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Why is FASD diagnosis so important?

Recently, I’ve participated in various on-line and in-person discussions with both school-based speech language pathologists (SLPs) as well as medical health professionals (e.g., neurologists, pediatricians, etc.) regarding their views on the need of formal diagnosis for school aged children with suspected alcohol related deficits. While their responses differed considerably from: “we do not base intervention on diagnosis, but rather on demonstrated student need” to “with a diagnosis of ASD ‘these children’ would get the same level of services“, the message I was receiving loud and clear was: “Why? What would be the point?”  So today I decided to share my views on this matter and explain why I think the diagnosis matters.
Continue reading Why is FASD diagnosis so important?

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FASD and Background History Collection: Asking the Right Questions

Note: This article was originally published in August 2013 Issue of Adoption Today Magazine (pp. 32-35).   

Sometime ago, I interviewed the grandmother of an at-risk 11 year old child in kinship care, whose language abilities I have been asked to assess in order to determine whether he required speech-language therapy services.  The child was attending an outpatient school program in a psychiatric hospital where I worked and his psychiatrist was significantly concerned regarding his listening comprehension abilities as well as social pragmatic skills. Continue reading FASD and Background History Collection: Asking the Right Questions

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Components of Qualitative Writing Assessments: What Exactly are We Trying to Measure?

Writing! The one assessment area that challenges many SLPs on daily basis! If one polls 10 SLPs on the topic of writing, one will get 10 completely different responses ranging from agreement and rejection to the diverse opinions regarding what should actually be assessed and how exactly it should be accomplished.

Consequently, today I wanted to focus on the basics involved in the assessment of adolescent writing. Why adolescents you may ask? Well, frankly because many SLPs (myself included) are far more likely to assess the writing abilities of adolescents rather than elementary-aged children.

Often, when the students are younger and their literacy abilities are weaker, the SLPs may not get to the assessment of writing abilities due to the students presenting with so many other deficits which require precedence intervention-wise. However, as the students get older and the academic requirements increase exponentially, SLPs may be more frequently asked to assess the students’ writing abilities because difficulties in this area significantly affect them in a variety of classes on a variety of subjects.

So what can we assess when it comes to writing? In the words of Helen Lester’s character ‘Pookins’: “Lots!”  There are various types of writing that can be assessed, the most common of which include: expository, persuasive, and fictional. Each of these can be used for assessment purposes in a variety of ways.

To illustrate, if we chose to analyze the student’s written production of fictional narratives then we may broadly choose to analyze the following aspects of the student’s writing: contextual conventions and writing composition.

The former looks at such writing aspects as the use of correct spelling, punctuation, and capitalization, paragraph formation, etc.

The latter looks at the nitty-gritty elements involved in plot development. These include effective use of literate vocabulary, plotline twists, character development,  use of dialogue, etc.

Perhaps we want to analyze the student’s persuasive writing abilities. After all, high school students are expected to utilize this type of writing frequently for essay writing purposes.  Actually, persuasive writing is a complex genre which is particularly difficult for students with language-learning difficulties who struggle to produce essays that are clear, logical, convincing, appropriately sequenced, and take into consideration opposing points of view. It is exactly for that reason that persuasive writing tasks are perfect for assessment purposes.

But what exactly are we looking for analysis wise? What should a typical 15 year old’s persuasive essays contain?

With respect to syntax, a typical student that age is expected to write complex sentences possessing nominal, adverbial, as well as relative clauses.

With the respect to semantics, effective persuasive essays require the use of literate vocabulary words of low frequency such as later developing connectors (e.g., first of all, next, for this reason, on the other hand, consequently, finally, in conclusion) as well as metalinguistic and metacognitive verbs (“metaverbs”) that refer to acts of speaking (e.g., assert, concede, predict, argue, imply) and thinking (e.g., hypothesize, remember, doubt, assume, infer).

With respect to pragmatics, as students  mature, their sensitivity to the perspectives of others improves, as a result, their persuasive essays increase in length (i.e., total number of words produced) and they are able to offer a greater number of different reasons to support their own opinions (Nippold, Ward-Lonergan, & Fanning, 2005).

Now let’s apply our knowledge by analyzing a writing sample of a 15-year-old with suspected literacy deficits. Below 10th-grade student was provided with a written prompt first described in the Nippold, et al, 2005 study, entitled: “The Circus Controversy”.   “People have different views on animals performing in circuses. For example, some people think it is a great idea because it provides lots of entertainment for the public. Also, it gives parents and children something to do together, and the people who train the animals can make some money. However, other people think having animals in circuses is a bad idea because the animals are often locked in small cages and are not fed well. They also believe it is cruel to force a dog, tiger, or elephant to perform certain tricks that might be dangerous. I am interested in learning what you think about this controversy, and whether or not you think circuses with trained animals should be allowed to perform for the public. I would like you to spend the next 20 minutes writing an essay. Tell me exactly what you think about the controversy. Give me lots of good reasons for your opinion. Please use your best writing style, with correct grammar and spelling. If you aren’t sure how to spell a word, just take a guess.”(Nippold, Ward-Lonergan, & Fanning, 2005)

He produced the following written sample during the allotted 20 minutes.

Analysis: This student was able to generate a short, 3-paragraph, composition containing an introduction and a body without a definitive conclusion. His persuasive essay was judged to be very immature for his grade level due to significant disorganization, limited ability to support his point of view as well as the presence of tangential information in the introduction of his composition, which was significantly compromised by many writing mechanics errors (punctuation, capitalization, as well as spelling) that further impacted the coherence and cohesiveness of his written output.

The student’s introduction began with an inventive dialogue, which was irrelevant to the body of his persuasive essay. He did have three important points relevant to the body of the essay: animal cruelty, danger to the animals, and potential for the animals to harm humans. However, he was unable to adequately develop those points into full paragraphs. The notable absence of proofreading and editing of the composition further contributed to its lack of clarity. The above coupled with a lack of a conclusion was not commensurate grade-level expectations.

Based on the above-written sample, the student’s persuasive composition content (thought formulation and elaboration) was judged to be significantly immature for his grade level and is commensurate with the abilities of a much younger student.  The student’s composition contained several emerging claims that suggested a vague position. However, though the student attempted to back up his opinion and support his position (animals should not be performing in circuses), ultimately he was unable to do so in a coherent and cohesive manner.

Now that we know what the student’s written difficulties look like, the following goals will be applicable with respect to his writing remediation:

Long-Term Goals:  Student will improve his written abilities for academic purposes.

  • Short-Term Goals
  1. Student will appropriately utilize parts of speech (e.g., adjectives, adverbs, prepositions, etc.)  in compound and complex sentences.
  2. Student will use a variety of sentence types for story composition purposes (e.g., declarative, interrogative, imperative, and exclamatory sentences).
  3. Student will correctly use past, present, and future verb tenses during writing tasks.
  4. Student will utilize appropriate punctuation at the sentence level (e.g., apostrophes, periods, commas, colons, quotation marks in dialogue, and apostrophes in singular possessives, etc.).
  5. Student will utilize appropriate capitalization at the sentence level (e.g., capitalize proper nouns, holidays, product names, titles with names, initials, geographic locations, historical periods, special events, etc.).
  6. Student will use prewriting techniques to generate writing ideas (e.g., list keywords, state key ideas, etc.).
  7. Student will determine the purpose of his writing and his intended audience in order to establish the tone of his writing as well as outline the main idea of his writing.
  8. Student will generate a draft in which information is organized in chronological order via use of temporal markers (e.g., “meanwhile,” “immediately”) as well as cohesive ties (e.g., ‘but’, ‘yet’, ‘so’, ‘nor’) and cause/effect transitions (e.g., “therefore,” “as a result”).
  9. Student will improve coherence and logical organization of his written output via the use of revision strategies (e.g., modify supporting details, use sentence variety, employ literary devices).
  10. Student will edit his draft for appropriate grammar, spelling, punctuation, and capitalization.

There you have it. A quick and easy qualitative writing assessment which can assist SLPs to determine the extent of the student’s writing difficulties as well as establish writing remediation targets for intervention purposes.

Using a different type of writing assessment with your students? Please share the details below so we can all benefit from each others knowledge of assessment strategies.

References:

  • Nippold, M., Ward-Lonergan, J., & Fanning, J. (2005). Persuasive writing in children, adolescents, and adults: a study of syntactic, semantic, and pragmatic development. Language, Speech, and Hearing Services in Schools, 36, 125-138.

 

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Functional Strategies for Improving the Language Abilities of Your Adopted School-Age Child

Functional Strategies for Improving the Language Abilities of Your Adopted School-Age Child.

While most internationally adopted children catch up to their peers in language development somewhat quickly, not all internationally adopted children demonstrate equal progress by the time they reach school age. Below are some suggestions on how parents can facilitate their school age child’s language skills and improve their language abilities via fun interactive games that the whole family can enjoy and benefit from.

There are several language functions important for academic success. Typically this hierarchy develops from the most basic to the most complex, with the earliest stages beginning long before the child reaches school age. These functions include the ability to: seek information, inform, compare, order, classify, analyze, infer, justify/persuade, solve problems, synthesize, and evaluate. For some children those abilities come naturally while for others – a creative push in the right direction might just do the trick. Luckily, there are plenty of children’s games on the market that address the above skills in a fun and functional way, oftentimes without the child even realizing that they are doing work.

One of the earliest and important areas of language development is vocabulary knowledge. Good vocabulary skills are essential for communication of thoughts and ideas, interaction with peers, as well as meeting the demands of the classroom. As academic demands increase the importance of good vocabulary comes prominently into play. Vocabulary hierarchy ranges from a simple ability of labeling (providing a name for people, actions and objects) to the advanced descriptions (using attributes, functions, and learned concepts to depict an object/item in a cohesive manner). As children’s vocabulary increases from basic labeling to using sophisticated descriptions it goes through several other important stages outlined below:

• Concept Knowledge – the ability to comprehend and identify qualitative (e.g., same–different, big– little, hot-cold), quantitative (e.g., few-many, more-less), temporal (e.g., before-after, next, first, last), or spatial (e.g., in-on, under-over) concepts
• Associations – knowledge of how words are semantically related/linked (e.g., knowing why a spoon and a knife go together)
• Categorization/Classification – the ability to identify items within a category (divergent naming) and provide labels for groups/classes of objects (convergent naming)

The following are just a few selected examples of available games (a more complete list will be provided at the end of this article) that should help facilitate the development of vocabulary language 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., colors) to more complicated (e.,. animals with stripes). This game is great for several players of different age groups (e.g., older siblings), since 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 the parents help the non readers with the cards. It’s great for encouraging children to become both better at describing and at listening. Parents are encouraged to allow their kids to select the word they want to describe in order to boost their confidence in own abilities. Parents are also encouraged to 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.

However, vocabulary knowledge alone does not determine academic success. There are other equally valuable language skills which are important as well. One of them is asking and answering questions. Being able to ask and answer questions is an integral part of academic success.

Asking questions is one of the main ways that children obtain knowledge about the world beyond their immediate experience. Children who are unable to ask questions are at a disadvantage when it comes to following directions or understanding difficult concepts since they are unable to request repetition and clarification from speakers. Moreover, the inability to answer questions effectively is an indication that the child will not be understood well by others. Being able to answer concrete and abstract questions is another necessary requirement for success in school. Games such as 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.

Another important ability in the language learning hierarchy is story telling. Being able to tell good stories is a difficult task for many children, even those without language impairment. Consequently, one way of learning to become a good story teller is through the usage of visual cues such as picture cards, or games. When children are very young speech therapists often work on improving their story telling abilities using props such as a variety of toys or puppets. As they get older they transition to picture cards or wordless story books with the final step being spontaneously produced stories with no visual support. One of such games is Fib or Not (ages 10+). The game 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.

As children grow older, they are required to do more and more tasks that focus on their verbal reasoning and problem solving abilities. If your child’s problem solving skills are on the weaker side consider using events from storybooks that illustrate problems. Talk aloud about the problem and offer a list of choices if your child is having difficulties figuring out the answers. Have your child talk through the process of how they arrived to their conclusions and offer suggestions and guidance along the way. The two popular games that work on improving verbal reasoning and problem solving abilities are: 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 classic 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.

A good way of implementing the above games in action is during family fun night. Select a game that focuses on one or more elements that you feel your child needs to work on and then involve your entire family in a game playing activity so the child does not feel that they are being isolated for “work”. For children who are younger or with weaker vocabularies, modify the rules to help to simplify the demands of the game, or play in a team so that the child doesn’t feel overwhelmed. Feel free to provide your own cues and prompts in order to achieve maximum success with all gaming activities.

Now that we have gone over the game description and selection process in some detail, please keep in mind that you can always learn more about children’s games by simply going to a popular internet websites such as Amazon and reading product descriptions in order to figure out whether specific game is right fit for your child.

As always, parents are advised to consult with related professionals (speech and language therapists, psychologists, etc) if they have any serious concerns regarding their child’s communication skills. Early detection and treatment are critical to the process of successful speech and language development not just in early childhood but also during school age, adolescence, and even early adulthood.

Best of luck and have fun playing!

List of Selected Games:
• 20 Questions for Kids
• 30 Second Mysteries
• A to Z Jr.
• Blurt
• Fib or Not
• Guess Where?
• Guess Who?
• Last Word
• Loaded Questions
• Mystery Garden
• Outburst
• Password Junior
• Tribond Junior

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Speech, Language, and Literacy Fun with Helen Lester’s Picture Books

Picture books are absolutely wonderful for both assessment and treatment purposes! They are terrific as narrative elicitation aids for children of various ages, ranging from pre-K through fourth grade.  They are amazing treatment aids for addressing a variety of speech, language, and literacy goals that extend far beyond narrative production. Continue reading Speech, Language, and Literacy Fun with Helen Lester’s Picture Books

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Spotlight on Syndromes: An SLPs Perspective on 22q Deletion Syndrome

Today’s guest post on genetic syndromes comes from Lauren Laur, who is contributing a post on the 22q11.2 Deletion Syndrome.

22q11.2 Deletion Syndrome is a syndrome of many names. Also known as Velocardiofacial Syndrome, Shprintzen syndrome as well as DiGeorge Syndrome, 22q11.2 Deletion Syndromeis is caused by a microdeletion on the long arm of chromosome 22 (at location marker q11.2).  This syndrome follows an autosomal dominant inheritance pattern (a child only needs to get the abnormal gene from one parent in order to inherit the disease), however, only around 10% of cases are inherited; the majority of cases are due to a random mutation. Continue reading Spotlight on Syndromes: An SLPs Perspective on 22q Deletion Syndrome