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

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

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Phonological Awareness Screening App Review: ProPA

pro-pa-img1Summer is in full swing and for many SLPs that means a welcome break from work. However, for me, it’s business as usual, since my program is year around, and we have just started our extended school year program.

Of course, even my program is a bit light on activities during the summer. There are lots of field trips, creative and imaginative play, as well as less focus on academics as compared to during the school year. However, I’m also highly cognizant of summer learning loss, which is the phenomena characterized by the loss of academic skills and knowledge over the course of summer holidays.

Image result for summer learning loss

According to Cooper et al, 1996, while generally, typical students lose about one month of learning, there is actually a significant degree of variability of loss based on SES. According to Cooper’s study, low-income students lose approximately two months of achievement. Furthermore, ethnic minorities, twice-exceptional students (2xE), as well as students with language disorders tend to be disproportionately affected (Graham et al, 2011;  Kim & Guryan, 2010; Kim, 2004). Finally, it is important to note that according to research, summer loss is particularly prominent in the area of literacy (Graham et al, 2011).

So this summer I have been busy screening the phonological awareness abilities (PA) of an influx of new students (our program enrolls quite a few students during the ESY), as well as rescreening PA abilities of students already on my caseload, who have been receiving services in this area for the past few months.

Why do I intensively focus on phonological awareness (PA)? Because PA is a precursor to emergent reading. It helps children to manipulate sounds in words (see Age of Aquisition of PA Skills). Children need to attain PA mastery (along with a host of a few literacy-related skills) in order to become good readers.

When children exhibit poor PA skills for their age it is a red flag for reading disabilities. Thus it is very important to assess the child’s PA abilities in order to determine their proficiency in this area.

While there are a number of comprehensive tests available in this area, for the purposes of my screening I prefer to use the ProPA app by Smarty Ears.

pro-pa-img14

The Profile of Phonological Awareness (Pro-PA) is an informal phonological awareness screening. According to the developers on average it takes approximately 10 to 20 minutes to administer based on the child’s age and skill levels. In my particular setting (outpatient school based in a psychiatric hospital) it takes approximately 30 minutes to administer to students on the individual basis. It is by no means a comprehensive tool such as the CTOPP-2 or the PAT-2, as there are not enough trials, complexity or PA categories to qualify for a full-blown informal assessment. However, it is a highly useful measure for a quick determination of the students’ strengths and weaknesses with respect to their phonological awareness abilities. Given its current retail price of $29.99 on iTunes, it is a relatively affordable phonological awareness screening option, as the app allows its users to store data, and generates a two-page report at the completion of the screening.

The Pro-PA assesses six different skill areas:

  • Rhyming
    • Identification
    • Production
  • Blending
    • Syllables
    • Sounds
  • Sound Isolation
    • Initial
    • Final
    • Medial
  • Segmentation
    • Words in sentences
    • Syllables in words
    • Sounds in words
    • Words with consonant clusters
  • Deletion
    • Syllables
    • Sounds
    • Words with consonant clusters
  • Substitution
    • Sounds in initial position of words
    • Sounds in final position of words

pro-pa-img21After the completion of the screening, the app generates a two-page report which describes the students’ abilities as:

  • Achieved (80%+ accuracy)
  • Not achieved (0-50% accuracy)
  • Emerging (~50-79% accuracy)

The above is perfect for quickly tracking progress or for generating phonological awareness goals to target the students’ phonological awareness weaknesses. While the report can certainly be provided as an attachment to parents and teachers, I usually tend to summarize its findings in my own reports for the purpose of brevity. Below is one example of what that looks like:

pro-pa-img29The Profile of Phonological Awareness (Pro-PA), an informal phonological awareness screening was administered to “Justine” in May 2017 to further determine the extent of her phonological awareness strengths and weaknesses.

On the Pro-PA, “Justine” evidenced strengths (80-100% accuracy) in the areas of rhyme identification, initial and final sound isolation in words, syllable segmentation, as well as substitution of sounds in initial position in words.

She also evidenced emerging abilities (~60-66% accuracy) in the areas of syllable and sound blending in words, as well as sound segmentation in CVC words,

However, Pro-PA assessment also revealed weaknesses (inability to perform) in the areas of: rhyme production, isolation of medial sounds in words, segmentation of words, segmentation of sounds in words with consonant blends,deletion of first sounds,  consonant clusters, as well as substitution of sounds in final position in words. Continuation of therapeutic intervention is recommended in order to improve “Justine’s” abilities in these phonological awareness areas.

Now you know how I quickly screen and rescreen my students’ phonological awareness abilities, I’d love to hear from you! What screening instruments are you using (free or paid) to assess your students’ phonological awareness abilities? Do you feel that they are more or less comprehensive/convenient than ProPA?

References:

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A Focus on Literacy

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

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

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

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

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

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

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

Helpful Smart Speech Therapy Resources:

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What Research Shows About the Functional Relevance of Standardized Language Tests

Image result for standardized language testsAs an SLP who routinely conducts speech and language assessments in several settings (e.g., school and private practice), I understand the utility of and the need for standardized speech, language, and literacy tests.  However, as an SLP who works with children with dramatically varying degree of cognition, abilities, and skill-sets, I also highly value supplementing these standardized tests with functional and dynamic assessments, interactions, and observations.

Since a significant value is placed on standardized testing by both schools and insurance companies for the purposes of service provision and reimbursement, I wanted to summarize in today’s post the findings of recent articles on this topic.  Since my primary interest lies in assessing and treating school-age children, for the purposes of today’s post all of the reviewed articles came directly from the Language Speech and Hearing Services in Schools  (LSHSS) journal.

We’ve all been there. We’ve all had situations in which students scored on the low end of normal, or had a few subtest scores in the below average range, which equaled  an average total score.  We’ve all poured over eligibility requirements trying to figure out whether the student should receive therapy services given the stringent standardized testing criteria in some states/districts.

Of course, as it turns out, the answer is never simple.  In 2006, Spaulding, Plante & Farinella set out to examine the assumption: “that children with language impairment will receive low scores on standardized tests, and therefore [those] low scores will accurately identify these children” (61).   So they analyzed the data from 43 commercially available child language tests to identify whether evidence exists to support their use in identifying language impairment in children.

Turns out it did not!  Turns out due to the variation in psychometric properties of various tests (see article for specific details), many children with language impairment are overlooked by standardized tests by receiving scores within the average range or not receiving low enough scores to qualify for services. Thus, “the clinical consequence is that a child who truly has a language impairment has a roughly equal chance of being correctly or incorrectly identified, depending on the test that he or she is given.” Furthermore, “even if a child is diagnosed accurately as language impaired at one point in time, future diagnoses may lead to the false perception that the child has recovered, depending on the test(s) that he or she has been given (69).”

Consequently, they created a decision tree (see below) with recommendations for clinicians using standardized testing. They recommend using alternate sources of data (sensitivity and specificity rates) to support accurate identification (available for a small subset of select tests).

The idea behind it is: “if sensitivity and specificity data are strong, and these data were derived from subjects who are comparable to the child tested, then the clinician can be relatively confident in relying on the test score data to aid his or her diagnostic decision. However, if the data are weak, then more caution is warranted and other sources of information on the child’s status might have primacy in making a diagnosis (70).”

Fast forward 6 years, and a number of newly revised tests later,  in 2012, Spaulding and colleagues set out to “identify various U.S. state education departments’ criteria for determining the severity of language impairment in children, with particular focus on the use of norm-referenced tests” as well as to “determine if norm-referenced tests of child language were developed for the purpose of identifying the severity of children’s language impairment”  (176).

They obtained published procedures for severity determinations from available U.S. state education departments, which specified the use of norm-referenced tests, and reviewed the manuals for 45 norm-referenced tests of child language to determine if each test was designed to identify the degree of a child’s language impairment.

What they found out was “the degree of use and cutoff-point criteria for severity determination varied across states. No cutoff-point criteria aligned with the severity cutoff points described within the test manuals. Furthermore, tests that included severity information lacked empirical data on how the severity categories were derived (176).”

Thus they urged SLPs to exercise caution in determining the severity of children’s language impairment via norm-referenced test performance “given the inconsistency in guidelines and lack of empirical data within test manuals to support this use (176)”.

Following the publication of this article, Ireland, Hall-Mills & Millikin issued a response to the  Spaulding and colleagues article. They pointed out that the “severity of language impairment is only one piece of information considered by a team for the determination of eligibility for special education and related services”.  They noted that  they left out a host of federal and state guideline requirements and “did not provide an analysis of the regulations governing special education evaluation and criteria for determining eligibility (320).” They pointed out that “IDEA prohibits the use of ‘any single measure or assessment as the sole criterion’ for determination of disability  and requires that IEP teams ‘draw upon information from a variety of sources.”

They listed a variety of examples from several different state departments of education (FL, NC, VA, etc.), which mandate the use of functional assessments, dynamic assessments criterion-referenced assessments, etc. for their determination of language therapy eligibility.

But are the SLPs from across the country appropriately using the federal and state guidelines in order to determine eligibility? While one should certainly hope so, it does not always seem to be the case.  To illustrate, in 2012, Betz & colleagues asked 364 SLPs to complete a survey “regarding how frequently they used specific standardized tests when diagnosing suspected specific language impairment (SLI) (133).”

Their purpose was to determine “whether the quality of standardized tests, as measured by the test’s psychometric properties, is related to how frequently the tests are used in clinical practice” (133).

What they found out was that the most frequently used tests were the comprehensive assessments including the Clinical Evaluation of Language Fundamentals and the Preschool Language Scale as well as one word vocabulary tests such as the Peabody Picture Vocabulary Test. Furthermore, the date of publication seemed to be the only factor which affected the frequency of test selection.

They also found out that frequently SLPs did not follow up the comprehensive standardized testing with domain specific assessments (critical thinking, social communication, etc.) but instead used the vocabulary testing as a second measure.  They were understandably puzzled by that finding. “The emphasis placed on vocabulary measures is intriguing because although vocabulary is often a weakness in children with SLI (e.g., Stothard et al., 1998), the research to date does not show vocabulary to be more impaired than other language domains in children with SLI (140).

According to the authors, “perhaps the most discouraging finding of this study was the lack of a correlation between frequency of test use and test accuracy, measured both in terms of sensitivity/specificity and mean difference scores (141).”

If since the time (2012) SLPs have not significantly change their practices, the above is certainly disheartening, as it implies that rather than being true diagnosticians, SLPs are using whatever is at hand that has been purchased by their department to indiscriminately assess students with suspected speech language disorders. If that is truly the case, it certainly places into question the Ireland, Hall-Mills & Millikin’s response to Spaulding and colleagues.  In other words, though SLPs are aware that they need to comply with state and federal regulations when it comes to unbiased and targeted assessments of children with suspected language disorders, they may not actually be using appropriate standardized testing much less supplementary informal assessments (e.g., dynamic, narrative, language sampling) in order to administer well-rounded assessments.  

So where do we go from here? Well, it’s quite simple really!   We already know what the problem is. Based on the above articles we know that:

  1. Standardized tests possess significant limitations
  2. They are not used with optimal effectiveness by many SLPs
  3.  They may not be frequently supplemented by relevant and targeted informal assessment measures in order to improve the accuracy of disorder determination and subsequent therapy eligibility

Now that we have identified a problem, we need to develop and consistently implement effective practices to ameliorate it.  These include researching psychometric properties of tests to review sample size, sensitivity and specificity, etc, use domain specific assessments to supplement administration of comprehensive testing, as well as supplement standardized testing with a plethora of functional assessments.

SLPs can review testing manuals and consult with colleagues when they feel that the standardized testing is underidentifying students with language impairments (e.g., HERE and HERE).  They can utilize referral checklists (e.g., HERE) in order to pinpoint the students’ most significant difficulties. Finally, they can develop and consistently implement informal assessment practices (e.g., HERE and HERE) during testing in order to gain a better grasp on their students’ TRUE linguistic functioning.

Stay tuned for the second portion of this post entitled: “What Research Shows About the Functional Relevance of Standardized Speech Tests?” to find out the best practices in the assessment of speech sound disorders in children.

References:

  1. Spaulding, Plante & Farinella (2006) Eligibility Criteria for Language Impairment: Is the Low End of Normal Always Appropriate?
  2. Spaulding, Szulga, & Figueria (2012) Using Norm-Referenced Tests to Determine Severity of Language Impairment in Children: Disconnect Between U.S. Policy Makers and Test Developers
  3. Ireland, Hall-Mills & Millikin (2012) Appropriate Implementation of Severity Ratings, Regulations, and State Guidance: A Response to “Using Norm-Referenced Tests to Determine Severity of Language Impairment in Children: Disconnect Between U.S. Policy Makers and Test Developers” by Spaulding, Szulga, & Figueria (2012)
  4. Betz et al. (2013) Factors Influencing the Selection of Standardized Tests for the Diagnosis of Specific Language Impairment

 

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Intervention at the Last Moment or Why We Need Better Preschool Evaluations

“Well, the school did their evaluations and he doesn’t qualify for services” tells me a parent of a 3.5 year old, newly admitted private practice client.  “I just don’t get it” she says bemusedly, “It is so obvious to anyone who spends even 10 minutes with him that his language is nowhere near other kids his age!” “How can this happen?” she asks frustratedly?

This parent is not alone in her sentiment. In my private practice I frequently see preschool children with speech language impairments who for all intents and purposes should have qualified for preschool- based speech language services but do not due to questionable testing practices.

To illustrate, several years ago in my private practice, I started seeing a young preschool girl, 3.2 years of age. Just prior to turning 3, she underwent a collaborative school-based social, psychological, educational, and speech language evaluation.  The 4 combined evaluators from each field only used one standardized assessment instrument “The Battelle Developmental Inventory – Second Edition (BDI-2)” along with a limited ‘structured observation’, without performing any functional or dynamic assessments and found the child to be ineligible for services on account of a low average total score on the BDI-2.

However, during the first session working 1:1 with this client at the age of 3.2 a number of things became very apparent.  The child had very limited highly echolalic verbal output primarily composed of one-word utterances and select two-word phrases.  She had highly limited receptive vocabulary and could not consistently point to basic pictures denoting common household objects and items (e.g., chair, socks, clock, sun, etc.)  Similarly, expressively she exhibited a number of inconsistencies when labeling simple nouns (e.g., called tree a flower, monkey a dog, and sofa a chair, etc.)  Clearly this child’s abilities were nowhere near age level, so how could she possibly not qualify for preschool based services?

Further work with the child over the next several years yielded slow, labored, and inconsistent gains in the areas of listening, speaking, and social communication.  I’ve also had a number of concerns regarding her intellectual abilities that I had shared with the parents.  Finally, two years after preschool eligibility services were denied to this child, she underwent a second round of re-evaluations with the school district at the age of 5.2.

This time around she qualified with bells on! The same speech language pathologist and psychologist who assessed her first time around two years ago, now readily documented significant communication (Preschool Language Scale-5-PLS-5 scores in the 1st % of functioning) and cognitive deficits (Full Scale Intelligence Quotient-FSIQ in low 50’s).

Here is the problem though. This is not a child who had suddenly regressed in her abilities.  This is a child who actually had improved her abilities in all language domains due to private language therapy services.  Her deficits very clearly existed at the time of her first school-based assessment and had continued to persist over time. For the duration of two years this child could have significantly benefited from free and appropriate education in school setting, which was denied to her due to highly limited preschool assessment practices.

Today, I am writing this post to shed light on this issue, which I’m pretty certain is not just confined to the state of New Jersey.  I am writing this post not simply to complain but to inform parents and educators alike on what actually constitutes an appropriate preschool speech-language assessment.

As per NJAC 6A:14-2.5  Protection in evaluation procedures (pgs. 29-30)

(a) In conducting an evaluation, each district board of education shall:

  1. Use a variety of assessment tools and strategies to gather relevant functional and developmental information, including information:
  2. Provided by the parent that may assist in determining whether a child is a student with a disability and in determining the content of the student’s IEP; and
  3. Related to enabling the student to be involved in and progress in the general education curriculum or, for preschool children with disabilities, to participate in appropriate activities;
  4. Not use any single procedure as the sole criterion for determining whether a student is a student with a disability or determining an appropriate educational program for the student; and
  5. Use technically sound instruments that may assess the relative contribution of cognitive and behavioral factors, in addition to physical or developmental factors.

Furthermore, according to the New Special Education Code: N.J.A.C. 6A:14-3.5(c)10 (please refer to your state’s eligibility criteria to find similar guidelinesthe eligibility of a “preschool child with a disability” applies to any student between 3-5 years of age with an identified disabling condition adversely affecting learning/development  (e.g., genetic syndrome), a 33% delay in one developmental area, or a 25% percent delay in two or more developmental areas below :

  1. Physical, including gross/fine motor and sensory (vision and hearing)
  2. Intellectual
  3. Communication
  4. Social/emotional
  5. Adaptive

—These delays can be receptive (listening) or expressive (speaking) and need not be based on a total test score but rather on all testing findings with a minimum of at least two assessments being performed.  A determination of adverse impact in academic and non-academic areas (e.g., social functioning) needs to take place in order for special education and related services be provided.  Additionally, a delay in articulation can serve as a basis for consideration of eligibility as well.

—Moreover, according to  the —State Education Agencies Communication Disabilities Council (SEACDC) Consulatent for NJ – Fran Liebner, the BDI-2 is not the only test which can be used to determine eligibility, since the nature and scope of the evaluation must be determined based on parent, teacher and IEP team feedback.

In fact, New Jersey’s Special Education Code, N.J.A.C. 6A:14 prescribes no specific test in its eligibility requirements.  While it is true that for NJ districts participating in Indicator 7 (Preschool Outcomes) BDI-2 is a required collection tool it does NOT preclude the team from deciding what other diagnostic tools are needed to assess all areas of suspected disability to determine eligibility. 

Speech pathologists have many tests available to them when assessing young preschool children 2 to 6 years of age.

SELECT SPEECH PATHOLOGY TESTS FOR PRESCHOOL CHILDREN (2-6 years of age)

 Articulation:

  • Sunny Articulation Test (SAPT)** Ages: All (nonstandardized)
  • Clinical Assessment of Articulation and Phonology-2 (CAAP-2) Ages: 2.6+
  • Linguisystems Articulation Test (LAT) Ages: 3+
  • Goldman Fristoe Test of Articulation-3 (GFTA-3)    Ages: 2+

 Fluency:

  • Stuttering Severity Instrument -4 (SSI-4) Ages: 2+
  • Test of Childhood Stuttering (TOCS) Ages 4+

General Language: 

  • Preschool Language Assessment Instrument-2 (PLAI-2)  Ages: 3+
  • Clinical Evaluation of Language Fundamentals -Preschool 2 (CELF-P2) Ages: 3+
  • Test of Early Language Development, Third Edition (TELD-3) Ages: 2+
  • Test of Auditory Comprehension of Language Third Edition (TACL-4)      Ages: 3+
  • Preschool Language Scale-5 (PLS-5)* (use with extreme caution) Ages: Birth-7:11

Vocabulary

  • Receptive One-Word Picture Vocabulary Test-4 (ROWPVT-4)  Ages 2+
  • Expressive One-Word Picture Vocabulary Test-4 (EOWPVT-4) Ages 2+
  • Montgomery Assessment of Vocabulary Acquisition (MAVA) 3+
  • Test of Word Finding-3 (TWF-3) Ages 4.6+

Auditory Processing and Phonological Awareness

  • Auditory Skills Assessment (ASA)    Ages 3:6+
  • Test of Auditory Processing Skills-3 (TAPS-3) Ages 4+
  • Comprehensive Test of Phonological Processing-2 (CTOPP-2) Ages 4+

Pragmatics/Social Communication

  • —Language Use Inventory LUI (O’Neil, 2009) Ages 18-47 months
  • —Children’s Communication Checklist-2 (CCC-2) (Bishop, 2006) Ages 4+

—In addition to administering standardized testing SLPs should also use play scales (e.g., Westby Play Scale, 1980) to assess the given child’s play abilities. This is especially important given that “play—both functional and symbolic has been associated with language and social communication ability.” (Toth, et al, 2006, pg. 3)

Finally, by showing children simple wordless picture books, SLPs can also obtain of wealth of information regarding ——the child’s utterance length, as well as narrative abilities ( a narrative assessment can be performed on a verbal child as young as two years of age).

—Comprehensive school-based speech-language assessments should be the norm and not an exception when determining preschoolers eligibility for speech language services and special education classification.

Consequently, let us ensure that our students receive fair and adequate assessments to have access to the best classroom placements, appropriate accommodations and modifications as well as targeted and relevant therapeutic services. Anything less will lead to the denial of Free Appropriate Public Education (FAPE) to which all students are entitled to!

Helpful Smart Speech Therapy Resources Pertaining to Preschoolers: 

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Creating A Learning Rich Environment for Language Delayed Preschoolers

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

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

Product Content:

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

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

Useful Smart Speech Therapy Resources:

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

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

 

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SLP Efficiency Bundles™ for Graduating Speech Language Pathologists

Graduation time is rapidly approaching and many graduate speech language pathology students are getting ready to begin their first days in the workforce. When it comes to juggling caseloads and managing schedules, time is money and efficiency is the key to success. Consequently,  a few years ago I created  SLP Efficiency Bundles™, which are materials highly useful for Graduate SLPs working with pediatric clients. These materials are organized by areas of focus for efficient and effective screening, assessment, and treatment of speech and language disorders.   Continue reading SLP Efficiency Bundles™ for Graduating Speech Language Pathologists

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Thematic Language Intervention with Language Impaired Children Using Nonfiction Texts

FullSizeRender (3)In the past a number of my SLP colleague bloggers (Communication Station, Twin Sisters SLPs, Practical AAC, etc.) wrote posts regarding the use of thematic texts for language intervention purposes. They discussed implementation of fictional texts such as the use of children’s books and fairy tales to target linguistic goals such as vocabulary knowledge in use, sentence formulation, answering WH questions, as well as story recall and production.

Today I would like to supplement those posts with information regarding the implementation of intervention based on thematic nonfiction texts to further improve language abilities of children with language difficulties.

First, here’s why the use of nonfiction texts in language intervention is important. While narrative texts have high familiarity for children due to preexisting, background knowledge, familiar vocabulary, repetitive themes, etc. nonfiction texts are far more difficult to comprehend. It typically contains unknown concepts and vocabulary, which is then used in the text multiple times. Therefore lack of knowledge of these concepts and related vocabulary will result in lack of text comprehension. According to Duke (2013) half of all the primary read-alouds should be informational text. It will allow students to build up knowledge and the necessary academic vocabulary to effectively participate and partake from the curriculum.

So what type of nonfiction materials can be used for language intervention purposes. While there is a rich variety of sources available, I have had great success using Let’s Read and Find Out Stage 1 and 2 Science Series with clients with varying degrees of language impairment.

Here’s are just a few reasons why I like to use this series.

  • They can be implemented by parents and professionals alike for different purposes with equal effectiveness.
  • They can be implemented with children fairly early beginning with preschool on-wards 
  • The can be used with the following pediatric populations:
    • Language Disordered Children
    • Children with learning disabilities and low IQ
    • Children with developmental disorders and genetic syndromes (Fragile X, Down Syndrome, Autism, etc.)
    • Children with Fetal Alcohol Spectrum Disorders
    • Internationally adopted children with language impairment
    • Bilingual children with language impairment
    • Children with dyslexia and reading disabilities
    • Children with psychiatric Impairments
  • The books are readily available online (Barnes & Noble, Amazon, etc.) and in stores.
  • They are relatively inexpensive (individual books cost about $5-6).
  • Parents or professionals who want to continuously use them seasonally can purchase them in bulk at a significantly cheaper price from select distributors (Source: rainbowresource.com)
  • They are highly thematic, contain terrific visual support, and are surprisingly versatile, with information on topics ranging from animal habitats and life cycles to natural disasters and space.
  • They contain subject-relevant vocabulary words that the students are likely to use in the future over and over again (Stahl & Fairbanks, 1986).
  • The words are already pre-grouped in semantic clusters which create schemes (mental representations) for the students (Marzano & Marzano, 1988).

Let’s Read and Find Out Science Level 2 - Weather and Seasons Package | Main Photo (Cover)

For example, the above books on weather and seasons contain information  on:

1. Front Formations
2. Water Cycle
3. High & Low Pressure Systems

Let’s look at the vocabulary words from Flash, Crash, Rumble, and Roll  (see detailed lesson plan HERE). (Source: ReadWorks):

Word: water vapor
Context
: Steam from a hot soup is water vapor.

Word: expands
Context: The hot air expands and pops the balloon.

Word: atmosphere
Context:  The atmosphere is the air that covers the Earth.

Word: forecast
Context: The forecast had a lot to tell us about the storm.

Word: condense
Context: steam in the air condenses to form water drops.

These books are not just great for increasing academic vocabulary knowledge and use. They are great for teaching sequencing skills (e.g., life cycles), critical thinking skills (e.g., What do animals need to do in the winter to survive?), compare and contrast skills (e.g., what is the difference between hatching and molting?) and much, much, more!

So why is use of nonfiction texts important for strengthening vocabulary knowledge and words in language impaired children?

As I noted in my previous post on effective vocabulary instruction (HERE): “teachers with many struggling children often significantly reduce the quality of their own vocabulary unconsciously to ensure understanding(Excerpts from Anita Archer’s Interview with Advance for SLPs).  

The same goes for SLPs and parents. Many of them are under misperception that if they teach complex subject-related words like “metamorphosis” or “vaporization” to children with significant language impairments or developmental disabilities that these students will not understand them and will not benefit from learning them.

However, that is not the case! These students will still significantly benefit from learning these words, it will simply take them longer periods of practice to retain them!

By simplifying our explanations, minimizing verbiage and emphasizing the visuals, the books can be successfully adapted for use with children with severe language impairments.  I have had parents observe my intervention sessions using these books and then successfully use them in the home with their children by reviewing the information and reinforcing newly learned vocabulary knowledge.

Here are just a few examples of prompts I use in treatment with more severely affected language-impaired children:

  • —What do you see in this picture?
  • —This is a _____ Can you say _____
  • What do you know about _____?
  • —What do you think is happening? Why?
  • What do you think they are doing? Why?
  • —Let’s make up a sentence with __________ (this word)
  • —You can say ____ or you can say ______ (teaching synonyms)
  • —What would be the opposite of _______? (teaching antonyms)
  • — Do you know that _____(this word) has 2 meanings
    • —1st meaning
    • —2nd meaning
  • How do ____ and _____ go together?

Here are the questions related to Sequencing of Processes (Life Cycle, Water Cycle, etc.)

  • —What happened first?
  • —What happened second?
  • —What happened next?
  • —What happened after that?
  • —What happened last?

As the child advances his/her skills I attempt to engage them in more complex book interactions—

  • —Compare and contrast items
  • — (e.g. objects/people/animals)
  • —Make predictions and inferences about will happen next?
  • Why is this book important?

“Picture walks” (flipping through the pages) of these books are also surprisingly effective for activation of the student’s background knowledge (what a student already knows about a subject). This is an important prerequisite skill needed for continued acquisition of new knowledge. It is important because  “students who lack sufficient background knowledge or are unable to activate it may struggle to access, participate, and progress through the general curriculum” (Stangman, Hall & Meyer, 2004).

These book allow for :

1.Learning vocabulary words in context embedded texts with high interest visuals

2.Teaching specific content related vocabulary words directly to comprehend classroom-specific work

3.Providing multiple and repetitive exposures of vocabulary words in texts

4. Maximizing multisensory intervention when learning vocabulary to maximize gains (visual, auditory, tactile via related projects, etc.)

To summarize, children with significant language impairment often suffer from the Matthew Effect (—“rich get richer, poor get poorer”), or interactions with the environment exaggerate individual differences over time

Children with good vocabulary knowledge learn more words and gain further knowledge by building of these words

Children with poor vocabulary knowledge learn less words and widen the gap between self and peers over time due to their inability to effectively meet the ever increasing academic effects of the classroom. The vocabulary problems of students who enter school with poorer limited vocabularies only worsen over time (White, Graves & Slater, 1990). We need to provide these children with all the feasible opportunities to narrow this gap and partake from the curriculum in a more similar fashion as typically developing peers. 

Helpful Smart Speech Therapy Resources:

References:

Duke, N. K. (2013). Starting out: Practices to Use in K-3. Educational Leadership, 71, 40-44.

Marzano, R. J., & Marzano, J. (1988). Toward a cognitive theory of commitment and its implications for therapy. Psychotherapy in Private Practice 6(4), 69–81.

Stahl, S. A. & Fairbanks, M. M. “The Effects of Vocabulary Instruction: A Model-based Metaanalysis.” Review of Educational Research 56 (1986): 72-110.

Strangman, N., Hall, T., & Meyer, A. (2004). Background knowledge with UDL. Wakefield, MA: National Center on Accessing the General Curriculum.

White, T. G., Graves, M. F., & Slater W. H. (1990). Growth of reading vocabulary in diverse elementary schools: Decoding and word meaning. Journal of Educational Psychology, 82, 281–290.

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Assessing and Treating Bilinguals Who Stutter: Facts for Bilingual and Monolingual SLPs

Introduction: When it comes to bilingual children who stutter there is still considerable amount of misinformation regarding the best recommendations on assessment and treatment. The aim of this article is to review best practices in assessment and treatment of bilingual children who stutter, to shed some light on this important yet highly misunderstood area in speech-language pathology.

Types of Bilingualism: Young bilingual children can be broadly divided into two categories: those who are learning several languages simultaneously from birth (simultaneous bilingual), and those who begin to learn a second language after two years of age (sequential bilingual) (De Houwer, 2009b). The language milestones for simultaneous bilinguals may be somewhat uneven but they are not that much different from those of monolingual children (De Houwer, 2009a). Namely, first words emerge between 8 and 15 months and early phrase production occurs around +/-20 months of age, with sentence production following thereafter (De Houwer, 2009b). In contrast, sequential bilinguals undergo a number of stages during which they acquire abilities in the second language, which include preproduction, early production, as well as intermediate and advanced proficiency in the second language.

Stuttering and Monolingual Children: With respect to stuttering in the monolingual children we know that there are certain risk factors associated with stuttering. These include family history (family members who stutter), age of onset (children who begin stuttering before the age of three have a greater likelihood of outgrowing stuttering), time since onset (depending on how long the child have been stuttering certain children may outgrow it), gender (research has shown that girls are more likely to outgrow stuttering than boys), presence of other speech/language factors (poor speech intelligibility, advance language skills etc.) (Stuttering Foundation: Risk Factors).  We also know that the symptoms of stuttering manifest via sound, syllable and word repetitions, sound prolongations as well as sound and word blocks. In addition to overt stuttering characteristics there could also be secondary characteristics including gaze avoidance, word substitutions, anxiety about speaking, muscle tension in the face, jaw and neck, as well as fist clenching, just to name a few.

Stuttering and Bilingual Children: So what do we currently know regarding the manifestations of stuttering in bilingual children?  Here is some information based on existing research. While some researchers believe that stuttering is more common in bilingual versus monolingual individuals, currently there is no data which supports such a hypothesis.  The distribution and severity of stuttering tend to differ from language to language and one language is typically affected more than the other (Van Borsel, Maes & Foulon, 2001). Lim and colleagues (2008) found that language dominance influences the severity but not the types of stuttering behaviors.  They also found that bilingual stutterers exhibit different stuttering characteristics in both languages such as displaying stuttering on content words in L1 and function words in L2 (less-developed language system). According to Watson & Kayser (1994) key features of ‘true’ stuttering include the presence of stuttering in both languages with accompanying self-awareness as well as secondary behaviors.   This is important to understand giving the fact that bilingual children in the process of learning another language may present with pseudo-stuttering characteristics related to word retrieval rather than true stuttering.

Assessment of Bilingual Stutterers: Now let’s talk about aspects of the assessment. Typically assessment should begin with the taking of detailed background history regarding stuttering risk factors, the extent of the child’s exposure and proficiency in each language, age of stuttering onset, the extent of stuttering in each language, as well as presence of any other concomitant concerns regarding the child’s speech and language (e.g., suspicion of language/articulation deficits etc.)  Shenker (2013) also recommends the parental use of perceptual rating scales to assess child’s proficiency in each language.

Assessment procedures, especially those for newly referred children (vs. children whose speech and language abilities were previously assessed), should include comprehensive assessments of speech and language in addition to assessment of stuttering in order to rule out any hidden concomitant deficits.  It is also important to obtain conversational and narrative samples in each language as well as reading samples when applicable.   When analyzing the samples it is very important to understand and make allowance for typical disfluencies (especially when it comes to preschool children) as well as understand the difference between true stuttering and word retrieval deficits (which pertain to linguistic difficulties), which can manifest as fillers, word phrase repetitions, as well as conversational pauses (German, 2005).

When analyzing the child’s conversational speech for dysfluencies it may be helpful to gradually increase linguistic complexity in order to determine at which level (e.g., word, phrase, etc.) dysfluencies take place (Schenker, 2013). To calculate frequency and duration of disfluencies, word-based (vs. syllable-based) counts of stuttering frequency will be more accurate across languages (Bernstein Ratner, 2004).

Finally during the assessment it is also very important to determine the family’s cultural beliefs toward stuttering since stuttering perceptions vary greatly amongst different cultures (Tellis & Tellis, 2003) and may not always be positive. For example, Waheed-Kahn (1998) found that Middle Eastern parents attempted to deal with their children’s stuttering in the following ways: prayed for change, asked them to “speak properly”, completed their sentences, changed their setting by sending them to live with a relative as well as asked them not to talk in public.  Gauging familial beliefs toward stuttering will allow clinicians to: understand parental involvement and acceptance of therapy services, select best treatment models for particular clients as well as gain knowledge of how cultural attitudes may impact treatment outcomes (Schenker, 2013).

 Image courtesy of mnsu.edu 

Treatment of Bilingual Stutterers: With respect to stuttering treatment delivery for bilingual children, research has found that treatment in one language results in spontaneous improvement in fluency in the untreated language (Rousseau, Packman, & Onslow, 2005). This is helpful for monolingual SLPs who often do not have the option of treating clients in their birth language.

For young preschool children both direct and indirect therapy approaches may be utilized.

For example, the Palin (PCI) approach for children 2-7 years of age uses play-based sessions, video feedback, and facilitated discussions to help parents support and increase their child’s fluency. Its primary focus is to modify parent–child interactions via a facilitative rather than an instructive approach by developing and reinforcing parents’ expertise via use of video feedback to set own targets and reinforce progress. In contrast, the Lidcombe Program for children 2-7 years of age is a behavioral treatment with a focus on stuttering elimination.  It is administered by the parents under the supervision of an SLP, who teaches the parents how to control the child’s stuttering with verbal response contingent stimulation (Onslow & Millard, 2012).   While the Palin PCI approach still requires further research to determine its use with bilingual children, the Lidcombe Program has been trialed in a number of studies with bilingual children and was found to be effective in both languages (Schenker, 2013).

For bilingual school-age children with persistent stuttering, it is important to focus on stuttering management vs. stuttering elimination (Reardon-Reeves & Yaruss, 2013).  Here we are looking to reduce frequency and severity of disfluencies, teach the children to successfully manage stuttering moments, as well as work on the student’s emotional attitude toward stuttering. Use of support groups for children who stutter (e.g., “FRIENDS”: http://www.friendswhostutter.org/), may also be recommended.

Depending on the student’s preferences, desires, and needs, the approaches may involve a combination of fluency shaping and stuttering modification techniques.  Fluency shaping intervention focuses on increasing fluent speech through teaching methods that reduce speaking rate such as easy onsets, loose contacts, changing breathing, prolonging sounds or words, pausing, etc. The goal of fluency shaping is to “encourage spontaneous fluency where possible and controlled fluency when it is not” (Ramig & Dodge, 2004). In contrast stuttering modification therapy focuses on modifying the severity of stuttering moments as well as on reduction of fear, anxiety and avoidance behaviors associated with stuttering. Stuttering modification techniques are aimed at assisting the client “to confront the stuttering moment through implementation of pre-block, in-block, and/or post-block corrections, as well as through a change in how they perceive the stuttering experience” (Ramig & Dodge, 2004). While studies on these treatment methods are still very limited it is important to note that each technique as well as a combination of both techniques have been trialed and found successful with bilingual and even trilingual speakers (Conture & Curlee, 2007; Howell & Van Borsel, 2011).

Finally, it is very important for clinicians to account for cultural differences during treatment. This can be accomplished by carefully selecting culturally appropriate stimuli, preparing instructions which account for the parents’ language and culture, attempting to provide audio/video examples in the child’s birth language, as well as finding/creating opportunities for practicing fluency in culturally-relevant contexts and activities (Schenker, 2013).

Conclusion:  Presently, no evidence has been found that bilingualism causes stuttering. Furthermore, treatment outcomes for bilingual children appear to be comparable to those of monolingual children. Bilingual SLPs encountering bilingual children who stutter are encouraged to provide stuttering treatment in the language the child is most proficient in. Monolingual SLPs encountering bilingual children are encouraged to provide stuttering treatment in English with the expectation that the treatment will carry over into the child’s birth language. All clinicians are encouraged to involve the children’s families in the stuttering treatment as well as utilize methods and interventions that are in agreement with the family’s cultural beliefs and values, in order to create optimum treatment outcomes for bilingual children who stutter.

References:

  1. Bernstein Ratner, N. (2004). Fluency and stuttering in bilingual children. In B. Goldstein (ed.). Language Development: a focus on the Spanish-English speaker. Baltimore, MD: Brookes. (287-310).
  2. Conture, E. G., & Curlee, R. F. (2007). Stuttering and related disorders of fl uency. New York, NY: Thieme Medical Publishers.
  3. De Houwer, A. (2009a). Bilingual first language acquisition. Bristol: Multilingual Matters.
  4. De Houwer, A. (2009b). Assessing lexical development in bilingual first language acquisition: What can we learn from monolingual norms? In M. Cruz-Ferreira (Ed.), Multilingual norms (pp. 279-322). Frankfurt: Peter Lang.
  5. German, D.J. (2005) Word-Finding Intervention Program, Second Edition (WFIP-2)Austin Texas: Pro.Ed
  6. Howell, P & Van Borsel, , (2011). Multicultural Aspects of Fluency Disorders, Multilingual Matters, Bristol, UK.
  7. Lim, V. P. C., Rickard Liow, S. J., Lincoln, M., Chan, Y. H., & Onslow, M. (2008). Determining language dominance in English–Mandarin bilinguals: Development of a selfreport classification tool for clinical use. Applied Psycholinguistics, 29, 389–412.
  8. Onslow M, Millard S. (2012). Palin Parent Child Interaction and the Lidcombe Program: Clarifying some issues. Journal of Fluency Disorders37(1 ):1-8.
  9. Tellis, G. & Tellis, C. (2003). Multicultural issues in school settings. Seminars in Speech and Language, 24, 21-26.
  10. Ramig, P. R., & Dodge, D. (2004, September 08). Fluency shaping intervention: Helpful, but why it is important to know more. Retrieved from http://www.mnsu.edu/comdis/isad7/papers/ramig7.html
  11. Reardon-Reeves, N., & Yaruss, J.S. (2013). School-age Stuttering Therapy: A Practical Guide. McKinney, TX: Stuttering Therapy Resources, Inc.
  12. Rousseau, I., Packman, A., & Onslow, M. (2005, June). A trial of the Lidcombe Program with school age stuttering children. Paper presented at the Speech Pathology National Conference, Canberra, Australia.
  13. Shenker, R. C. (2013). Bilingual myth-busters series. When young children who stutter are also bilingual: Some thoughts about assessment and treatment. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse (CLD) Populations, 20(1), 15-23.
  14. Stuttering Foundation website: Stuttering Risk Factors http://www.stutteringhelp.org/risk-factors
  15. Van Borsel, J. Maes, E., & Foulon, S. (2001). Stuttering and bilingualism: A review. Journal of Fluency Disorders, 26, 179-205.
  16. Waheed-Kahn, N. (1998). Fluency therapy with multilingual clients. In Healey, E. C. & Peters, H. F. M. (Eds.),Proceedings of the Second World Congress on Fluency Disorders, San Francisco, August 1822(pp. 195–199). Nijmegen, The Netherlands: Nijmegen University Press.
  17. Watson, J., & Kayser, H. (1994). Assessment of bilingual/bicultural adults who stutter. Seminars in Speech and Language, 15, 149-163.

 

 

 

 

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Dear Pediatrician: Please Don’t Say That!

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Recently, a new client came in for therapy.  He was a little over three years of age with limited verbal abilities,  and a number of stereotypical behaviors consistent with autism spectrum disorder.  During the course of parental interview, the child’s mother mentioned that he had previously briefly received early intervention services  but  aged out from the early intervention system after only a few months.  As we continued to discuss the case, his mother revealed that she  had significant concerns regarding her son’s language abilities and behavior from a very early age  because it  significantly differed from his older sister’s developmental trajectory. However,  every time she brought it up to her pediatrician  she invariably received the following answers:  “Don’t compare him to his sister, they are different  children”  and   “Don’t  worry,  he will catch up”,  which resulted in the child being referred for early intervention services when he was almost 3 years of age,  and unable to receive consistent  speech therapy services prior to aging out of the program all together.

This is not the first time I heard such a story,  and I’m sure it won’t be the last time as well.  Sadly, myself and other speech language therapists are very familiar with such cases and that is such a shame.  It is a shame, because  a parent was absolutely correct in trusting her instincts but was not validated by a medical professional she trusted the most, her child’s pediatrician.  Please don’t get me wrong,  I am not  playing the blame game  or trying to denigrate members of another profession.   My  aim  today is rather different and that is along with my colleagues to continue increasing awareness among all health professionals  regarding the early identification  of communication disorders  in children in order for them to receive  effective early intervention services  to improve their long-term outcomes.

getty_rf_photo_of_toddler_feeding_teddy_bear

 Whenever one “Googles” the term “Language Milestones In Children”  or “When  do children begin to talk?”   Numerous links pop-up,  describing developmental milestones in children.  Most of them contain  fairly typical information such as: first word emerge at approximately 12 months of age,   2 word combinations emerge when the child has a lexicon of approximately 50 words or more, which corresponds  to  a period between  18 months to 2 years of age,  and sentences emerge when a child is approximately 3 years of age. While most of this information is hopefully common knowledge for many healthcare professionals working with children including pediatricians,  is also important to understand that when the child comes in for a checkup one should not look at these abilities in isolation but  rather  look at the child  holistically.  That means  asking the parents the right questions to compare the child’s cognitive, adaptive,  social emotional, as well as communicative functioning  to that of typically developing peers  or siblings  in order to determine whether anything is amiss.  Thus, rather than to discourage the  parent  from  comparing their child to typically developing children his age, the parents  should actually be routinely asked the variation of the following question: “How  do your child’s abilities  and functioning compare to other typically developing children your child age?”

woman-talking-to-doctorWhenever I ask this question during the process of evaluation or initiation of therapy  services,  90% of the time I receive highly detailed and intuitive responses  from well-informed parents. They immediately begin describing in significant detail the difference in functioning  between their own delayed child  and  his/her  siblings/peers.   That is why in the majority of cases  I find the background information provided by the parent to be almost as valuable  as the evaluation itself.  For example, I recently assessed  a 3-5 year-old child  due to communication concerns.   The pediatrician was very reluctant to refer to the child for services due to the fact that the child was adequately verbal.   However,  the child’s  parents were insistent,  a script for services was written, and the child was brought to me for an evaluation.  Parents reported that while their child was very verbal and outgoing,  most of the time they had significant difficulty  understanding what she was trying to tell them due to poor grammar as well as nonsensical content of her messages.   They also reported that the child had a brother , who was older than her last several years.  However,  they stated that they had never experienced similar difficulties with the child’s brother when he was her age,  which is why they became so concerned with each passing day regarding the child’s language abilities.

Indeed, almost  as soon as the evaluation began, it became apparent that while the child’s verbal output was adequate, the semantic content of those messages  as well as the pragmatic use in conversational exchanges  was significantly impaired. In  other words,  the  child may have been adequately verbose but  the coherence of her discourse left a lot to be desired.   This child was the perfect candidate for therapy but had parents not insisted, the extent of her expressive language difficulties  may have been overlooked until she was old enough to go to kindergarten. By then  many valuable intervention  hours would have been lost  and the extent of the child deficits have been far greater.

So dear pediatrician,  the next time  a concerned parent utters the words: “I think something is wrong…” or “His language is nothing like his brother’s/sister’s when s/he was that age” don’t be so hasty in dismissing their concerns. Listen to them,  understand that while you are the expert in childhood health and diseases,   they are  the expert  in their own child,  and are highly attuned  to their child’s functioning and overall abilities. Encourage them to disclose their worries by asking follow-up questions and validating their concerns.

why_your_doctor_needs_to_know_your_life_story_4461_98044748There are significant benefits  to receiving early targeted  care  beyond the improvement in language abilities.  These include but are not limited to:  reduced chances of behavioral deficits or mental illness, reduced chances of reading, writing and learning difficulties  when older,  reduced chances of  impaired socialization abilities and self-esteem,  all of which can affect children with language deficits when appropriate services are delayed or never provided.  So please, err on the side of caution  and refer the children with suspected deficits to speech language pathologists.  Please give us an opportunity to thoroughly assess these children in order to find out  whether there truly is  speech/language disorder/delay.  Because by doing this you truly will be serving the interests of your clients.

Helpful Smart Speech Therapy Resources: