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FREE Resources for Working with Russian Speaking Clients: Part II

Image result for ресурсы для логопедииA few years ago I wrote a blog post entitled “Working with Russian-speaking clients: implications for speech-language assessment” the aim of which was to provide some suggestions regarding assessment of bilingual Russian-American birth-school age population in order to assist SLPs with determining whether the assessed child presents with a language difference, insufficient language exposure, or a true language disorder.

Today I wanted to provide Russian speaking clinicians with a few FREE resources pertaining to the typical speech and language development of Russian speaking children 0-7 years of age.

Below materials include several FREE questionnaires regarding Russian language development (words and sentences) of children 0-3 years of age, a parent intake forms for Russian speaking clients, as well as a few relevant charts pertaining to the development  of phonology, word formation, lexicon, morphology, syntax, and metalinguistics of children 0-7 years of age.

It is, however, important to note that due to the absence of research and standardized studies on this subject much of the below information still needs to be interpreted with significant caution.

Select Speech and Language Norms:

Image result for развитие речи детей

Select Parent Questionnaires (McArthur Bates Adapted in Russian):

  • Тест речевого и коммуникативного развития детей раннего возраста: слова и жесты (Words and Gestures)
  • Тест речевого и коммуникативного развития детей раннего возраста:  слова и предложения (Sentences)
  • Анкета для родителей (Child Development Questionnaire for Parents)

Материал Для Родителей И Специалистов По  Речевым
Нарушениям contains detailed information (27 pages) on Russian child development as well as common communication disrupting disorders

Stay tuned for more resources for Russian speaking SLPs coming shortly.

Related Resources:

 

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It’s All Due to …Language: How Subtle Symptoms Can Cause Serious Academic Deficits

Scenario: Len is a 7-2-year-old, 2nd-grade student who struggles with reading and writing in the classroom. He is very bright and has a high average IQ, yet when he is speaking he frequently can’t get his point across to others due to excessive linguistic reformulations and word-finding difficulties. The problem is that Len passed all the typical educational and language testing with flying colors, receiving average scores across the board on various tests including the Woodcock-Johnson Fourth Edition (WJ-IV) and the Clinical Evaluation of Language Fundamentals-5 (CELF-5). Stranger still is the fact that he aced Comprehensive Test of Phonological Processing, Second Edition (CTOPP-2), with flying colors, so he is not even eligible for a “dyslexia” diagnosis. Len is clearly struggling in the classroom with coherently expressing self, telling stories, understanding what he is reading, as well as putting his thoughts on paper. His parents have compiled impressively huge folders containing examples of his struggles. Yet because of his performance on the basic standardized assessment batteries, Len does not qualify for any functional assistance in the school setting, despite being virtually functionally illiterate in second grade.

The truth is that Len is quite a familiar figure to many SLPs, who at one time or another have encountered such a student and asked for guidance regarding the appropriate accommodations and services for him on various SLP-geared social media forums. But what makes Len such an enigma, one may inquire? Surely if the child had tangible deficits, wouldn’t standardized testing at least partially reveal them?

Well, it all depends really, on what type of testing was administered to Len in the first place. A few years ago I wrote a post entitled: “What Research Shows About the Functional Relevance of Standardized Language Tests“.  What researchers found is that there is a “lack of a correlation between frequency of test use and test accuracy, measured both in terms of sensitivity/specificity and mean difference scores” (Betz et al, 2012, 141). Furthermore, they also found 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”. Most damaging finding was the fact 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”.(Betz et al, 2012, 140)

In other words, many SLPs only use the tests at hand rather than the RIGHT tests aimed at identifying the student’s specific deficits. But the problem doesn’t actually stop there. Due to the variation in psychometric properties of various tests, 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 (Spaulding, Plante & Farinella, 2006, 69).”

There’s of course yet another factor affecting our hypothetical client and that is his relatively young age. This is especially evident with many educational and language testing for children in the 5-7 age group. Because the bar is set so low, concept-wise for these age-groups, many children with moderate language and literacy deficits can pass these tests with flying colors, only to be flagged by them literally two years later and be identified with deficits, far too late in the game.  Coupled with the fact that many SLPs do not utilize non-standardized measures to supplement their assessments, Len is in a pretty serious predicament.

But what if there was a do-over? What could we do differently for Len to rectify this situation? For starters, we need to pay careful attention to his deficits profile in order to choose appropriate tests to evaluate his areas of needs. The above can be accomplished via a number of ways. The SLP can interview Len’s teacher and his caregiver/s in order to obtain a summary of his pressing deficits. Depending on the extent of the reported deficits the SLP can also provide them with a referral checklist to mark off the most significant areas of need.

In Len’s case, we already have a pretty good idea regarding what’s going on. We know that he passed basic language and educational testing, so in the words of Dr. Geraldine Wallach, we need to keep “peeling the onion” via the administration of more sensitive tests to tap into Len’s reported areas of deficits which include: word-retrieval, narrative production, as well as reading and writing.

For that purpose, Len is a good candidate for the administration of the Test of Integrated Language and Literacy (TILLS), which was developed to identify language and literacy disorders, has good psychometric properties, and contains subtests for assessment of relevant skills such as reading fluency, reading comprehension, phonological awareness,  spelling, as well as writing  in school-age children.

Given Len’s reported history of narrative production deficits, Len is also a good candidate for the administration of the Social Language Development Test Elementary (SLDTE). Here’s why. Research indicates that narrative weaknesses significantly correlate with social communication deficits (Norbury, Gemmell & Paul, 2014). As such, it’s not just children with Autism Spectrum Disorders who present with impaired narrative abilities. Many children with developmental language impairment (DLD) (#devlangdis) can present with significant narrative deficits affecting their social and academic functioning, which means that their social communication abilities need to be tested to confirm/rule out presence of these difficulties.

However, standardized tests are not enough, since even the best-standardized tests have significant limitations. As such, several non-standardized assessments in the areas of narrative production, reading, and writing, may be recommended for Len to meaningfully supplement his testing.

Let’s begin with an informal narrative assessment which provides detailed information regarding microstructural and macrostructural aspects of storytelling as well as child’s thought processes and socio-emotional functioning. My nonstandardized narrative assessments are based on the book elicitation recommendations from the SALT website. For 2nd graders, I use the book by Helen Lester entitled Pookins Gets Her Way. I first read the story to the child, then cover up the words and ask the child to retell the story based on pictures. I read the story first because: “the model narrative presents the events, plot structure, and words that the narrator is to retell, which allows more reliable scoring than a generated story that can go in many directions” (Allen et al, 2012, p. 207).

As the child is retelling his story I digitally record him using the Voice Memos application on my iPhone, for a later transcription and thorough analysis.  During storytelling, I only use the prompts: ‘What else can you tell me?’ and ‘Can you tell me more?’ to elicit additional information. I try not to prompt the child excessively since I am interested in cataloging all of his narrative-based deficits. After I transcribe the sample, I analyze it and make sure that I include the transcription and a detailed write-up in the body of my report, so parents and professionals can see and understand the nature of the child’s errors/weaknesses.

Now we are ready to move on to a brief nonstandardized reading assessment. For this purpose, I often use the books from the Continental Press series entitled: Reading for Comprehension, which contains books for grades 1-8.  After I confirm with either the parent or the child’s teacher that the selected passage is reflective of the complexity of work presented in the classroom for his grade level, I ask the child to read the text.  As the child is reading, I calculate the correct number of words he reads per minute as well as what type of errors the child is exhibiting during reading.  Then I ask the child to state the main idea of the text, summarize its key points as well as define select text embedded vocabulary words and answer a few, verbally presented reading comprehension questions. After that, I provide the child with accompanying 5 multiple choice question worksheet and ask the child to complete it. I analyze my results in order to determine whether I have accurately captured the child’s reading profile.

Finally, if any additional information is needed, I administer a nonstandardized writing assessment, which I base on the Common Core State Standards for 2nd grade. For this task, I provide a student with a writing prompt common for second grade and give him a period of 15-20 minutes to generate a writing sample. I then analyze the writing sample with respect to contextual conventions (punctuation, capitalization, grammar, and syntax) as well as story composition (overall coherence and cohesion of the written sample).

The above relatively short assessment battery (2 standardized tests and 3 informal assessment tasks) which takes approximately 2-2.5 hours to administer, allows me to create a comprehensive profile of the child’s language and literacy strengths and needs. It also allows me to generate targeted goals in order to begin effective and meaningful remediation of the child’s deficits.

Children like Len will, unfortunately, remain unidentified unless they are administered more sensitive tasks to better understand their subtle pattern of deficits. Consequently, to ensure that they do not fall through the cracks of our educational system due to misguided overreliance on a limited number of standardized assessments, it is very important that professionals select the right assessments, rather than the assessments at hand, in order to accurately determine the child’s areas of needs.

References:

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Making Our Interventions Count or What’s Research Got To Do With It?

Two years ago I wrote a blog post entitled: “What’s Memes Got To Do With It?” which summarized key points of Dr. Alan G. Kamhi’s 2004 article: “A Meme’s Eye View of Speech-Language Pathology“. It delved into answering the following question: “Why do some terms, labels, ideas, and constructs [in our field] prevail whereas others fail to gain acceptance?”.

Today I would like to reference another article by Dr. Kamhi written in 2014, entitled “Improving Clinical Practices for Children With Language and Learning Disorders“.

This article was written to address the gaps between research and clinical practice with respect to the implementation of EBP for intervention purposes.

Dr. Kamhi begins the article by posing 10 True or False questions for his readers:

  1. Learning is easier than generalization.
  2. Instruction that is constant and predictable is more effective than instruction that varies the conditions of learning and practice.
  3. Focused stimulation (massed practice) is a more effective teaching strategy than varied stimulation (distributed practice).
  4. The more feedback, the better.
  5. Repeated reading of passages is the best way to learn text information.
  6. More therapy is always better.
  7. The most effective language and literacy interventions target processing limitations rather than knowledge deficits.
  8. Telegraphic utterances (e.g., push ball, mommy sock) should not be provided as input for children with limited language.
  9. Appropriate language goals include increasing levels of mean length of utterance (MLU) and targeting Brown’s (1973) 14 grammatical morphemes.
  10. Sequencing is an important skill for narrative competence.

Guess what? Only statement 8 of the above quiz is True! Every other statement from the above is FALSE!

Now, let’s talk about why that is!

First up is the concept of learning vs. generalization. Here Dr. Kamhi discusses that some clinicians still possess an “outdated behavioral view of learning” in our field, which is not theoretically and clinically useful. He explains that when we are talking about generalization – what children truly have a difficulty with is “transferring narrow limited rules to new situations“. “Children with language and learning problems will have difficulty acquiring broad-based rules and modifying these rules once acquired, and they also will be more vulnerable to performance demands on speech production and comprehension (Kamhi, 1988)” (93). After all, it is not “reasonable to expect children to use language targets consistently after a brief period of intervention” and while we hope that “language intervention [is] designed to lead children with language disorders to acquire broad-based language rules” it is a hugely difficult task to undertake and execute.

Next, Dr. Kamhi addresses the issue of instructional factors, specifically the importance of “varying conditions of instruction and practice“.  Here, he addresses the fact that while contextualized instruction is highly beneficial to learners unless we inject variability and modify various aspects of instruction including context, composition, duration, etc., we ran the risk of limiting our students’ long-term outcomes.

After that, Dr. Kamhi addresses the concept of distributed practice (spacing of intervention) and how important it is for teaching children with language disorders. He points out that a number of recent studies have found that “spacing and distribution of teaching episodes have more of an impact on treatment outcomes than treatment intensity” (94).

He also advocates reducing evaluative feedback to learners to “enhance long-term retention and generalization of motor skills“. While he cites research from studies pertaining to speech production, he adds that language learning could also benefit from this practice as it would reduce conversational disruptions and tunning out on the part of the student.

From there he addresses the limitations of repetition for specific tasks (e.g., text rereading). He emphasizes how important it is for students to recall and retrieve text rather than repeatedly reread it (even without correction), as the latter results in a lack of comprehension/retention of read information.

After that, he discusses treatment intensity. Here he emphasizes the fact that higher dose of instruction will not necessarily result in better therapy outcomes due to the research on the effects of “learning plateaus and threshold effects in language and literacy” (95). We have seen research on this with respect to joint book reading, vocabulary words exposure, etc. As such, at a certain point in time increased intensity may actually result in decreased treatment benefits.

His next point against processing interventions is very near and dear to my heart. Those of you familiar with my blog know that I have devoted a substantial number of posts pertaining to the lack of validity of CAPD diagnosis (as a standalone entity) and urged clinicians to provide language based vs. specific auditory interventions which lack treatment utility. Here, Dr. Kamhi makes a great point that: “Interventions that target processing skills are particularly appealing because they offer the promise of improving language and learning deficits without having to directly target the specific knowledge and skills required to be a proficient speaker, listener, reader, and writer.” (95) The problem is that we have numerous studies on the topic of improvement of isolated skills (e.g., auditory skills, working memory, slow processing, etc.) which clearly indicate lack of effectiveness of these interventions.  As such, “practitioners should be highly skeptical of interventions that promise quick fixes for language and learning disabilities” (96).

Now let us move on to language and particularly the models we provide to our clients to encourage greater verbal output. Research indicates that when clinicians are attempting to expand children’s utterances, they need to provide well-formed language models. Studies show that children select strong input when its surrounded by weaker input (the surrounding weaker syllables make stronger syllables stand out).  As such, clinicians should expand upon/comment on what clients are saying with grammatically complete models vs. telegraphic productions.

From there lets us take a look at Dr. Kamhi’s recommendations for grammar and syntax. Grammatical development goes much further than addressing Brown’s morphemes in therapy and calling it a day. As such, it is important to understand that children with developmental language disorders (DLD) (#DevLang) do not have difficulty acquiring all morphemes. Rather studies have shown that they have difficulty learning grammatical morphemes that reflect tense and agreement  (e.g., third-person singular, past tense, auxiliaries, copulas, etc.). As such, use of measures developed by (e.g., Tense Marker Total & Productivity Score) can yield helpful information regarding which grammatical structures to target in therapy.

With respect to syntax, Dr. Kamhi notes that many clinicians erroneously believe that complex syntax should be targeted when children are much older. The Common Core State Standards do not help this cause further, since according to the CCSS complex syntax should be targeted 2-3 grades, which is far too late. Typically developing children begin developing complex syntax around 2 years of age and begin readily producing it around 3 years of age. As such, clinicians should begin targeting complex syntax in preschool years and not wait until the children have mastered all morphemes and clauses (97)

Finally, Dr. Kamhi wraps up his article by offering suggestions regarding prioritizing intervention goals. Here, he explains that goal prioritization is affected by

  • clinician experience and competencies
  • the degree of collaboration with other professionals
  • type of service delivery model
  • client/student factors

He provides a hypothetical case scenario in which the teaching responsibilities are divvied up between three professionals, with SLP in charge of targeting narrative discourse. Here, he explains that targeting narratives does not involve targeting sequencing abilities. “The ability to understand and recall events in a story or script depends on conceptual understanding of the topic and attentional/memory abilities, not sequencing ability.”  He emphasizes that sequencing is not a distinct cognitive process that requires isolated treatment. Yet many SLPs “continue to believe that  sequencing is a distinct processing skill that needs to be assessed and treated.” (99)

Dr. Kamhi supports the above point by providing an example of two passages. One, which describes a random order of events, and another which follows a logical order of events. He then points out that the randomly ordered story relies exclusively on attention and memory in terms of “sequencing”, while the second story reduces demands on memory due to its logical flow of events. As such, he points out that retelling deficits seemingly related to sequencing, tend to be actually due to “limitations in attention, working memory, and/or conceptual knowledge“. Hence, instead of targeting sequencing abilities in therapy, SLPs should instead use contextualized language intervention to target aspects of narrative development (macro and microstructural elements).

Furthermore, here it is also important to note that the “sequencing fallacy” affects more than just narratives. It is very prevalent in the intervention process in the form of the ubiquitous “following directions” goal/s. Many clinicians readily create this goal for their clients due to their belief that it will result in functional therapeutic language gains. However, when one really begins to deconstruct this goal, one will realize that it involves a number of discrete abilities including: memory, attention, concept knowledge, inferencing, etc.  Consequently, targeting the above goal will not result in any functional gains for the students (their memory abilities will not magically improve as a result of it). Instead, targeting specific language and conceptual goals  (e.g., answering questions, producing complex sentences, etc.) and increasing the students’ overall listening comprehension and verbal expression will result in improvements in the areas of attention, memory, and processing, including their ability to follow complex directions.

There you have it! Ten practical suggestions from Dr. Kamhi ready for immediate implementation! And for more information, I highly recommend reading the other articles in the same clinical forum, all of which possess highly practical and relevant ideas for therapeutic implementation. They include:

References:

Kamhi, A. (2014). Improving clinical practices for children with language and learning disorders.  Language, Speech, and Hearing Services in Schools, 45(2), 92-103

Helpful Social Media Resources:

SLPs for Evidence-Based Practice

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It’s a Fairy Tale (Well, Almost) Therapy!

I’ve always loved fairy tales! Much like Audrey Hepburn “If I’m honest I have to tell you I still read fairy-tales and I like them best of all.” Not to compare myself with Einstein (sadly in any way, sigh) but “When I examine myself and my methods of thought, I come to the conclusion that the gift of fantasy has meant more to me than any talent for abstract, positive thinking.”

It was the very first genre I’ve read when I’ve learned how to read. In fact, I love fairy tales so much that I actually took a course on fairy tales in college (yes they teach that!) and even wrote some of my own (though they were primarily satirical in nature).

So it was a given that I would use fairy tales as a vehicle to teach speech and language goals to the children on my caseload (and I am not talking only preschoolers either). Continue reading It’s a Fairy Tale (Well, Almost) Therapy!

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What Should be Driving Our Treatment?

Today  I want to talk treatment.  That thing that we need to plan for as we are doing our assessments.   But are we starting our treatments the right way? The answer may surprise you. I often see SLPs phrasing questions regarding treatment the following way: “I have a student diagnosed with ____ (insert disorder here). What is everyone using (program/app/materials) during therapy sessions to address ___ diagnosis?”

Of course, the answer is never that simple. Just because a child has a diagnosis of a social communication disorder, word-finding deficits, or a reading disability does not automatically indicate to the treating clinician, which ‘cookie cutter’ materials and programs are best suited for the child in question. Only a profile of strengths and needs based on a comprehensive language and literacy testing can address this in an adequate and targeted manner.

To illustrate,  reading intervention is a much debated and controversial topic nowadays. Everywhere you turn there’s a barrage of advice for clinicians and parents regarding which program/approach to use. Barton, Wilson, OG… the well-intentioned advice just keeps on coming. The problem is that without knowing the child’s specific deficit areas, the application of the above approaches is quite frankly … pointless.

There could be endless variations of how deficits manifest in poor readers. Is it aspects of phonological awareness, phonics, morphology, etc. What combination of deficits is preventing the child from becoming a good reader?

Let’s a take a look at an example, below. It’s the CTOPP-2 results of a 7-6-year-old female with a documented history of extensive reading difficulties and a significant family history of reading disabilities in the family.

Results of the Comprehensive Test of Phonological Processing-2 (CTOPP-2)

Subtests Scaled Scores Percentile Ranks Description
Elision (EL) 7 16 Below Average
Blending Words (BW) 13 84 Above Average
Phoneme Isolation (PI) 6 9 Below Average
Memory for Digits (MD) 8 25 Average
Nonword Repetition (NR) 8 25 Average
Rapid Digit Naming (RD) 10 50 Average
Rapid Letter Naming (RL) 11 63 Average
Blending Nonwords (BN) 8 25 Average
Segmenting Nonwords (SN) 8 25 Average

However, the results of her CTOPP-2 testing clearly indicate that phonological awareness, despite two areas of mild weaknesses, is not really a significant problem for this child.  So let’s look at the student’s reading fluency results.

Reading Fluency: “LG’s reading fluency during this task was judged to be significantly affected by excessive speed, inappropriate pausing, word misreadings, choppy prosody, as well as inefficient word attack skills.  While she was able to limitedly utilize the phonetic spelling of unfamiliar words (e.g., __) provided to her in parenthesis next to the word (which she initially misread as ‘__’), she exhibited limited use of metalinguistic strategies (e.g., pre-scanning sentences to aid text comprehension, self-correcting to ensure that the read words made sense in the context of the sentence, etc.), when reading the provided passage. To illustrate, during the reading of the text, LG was observed to frequently (at least 3 times) lose her place and skip entire lines of text without any attempts at self-correction. At times she was observed to read the same word a number of different ways (e.g., read ‘soup’ as ‘soup’ then as ‘soap’,  ‘roots’ as ‘roofs’ then as ‘roots’, etc.) without attempting to self-correct. LG’s oral reading rate was also observed to be impaired for her age/grade levels. Her prosody was significantly adversely affected due to lack of adequate pausing for punctuation marks (e.g., periods, commas, etc.).  Instead, she paused during text reading only when he could not decode select words in the text.  Though, LG was able to read 70 words per minute, which was judged to be grossly commensurate with grade-level, out of these 70 words she skipped 2 entire lines of text, invented an entire line of text, as well as made 4 decoding errors and 6 inappropriate pauses.”

So now we know that despite quite decent phonological awareness abilities, this student presents with quite poor sound-letter correspondence skills and will definitely benefit from explicit phonics instruction addressing the above deficit areas. But that is only the beginning!   By looking at the analysis of specific misreadings we next need to determine what other literacy areas need to be addressed. For the sake of brevity, I can specify that further analysis of this child reading abilities revealed that reading comprehension, orthographic knowledge, as well as morphological awareness were definitely areas that also required targeted remediation. The assessment also revealed that the child presented with poor spelling and writing abilities, which also needed to be addressed in the context of therapy.

Now, what if I also told you that this child had already been receiving private, Orton-Gillingham reading instruction for a period of  2 years, 1x per week, at the time the above assessment took place? Would you change your mind about the program in question? 

Well, the answer is again not so simple! OG is a fine program, but as you can see from the above example it has definite limitations and is not an exclusive fit for this child, or for any child for that matter. Furthermore, a solidly-trained in literacy clinician DOES NOT need to rely on just one program to address literacy deficits. They simply need solid knowledge of typical and atypical language and literacy development/milestones and know how to create a targeted treatment hierarchy in order to deliver effective intervention services. But for that, they need to first, thoughtfully, construct assessment-based treatment goals by carefully taking into the consideration the child’s strengths and needs.

So let’s stop asking which approach/program we should use and start asking about the child’s profile of strengths and needs in order to create accurate language and literacy goals based on solid evidence and scientifically-guided treatment practices.

Helpful Resources Pertaining to Reading:

 

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Smart Speech Therapy Black Friday Sale!

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New Products for the 2017 Academic School Year for SLPs

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

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

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

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

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

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

Checklist for Identification of Speech Language Disorders in Bilingual and Multicultural Children was created to assist Speech Language Pathologists (SLPs) and Teachers in the decision-making process of how to appropriately identify bilingual and multicultural children who present with speech-language delay/deficits (vs. a language difference), for the purpose of initiating a formal speech-language-literacy evaluation.  The goal is to ensure that educational professionals are appropriately identifying bilingual children for assessment and service provision due to legitimate speech language deficits/concerns, and are not over-identifying students because they speak multiple languages or because they come from low socioeconomic backgrounds.

Comprehensive Assessment and Treatment of Literacy Disorders in Speech-Language Pathology is a 125 slide presentation which describes how speech-language pathologists can effectively assess and treat children with literacy disorders, (reading, spelling, and writing deficits including dyslexia) from preschool through adolescence.  It explains the impact of language disorders on literacy development, lists formal and informal assessment instruments and procedures, as well as describes the importance of assessing higher order language skills for literacy purposes. It reviews components of effective reading instruction including phonological awareness, orthographic knowledge, vocabulary awareness,  morphological awareness, as well as reading fluency and comprehension. Finally, it provides recommendations on how components of effective reading instruction can be cohesively integrated into speech-language therapy sessions in order to improve literacy abilities of children with language disorders and learning disabilities.

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

from wordless books to reading From Wordless Picture Books to Reading Instruction: Effective Strategies for SLPs Working with Intellectually Impaired Students is a full 92 slide presentation which discusses how to address the development of critical thinking skills through a variety of picture books  utilizing the framework outlined in Bloom’s Taxonomy: Cognitive Domain which encompasses the categories of knowledge, comprehension, application, analysis, synthesis, and evaluation in children with intellectual impairments. It shares a number of similarities with the above product as it also reviews components of effective reading instruction for children with language and intellectual disabilities as well as provides recommendations on how to integrate reading instruction effectively into speech-language therapy sessions.

Best Practices in Bilingual LiteracyBest Practices in Bilingual Literacy Assessments and Interventions is a 105 slide presentation which focuses on how bilingual speech-language pathologists (SLPs) can effectively assess and intervene with simultaneously bilingual and multicultural children (with stronger academic English language skills) diagnosed with linguistically-based literacy impairments. Topics include components of effective literacy assessments for simultaneously bilingual children (with stronger English abilities), best instructional literacy practices, translanguaging support strategies, critical questions relevant to the provision of effective interventions, as well as use of accommodations, modifications and compensatory strategies for improvement of bilingual students’ performance in social and academic settings.

Comprehensive Literacy Checklist For School-Aged Children was created to assist Speech Language Pathologists (SLPs) in the decision-making process of how to identify deficit areas and select assessment instruments to prioritize a literacy assessment for school aged children. The goal is to eliminate administration of unnecessary or irrelevant tests and focus on the administration of instruments directly targeting the specific areas of difficulty that the student presents with.

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

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Early Intervention Part V: Assessing Feeding and Swallowing in Children Under Three

  1. General speech and language assessments of children under 3 years of age.
  2. Assessments of toddlers with suspected motor speech disorders 
  3. Assessments of children ~16-18 months of age
  4. Assessments of Social Pragmatic Abilities of Children Under 3

Today I’d like to talk about the assessment of feeding abilities of children under 3 years of age. Just to be clear, in my post, I am not offering tips on the assessment of medically fragile or neurologically impaired children with complex swallowing and feeding disorders such as severe food selectivity. Rather, I am offering suggestions for routine orofacial and feeding assessments of young children with normal swallowing but slightly immature feeding abilities.

First, let take a look at what the typical feeding development looks like in children 0-3 years of age. For this, I really like to use a resource from Dr. Joan Arvedson entitledDevelopmental milestones and feeding skills birth to 36 months from her article Swallowing and feeding in infants and young children which was published online in 2006

Age (months) Development/posture Feeding/oral sensorimotor
Source: Adapted from Arvedson and Brodsky (pp. 62–67).
Birth to 4–6 Neck and trunk with balanced flexor and extensor tone
Visual fixation and tracking
Learning to control body against gravity
Sitting with support near 6 months
Rolling over
Brings hands to mouth
Nipple feeding, breast, or bottle
Hand on bottle during feeding (2–4 months)
Maintains semiflexed posture during feeding
Promotion of infant–parent interaction
6–9 (transition feeding) Sitting independently for short time
Self-oral stimulation (mouthing hands and toys)
Extended reach with pincer grasp
Visual interest in small objects
Object permanence
Stranger anxiety
Crawling on belly, creeping on all fours
Feeding more upright position
Spoon feeding for thin, smooth puree
Suckle pattern initially Suckle  suck
Both hands to hold bottle
Finger feeding introduced
Vertical munching of easily dissolvable solids
Preference for parents to feed
9–12 Pulling to stand
Cruising along furniture
First steps by 12 months
Assisting with spoon; some become independent
Refining pincer grasp
Cup drinking
Eats lumpy, mashed food
Finger feeding for easily dissolvable solids
Chewing includes rotary jaw action
12–18 Refining all gross and fine motor skills
Walking independently
Climbing stairs
Running
Grasping and releasing with precision
Self-feeding: grasps spoon with whole hand
Holding cup with 2 hands
Drinking with 4–5 consecutive swallows
Holding and tipping bottle
>18–24 Improving equilibrium with refinement of upper extremity coordination.
Increasing attention and persistence in play activities
Parallel or imitative play
Independence from parents
Using tools
Swallowing with lip closure
Self-feeding predominates
Chewing broad range of food
Up–down tongue movements precise
24–36 Refining skills
Jumping in place
Pedaling tricycle
Using scissors
Circulatory jaw rotations
Chewing with lips closed
One-handed cup holding and open cup drinking with no spilling
Using fingers to fill spoon
Eating wide range of solid food
Total self-feeding, using fork

Now, let’s discuss the importance of examining the child’s facial features and oral structures. During these examinations it is important to document anything out of the ordinary noted in the child’s facial features or oral cavity.

Facial dysmorphia, signs of asymmetry indicative of paresis, unusual spots, nodules, openings, growths, etc, all need to be documented.  Note the condition of the child’s mouth. Is there excessive tooth decay? Do you see an unusual absence of teeth? Is there an unusual bite (open, cross, etc.), unusual voice or a cough, in the absence of a documented illness?  Here’s an example from a write up on a 2-8-year-old male toddler, below:

Facial observations revealed dysmorphic features: microcephaly (small head circumference), anteriorly rotated ears (wide set), and medially deviated, inward set eyes. A presence of mild-moderate hypotonicity (low tone) of the face [and trunk] was also noted.  FA presented with mostly closed mouth posture and appropriate oral postural control at rest but moderate drooling (drool fell on clothes vs. touching chin only) was noted during speech tasks and during play.  It’s important to note that the latter might be primarily behavioral in origin since FA was also observed to engage in “drool play” – gathering oral secretions at lip level then slowly and deliberately expelling them in a thin stream from his mouth and onto his shirt.

Articulatory structures including lips, tongue, hard palate and velum appeared to be unremarkable and are adequate for speech purposes. FA’s dentition was adequate for speech purposes as well.  Oral motor function was appropriate for lingual lateralization, labial retraction, volitional pucker and lingual elevation. Lingual depression was not achieved.  Diadochokinesis for sequential and alternate movements was unremarkable.  Overall, FA’s oral structures and function presented to be adequate for speech production purposes. 

FA’s prosody, pitch, and loudness were within normal limits for age and gender. No clinical dysfluencies were present during the evaluation.  Vocal quality was remarkable for intermittent hoarseness which tended to decrease (clear up) as speech output increased and may be largely due to a cold (he presented with a runny nose during the assessment). Vocal quality should continue to be monitored during therapy sessions for indications of persistent hoarseness in the absence of a cold.

From there I typically segue into a discussion of the child’s feeding and swallowing abilities. Below is an excerpt discussing the strengths and needs of an 18-month-old internationally adopted female.

During the assessment concerns presented regarding AK’s feeding abilities only. No swallowing concerns were reported or observed during the assessment. As per the parental report, at the age of 18 months, AK is still drinking from the bottle and consuming only puréed foods, which is significantly delayed for a child her age. AK’s feeding skills were assessed at snack time via indirect observation and select direct food administration.  The following foods and liquids were presented to AK during the assessment: 2 oz of yogurt, 18 cheerios, 4 banana and 2 apple bites, and 40 ml of water (via cup and straw). AK was observed to accept all of the above foods and liquids readily when offered.

Image result for toddler biting foodSpoon Stripping and Mouth Closure: During the yogurt presentation, AK’s spoon stripping abilities and mouth closure were deemed good (adequate) when fed by a caregiver and fair when AK fed self (incomplete food stripping from the spoon was observed due to only partial mouth closure). According to parental report, AK’s spoon stripping abilities have improved in recent months. Ms. K was observed to present spoon upwardly in AK’s mouth and hold it still until AK placed her lips firmly around the spoon and initiated spoon stripping.  Since this strategy is working adequately for all parties in question no further recommendations regarding spoon feeding are necessary at this time. Skill monitoring is recommended on an ongoing basis for further refinement.  

Biting and Chewing Abilities on Solids and Semi-Solids: AK’s chewing abilities were judged to be immature at this time for both solid (e.g., Cheerios) and semi-solid foods (e.g., banana). AK was observed to feed self Cheerios from a plate (1 at a time). She placed a cheerio laterally on lower right molars and attempted to grind it.  When the cheerio was presented to AK midline she was observed to anteriorly munch it, or mash it against the hard palate.  Notably, when too many cheerios were presented to her, rather than grasping and consuming them AK began to bang on a plate with both hands and throw the cheerios around the room. 

During feeding, the most difficulty was observed with biting and chewing solid and semisolid fruit (e.g., apple and banana pieces). When presented with a banana, AK manifested moderate difficulties biting off an adequately sized piece (she bit off too much). Consequently, due to the fact that she was unable to adequately chew on a piece that large, manual extraction of food from the oral cavity was initiated due to choking concerns.  It is important to note that during all food presentations AK did not display a diagonal rotary chew, which is below age expectancy for a child her age. Feeding strengths noted during today’s assessment included complete mouth closure (including lack of drooling and anterior food loss) during assisted spoon and finger foods feeding.

Image result for toddler drinking from strawCup and Straw Drinking: AK was also observed to drink 40 mls of water from a cup given parental assistance.  Minor anterior spillage was intermittently noted during liquid intake. It is recommended that the parents modify cup presentation by providing AK with a plastic cup with two handles on each side, which would improve her ability to grasp and maintain hold on cup while drinking.

Straw drinking trials were attempted during the assessment as it is a skill which typically emerges between 8-9 months of age and solidifies around 12-13 months of age (Hunt et al, 2000).  When AK was presented with a shortened straw placed in cup, she was initially able to create enough intraoral pressure to suck in a small amount of liquid.  However, AK quickly lost the momentum and began to tentatively chew on the presented straw as which point the trial was discontinued.

Based on the feeding assessment AK presented with mildly decreased abilities in the oral phase of feeding. It is recommended that she receive feeding therapy with a focus on refining her feeding abilities.”  

I follow the above, with a summary of evaluation impressions, recommendations, as well as suggested therapy goals. Finally, I conclude my report with a statement regarding the child’s prognosis (e.g., excellent, good, fair, etc.) as well as list potential maintaining factors affecting the duration of therapy provision.

So what about you? How do you assess the feeding and swallowing of abilities of children under 3 on your caseload? What foods, tasks, and procedures do you use?

   

 

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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)