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Identifying Word Finding Deficits in Narrative Retelling of School-Aged Children

Image result for word-finding In the past, I have written several posts on the topic of word finding difficulties (HERE and HERE) as well as narrative assessments (HERE and HERE) of school-aged children. Today I am combining these posts  together by offering suggestions on how SLPs can identify word finding difficulties in narrative samples of school-aged children.

Word finding difficulties can manifest via a variety of ways, including pauses, semantic (e.g., ‘wolf’ for ‘fox’) and phonological substitutions of words (e.g., ‘dicar’ for ‘guitar’), use the fillers (e.g., ‘um’, ‘like’), use of mazes (nonspecific vocabulary, circumlocutions, or revisions), iconic gestures (e.g., miming a word) as well as gestures of frustration (e.g., hand on head in frustration, hand waving, etc.), etc (German, 2005).  Furthermore, for many children, word finding difficulties may not be very apparent at the word level, when only a retrieval of one vocabulary word is required during confrontational naming tasks. However, their word-finding difficulties may become very glaring when these children have to engage in discourse as well as produce a variety of narratives.

Students may also display a significant variability in their word-finding profiles. They could present with both slow and inaccurate retrieval of words (take more processing time to produce language and produce it imprecisely). They could also be fast and inaccurate retrievers (speak without pauses but use an imprecise choice of words).  Finally, they could be slow but accurate retrievers (take more processing time to produce language but produce it precisely) (German, 2005).

Below is a narrative reassessment of a 4th-grade student who was read a book by William Steig entitled: “Dr. De Soto” (Plot Summary). He was then asked to retell the story without the benefit of visual support.  The following was the narrative produced by him:

Image result for dr de sotoAnalysis: This student’s narrative retelling was judged to be significantly impaired for his age. With respect to macrostructure, his narrative lacked a number of story grammar elements including a definitive introduction, a problem, as well as a definitive conclusion which is significantly below age-level. While the student’s story followed a semblance of chronological order, it was also significantly decontextualized.  Furthermore, the student displayed very limited use of perspective taking vocabulary. He was able to reference several emotional reactions (e.g., ‘pain’, hurts’, ‘smiled’), but was unable to demonstrate consistent perspective taking (insight into the characters’ feelings, beliefs, and thoughts) throughout his narrative as is commensurate with age.

The student’s microstructure was also significantly adversely affected and was characterized by numerous syntactic errors (e.g., poorly constructed sentences, mazes, etc.), limited use of cohesive ties (e.g., and), as well as a lack of temporal markers denoting the sequence of narrative events  (e.g., first, next, then, finally). His vocabulary was judged to be immature as evidenced by usage of reduced number and variety of words throughout his narrative.

Finally, this student demonstrated severe word finding deficits characterized by fast but inaccurate word-retrieval marked by excessive presence of metacognitive comments (“what was it” produced 21 times during a 2-minute retelling sample), overuse of select phrases (e.g., ‘And they um’), fillers (e.g. uh), false starts (‘sm-help’), word repetitions (e.g. it, it,) as well as form-related word substitutions (‘Dr. Ricotto’/ ‘Dr. Risotto’ vs. ‘Dr. De Soto’ ).

It is also noteworthy to mention that the present testing was actually a reassessment. Interestingly, this particular student had always presented with significant expressive language formulation difficulties.  However, the nature of his difficulties differed between assessments. When assessed previously several years before, this student presented with significantly incoherent and disorganized discourse. However, at that time his narrative abilities were tested via the usage of another book (‘Pookins Gets Her Way’ by Helen Lester) with the benefit of visual support. As a result, his word-finding deficits in narratives were not as glaring as they were during the present retesting. In contrast, the production of narratives in the absence of visual support is far more complex and contextually demanding, as a result of which this student’s narrative was marked by a significant increase in word-finding errors. 

A student of this chronological age (10-0) is expected to produce Second Level True Narratives (Hegberg and Wesby (1993), characterized by subjective and/or objective summarization and categorization of stories.    Continuation of therapeutic intervention is strongly recommended to continue improving the student’s as well as addressing his word-finding deficits in discourse and narratives. 

I hope you found the above narrative example useful for your word-finding assessment purposes. Please feel free to share in the comments section of this post, how you perform word-finding assessments and what materials you use for this purpose.

References:

  • German, D.J. (2005) Word-Finding Intervention Program, Second Edition (WFIP-2)  Austin Texas: Pro.Ed
  • Hedberg, N.L., & Westby, C.E. (1993). Analyzing storytelling skills Theory to Practice. Tucson, AZCommunication Skill Builders.
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The Importance of Narrative Assessments in Speech Language Pathology (Revised)

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

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Improving Executive Function Skills of Language Impaired Students with Hedbanz

Image result for hedbanzThose of you who have previously read my blog know that I rarely use children’s games to address language goals.  However, over the summer I have been working on improving executive function abilities (EFs) of some of the language impaired students on my caseload. As such, I found select children’s games to be highly beneficial for improving language-based executive function abilities.

For those of you who are only vaguely familiar with this concept, executive functions are higher level cognitive processes involved in the inhibition of thought, action, and emotion, which located in the prefrontal cortex of the frontal lobe of the brain. The development of executive functions begins in early infancy; but it can be easily disrupted by a number of adverse environmental and organic experiences (e.g., psychosocial deprivation, trauma).  Furthermore, research in this area indicates that the children with language impairments present with executive function weaknesses which require remediation.

Image result for executive functions brain

EF components include working memory, inhibitory control, planning, and set-shifting.

  • Working memory
    • Ability to store and manipulate information in mind over brief periods of time
  • Inhibitory control
    • Suppressing responses that are not relevant to the task
  • Set-shifting
    • Ability to shift behavior in response to changes in tasks or environment

Simply put, EFs contribute to the child’s ability to sustain attention, ignore distractions, and succeed in academic settings. By now some of you must be wondering: “So what does Hedbanz have to do with any of it?”

Well, Hedbanz is a quick-paced multiplayer  (2-6 people) game of “What Am I?” for children ages 7 and up.  Players get 3 chips and wear a “picture card” in their headband. They need to ask questions in rapid succession to figure out what they are. “Am I fruit?” “Am I a dessert?” “Am I sports equipment?” When they figure it out, they get rid of a chip. The first player to get rid of all three chips wins.

The game sounds deceptively simple. Yet if any SLPs or parents have ever played that game with their language impaired students/children as they would be quick to note how extraordinarily difficult it is for the children to figure out what their card is. Interestingly, in my clinical experience, I’ve noticed that it’s not just moderately language impaired children who present with difficulty playing this game. Even my bright, average intelligence teens, who have passed vocabulary and semantic flexibility testing (such as the WORD Test 2-Adolescent or the  Vocabulary Awareness subtest of the Test of Integrated Language and Literacy ) significantly struggle with their language organization when playing this game.

So what makes Hedbanz so challenging for language impaired students? Primarily, it’s the involvement and coordination of the multiple executive functions during the game. In order to play Hedbanz effectively and effortlessly, the following EF involvement is needed:

  • Task Initiation
    • Students with executive function impairments will often “freeze up” and as a result may have difficulty initiating the asking of questions in the game because many will not know what kind of questions to ask, even after extensive explanations and elaborations by the therapist.
  • Organization
    • Students with executive function impairments will present with difficulty organizing their questions by meaningful categories and as a result will frequently lose their track of thought in the game.
  • Working Memory
    • This executive function requires the student to keep key information in mind as well as keep track of whatever questions they have already asked.
  • Flexible Thinking
    • This executive function requires the student to consider a situation from multiple angles in order to figure out the quickest and most effective way of arriving at a solution. During the game, students may present with difficulty flexibly generating enough organizational categories in order to be effective participants.
  • Impulse Control
    • Many students with difficulties in this area may blurt out an inappropriate category or in an appropriate question without thinking it through first.
      • They may also present with difficulty set-shifting. To illustrate, one of my 13-year-old students with ASD, kept repeating the same question when it was his turn, despite the fact that he was informed by myself as well as other players of the answer previously.
  • Emotional Control
    • This executive function will help students with keeping their emotions in check when the game becomes too frustrating. Many students of difficulties in this area will begin reacting behaviorally when things don’t go their way and they are unable to figure out what their card is quickly enough. As a result, they may have difficulty mentally regrouping and reorganizing their questions when something goes wrong in the game.
  • Self-Monitoring
    • This executive function allows the students to figure out how well or how poorly they are doing in the game. Students with poor insight into own abilities may present with difficulty understanding that they are doing poorly and may require explicit instruction in order to change their question types.
  • Planning and Prioritizing
    • Students with poor abilities in this area will present with difficulty prioritizing their questions during the game.

Image result for executive functionsConsequently, all of the above executive functions can be addressed via language-based goals.  However, before I cover that, I’d like to review some of my session procedures first.

Typically, long before game initiation, I use the cards from the game to prep the students by teaching them how to categorize and classify presented information so they effectively and efficiently play the game.

Rather than using the “tip cards”, I explain to the students how to categorize information effectively.

This, in turn, becomes a great opportunity for teaching students relevant vocabulary words, which can be extended far beyond playing the game.

I begin the session by explaining to the students that pretty much everything can be roughly divided into two categories animate (living) or inanimate (nonliving) things. I explain that humans, animals, as well as plants belong to the category of living things, while everything else belongs to the category of inanimate objects. I further divide the category of inanimate things into naturally existing and man-made items. I explain to the students that the naturally existing category includes bodies of water, landmarks, as well as things in space (moon, stars, sky, sun, etc.). In contrast, things constructed in factories or made by people would be example of man-made objects (e.g., building, aircraft, etc.)

When I’m confident that the students understand my general explanations, we move on to discuss further refinement of these broad categories. If a student determines that their card belongs to the category of living things, we discuss how from there the student can further determine whether they are an animal, a plant, or a human. If a student determined that their card belongs to the animal category, we discuss how we can narrow down the options of figuring out what animal is depicted on their card by asking questions regarding their habitat (“Am I a jungle animal?”), and classification (“Am I a reptile?”). From there, discussion of attributes prominently comes into play. We discuss shapes, sizes, colors, accessories, etc., until the student is able to confidently figure out which animal is depicted on their card.

In contrast, if the student’s card belongs to the inanimate category of man-made objects, we further subcategorize the information by the object’s location (“Am I found outside or inside?”; “Am I found in ___ room of the house?”, etc.), utility (“Can I be used for ___?”), as well as attributes (e.g., size, shape, color, etc.)

Thus, in addition to improving the students’ semantic flexibility skills (production of definitions, synonyms, attributes, etc.) the game teaches the students to organize and compartmentalize information in order to effectively and efficiently arrive at a conclusion in the most time expedient fashion.

Now, we are ready to discuss what type of EF language-based goals, SLPs can target by simply playing this game.

1. Initiation: Student will initiate questioning during an activity in __ number of instances per 30-minute session given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

2. Planning: Given a specific routine, student will verbally state the order of steps needed to complete it with __% accuracy given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

3. Working Memory: Student will repeat clinician provided verbal instructions pertaining to the presented activity, prior to its initiation, with 80% accuracy  given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

4. Flexible Thinking: Following a training by the clinician, student will generate at least __ questions needed for task completion (e.g., winning the game) with __% accuracy given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

5. Organization: Student will use predetermined written/visual cues during an activity to assist self with organization of information (e.g., questions to ask) with __% accuracy given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

6. Impulse Control: During the presented activity the student will curb blurting out inappropriate responses (by silently counting to 3 prior to providing his response) in __ number of instances per 30 minute session given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

7. Emotional Control: When upset, student will verbalize his/her frustration (vs. behavioral activing out) in __ number of instances per 30 minute session given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

8. Self-Monitoring:  Following the completion of an activity (e.g., game) student will provide insight into own strengths and weaknesses during the activity (recap) by verbally naming the instances in which s/he did well, and instances in which s/he struggled with __% accuracy given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

There you have it. This one simple game doesn’t just target a plethora of typical expressive language goals. It can effectively target and improve language-based executive function goals as well. Considering the fact that it sells for approximately $12 on Amazon.com, that’s a pretty useful therapy material to have in one’s clinical tool repertoire. For fancier versions, clinicians can use “Jeepers Peepers” photo card sets sold by Super Duper Inc. Strapped for cash, due to highly limited budget? You can find plenty of free materials online if you simply input “Hedbanz cards” in your search query on Google. So have a little fun in therapy, while your students learn something valuable in the process and play Hedbanz today!

Related Smart Speech Therapy Resources:

 

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Word-Finding Remediation: EBP Resources for SLPs

It’s on the tip of my tongue! How many times have you used this expression or heard it from other people. Oftentimes when we think of word-finding deficits we automatically think of it as an adult affliction, however, you would be surprised how many children including even very young children (4+ years of age) are affected by it. Did you know that “up to 7% of children have specific language needs and around 25% of children attending language support services have word-finding difficulties (WFD; Dockrell et al., 1998)?”

If you participate in various speech language and education related forums you may frequently see a variation on this question: “How would you assess and treat a child with word finding difficulties?” Before I provide some recommendations on this matter I’d like to talk a little bit about what word-finding is as well as what impact untreated word finding issues may have in a child.

So how do word-finding deficits manifest in children? In a vast variety of ways actually! For starters they could occur at the word level, conversational level or both. Below are just a few examples of word-level errors from German, 2005:

  • —Error Pattern 1- Lemma Related Semantic Errors
    • “—Slips of the tongue” or semantic word substitutions  such as —fox→ wolf;  clown → gnome
  • —Error Pattern 2 – Form Related Blocked Errors
    • “Tips of the tongue” or responses characterized by word blocks, pauses, fillers (um, ah, etc), repetitions, metalinguistic or metacognitive comments such as “I know”, “I don’t know”, etc.
  • —Error Pattern 3 – Form & Segment Related Phonologic Errors
    • —”Twists of the tongue” which include phoneme omissions, substitutions and additions such as cactus → catus; octopus →opotus, etc.

Further complicating the above may be the speed (some delay or no delay) with which they retrieve words as well as accuracy/inaccuracy of their retrieval once the words are retrieved. Additionally, a number of secondary characteristics may also play a role which include gestures (e.g, miming a word, frustration, etc) as well as extra verbalizations (metalinguistic and metacognitive comments).

At discourse level, students with word-finding deficits typically occupy one of two categories: productive vs. insufficiently productive language users. While their narrative language profile may be marked by frequent pauses, word fillers, as well as word and phrase revisions and repetitions.

Moreover, word-retrieval deficits are not limited to discourse, they are also found in reading tasks.  There word-finding issues  may manifest  as  omitted words or almost stuttering/cluttering like behaviors.  Interestingly German and Newman (2005; 2007) found that  students with word retrieval difficulties are able to successfully correctly identify  the words they missed during oral reading tasks in silent reading recognition tasks.

Difficulty coherently expressing oneself can have significant detrimental effect on the child’s academic performance, social relationships and ultimately self-esteem, which without appropriate intervention may potentially lead to poor school performance as well as mental issues (e.g., anxiety, depression, etc.)

So how can word-finding deficits be assessed?  Please note that common comprehensive language tests  will not do a good job of teasing out  word–finding deficits.  While you may notice some word finding errors on the Sentence Formulation subtest of the CELF-5, you may need to use specialized tests in order to assess word finding at word and discourse levels. Presently there are three standardized tests available for that purpose: Test of Word Finding Third Edition, The Test of Adolescent/Adult Word Finding, as well as The Test of Word Finding In Discourse created by Dr. Diane German (available via PRO-ED).

However, in the absence of these tests, you can assess word-finding at both word and narrative levels using the adaptations of standardized tests as well this informal narrative assessments.

For example, you can use the Expressive One Word Picture Vocabulary Test (EOWPVT) in order to test the efficiency of the student’s word retrieval in single word context. Here, the goal is not necessarily to test their expressive vocabulary knowledge but rather to see what type of word finding errors the students are making as they are attempting to correctly recall the visually shown word. Depending on the extent of the child’s word finding deficits you may have some very useful information to derive from the presentation of this test.

To illustrate, I recently informally administered applicable portions of this test to a four-year old Russian speaking preschooler. Based on his performance I was able to determine that his errors are primarily Error Pattern 3 – Form & Segment Related Phonologic Errors or —”Twists of the tongue”. This was further confirmed when I had the child to participate in the narrative retelling task.

So where can we find reputable evidence-based practice information on effective assessment and treatment strategies for word finding deficits? My answer is invariably to go and explore the resources made available by the “queen of word-finding” Dr. Diane German, who has conducted an extensive amount of research on this particular topic. Start with her website, entitled Word Finding.

She has a lot of good information to offer  there for free to both speech language professionals as well as parents. Take a look at her recommended materials and resources, they are very valuable and incredibly helpful when it comes to assessing and treating children with word finding deficits. And if you get the opportunity take the online course on word finding deficits in children that she offers. I took it several summers ago through National Louis University. She will also be offering it once again this upcoming winter (SPE 525 On Line, Word Finding Intervention) at National Louis University. I highly recommend that you take it, but if you can’t you can’t take it, she also offers a CEU course through Northern Speech Services.  Taking her course through  National Louis University changed my entire outlook on how to work with children with word finding deficits. I even wrote about it on ASHAsphere HERE. So the next time someone asks you a question on how to assess or treat word finding you know exactly where to refer them for evidence-based practice resources.

So have fun and evidence-base practice on!

PS. Calculating percentage of word-finding difficulties in children.

Dr. German recommends the following procedure: Obtain a language sample of 50 T-units (kernel sentence + subordinate clause)  in length using stimuli of  interest to the learner (or use one you have as long as all utterances in the sample are included). Then asses each T unit for the presence of one or more of the following  7 WF behaviors in discourse: repetitions, revisions (reformulations), substitutions, insertions (comment that reflects on the WF process like I cannot think of it, etc. ), time fillers (um, er, uh),  delays with in the T unit, and empty words (thing, stuff). Learners with WF difficulties manifest one or more WF behaviors in 33% or more of their T units (often 40% – 50%).  Typical language learners display WF behaviors in 19% or less of their T-Units (German, 1991) (German, 2015: SIG 16 Topic: Assessing Word-Finding Skills)

Helpful Smart Speech Therapy Resources:

References:

  1. Dockrell, J.E., Messer, D., George, R. & Wilson, G. (1998). Notes and Discussion  Children with word-finding difficulties-prevalence, presentation and naming problems. International Journal of Language & Communication Disorders, 33 (4), 445-454.
  2. German, D. J. (2009, Feb. 10). Child Word Finding: Student Voices Enlighten Us. The ASHA Leader, 14 (2), 10-13.
  3. German, D.J. (2005) Word-Finding Intervention Program, Second Edition (WFIP-2)  Austin Texas: Pro.Ed
  4. German, D.J. (2001) It’s on the Tip of My Tongue, Word Finding Strategies to Remember Names and Words You Often Forget.  Word Finding Materials, Inc.
  5. Dr. German’s Word Finding Website: http://www.wordfinding.com/

Disclaimer: The views expressed in this post are the personal opinion of the author. The author is not affiliated with dr. Diane German nor PRO-ED publications in any way and was not provided by them with any complimentary products or compensation for this post. 

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Why Do I Have to Tell You What’s Wrong with My Child? Or On the Importance of Targeted Assessments

A few days ago I received a phone call from a parent who was seeking a language evaluation for her child. As it is my policy with all assessments, I asked her to fill out an intake and a checklist to identify her child’s specific areas of difficulty in order to compile a comprehensive and targeted testing battery.  Her response to me was: “I’ve never heard of this before? Why do I have to tell you what’s wrong with my child? Why can’t you figure it out?” Similarly, last week, another parent has questioned: “So you can’t do the assessment without this form?” Given the above questions, and especially because May is a Better Hearing and Speech Month #BHSM, during which it is important to raise awareness about communication disorders, I want to take this time to explain to parents why performing targeted speech language assessments is SO CRUCIAL.

To begin with it is very important to understand that speech and language can be analyzed in many different ways beyond looking at pronunciation, vocabulary or listening and speaking skills.

Targeted areas within the scope of practice of pediatric school based speech language pathologists include the assessment of:

  • SPEECH
    • The child may have difficulties with pronunciation of sounds in words, stutter, clutter, have a lisp or have difficulties in the areas of voice, prosody, or resonance. For the majority of  the above difficulties completely different tests and testing procedures may be needed in order to appropriately assess the child.
  • LANGUAGE
    • Receptive Language
      • Ability to follow directions, answer questions, recall sentences, understand verbal messages, as well as comprehend orally presented text
    • Memory and Attention 
      • Also see executive function skills
    • Expressive Language
      • Vocabulary knowledge and use, formulation of words and sentences as well as production of narratives or stories
    • Problem Solving
      • Verbal reasoning and critical thinking skills are very important for successful independent decision making as well as for interpretation of academically based texts and complete assignments
    • Pragmatic Language 
      • Successful use of language for a variety of communicative purposes
        • Initiate and maintain topics, maintain conversational exchanges, request help, etc
    • Social Emotional Competence
      • Effective interpersonal negotiation skills, compromise and negotiation abilities, as well as perspective taking are integral to academic and social success. These abilities are often compromised in children with language disorders and require a thorough assessment
    • Executive Functions (EFs) 
      • These are higher level cognitive processes involved in inhibition of thought, action and emotion, which are located in the prefrontal cortex of the frontal lobe of the brain.  
      • Major EF components include working memory, inhibitory control, planning, and set-shifting. EFs contribute to child’s ability to sustain attention, ignore distractions, and succeed in academic settings. 
  • READING DISABILITIES AND DYSLEXIA
    • Phonological Awareness
    • Reading Ability
    • Writing
    • Spelling 

One General Language Test Does Not Fit All! 

Children with speech and language disorders do not necessarily display weaknesses in all affected areas but may only display difficulties in selected few.

To illustrate, high functioning students on the autistic spectrum may have very strong academic skills related to comprehension and expression of language but may display significant social pragmatic language weaknesses, which will not be apparent on general language testing (e.g., administration of Clinical Evaluation of Language Fundamentals -5). Thus, the administration of a general language test will be contraindicated for these students as it will only show typical performance on these tests and will not qualify them for targeted language based services that they need.  However, by administering to them a testing battery composed of tests sensitive to social pragmatic language competence will highlight their areas of difficulty and result in a creation of a targeted intervention plan to improve their abilities in the affected areas. 

Similarly, children at risk for reading disabilities will not benefit from the administration of general language testing either, since their deficits may lie in the areas of sound discrimination, isolation, or blending as well as as impaired decoding ability.  So the administration of tests sensitive to phonological awareness and emergent reading ability would be much more relevant. 

This is exactly why taking an extra step and filling out a simple form will result in a much more targeted and beneficial speech language assessment for the child.  The goal of any competent professional assessment is to eliminate the administration of unnecessary and irrelevant tests and focus only on the administration of instruments directly targeting the areas of difficulty that the child presents with.  Given the fact that assessment of language covers so many broad areas, it makes perfect sense to ask parents to fill out relevant checklists/intakes as a routine part of a pre-assessment procedure.  Otherwise, even after observations in school setting, I would still just be blindly ‘fishing’ for deficits without really knowing whether I will  ‘accidentally stumble upon them’ using a general test at hand.

Of course, even checklists need to be targeted by age and areas of functioning. Here’s how I use mine. When performing comprehensive fist time assessments I ask the parent to fill out the comprehensive checklists based on the child’s age.    These are broken down as follows:

However, oftentimes when I perform reassessments or second opinion evaluations, I may ask the parent to fill out checklists pertaining to specific, known, areas of difficulty. These currently include:

After the parent fills the checklist out, the child’s areas of difficulty literally jump out from the pages. Now, all I need to do is to choose the appropriate testing instruments, which will BEST help me determine the exact nature and cause of the child’s deficits and I am all set. I administer the testing, interpret the results and write a comprehensive report detailing which therapy goals will be targeted. And this is why pre-assessment checklist administration is so important.

Helpful Resources

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SPEECH LANGUAGE ASSESSMENT CHECKLIST FOR PRESCHOOL CHILDREN

Today I am excited to tell you about another product in my assessment referral series: SPEECH LANGUAGE ASSESSMENT CHECKLIST FOR PRESCHOOL CHILDREN 

I created this 9 page guide to assist speech language pathologists in the decision making process of how to select assessment instruments and prioritize assessment for preschool children. In doing that you are eliminating the administration of irrelevant tests and focusing on the administration of instruments directly targeting the areas of difficulty that the child presents with. Continue reading SPEECH LANGUAGE ASSESSMENT CHECKLIST FOR PRESCHOOL CHILDREN

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In case you missed it: The importance of targeted assessments for school aged children

Last week I did a guest post for The Simply Speech Blog. In case you missed it,  below I offer an explanation why targeted speech language assessments are so important, as well as list helpful resources that will aid you in speech language assessment preparation.

In both my hospital based job and in private practice I do a lot of testing. During staff/caregiver interviews I used to get a laundry list of both specific and non-specific problems by the parents and teachers, which did not always accurately reflect the students true deficits.  Experience quickly taught me that administering general comprehensive language testing to every student simply did not work. Oftentimes the administration of such testing revealed one of two things: Continue reading In case you missed it: The importance of targeted assessments for school aged children

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Stimulating Language Abilities of Internationally Adopted Children: Fun with Ready-Made Fall and Halloween Bingo

  There are many fun language based activities parents can do at home with their newly (and not so newly) internationally adopted  preschool and school aged children in the fall. One of my personal favorites is bingo. Boggles World, an online ESL teacher resource actually has a number of ready made materials, flashcards, and worksheets which can be adapted for such purposes. For example, their Fall and Halloween Bingo comes with both call out cards and a 3×3 and a 4×4 (as well as 3×3) card generator/boards. Clicking the refresh button will generate as many cards as you need, so the supply is endless! You can copy and paste the entire bingo board into a word document resize it and then print it out on reinforced paper or just laminate it.

Fall vocabulary words includecorn, crops, farmer, scarecrow, apples, acorns, oak leaf, maple leaves, ginkgo leaves, grapes, mushrooms, salmon, geese, squirrel, jacket, turkey, Jack-O’-Lantern, rake, pumpkins, harvest moon, hay, chestnuts, crow, and sparrow

Halloween vocabulary words includewitch, ghost, skeleton, skull, spider, owl, Jack-O’-Lantern, devil, cobweb, graveyard, clown, pirate, robot, superhero, mummy, vampire, bat, black cat, trick or treaters, alien, werewolf

Now the fun begins!

Some suggested activities:

Practice Vocabulary Labeling: Label the words for newly adopted IA children and get them to say the words after you.

Practice Simple Sentences: Make up simple sentences such as A spider lives in a cobweb or  A squirrel is eating an acorn.

Practice Rhyming:  what rhymes with cat/bat/ trick/leaf/ rake/moon?

For those children who are having articulation (speech) difficulties practice saying  words with select sounds (/ch/, /sh/, /l/, etc) to improve their  intelligibility (pronunciation)

Practice Categorization Skills: Name some fall words, Halloween words, name some popular halloween costumes, name some popular fall activities, etc

Practice naming Associations: what goes with a witch (broom), what goes with a squirrel (acorn), etc

Practice expanding vocabulary by providing Attributes (object characteristics):  Take a noun-word (thing) such as “squirrel” and answer some questions about it: what is it? what does it do? where do you find it? what are its parts? What color/shape is it? does it make any sounds? what goes with it.  Here’s one example, (I see a pumpkin. It’s a fruit/vegetable that you can plant, grow and eat. You find it on a farm. It’s round and orange and is the size of a ball. Inside the pumpkin are seeds. You can carve it and make a jack o lantern out of it).

Practice expanding language by providing relevant  Definitions: Tell me what a skeleton is. Tell me what a scarecrow is.

Practice improving their Problem Solving abilities by naming Similarities and Differences among semantically related items: How are pumpkin and apple alike? How are they different?

Help them understand that many words can have more than one meaning and  explain Multiple Meaning words to them:   A bat, witch, clown, can mean _____ and also mean _________

So join in the fun and start playing today! 

Resources:

Bogglesworld Halloween Bingo Board and Cards http://bogglesworldesl.com/halloweenbingo.htm

Bogglesworld Fall Bingo Board and Cards http://bogglesworldesl.com/autumn_bingo.htm

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

 

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

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

BUMMER!

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

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

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

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

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

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

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

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

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

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

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

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

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

Have fun playing!

References:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References and Resources:

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

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

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

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