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How Early can “Dyslexia” be Diagnosed in Children?

Image result for dyslexiaIn recent years there has been a substantial rise in awareness pertaining to reading disorders in young school-aged children. Consequently, more and more parents and professionals are asking questions regarding how early can “dyslexia” be diagnosed in children.

In order to adequately answer this question it is important to understand the trajectory of development of literacy disorders in children.

Image result for ida dyslexiaAccording to the definition set forth by the International Dyslexia Association“Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.”

Thus, despite the significant controversy over the use of the label “dyslexia”, as being ‘unscientific and conceptually problematic’, the above definition affirms the fact that it is undisputedly a linguistically based disability.   While it is true that merely using the term “dyslexia” does not automatically evoke our understanding of what type of specific reading-related deficits the child is experiencing, which prevents him/her from reading effectively, it does alert us right away to the fact that a reading disability exists.

In this post, rather than utilizing the term “dyslexia”, I will use a more broad term “literacy deficits” to refer to children who develop trouble reading, writing, and spelling.

Image result for genetic inheritanceSo who exactly are those children? Well, with respect to genetic inheritance, children with immediate and/or extended family members who have in the past received diagnoses such as “dyslexia”, “reading disability”, “learning disability” or who had experienced special education placements during school years are significantly more at risk of developing literacy based deficits than children with no history of above problems in the family.

Unfortunately, the situation is further complicated by the fact that some children with no recognizable family history of learning disabilities, may be at risk for future literacy deficits if they display a pattern of linguistic difficulties during early development (e.g., delayed developmental milestones).

Below is the approximate hierarchy of language development in young children:

  • Exploration of the environment (early socio-emotional development)
  • Play (continuation of socio-emotional development)
  • Receptive Language
    • Comprehension of  words, phrases, sentences, stories
  • Expressive Language
    • Speaking single words, phrases, sentences, engaging in conversations, producing stories
  • Social Emotional Development (Pragmatics) continues to be refined and becomes more sophisticated
  • Reading
    • Words, sentences, short stories, chapter books, etc.
    • General topics
    • Domain specific topics (science, social studies, etc)
  • Spelling
  •  Writing
    • Words, sentences, short stories, essays

The fact is that if the child experiences any deficits in the foundational language areas such as listening and speaking, s/he will most certainly experience difficulties in more complex areas of language: reading, writing, and spelling.

So now that we know that children with a history of language delay/disorder are at a significant risk of having the disorder turn into a learning disability when they’re older, let’s talk about how early can these children be assessed in order to better plan their future literacy based interventions for optimal functional outcomes.

The first scenario is a more obvious one.  If a child has a documented history of language impairments and is receiving services from a very early age (e.g., early intervention, preschool, etc.) then given what we know about the connection between language disorders and learning disabilities, professionals can begin administering phonological awareness/emergent reading interventions during the early preschool years in order to optimally facilitate the child’s literacy outcomes.

Image result for detective clipartNow our second scenario is not so clear-cut. In our second scenario, the child may have never been identified as having language difficulties during toddlerhood or even early preschool years. However, as the child grows older (e.g., 4-5 years of age) his/her parents may be noticing some subtle difficulties such as difficulty remembering nursery rhymes and songs, trouble remembering the letters of the alphabet, trouble recognizing simple rhyming words, etc.  A such, even without a pertinent family history of literacy disabilities it may be important for a child to undergo an early literacy assessment in order to determine whether intervention is warranted.

Now let’s talk about various assessment options available for preschool children with suspected literacy deficits.  Firstly, if the child has never received a language assessment it is paramount that the child’s language abilities in the areas of listening comprehension, verbal expression, problem-solving and social communication be assessed prior to assessment of literacy  to ensure that the child does not present with any unrecognized/previously undetected deficits in any of the above areas.  This is done in order to ensure optimal intervention outcomes as failure to address gaps/deficits in foundational language areas may significantly impede any potential literacy gains even when the child is provided with optimal literacy based interventions (click HERE to view my post discussing select speech-language tests for preschool children 2-6 years of age).

Now that we’ve covered some basics let us move on to discuss how early can select literacy tests be administered.  Luckily, there are a number of tests pertaining to literacy which can be administered to children as young as 3:6 years of age.

Image result for asa pearsonTo illustrate: The Auditory Skills Assessment (ASA) can be administered to children 3:6—6:11 years of age. Present controversy over CAPD notwithstanding, it does assess important areas related to early phonological awareness development including nonsense word repetition, phonemic blending, as well as rhyming.  Similarly, the Test of Auditory Processing Skills-3 (TAPS-3) begins at 4 years of age and covers several areas pertaining to phonological awareness including auditory discrimination of words, phonological segmentation, as well as phonological blending abilities.

Image result for ctoppHowever, for a thorough phonological awareness assessment for children that age (4+) nothing beats the Comprehensive Test of Phonological Processing-2 —(CTOPP-2), which assesses such areas as:

  • Phonological Segmentation
  • Blending Words
  • Sound Matching
  • Initial, Medial and Final Phoneme Isolation
  • Blending Nonwords*
  • Segmenting Nonwords*
  • Memory for Digits
  • Nonword Repetition*
  • Rapid Digit Naming 
  • Rapid Letter Naming 
  • Rapid Color Naming 
  • Rapid Object Naming 

(—Assesses the ability to manipulate real and *nonsense words)

(—Assesses word fluency skills via a host of rapid naming tasks)

Image result for Emerging Literacy & Language Assessment®For children 4:6 years of age and older the  Emerging Literacy & Language Assessment (ELLA) deserves a mention. It assesses the following literacy related abilities:

  • Section 1 – Phonological Awareness and Flexibility assesses rhyming (awareness and production), initial sound identification, blending and segmenting sounds, words, and syllables, and deleting and substituting sounds in the initial and final positions of words.
  • Section 2 – Sign and Symbol Recognition and Interpretation assesses environmental symbol identification, letter-symbol identification, word reference association, and reading comprehension for one to three sentences.
  • Section 3 – Memory, Retrieval, and Automaticity assesses rapid naming, word associations (name items that start with the “S” sound), and story retell (includes three story levels based on the child’s age).

For children between 5:0-9:11 years of age, —The Phonological Awareness Test 2 (PAT 2) will assess the following areas:Product Image

  • —Rhyming:  Discrimination and Production—identify rhyming pairs and provide a rhyming word
  • —Segmentation:  Sentences, Syllables, and Phonemes—dividing by words, syllables and phonemes
  • —Isolation:  Initial, Final, Medial—identify sound position in words
  • —Deletion:  Compound Words, Syllables, and Phonemes—manipulate root words, syllables, and phonemes in words
  • —Substitution With Manipulatives—isolate a phoneme in a word, then change it to another phoneme to form a new word
  • —Blending:  Syllables and Phonemes—blend units of sound together to form words
  • —Graphemes—assess knowledge of sound/symbol correspondence for consonants, vowels, consonant blends, consonant digraphs, r-controlled vowels, vowel digraphs, and diphthongs
  • —Decoding—assess  general knowledge of sound/symbol correspondence to blend sounds into nonsense words
  • —Invented Spelling (optional)—write words to dictation to show encoding ability

Furthermore, starting from 5 years of age the —Rapid Automatized Naming and Rapid Alternating Stimulus Test RAN/RAS  tests can be administered in order to assess the child’s word fluency skills.  Decreased word fluency is a significant indicator of reading deficits, which is why this ability is very important to test.

—In addition to the above assessments, there are several tests of early reading and writing abilities which are available for younger children with suspected literacy deficits

TERA-3: Test of Early Reading Ability–Third EditionThe  Test of Early Reading Ability–Third Edition (TERA-3) assesses  the emergent reading abilities of children starting from 3:6 years of age. Similarly, the Test of Early Written Language, Third Edition (TEWL-3) assesses  the emergent writing abilities of children starting from 4:0 years of age.

So there you have it! Now you know that if needed children as young 3:6 years of age can undergo early literacy assessments in order to determine their potential risk of developing literacy deficits when older.

Of course, due to the precociously young age of the children, it is important for examiners to exercise significant caution when it comes to interpretation of standardized testing results. It is a well-documented fact that standardized tests present with numerous limitations when it comes to identification of children with language and literacy disorders.

As such, due to the children’s young age there will be a number of instances when testing may reveal “false negative results” (show that there are no deficits when deficits still exist).  Consequently, in such cases, it is important to carefully monitor the child’s school performance in order to perform a literacy reassessment (if needed) when the child is older and his/her difficulties may be more apparent (click HERE to view my 4-part post discussing Components of Comprehensive Dyslexia Testing for further details).

Finally, it is very important to reiterate that children presenting with language and literacy deficits will not outgrow these deficits on their own. While there may be periods of “illusory recovery” when it looks like children with early language disorders have caught up with their peers, such “spurts” are typically followed by a “post-spurt plateau” (Sun & Wallach, 2014). This is because due to the ongoing challenges and an increase in academic demands “many children with early language disorders fail to “outgrow” these difficulties or catch up with their typically developing peers” (Sun & Wallach, 2014).  That is why it is crucial that we identify language and literacy deficits in children at a very early age in order to ensure their optimal educational outcomes.

Related Posts:

Helpful Smart Speech Therapy Resources Pertaining to Preschoolers: 

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Friend or Friendly: What Does Age Have To Do with It?

In my social pragmatic language groups I target a wide variety of social communication goals for children with varying levels and degrees of impairment with a focus on improving their social pragmatic language competence.  In the past I have written blog posts on a variety of social  pragmatic language therapy topics, including strategies for improving students’ emotional intelligence as well as on how to teach students to develop insight into own strengths and weaknesses.  Today I wanted to discuss the importance of teaching students with social communication impairments, age recognition for friendship and safety purposes.

Now it is important to note that the focus of my sessions is a bit different from the focus of “teaching protective behaviors”, “circles of intimacy and relationships” or “teaching kids to deal with tricky people. Rather the goal is to teach the students to recognize who it is okay “to hang out” or be friends with, and who is considered to be too old/too young to be a friend.

Why is it important to teach age recognition?

There are actually quite a few reasons.

Firstly, it is a fairly well-known fact that in the absence of age-level peers with similar weaknesses, students with social communication deficits will seek out either much younger or much older children as playmates/friends as these individuals are far less likely to judge them for their perceived social deficits. While this may be a short-term solution to the “friendship problem” it also comes with its own host of challenges.  By maintaining relationships with peers outside of their age group, it is difficult for children with social communication impairments to understand and relate to peers of their age group in school setting. This creates a wider chasm in the classroom and increases the risk of peer isolation and bullying.

Secondly, the difficulty presented by friendships significantly outside of one’s peer group, is  the risk of, for lack of better words, ‘getting into trouble’. This may include but is not limited to exploring own sexuality (which is perfectly normal) with a significantly younger child (which can be problematic) or be instigated by an older child/adolescent in doing something inappropriate (e.g, shoplifting, drinking, smoking, exposing self to peers, etc.).

Thirdly, this difficulty (gauging people’s age) further exacerbates the students’ social communication deficits as it prevents them from effectively understanding such pragmatic parameters such as audience (e.g., with whom its appropriate to use certain language in a certain tone and with whom it is not) and topic (with whom it is appropriate to discuss certain subjects and with whom it is not).

So due to the above reasons I began working on age recognition with the students (6+ years of age) on my caseload diagnosed with social communication and language impairments.   I mention language impairments because it is very important to understand that more and more research is coming out connecting language impairments with social communication deficits. Therefore it’s not just students on the autism spectrum or students with social pragmatic deficits (an official DSM-5 diagnosis) who have difficulties in the area of social communication. Students with language impairments could also benefit from services focused on improving their social communication skills.

I begin my therapy sessions on age recognition by presenting the students with photos of people of different ages and asking them to attempt to explain how old do they think the people in the pictures are and what visual clues and/or prior knowledge assisted them in the formulation of their responses. I typically select the pictures from some of the social pragmatic therapy materials packets that I had created over the years (e.g., Gauging Moods, Are You Being Social?, Multiple Interpretations, etc.).

I make sure to carefully choose my pictures based on the student’s age and experience to ensure that the student has at least some degree of success making guesses.  So for a six-year-old I would select pictures of either toddlers or children his/her age to begin teaching them recognition of concepts: “same” and “younger” (e.g., Social Pragmatic Photo Bundle for Early Elementary Aged Children).

Kids playing in the room

For older children, I vary the photos of different aged individuals significantly.  I also introduce relevant vocabulary words as related to a particular age demographic, such as:

  • Infant (0-1 years of age)
  • Toddler (2-3 years of age)
  • Preschooler (3-5 years of age)
  • Teenager (individual between 13-19 years of age)
  • Early, mid and late 20s, 30s, 40s
  • Middle-aged (individuals around 50 years of age)
  • Senior/senior citizen (individuals ~65+ years of age)

I explain to the students that people of different ages look differently and teach them how to identify relevant visual clues to assist them with making educated guesses about people’s ages.  I also use photos of my own family or ask the students to bring in their own family photos to use for age determination of people in the presented pictures.  When students learn the ages of their own family members, they have an easier time determining the age ranges of strangers.

My next step is to explain to students the importance of understanding people’s ages.  I present to the students a picture of an individual significantly younger or older than them and ask them whether it’s appropriate to be that person’s friend.   Here students with better developed insight will state that it is not appropriate to be that person’s friend because they have nothing in common with them and do not share their interests. In contrast, students with limited insight will state that it’s perfectly okay to be that person’s friend.

This is the perfect teachable moment for explaining the difference between “friend” and “friendly”. Here I again reiterate that people of different ages have significantly different interests as well as have significant differences in what they are allowed to do (e.g., a 16-year-old is allowed to have a driver’s permit in many US states as well as has a later curfew while an 11-year-old clearly doesn’t).  I also explain that it’s perfectly okay to be friendly and polite with older or younger people in social situations (e.g., say hello all, talk, answer questions, etc.) but that does not constitute true friendship.

I also ask students to compile a list of qualities of what they look for in a “friend” as well as have them engage in some perspective taking (e.g, have them imagine that they showed up at a toddler’s house and asked to play with him/her, or that a teenager came into their house, and what their parents reaction would be?).

Finally, I discuss with students the importance of paying attention to who wants to hang out/be friends with them as well as vice versa (individuals they want to hang out with) in order to better develop their insight into the appropriateness of relationships. I instruct them to think critically when an older individual (e.g,  young adult) wants to get particularly close to them.  I use examples from an excellent post written by a colleague and good friend, Maria Del Duca of Communication Station Blog re: dealing with tricky people, in order to teach them to recognize signs of individuals crossing the boundary of being friendly, and what to do about it.

So there you have it. These are some of the reasons why I teach age recognition to clients with social communication weaknesses. Do you teach age recognition to your clients? If so, comment under this post, how do you do it and what materials do you use?

Helpful Smart Speech Resources Related to Assessment and Treatment of Social Pragmatic Disorders 

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Improving Emotional Intelligence of Children with Social Communication Disorders

Our ability to recognize our own and other people’s emotions, distinguish between and correctly identify different feelings, as well as use that information to guide our thinking and behavior is called Emotional Intelligence (EI) (Salovey, et al, 2008).

EI encompasses dual areas of: emotion understanding, which is an awareness and comprehension of one’s and others emotions (Harris, 2008) and emotion regulation, which are internal and external strategies people use to regulate emotions (Thompson, 1994).

Many students with social communication challenges experience problems with all aspects of EI, including the perception, comprehension, and regulation of emotions (Brinton & Fujiki, 2012).

A number of recent studies have found that children with language impairments also present with impaired emotional intelligence including impaired perception of facial expressions (Spackman, Fujiki, Brinton, Nelson, & Allen, 2005), prosodic emotions (Fujiki, Spackman, Brinton, & Illig, 2008) as well as abstract emotion comprehension (Ford & Milosky, 2003).

Children with impaired emotional intelligence will experience numerous difficulties during social interactions due to their difficulty interpreting emotional cues of others (Cloward, 2012).  These may include but not be limited to active participation in cooperative activities, as well as full/competent interactions during group tasks (Brinton, Fujiki, & Powell, 1997)

Many students with social pragmatic deficits and language impairments are taught to recognize emotional states as part of their therapy goals. However, the provided experience frequently does not go beyond the recognition of the requisite “happy”, “mad”, “sad” emotions. At times, I even see written blurbs from others therapists, which state that “the student has mastered the goals of emotion recognition”.  However, when probed further it appears that the student had merely mastered the basic spectrum of simple emotional states, which places the student at a distinct disadvantage  as compared to typically developing peers who are capable of recognition and awareness of a myriad of complex emotional states.

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That is why I developed a product to target abstract emotional states comprehension in children with language impairments and social communication disorders. “Gauging Moods and Interpreting Abstract Emotional States: A Perspective Taking Activity Packet” is a social pragmatic photo/question set,  intended for children 7+ years of age, who present with difficulty recognizing abstract emotional states of others (beyond the “happy, mad, sad” option) as well as appropriately gauging their moods.

Many sets contain additional short stories with questions that focus on making inferencing, critical thinking as well as interpersonal negotiation skills.  Select sets require the students to create their own stories with a focus on the reasons why the person in the photograph might be feeling what s/he are feeling.

There are on average 12-15 questions per each photo.  Each page contains a photograph of a person feeling a particular emotion. After the student is presented with the photograph, they are asked a number of questions pertaining to the recognition of the person’s emotions, mood, the reason behind the emotion they are experiencing as well as what they could be potentially thinking at the moment.  Students are also asked to act out the depicted emotion they use of mirror.

Activities also include naming or finding (in a thesaurus or online) the synonyms and antonyms of a particular word in order to increase students’ vocabulary knowledge. A comprehensive two page “emotions word bank” is included in the last two pages of the packet to assist the students with the synonym/antonym selection, in the absence of a thesaurus or online access.

Students are also asked to use a target word in a complex sentence containing an adverbial (pre-chosen for them) as well as to identify a particular word or phrase associated with the photo or the described story situation.

Since many students with social pragmatic language deficits present with difficulty determining a person’s age (and prefer to relate to either younger or older individuals who are perceived to be “less judgmental of their difficulties”), this concept is also explicitly targeted in the packet.

This activity is suitable for both individual therapy sessions as well as group work.  In addition to its social pragmatic component is also intended to increase vocabulary knowledge and use as well as sentence length of children with language impairments.

Intended Audiences:

  • Clients with Language Impairments
  • Clients with Social Pragmatic Language Difficulties
  • Clients with Executive Function Difficulties
  • Clients with Psychiatric Impairments
    • ODD, ADHD, MD, Anxiety, Depression, etc.
  • Clients with Autism Spectrum Disorders
  • Clients with Nonverbal Learning Disability
  • Clients with Fetal Alcohol Spectrum Disorders
  • Adult and pediatric post-Traumatic Brain Injury (TBI) clients
  • Clients with right-side CVA Damage

Areas covered in this packet:

  1. Gauging Age (based on visual support and pre-existing knowledge)
  2. Gauging Moods (based on visual clues and context)
  3. Explaining Facial Expressions
  4. Making Social Predictions and Inferences (re: people’s emotions)
  5. Assuming First Person Perspectives
  6. Understanding Sympathy
  7. Vocabulary Knowledge and Use (pertaining to the concept of Emotional Intelligence)
  8. Semantic Flexibility (production of synonyms and antonyms)
  9. Complex Sentence Production
  10. Expression of Emotional Reactions
  11. Problem Solving Social Situations
  12. Friendship Management and Peer Relatedness

This activity is suitable for both individual therapy sessions as well as group work.  In addition to its social pragmatic component is also intended to increase vocabulary knowledge and use as well as sentence length of children with language impairments. You can find it in my online store (HERE).

Helpful Smart Speech Resources:

References:

  1. Brinton, B., Fujiki, M., & Powell, J. M. (1997). The ability of children with language impairment to manipulate topic in a structured task. Language, Speech and Hearing Services in Schools, 28, 3-11.
  2. Brinton B., & Fujiki, M. (2012). Social and affective factors in children with language impairment. Implications for literacy learning. In C. A. Stone, E. R. Silliman, B. J. Ehren, & K. Apel (Eds.), Handbook of language and literacy: Development and disorders (2nd Ed.). New York, NY: Guilford.
  3. Cloward, R. (2012). The milk jug project: Expression of emotion in children with language impairment and autism spectrum disorder (Unpublished honor’s thesis). Brigham Young University, Provo, Utah.
  4. Ford, J., & Milosky, L. (2003). Inferring emotional reactions in social situations: Differences in children with language impairment. Journal of Speech, Language, and Hearing Research, 46(1), 21-30.
  5. Fujiki, M., Spackman, M. P., Brinton, B., & Illig, T. (2008). Ability of children with language impairment to understand emotion conveyed by prosody in a narrative passage. International Journal of Language & Communication Disorders, 43(3), 330-345
  6. Harris, P. L. (2008). Children’s understanding of emotion. In M. Lewis, J. M. Haviland-Jones, & L. Feldman Barrett, (Eds.), Handbook of emotions (3rd ed., pp. 320–331). New York, NY: Guilford Press.
  7. Salovey, P., Detweiler-Bedell, B. T., Detweiler-Bedell, J. B., & Mayer, J. D. (2008). Emotional intelligence. In M. Lewis, J. M. Haviland-Jones, & L. Feldman Barrett (Eds.), Handbook of Emotions (3rd ed., pp. 533-547). New York, NY: Guilford Press.
  8. Spackman, M. P., Fujiki, M., Brinton, B., Nelson, D., & Allen, J. (2005). The ability of children with language impairment to recognize emotion conveyed by facial expression and music. Communication Disorders Quarterly, 26(3), 131-143.
  9. Thompson, R. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59(2-3), 25-52

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Teaching “Insight” to students with language, social communication, and executive functions impairments

One common difficulty our “higher functioning” (refers to subjective notion of ‘perceived’ functioning in school setting only) language impaired students with social communication and executive function difficulties present with – is lack of insight into own strengths and weaknesses.

Yet insight is a very important skill, which most typically developing students exhibit without consciously thinking about it. Having insight allows students to review work for errors, compensate for any perceived weaknesses effectively, and succeed with efficient juggling of academic workload.

In contrast, lack of insight in students with language deficits further compounds their difficulties, as they lack realization into own weaknesses and as a result are unable to effectively compensate for them.

That is why I started to explicitly teach the students on my caseload in both psychiatric hospital and private practice the concept of insight.

Now some of you may have some legitimate concerns. You may ask: “How can one teach such an abstract concept to students who are already impaired in their comprehension of language?” The answer to that is – I teach this concept through a series of concrete steps as well as through the introduction of abstract definitions, simplified for the purpose of my sessions into concrete terms.

Furthermore, it is important to understand that the acquisition of “insight” cannot be accomplished in one or even several sessions. Rather after this concept is introduced and the related vocabulary has been ‘internalized’ by the student,  thematic therapy sessions can be used to continue the acquisition of “insight” for months and even years to come.

"The Beginning" Road Sign with dramatic blue sky and clouds.

How do we begin? 

When I first started teaching this concept I used to explain the terminology related to “insight” verbally to students. However, as my own ‘insight’ developed in response to the students’ performance, I created a product to assist them with the acquisition of insight (See HERE).

Intended Audiences:

  • Clients with Language Impairments
  • Clients with Social Pragmatic Language Difficulties
  • Clients with Executive Function Difficulties
  • Clients with Psychiatric Impairments
    • ODD, ADHD, MD, Anxiety, Depression, etc.
  • Clients with Autism Spectrum Disorders
  • Clients with Nonverbal Learning Disability
  • Clients with Fetal Alcohol Spectrum Disorders
  • Adult and pediatric post-Traumatic Brain Injury (TBI) clients
  • Clients with right-side CVA Damage

kid-lightbulb-shutterstock_166297358-300×198

This thematic 10 page packet targets the development of “insight” in students with average IQ, 8+ years of age, presenting with social pragmatic and executive function difficulties.

The packet contains 1 page text explaining the concept of insight to students.

It also contains 11 Tier II vocabulary words relevant to the discussion of insight and their simplified definitions. The words were selected based on course curriculum standards for several grade levels (fourth through seventh) due to their wide usage in a variety of subjects (social studies, science, math, etc.)

Language activities in this packet include:

  • Explaining definitions
  • Answering open-ended comprehension questions
  • Sentence construction activity
  • Crossword puzzle
  • Two morphological awareness activities
    • Define prefixes and suffixes
    • Change word meanings by adding prefixes and suffixes to words
  • Self-reflection page in written format contains questions for students to assist them with judging their own strengths and weaknesses related to academic performance

And now a few words regarding the lesson structure

I introduce the concept of “insight” to clients by writing down the word and asking them to identify its parts: ‘in‘ and ‘sight‘. Depending on the student’s level of abilities I either get to the students to explain it to me or explain it myself that it is a compound word made up of two other words.

I then ask the students to interpret what the word could potentially mean. After I hear their responses I either confirm the correct one or end up explaining that this word refers to “looking into one’s brain” for answers related to how well someone understands information.

I have the students read the text located on the first page of my packet going over the concept of insight and some of its associated vocabulary words.  I ask the students to tell me the main idea of each paragraph as well as answer questions regarding supporting text details.

Once I am confident that the students have a fairly good grasp of the presented text I move on to the definitions page. There are actually two definition pages in the lesson: one at the beginning and one at the end of the packet. The first definitions page also contains word meaning and what parts of speech the definitions belong to.  The definition page at the end of the packet contains only the targeted words. It is now the students responsibility to write down the definition of all the vocabulary words and phrases in order for me to see how well they remember the meanings of pertinent words.

The packet also includes comprehension questions, a section on sentence construction several morphological awareness activities, a crossword puzzle and a self-reflection page.

The final activity in the packet requires the student to judge their own work performance during this activity.  I ask students questions such as:

  • How do you think you did on this task?
  • How do you know you did ________?
  • How can you prove to me you understood ________?

If a student responds “I know I did well because I understood everything”, I typically ask them to prove their comprehension to me, verbally. Here the goal is to have the student provide concrete verbal examples supporting their insight of their performance.

 This may include statements such as:

  • I know I did well because you said: “Nice Work!”
  • I know I did well because you didn’t correct me too much
  • I know I did well because you  kept smiling and showed me thumbs up as I was talking

As mentioned above this activity is only the beginning. After I ensure that the students have a decent grasp of this concept I continue working on it indirectly by having the students continuously judge their own performance on a variety of other therapy related activities and assignments.

You can find the complete packet on teaching “insight” in my online store (HERE).  Also, stay tuned for Part II of this series, which will describe how to continue solidifying the concept of “insight” in the context of therapy sessions for students with social pragmatic and executive function deficits.

Helpful Smart Speech Resources:

 

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Normal Simultaneous Bilingual Language Development and Milestones Acquisition

5428Today I am excited to introduce another product aimed at explaining one of the aspects of typical bilingual language development. This 26 page introductory material describes simultaneous (from infancy) bilingual language development. It is part of several comprehensive bilingual assessment materials found HERE as a part of a “Multicultural Assessment and Treatment Bundle”  AND  HERE as an individual product entitled “Language Difference vs. Language Disorder: Assessment & Intervention Strategies for SLPs Working with Bilingual Children“.

 Learning objectives:
  • —Explain Dual Language System Hypothesis
  • —List important milestones of bilingual language development
  • —Discuss the difference between code-mixing and code-switching
  • —Review advantages of bilingual language development

Presentation Content

  • Simultaneous dual language acquisition in infancy
  • Dual Language System Hypothesis
  • Similarities between monolingual and bilingual language acquisition
  • Simultaneous Bilingualism
  • Vocabulary differences between L1 and L2
  • Bilingual Language Development
  • Important Bilingual Milestones
  • Bilingual Milestones and Age of Onset
  • Simultaneous dual language learning
  • Simultaneous dual language learning & language delay
  • Conclusion
  • Helpful Smart Speech Therapy Resources
  • References

Would you like a copy? You can find it HERE in my online store.

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New Giveaway: Overview of Standardized Assessments for Preschool and School Aged Children

When my FB page hits 600 Likes I’ll be giving away the handouts to my presentation: “Overview of Standardized Assessments for Preschool and School Aged Children.”
The handouts contain the following information:

Review of the Renfrew Bus Story

Review of The Strong Narrative Assessment 

Review of the  Test of Narrative Language (TNL)

Review of the   Narrative Assessment Protocol (NAP)

Review of the Narrative Language Measures (NLM)

Links to Select Free Assessment and Intervention Resources

How to win:

1. Share my FB page https://www.facebook.com/SmartSpeechTherapyLlc publicly and leave a Comment on FB that you’ve entered this giveaway.

2. Comment ON MY BLOG below this entry why you would like this handout.

Once my FB page hits 600 likes, I will choose 20 winners, whose responses I liked the best.

Good Luck!

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ASHA Community Spotlight

I just got an email that I’ll be profiled on ASHA Community Page for the next month or so. So click on the link to find out why I participate in ASHA’s Professional Community.

Here are some ways in which I participate:

I contribute to forum discussions including those which pertain to Special Interest Groups 1, 14, and 16.

I share materials with members and post them in various ASHA Libraries.

I am an ASHA S.T.E.P Mentor.

I also intermittently contribute blog posts to ASHAsphere, the official blog of the American Speech Language and Hearing Association.

If you are a certified speech language pathologist I highly recommend ASHA Community Participation as as part of your professional growth.

If you haven’t done it yet, try it!

I guarantee you’ll like it!

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Rutgers 31 Annual Let’s Talk Adoption Conference

Tatyana ElleseffCo-presenting 2 sessions at the Rutgers 31 Annual Let’s Talk Adoption Conference on November 3, 2012. Rutgers 31 Annual Let’s Talk Adoption Conference

1:45-2:45pm

24. “Inattentiveness and Hyperactivity in Adopted and Foster Care Children;; Not All ADHD is Bouncing Off the Walls” [AF, ED, FP, HC, MP, PA, SW-­2] Inattentiveness, hyperactivity, and impulsivity are the most common behavioral problems in adopted and foster care children. The effectiveness of any preventative and/or therapeutic intervention greatly depends on accurate diagnosis of the underlying issue. A general pediatrician and a speech/language pathologist, both specializing in adoption/foster care as well as in educational issues, will discuss the multi-­faceted problem in the ‘at-­risk’ population, children and their caregivers. Special emphasis will be made on major medical, developmental, educational, and/or mental health causes of hyperactivity and inattentiveness in children and teenagers beyond the ADHD diagnosis, including FASD, PTSD, traumatic brain injury, and other entities. Alla Gordina, MD, FAAP and Tatyana Elleseff, MA CCC-­SLP (1 CEH)

3:00-4:00pm

33. “Sobering Thoughts on Attitudes Towards Fetal Alcohol Spectrum Disorders” [AF, ED, FP, HC, MP, PA, SW-­4] The group of Fetal Alcohol Spectrum Disorders, affecting up to 10% of adopted and foster care children, is the single most common preventable cause of mental retardation in the United States. Yet it is one of the least diagnosed and worst managed conditions by medical, mental health and educational professionals. A general pediatrician and a speech/language pathologist, both specializing in adoption/foster care as well as in educational issues, will discuss the approaches to evaluation and management of individuals affected by Fetal Alcohol Spectrum Disorders, as well as recommendations on local resources and advocacy strategies. Alla Gordina, MD, FAAP and Tatyana Elleseff, MA CCC-­SLP (1 CEH)

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The Value of Multidisciplinary Collaboration and Follow -up among International Adoption Professionals: A Speech Pathologist’s Perspective

As a speech language pathologist who works with internationally adopted children, I often encounter difficult cases on which I require multidisciplinary collaboration from other professionals such as pediatricians, neurologists, psychologists, occupational therapists and other related specialists. However, over the years of working with this unique population, I have noted that among adoption professionals and adoptive parents this practice is not as popular, as I would like it to be, despite evidence based practice recommendations (Catlett & Halper, 1992; Ellingson, 2002; Hwa-Froelich, Pettinelli, & Jones, 2006; Tzenalis & Sotiriadou, 2010). Oftentimes, medical professionals may initially examine a child post adoption, recommend a related service (e.g., “you child needs speech therapy”) but will not follow up with the related service provider regarding the child’s progress or lack of thereof.  Of course the same goes the other way, I have also encountered cases where a related services provider (e.g., OT, ST) had made clinically relevant observations and did not find it “important” to follow up with relevant medical professional/s regarding the findings.  I’ve also encountered numerous adoptive parents who did not follow through on specific recommendations regarding related services provision (speech or occupational therapy services) or psychiatric/neurological referrals.

Consequently, for the purpose of this article I would like to demonstrate to both adoptive parents and professionals two case examples in which multidisciplinary and parental collaboration was key to confirming specific relevant to social and academic functioning diagnoses, which then in turn supported the provision of relevant services for the children in question, to help them function appropriately.

Last year a received a private referral to perform a speech-language evaluation on a preschooler, 8 months post adoption.  He had previously underwent a post adoption assessment at a prominent hospital in my area,  where a neurologist had noted his small head circumference and significantly reduced language abilities and made a general referral for the child to be evaluated by a speech pathologist but did not emphasize the importance of follow-up to the adoptive parent.  Fast forward 8 months later, this child was still presenting with significant language delay as well as behavioral outbursts, when he was reluctantly brought in for an assessment by his parent based on a recommendation of a privately seen psychotherapist.

During the course of my assessment I noticed his atypical facial features.  He had a very small head, inward set eyes, and widely set ears.  At that time, even though this boy had already seen a number of other adoption professionals. I still documented my findings and referred him for a second opinion due to a number of additional red flags, which included his significantly decreased play skills, severely impaired language ability, as well as significant social emotional and behavioral difficulties.  This time around the second opinion consultations “paid off”, and yielded a diagnosis of Fetal Alcohol Spectrum Disorder, which allowed this child to be placed in preschool disabled classroom as well as to receive appropriate accommodations and related services to improve his language abilities and social emotional functioning.

While many professionals might consider this a successful conclusion to this story I would like to point out that this child presented with significant unrecognized and unaddressed deficits for 8 months post adoption due to lack of consistent collaboration and follow through in his case. Had the collaborative process been more cohesive this child could have been receiving relevant and necessary services since adoption, and could have feasibly improved his abilities by the time 8 months had passed.  

Here’s another case example in which the collaborative process was equally important.  A number of months ago during presentation preparation with two of my colleagues, a pediatrician and a clinical social worker, the conversation turned to progress of our mutual clients.   At that point I expressed frustration with halting and inconsistent progress of one of my clients, who was receiving weekly private speech therapy from me as well as private tutoring three times a week, and whose issues with attention and cognition persisted, despite the absence of a particular diagnosis (e.g., ASD).

After, I shared my concerns with my colleagues; the pediatrician stated that she has long been concerned with the presence of café au lait spots on this child’s skin and has sent him out for blood work but have not heard anything from his parents since. Though the pediatrician was not stating her suspicious explicitly, café au lait spots on the skin are often indicative of neurofibromatosis, a neurocutaneous syndrome that leads to benign tumor growths in various parts of the body, can affect the brain, spinal cord, nerves, skin, and other body systems as well as cause cognitive deficits and learning disabilities that affect appropriate knowledge acquisition and retention.  In this situation, it was very important to make sure that the parent was “on the same page” as the other professionals and followed through on their recommendations, in order to coordinate appropriate services and supports for this child both privately and through his school.

I use these examples to emphasize the value and importance of working as part of a team to treat the “whole” child.  Those adoption professionals who specialize in working with children on the spectrum are most familiar with being part of a team, since they are just one of many professionals such as behaviorists, OT’s, psychologists or neurologists who are working with a child.  Being part of a team is also a much more acceptable practice when a child is treated in a hospital or a rehab setting and presents with a complex disorder (e.g., has a genetic syndrome, etc).

However, in the field of adoptive services, even outside of specialty settings (hospital/rehab) we are frequently confronted with clients who stump our thinking processes, and who require the team approach.  Yet oftentimes that creates a significant challenge for many professionals isolated in private practice.  Being part of a team when one is sole practitioner is a much more difficult feat, especially when select adoptive professionals are just striking out on their own for the first time.

Yet, both interdisciplinary and multidisciplinary teamwork is oftentimes so crucial in our field. Working as part of a team allows us to collectively pursue common goals, combine our selective expertise, initiate a discussion to solve difficult problems, as well as to have professional lifelines when working on difficult cases.   Different providers (neurologist, SLP, OT, psychotherapist) see different symptoms as well as different aspects of the patient’s disorder. Consequently, different providers bring different perspectives to the table, which ultimately positively contributes to the treatment of the whole child.

So how can we develop productive professional relationships with other service providers which go beyond the initial referral? I’ll be the first one to admit that it is not an easy accomplishment especially which it comes to physicians such as psychiatrists, neurologists, geneticists, or developmental pediatricians.  I can tell you that while some of my professional relationships came easy, others took years to attain and refine.

When I first started working with internationally adopted children in private practice, in a fairly short period of time I ended up having a number of clients with complex diagnoses and no one to refer them to.  What complicated matters further was that some parents did not bring their child to pediatrician specializing in adoptions post arrival (the child just saw a regular pediatrician), but simply brought their child to me when the child’s most “visible issues” speech language deficits, became evident. I had to be the one to initiate the referral process to suggest to their parents relevant medical adoption professionals, which needed to be visited in order to figure out why their children were having such complex language difficulties (among other symptoms) in the first place.

Consequently, I’ve compiled some suggestions for adoption professionals on how to initiate and maintain professional relationships with other relevant adoption providers. Adoptive parents can also benefit from these, since it can help them to initiate the process of obtaining appropriate services for their adopted child.

Start by doing a little reconnaissance.  Become a member of select adoption forums, poke around for advice in support groups, subscribe to relevant adoption publications, network with adoption professionals on LinkedIn,  ask around locally based colleagues, talk to other client’s parents who already did the necessary legwork, or find out whether there are any good international adoption programs/professionals in the local area hospitals.  Personally, when word of mouth failed to do the trick, I turned to “Google” to provide me with desired results.  Surprisingly, simply typing in a string search containing the words adoption as well as “best _______ (profession) in _____ (name of state)” frequently did the trick and allowed me to locate relevant professionals, after browsing through the multitude of web reviews.

Of course depending on the length of client treatment, you will have different relationships with different adoption professionals.   You may collaborate for years with some (e.g., pediatricians, psychiatrists), and only infrequently speak with select specialists (geneticist, otolaryngologist, pediatric ophthalmologist).

Typically, when I refer a client for additional testing or consultation, in my referral letter, I request to receive the results in writing, asking the adoption professional to also include relevant recommendations (if needed). Oftentimes, I also try to set some time to discuss the findings in a phone call in case I have any additional questions or concerns. Of course, I also send out to others, relevant information from my end (progress reports, evaluations) so all of professionals on a specific case will have a more comprehensive profile of the client’s disorder/deficit.

After all, ST’s, OT’s and PT’s are not the only ones who are dependent on information from doctors in order to do our work better. There are times when physicians need information from related professionals in order to move further in treatment such as order specific tests. For example, just recently a pediatrician used my therapy progress report in conjunction with another provider’s, to order an MRI on our mutual recently adopted client.  The pediatrician had significant concerns over client’s development and presenting symptomatology, and needed to gather additional reports supporting her cause for concern in order to justify her course of action (ordering an MRI) to the HMO.

As mentioned previously there are numerous benefits to teamwork including the fact that it allows for appreciation of other disciplines, creation of functional goals for the child,  integration of interventions as well as “brings together diverse knowledge and skills and can result in quicker decision making” (Catlett & Halper, 1992).

Given the above, I highly recommend that adoptive parents and professionals attempt to coordinate care and maintain relationships throughout the duration of the child’s treatment.  This will improve decision making, allow the professionals to address the child’s deficits in a holistic manner, an even potentially expedite the child’s length of stay in therapies.

References:

  • Catlett, C & Halper, A (1992) Team Approaches: Working Together to Improve Quality. ASHA: Quality Improvement Digest.http://www.asha.org/uploadedFiles/aud/TeamApproaches.pdf
  • Ellingson, L (2002) Communication, Collaboration, and Teamwork among Health Care Professionals. Communication Research Trends 21(3) 1-43.
  • Hwa-Froelich, D. A., Pettinelli, J. D., & Jones, S. (2006). Multidisciplinary Collaboration  with Internationally Adopted Children. Perspectives on Communication  Disorders in Culturally and Linguistically Diverse Populations, 13(3), 8-16.
  • Matsuo, H. Hwa-Froelich, D. A., Pettinelli, J. D., Pryor, C., & Sessions, L. (2006).   Constructing Shared Realities: Multidisciplinary Collaboration of Internationally   Adopted Children’s Clinic. Presentation at the Second International Congress of  Qualitative Inquiry, Urbana-Champaign, IL.
  • National Institute of Neurological Disorders and Stroke (NINDS) Neurofibromatosis Information Page http://www.ninds.nih.gov/disorders/neurofibromatosis/neurofibromatosis.htm
  • Pettinelli, D. J., Matsuo, H., & Hwa-Froelich, D. A. (2006). Supervision in   multidisciplinary collaboration. Presentation at the Missouri Family Therapy   Conference, St. Louis, MO.
  • Tzenalis, A & Sotiriadou, C (2010) Health Promotion as Multi-Professional and Multi-Disciplinary Work.  International Journal of Caring Sciences 3(2)49-55
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Upcoming Presentations: Narrative Assessments of Preschool and School Aged Children

On October 24th 2012, I will be presenting at the Morris County Speech Hearing Association in Whippany, NJ on the importance of Narrative Assessments of Preschool and School Aged Children.  See MCSHA’s August 2012 Newsletter regarding registration details.

Learning Objectives:

Participants will be able to

•Explain the impact of narrative difficulties on language development and academic performance
•Discuss stages of narrative development in preschool and school aged children
•List formal and informal instruments that can be used to elicit narratives in children of various ages
•Identify specific elements of narrative assessment
•Formulate measurable goals and objectives targeting narrative skills for IEP reports