risk Children” with our clinical team, Alla Gordina, MD, FAAP and Lydia Shifrin, LCSW.

We had a terrific crowd, who asked great questions and gave excellent feedback.

Presentation Highlights:

Attention Deficit/Hyperactivity Disorder is one of the most common and  the most controversial neurobehavioral disorders in children diagnosed today

Core symptoms of ADHD include  Inattention, Impulsivity and Hyperactivity

Some ADHD statistics:

  • Approximately 9.5% or 5.4 million children 4-17 years of age have ever been diagnosed with ADHD, as of 2007.
  • The percentage of children with a parent-reported ADHD diagnosis increased by 22% between 2003 and 2007.
  • Rates of ADHD diagnosis increased an average of 3% per year from 1997 to 2006 and an average of 5.5% per year from 2003 to 2007.
  • Boys (13.2%) were more likely than girls (5.6%) to have ever been diagnosed with ADHD.
  • The highest rates of parent-reported ADHD diagnosis were noted among children covered by Medicaid and multiracial children.

However,  numerous medical, psychiatric, neurological, psychological, speech-language and other disorders are frequently misdiagnosed as ADHD

NEARLY 1 MILLION CHILDREN ARE MISDIAGNOSED WITH ADHD

“Since ADHD is an underlying neurological problem where incidence rates should not change dramatically from one birth date to the next, these results suggest that age relative to peers in class, and the resulting differences in behavior, directly affects a child’s probability of being diagnosed with and treated for ADHD.”  (Elder, 2010). Journal of Health Economics

 

Disorders frequently misdiagnosed as AD/HD :

  • Respiratory Disorders (e.g., adenoid hypertrophy, asthma, allergic rhinitis)
  • Metabolic /Endocrine Disorders (e.g.,  diabetes, hypo/hyperthyroidism)
  • Hematological Disorders  (e.g., anemia)
  • Immunological Disorders (acquired and congenital immune problems)
  • Cardiac Disorders (e.g., congenital and acquired heart disease, syncopy)
  • Digestive  Disorders (e.g., irritable bowel syndrome, GERD, etc)
  • Neurological Disorders  (e.g., Traumatic Brain Injuries, Tumors, Encephalopathy, etc)
  • Sleep Disorders
  • Genetic Disorders (e.g., FASD, Fragile X Syndrome)
  • Toxin Exposure (e.g., Lead, Mercury, Drug Exposure)
  • Infections and Infestations (e.g., yeast overgrowth , intestinal worms/parasites)
  • Mental Health Disorders (e.g., anxiety, mood disorders, adjustment disorders)
  • Mental Retardation
  • Sensory Processing Disorders (vision, hearing, auditory, tactile)
  • Language Processing Disorders
  • Auditory processing Disorders

My presentation focused on explaining that having select language based difficulties can cause the child to act as inattentive, hyperactive and impulsive without actually having ADHD

My examples included:

  • Traumatic Brain Injury
  • Severe Language Delay
  • Auditory Processing Disorders
  • Social Pragmatic Language Deficits

Relevance and Implications for Adoption Professionals:

  • Multidisciplinary approach to identification, differential diagnosis, and management of disorders with “AD/HD” symptoms is NEEDED
  • One individual assessment (e.g.,  psychological) CANNOT reliably determine accurate diagnosis, especially when the diagnostic criteria is based on generalized symptomology
  • Refer adopted children with behavioral, listening, sensory, and any unusual deficits for multidisciplinary assessments which include in depth assessment of language abilities before making a conclusive diagnosis
  • Children who receive one assessment ONLY are at risk of misdiagnosis, misidentification, and are delayed in getting appropriate intervention services
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AAP: Council on Foster Care, Adoption and Kinship Care Presentation

Boston MA- First conference of the Fall 2011 season:

October 17, 2011: Got to co-present with my favorite pediatrician (Alla Gordina, MD, FAAP) an interesting clinical case in front of American Academy Of Pediatrics: Council on Foster Care, Adoption and Kinship Care. Granted my part was via phone and connection wasn’t great but it so nice to see medical professionals being interested in ancillary professionals’ perspective on issues of internationally adopted children.

Presentation Title: A Case of Isolated Social Pragmatic Language Deficits in an Internationally Adopted Child

Presentation Highlights:

Language based deficits may affect internationally adopted children many years post adoption

Even children adopted at very young ages can present with subtle BUT significant delays in select areas of functioning (see below)

One such delay may be in the area of social pragmatic functioning  or the use of language

Select examples of social pragmatic deficits include:

  • Impaired ability to appropriately interpret social situations, events and contexts
  • Impaired ability to create and convey messages to different audiences (adults vs. children)
  • Impaired ability to interpret facial expressions, body language and gestures
  • Difficulty labeling and identifying basic emotions of self and others
  • Poor or absent perspective taking (understanding thoughts and feelings of others)
  • Inappropriate initiation of social interactions (e.g., not knowing how to start a conversation or appropriately interrupt a game)
  • Comprehension of age-level abstract and inferential information (stories, sarcasm, figurative language, etc)
  • Missing “the big picture” (integrating ideas into a whole, synthesizing and summarizing information)
  • Poor connection and relatedness to peers

Implications for Professionals:

Very easy to misdiagnose a child with social pragmatic deficits as someone with psychiatric disturbances (e.g., ADHD or Autism) without multidisciplinary differential diagnosis

“Low risk referrals” do carry a significant risk of deprivation-related issues, which can surface years after adoption

Internationally adopted children with behavioral, listening, sensory, and any unusual deficits need a differential  diagnosis (including assessment of language abilities before a conclusive diagnosis is made)