Posted on 30 Comments

Why (C) APD Diagnosis is NOT Valid!

Today’s post will make a number of people quite angry and is intended to be controversial!  Why? Because controversy promotes critical thinking, broadens perspectives, allows to acquire better knowledge of the construct in question as well as ultimately guides better decision making on the part of the parties in question. So why the lengthy disclaimer? Because today via the use of the latest research publications, I would like discuss the fact that the diagnosis of Auditory Processing Disorder (APD) or what some may know as Central Auditory Processing Disorder (CAPD) is NOT valid!

Here are just a few reasons why:

  1. There is a strong desire for the (C)APD label on the part of those encountering processing difficulties, yet once the label is given no direct/specific auditory interventions are provided by the audiologist. Subsequent to the diagnosis, confusion ensues regarding the type, frequency, and duration of service provision (typically performed by the SLP) as well as what those services should actually constitute 
  2. Recommendations for training deficits specific areas such as working memory, auditory discrimination, auditory sequencing, etc., do not functionally transfer into practice and fail to create generalization affect
  3. Recommendations for specific costly auditory training programs such Auditory Integration Training (AIT), The Listening Program (TLP), Fast ForWord® (FFW) at the exclusion of all others, without the provision of a detailed breakdown of the child’s deficit areas often cause an incursion of unnecessary expenses for parents and professionals and are found to be INEFFECTIVE or limitedly effective in the long run
  4. General audiological recommendations for accommodations (e.g., FM systems, etc.) are frequently unnecessary, and may actually exacerbate the isolation effect while in no way alleviating the student’s deficits, which require direct and targeted intervention
  5. Auditory deficits don’t cause speech, language, and academic learning difficulties
  6. Numerous non-linguistic based disorders can be misdiagnosed as (C)APD without differential diagnosis
  7. (C)APD testing is hugely influenced by non-auditory factors grounded in higher order cognitive and linguistic processes
  8. Presently there’s no no clear performance criteria to make the (C)APD diagnosis
  9. The diagnosis of (C)APD is appealing because it presents a more attractive explanation than the diagnoses of language and learning disabilities for children with processing deficits
  10. The diagnosis of (C)APD may often detract from identifying legitimate language based deficits in the areas of comprehension, expression, social communication and literacy development, as the result of which these areas will not get adequate therapeutic attention by relevant professionals

A few words on (C)APD popularity, well sort of:

(C)APD  is currently rampantly diagnosed in the United States, Australia and New Zealand, and is even beginning to be diagnosed in the United Kingdom (Dawes & Bishop, 2009). However, presently, (C)APD is not a mainstream diagnostic classifications in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) nor is part of an actual educational classification in United States.  Already many of you can see the beginnings of the controversy.  If this diagnoses is so popular and so prevalent why is that major psychological and educational governing bodies such as American Psychiatric Association and the US Department of Education still do not officially recognize it?

(C)APD symptomology:

A. Student presents with difficulty processing information efficiently

  • Requires increased processing time to respond to questions
  • Presents like s/he are ignoring the speaker
  • May request frequent repetition of presented information from speakers
  • Difficulty following long sentences
  • Difficulty keeping up with class discussions in group settings
  • Poor listening abilities under noisy conditions may be interpreted as “distractibility”

B. Student has difficulty maintaining attention on presented tasks

  • Frequent loss of focus
  • Difficulty completing assignments on their own

C. Student has poor short term memory – difficulty remembering instructions and directions or verbally presented information

D.Student has difficulty with phonemic awareness, reading and spelling

  • Poor ability to recognize and produce rhyming words
  • Poor segmentation abilities (separation of sentences, syllables and sounds)
  • Poor sound manipulation abilities (isolation, deletion, substitution, blending, etc)
  • Poor sound letter identification abilities
  • Poor vowel recognition abilities
  • Poor decoding
  • Poor comprehension
  • Spelling errors
  • Limited/disorganized writing

E. The combination of above factors may result in generalized deficits across the board, affecting the child’s social and academic performance:

  • Poor reading comprehension
  • Poor oral and written expression
  • Disorganized thinking (e.g., disjointed narrative production)
  • Sequencing errors (recalling/retelling information in order, following recipes, etc)
  • Poor message interpretation
  • Difficulty making inferences
  • Misinterpreting the meaning of abstract information

I do not know what you see when you read the above description but to me those are the classical signs of a language impairment which has turned into a learning disability masking under the ambiguous label of  (C)APD. 

That is exactly what Dawes & Bishop, stated in 2009, when they asserted that “a child who is regarded as having a specific learning disability by one group of experts may be given an APD diagnosis by another.” They concluded that: “APD, as currently diagnosed, is not a coherent category, but that rather than abandoning the construct, we need to develop improved methods for assessment and diagnosis, with a focus on interdisciplinary evaluation“.

Let us now deconstruct each of the above statements with the assistance of direct quotes from current research.

1. (C)APD – what is it good for? Child goes to an audiologist and receives an ambiguous battery of (C)APD  testing with unclear qualification criteria (more on that below). There are some abnormal findings, so the audiologist states that the child has (C)APD, recommends accommodations and modifications, services in the form of speech language therapy with a focus on auditory training (more below) and/or some form of program similar to Fast ForWord®, and doesn’t see the child again for some time (maybe even years).  Since the child is now being seen by an SLP, who by the way frequently has no idea what to do with that child based on the ambiguous audiological findings, what exactly did the diagnosis of (C) APD just accomplish?

2. Processing Skills Training – Say What? In 2011 Fey and colleagues  (many notable audiologists and speech language pathologists) conducted a systematic review of  25 journal articles on the efficacy of interventions for school-age children with auditory processing disorder (C)APD. Their review found no compelling evidence that auditory interventions provided any unique benefit to auditory, language, or academic outcomes for children with diagnoses of (C)APD or language disorder.

Presently there is no valid evidence that targeting specific processing skills such as auditory discrimination, auditory sequencing, phonological memory, working memory, or rapid serial naming actually improves children’s ‘auditory processing’, language or reading abilities (Fey et al., 2011).

To illustrate further, Melby-Lervåg & Hulme, 2013 performed a meta analysis  of 23 working memory training studies. They found no evidence that memory training was an effective intervention for children with ADHD or dyslexia as it did not lead to better performance outside of the tasks presented within the memory tests. They concluded: “In the light of such evidence, it seems very difficult to justify the use of working memory training programs in relation to the treatment of reading and language disorders.” Further adding: “Our findings also cast strong doubt on claims that working memory training is effective in improving cognitive ability and scholastic attainment.” (Melby-Lervåg, 2013, p. 282).

3. The trouble with prescriptive programs.  (C)APD assessments often yield recommendations for a number of specific costly prescriptive programs such as AIT, FFW, etc.. As humans we are “attracted to interventions that promise relatively rapid improvements in language and academic skills. Interventions that target processing abilities are appealing because they promise significant improvements in language and reading without having to directly target the specific knowledge and skills required to be a proficient speaker, listener, reader, and writer.” (Kamhi and Wallach, 2012)

These programs claim to improve the child’s processing abilities through music, phonics, hearing distortions, etc. When such recommendations are made parents and professionals are urged to carefully review evidence-based research supported information regarding these prescribed programs in order to determine their effectiveness. Presently, there’s no research to support the use of any of these programs with children presenting with processing difficulties. 

Let’s take a look at Fast ForWord®, which is a highly costly program frequently recommended for children with auditory processing deficits. It is designed to help children’s reading and spoken language by training their memory, attention, processing, and sequencing by training 3 to 5 days per week, for 8 to 12 weeks. However, systematic reviews found no sign of a reliable effect of Fast ForWord® on reading or on expressive or receptive spoken language. 

Now some of you may legitimately tell me: “How dare you? I’ve tried it with my child and seen great gains”. And that is terrific! However, it is important to note that ANY intervention is better than NO intervention! And there is currently no scientific proof out there that this program works better than other programs aimed directly at improving the children’s reading abilities and listening skills.  Furthermore, if the child needs assistance with reading rather than spending the money  on Fast ForWord® it would be far more effective to select a systematic Orton-Gillingham (OG) (or similar) reading based program to teach her/him reading!

4. The dreaded FM system! FM systems have become an almost automatic recommendation for children diagnosed with (C)APD but are they actually effective?

Here is what one notable audiologist had to say in the subject. An FM system brings the speaker’s voice via the mic to the listener via loudspeakers or earphones through an amplifier. Only personal systems appropriate for children with TRUE APD-based auditory distractibility problems (understanding speech in the presence of background noise)”.  However, when he did his testing he found that only ~25% of children with (C)APD had issues with hearing speech in noise, the other ~75% didn’t. 

Guess what… a recent meta-analysis showed? Lemos et, al, 2009 did a systematic literature review of articles recommending the use of FM systems for APD. They concluded that: “Strong scientific evidence supporting the use of personal FM systems for APD intervention was not found. Since such device is frequently recommended for the treatment of APD, it becomes essential to carry out studies with high scientific evidence that could safely guide clinical decision making on this subject.

5. (C)APD diagnosis does NOT Language Disorder Make. “There little evidence that auditory perceptual impairments (not referring to hearing deficits) are a significant risk factor for language and academic performance (e.g., Hazan, Messaoud-Galusi, Rosan, Nouwens, & Shakespeare, 2009; Watson & Kidd, 2009)” (Kamhi, 2011, p. 265).  

  • Watson et al., 2003 found that measures of auditory processing (NOT hearing) had no impact on children’s reading or language abilities in Grades 1 through 4.
  • Sharma, Purdy, and Kelly (2009)  found that having auditory processing difficulties did not increase the likelihood that a child would have a language or reading disorder.
  • Hazan et al., 2009; Ramus et al., 2006) found that despite poor phonological processing abilities, individuals with dyslexia perform within normal limits on measures of speech perception. 

(From Kamhi, 2011, p. 268)

6. Are you sure it’s (C)APD?

—Without a careful differential diagnosis, numerous non-linguistic based medical, psychiatric neurological, psychological, and cognitive conditions can be misdiagnosed as (C)APD including (but not limited):

  • —Respiratory Disorders
    • —Adenoid hypertrophy, asthma, allergic rhinitis
  • —Metabolic/Endocrine Disorders
    • —Diabetes  hypo/hyperthyroidism
  • —Hematological Disorders
    • —Anemia
  • —Immunological Disorders
    • —Acquired and congenital immune problems
  • —Cardiac Disorders
    • —Congenital and acquired heart disease, syncopy
  • —Digestive  Disorders
    • —Irritable bowel syndrome, GERD
  • —Neurological Disorders
    • —Traumatic Brain Injuries, Tumors, Encephalopathy
  • Genetic Disorders
    • —Fragile X Syndrome
  • —Toxin Exposure
    • —Lead, Mercury, Drug Exposure
  • —Infections and Infestations
    • —Yeast overgrowth , intestinal worms/parasites
  • —Sleep Disorders
    • Sleep Apnea
  • —Mental Health Disorders
    • —Trauma, Anxiety, mood disorders, adjustment disorders
  • ——Sensory Processing Disorders
    • —Vision, hearing, auditory, tactile
  • —Acquired Disorders
    • —FASD

7. (C)APD testing is NOT so PURE 

(C)APD testing does not simply consists of pure tone audiometry and is heavily comprised of higher order linguistic and cognitive tasks. Testing requires that the listeners attend to given directions, remember and label the presented auditory sequences, etc, in other words participate in tasks aimed to task their linguistic system and executive functions  (DeBonis, 2015)

So what does the research show?

  • Wallach (2011) has indicated that  (C) APD ‘symptomology’ “reflects broader underlying problems in language comprehension and metalinguistic awareness.
  • Dawes and Bishop (2009)  compared children with a CAPD to children diagnosed with dyslexia and found similar attention, reading, and language deficits in both groups.
  •  Kelly et al. (2009)  found that 76% of a sample of 68 children with suspected auditory processing disorder also had language impairment with 53% demonstrating decreased auditory attention and 59% demonstrated decreased auditory memory.
  • Ferguson et al. (2011)  concluded that “the current labels of CAPD and SLI [specific language impairment] may, for all practical purposes, be indistinguishable” (p. 225).

(From DeBonis, 2015 pgs. 126-127)

8. What to Test and How to do it – That IS the Question? 

“Despite lofty claims to the contrary, there is no clear consensus concerning the battery of tests that lead to a diagnosis of CAPD.”  (Burkard, 2009, p. vii) Presently, neither the American Academy of Audiology nor the American Speech Language Hearing Association have a clear criteria on what testing to administer, how many standard deviations the client has to be in order to qualify, as well as even who is a good candidate for (C)APD testing.  (DeBonis, 2015 pg. 125)

As such, presently children diagnosed with (C)APD are diagnosed purely in an arbitrary fashion rather than based on a specific widely accepted standard.  To illustrate W. J. Wilson and Arnott (2013) found that “in a sample of records of 150 school-aged children who had completed at least four CAPD tests, rates of diagnosis ranged from 7.3% to 96% depending on the criteria used” (DeBonis, 2015 pg. 125). Are you “processing” what I am saying? 

9. Looking for the “Right” Label 

As an SLP, I frequently hear the following statement from parents: “We were searching for what was wrong with our child for such a long time; we are so happy that we were finally able to identify that it’s (C)APD.

The above comment is certainly understandable.  After all (C)APD sounds manageable!  The appeal to it is that presumably if the child undergoes specific auditory interventions to improve deficit areas, s/he will get better and all the problems will go away.  In contrast, finding out that the child’s processing difficulties are the result of linguistic deficits in the areas of listening, speaking, reading, and writing can be incredibly overwhelming especially because what we know about the nature of language impairments and that is that more often than not they turn into lifelong learning disabilities.

Some parents and professionals may disagree.  They might point out that many children with (C)APD test just fine on generalized language testing and only present with isolated deficits in the areas of attention, memory, as well as phonological processing. Yet here is the problem! General language testing in the form of administration of tests such as the CELF-5 or the CASL does not complete language assessment make!

The same children who test ‘just fine’ on these assessments often test quite poorly on the measures of social communication, executive function, as well as reading.  In other words if the professionals dig deep enough they often find out that something which outwardly presents as (C)APD is part of much broader language related issues, which require relevant intervention services. This leads me to my final point below.

10. Missing the Big Picture

“The primacy given to auditory processing abilities has resulted at times in neglect of other cognitive factors” (Cowan et al. 2009, p. 192). Focusing on the diagnosis of (C)APD obscures REAL, language-based deficits in children in question. It forces SLPs to address erroneous therapeutic targets based on AuD recommendations. It makes us ignore the BIG Picture and  “Consider non-auditory reasons for listening and comprehension difficulties, such as limitations in working memory, language knowledge, conceptual abilities, attention, and motivation and consequently targeting language, literacy, and knowledge-based goals in therapy.” —(Kamhi &Wallach, 2012)

Conclusion:

So what will happen next? Well, I can tell you with certainty that the controversy will certainly not end here!  Presently, not only is that there is a fierce academic debate between speech language pathologist and audiologists but there is also a raging debate among audiologists themselves!  This controversy will continue for many years among some highly educated people.  And SLPs? Well, we will continue seeing numerous children diagnosed with (C)APD.  Except, I do hope something will change and that is our collective outlook on how we view ambiguously defined and assessed disorders such as (C)APD.

I sincerely hope that we do not blindly defer to other professions and reject current valid research regarding this controversial diagnosis without first spending some time reflecting and critically reviewing these findings in order to better assist us with making informed and educated decisions regarding our clients’ plan of care.

Click HERE to read the second part of this post, which describes how SLPs SHOULD assess and treat children diagnosed by audiologists with (C)APD

References:

  • Burkard, R. (2009). Foreword. In A. Cacace & D. McFarland (Eds.), Controversies in central auditory processing disorder (pp. vii-viii). San Diego, CA: Plural.
  • Cowan, J., Rosen, S., & Moore, D. (2009). Putting the auditory back into auditory processing disorder in children. In Cacace, A., & McFarland, D. (Eds.),Controversies in central auditory processing disorder(pp. 187–197). San Diego, CA: Plural Publishing.
  • Dawes, P., & Bishop, D. (2009). Auditiory processing disorder in relation to developmental disorders of language, communication and attention: A review and critique. International Journal of Language and Communication Disorders, 44, 440–465.
  • DeBonis, D. A. (2015) It Is Time to Rethink Central Auditory Processing Disorder Protocols for School-Aged Children. American Journal of Audiology. v. 24, 124-136.
  • Ferguson, M. A., Hall, R. L., Moore, D. R., & Riley, A. (2011). Communication, listening, cognitive and speech perception skills in children with auditory processing disorder (APD) or specific language impairment (SLI). Journal of Speech, Language, and Hearing Research, 54, 211–227.
  • Fey, M. E., Richard, G. J., Geffner, D., Kamhi, A. G., Medwetsky, L., Paul, D., Schooling, T. (2011). Auditory processing disorder and auditory/language interventions: An evidence-based systematic review. Language, Speech and Hearing Services in Schools, 42, 246–264.
  • Hazan, V., Messaoud-Galusi, S., Rosen, S., Nouwens, S., Shakespeare, B. (2009). Speech perception abilities of adults with dyslexia: Is there any evidence for a true deficit?. Journal of Speech, Language, and Hearing Research. 52 1510–1529
  • Kamhi, A. G. (2011). What speech-language pathologists need to know about auditory processing disorder. Language, Speech, and Hearing Services in Schools, 42, 265–272.
  • Kamhi, A & Wallach, G (2012) What Speech-Language Pathologists Need to Know about Auditory Processing Disorders. ASHA Convention Presentation. Atlanta, GA.
  • Kelly, A. S., Purdy, S. C., & Sharma, M. (2009). Comorbidity of auditory processing, language, and reading disorders. Journal of Speech, Language, and Hearing Research, 53, 706–722.
  • Lemos IC, Jacob RT, Gejao MG, et al. (2009) Frequency modulation (FM) system in auditory processing disorder: An evidence-based practice? Pró-Fono Produtos Especializados para Fonoaudiologia Ltda. 21(3):243-248.
  • Melby-Lervåg, M., & Hulme, C. (2013). Is working memory training effective? A meta-analytic review. Developmental Psychology, 49, 270–291.
  • Ramus, F., White, S., Frith, U. (2006). Weighing the evidence between competing theories of dyslexia.Developmental Science. 9 265–269
  • Sharma, M., Purdy, S. C., Kelly, A. S. (2009). Comorbidity of auditory processing, language, and reading disorders. Journal of Speech, Language, and Hearing Research. 52 706–722
  • Wallach, G. P. (2011). Peeling the onion of auditory processing disorder: A language/curricular-based perspective. Language, Speech, and Hearing Services in Schools, 42, 273–285.
  • Watson, C., Kidd, G. (2009). Associations between auditory abilities, reading, and other language skills in children and adults. Cacace, A., McFarland, D.Controversies in central auditory processing disorder.  218–242 San Diego, CA Plural.
  • Wilson, W. J., & Arnott, W. (2013). Using different criteria to diagnose (central) auditory processing disorder: How big a difference does it make? Journal of Speech, Language, and Hearing Research, 56, 63–70.
Posted on 4 Comments

New Product Giveaway: Comprehensive Literacy Checklist For School-Aged Children

I wanted to start the new year right by giving away a few copies of a new checklist I recently created entitled: “Comprehensive Literacy Checklist For School-Aged Children“.

It was created to assist Speech Language Pathologists (SLPs) in the decision-making process of how to identify deficit areas and select assessment instruments to prioritize a literacy assessment for school aged children.

The goal is to eliminate administration of unnecessary or irrelevant tests and focus on the administration of instruments directly targeting the specific areas of difficulty that the student presents with.

*For the purpose of this product, the term “literacy checklist” rather than “dyslexia checklist” is used throughout this document to refer to any deficits in the areas of reading, writing, and spelling that the child may present with in order to identify any possible difficulties the child may present with, in the areas of literacy as well as language.

This checklist can be used for multiple purposes.

1. To identify areas of deficits the child presents with for targeted assessment purposes

2. To highlight areas of strengths (rather than deficits only) the child presents with pre or post intervention

3. To highlight residual deficits for intervention purpose in children already receiving therapy services without further reassessment

Checklist Contents:

  • Page 1 Title
  • Page 2 Directions
  • Pages 3-9 Checklist
  • Page 10 Select Tests of Reading, Spelling, and Writing for School-Aged Children
  • Pages 11-12 Helpful Smart Speech Therapy Materials

Checklist Areas:

  1. AT RISK FAMILY HISTORY
  2. AT RISK DEVELOPMENTAL HISTORY
  3. BEHAVIORAL MANIFESTATIONS 
  4. LEARNING DEFICITS   
    1. Memory for Sequences
    2. Vocabulary Knowledge
    3. Narrative Production
    4. Phonological Awareness
    5. Phonics
    6. Morphological Awareness
    7. Reading Fluency
    8. Reading Comprehension
    9. Spelling
    10. Writing Conventions
    11. Writing Composition 
    12. Handwriting

You can find this product in my online store HERE.

Would you like to check it out in action? I’ll be giving away two copies of the checklist in a Rafflecopter Giveaway to two winners.  So enter today to win your own copy!

a Rafflecopter giveaway

Testimonials

Click HERE to download a pdf containing client testimonials for the time period from January 2009 – June 2018

Teleassessment Testimonial

Our family engaged Tatyana Elleseff, M.A., CCC-SLP of Smart Speech Therapy LLC to administer an independent SLP assessment to our ten-year-old 5th-grader. Our child was identified as twice-exceptional (2e); i.e., superior gifted IQ with ADHD-Combined type. Ms. Elleseff was highly recommended by several private-sector clinical psychologists across the country as having the skill to assess and diagnose 2e children. We have only high praise for the work she continues to do for our child.

For the prior 3 years, we, the parents, have struggled and advocated to get help for our son. Multiple assessments by outside assessors have continued to show a significant gap between our son’s achievement and his cognitive abilities. However, our school district asserted that his academic performance was average and therefore he didn’t need an IEP.

This year, our child psychologist recommended an SLP assessment to explore and possibly rule out speech and language impairments (SLI). It was hypothesized that the child’s giftedness and high level of functioning enabled him to partially mask his learning deficits. Ms. Elleseff’s assessment revealed pronounced speech and language impairments that had completely escaped detection before.

Ms. Elleseff administered her assessments via teleassessment because we are located in California and she in New Jersey. Teleassessment was comprised of live GoToMeeting sessions augmented by audio/video recordings forwarded to her.

Ms. Elleseff has met and exceeded our expectations in 3 key areas:

  1. She demonstrated tremendous skill in telemedicine. She maintained our child’s attention and kept him engaged throughout the multi-hour two-day assessment process. For a child with ADHD combined-type, this was no small feat.
  2. She produced a comprehensive SLP assessment report that uncovered language and literacy impairments that had been overlooked by other experts. Her insight has helped connect the dots between twice-exceptionality, ADHD and language symptoms.
  3. Her assessment methodology has been praised by several experts and attorneys for its multidimensionality and thoroughness.

As parents, we value answers to the following questions.

Would we recommend Ms. Elleseff to other parents? Absolutely.

Why do we recommend Ms. Elleseff? Her work is stellar. Her report organization is detailed and accessible to professional SLPs, psychologists, attorneys, educators, parents, and others. She was able to definitively identify the SLI needs of our 2e child help others connect the dots between his SLI needs and current achievement performance.

How has Ms. Elleseff’s work helped our child? Her work has enabled us to add speech and language treatments that target child’s areas of need.

Ms. Elleseff is highly responsive. She is available by phone and e-mail to consult with all the professionals engaged in our child’s care to ensure all the various providers understand the nuances of servicing the learning needs of this 2e child.

Please do not hesitate to ask Ms. Elleseff for our contact information.

Sincerely,

Southern California Parent of a 2e child

November 25th, 2018

Post Treatment Therapy Testimonial (Internationally Adopted Child)

In 2010 we brought home our adopted daughter from Kazakhstan.  We were initially worried about the hurdles that we would face with adopting a four year old that didn’t understand English and had no formal schooling.  We went to Tatyana based on a recommendation from a psychologist and started sessions in the Fall of 2010.   From the very start, we knew we made the right decision.  She did an initial evaluation that was very thorough and gave us a step by step overview of the process that we would follow together once a week.

Tatyana has a very pleasant demeanor working with internationally adopted children, but also knows how to push them so that they get the most out of themselves.  As a parent with so many worries initially, it was very calming to sit in on each session and see her development from week to week.  It really helps when you have someone that you can voice your concerns to and get a well thought out and practical approach to your needs.  Needless to say, our daughter picked up English very quickly and was able to get much needed help with reading comprehension as well as other skills that many of us use without even realizing, like the use of figurative and ambiguous language (e.g., idioms, synonyms, antonyms), etc..  Tatyana also reviewed our child’s progress regularly to pinpoint areas that needed more concentration.

We continued for several years, and we felt that the instruction she had received at Smart Speech Therapy, laid a solid foundation for her future development.  Our daughter will be turning thirteen this fall.  We can honestly say that the time invested in these sessions has given her the opportunity to flourish in school.   Her favorite subject now is Language Arts, and she has currently made the honor roll at her middle school.  She loves to read books and her vocabulary has expanded exponentially.  Sometimes when we are just sitting around, our daughter will come over and sit with us, with a book in hand, and just read.  My wife and smile at each other and think about how blessed we’ve been, to have given her this opportunity.

Thank You so much for your devotion Tatyana, we couldn’t have done it without you!

M & J, Monroe NJ

Comprehensive Independent Language and Literacy Evaluation

I retained Tatyana to do a Comprehensive Language and Literacy Evaluation for my teenage son.  As he has always struggled with reading and writing, and has had an IEP since third grade, I was no newcomer to evaluations.  He has had educational, psychological, neuropsychological and language/literacy evaluations.  Despite all of these inquiries into his needs, as well as the provision of special education services, he was still struggling in his school placement.  I decided to look for a professional who could delve deeper, to help me understand why my son struggled so, and what, if anything, could be done to help him.  Well, I certainly found that professional in Tatyana!  And her Comprehensive Language and Literacy evaluation was exactly that: comprehensive.  She spent more than nine hours with my son and administered a variety of tests that he had never before faced.  I found them fascinating because the results replicated the academic struggles he has, and gave us a link to the foundation of them.  Interestingly, they also gave us some insight to how he thinks, and how he approaches problems and social interactions, which are areas that had not previously been explored from a linguistic perspective.  To be sure, she did not simply go through the motions of administering tests.  She made observations about his behavior that added to her test results and provided a comprehensive picture of my son’s strengths, weaknesses and needs.  In addition, her work product was completed in a timely manner, and she responds promptly to phone calls and emails.  I found my experience working with Tatyana to be a positive one, and the product to be an indispensable part of my quest to find the right education for my son.

NJ Parent

Language and Literacy Teleconsultation

Tatyana has recently provided me with a teleconsultation regarding my 13-year-old son with respect to the potential testing needed to tease out the extent of his language and literacy difficulties. I am a speech-language pathologist myself, but I had a very hard time pinpointing the exact nature and extent of his deficits. All previous educational and neuropsychological assessments showed him to be within average limits on a select battery of tests yet he was significantly struggling in social and academic areas.

It takes years of experience and additional study to accurately assess a child like my son who has an average IQ but a subtle pattern of language and literacy weaknesses. After reviewing all records of the previous testing and speaking to my son for a short period of time via teleconferencing, Tatyana was able to quite effortlessly articulate my child’s language and literacy difficulties as well as explicitly indicate exactly which formal and informal language assessments my son would need  in order to showcase his present strengths and ongoing social and academic challenges. It truly was amazing! Tatyana is remarkably good at her job. I have not met a more skilled diagnostician in all my years as an SLP. I look forward to having her complete a comprehensive assessment for my son in the near future. We have waited thirteen years but we have finally found the right diagnostician for the job. Thank you, Tatyana!

Grateful SLP mom from Illinois.

Comprehensive Independent Language and Literacy Evaluation

I am a CCC-SLP mom of an intellectually gifted 7-year-old girl, who is on the verge of academic failure and has been since Kindergarten. The school system has not been interested in identifying a cause, as my daughter manages to squeak by to a passing standard. I did not believe that the Independent Evaluations I previously had done were in-depth enough to pinpoint where her breakdowns are occurring.  Fortunately, I became aware of Tatyana through social media and initiated my contact with her via Facebook.  Tatyana was so kind to answer questions through private messages. After several months of following her blog and Facebook group, I had the epiphany that Tatyana would be the perfect clinician to evaluate my child.  Tatyana is professional and thorough beyond belief, from the initial contact regarding the evaluation she will conduct.  She sent the most thorough intake document I’ve ever seen and requested to see all previous evaluations, to research my daughter my see if she could clinically add information to what had already been tested. It was our good fortune that Tatyana saw there was so much information missing from the previous evaluations I had done for my daughter.

Prior to testing, Tatyana provided a detailed outline of what she would be testing for, a specific timeframe for the evaluation broken down into multiple sessions, the protocols she would be using, the amount of time it would take for testing within each domain, clinical hours evaluating her data and summarizing into a report.   From the initial evaluation session, she was welcoming, friendly and put my daughter and myself at ease. At the end of each testing session, plenty of time was taken to explain some of the findings of the session, and any adjustments to the proposed plan based on results to date were discussed.  The final report is an in-depth evaluation/summary of my daughter’s skills and weaknesses in every area related to Expressive Communication skills, Social Pragmatic communication skills, Literacy skills (inclusive of all domains within reading and writing).  The schools try to avoid service initiation or to provide the most simplistic approach to remediation…. They will not be able to get away with that model given the evaluation report I have received. Tatyana perfectly outlined my daughter’s deficit areas, along with the future educational implications throughout the report. Tatyana provided very specific Long Term and Short Term objectives, personally tailored for my daughter within all the domains she evaluated. It’s a gift for the future treating clinician.

Tatyana says don’t hesitate to contact her in the future if she can be of assistance as I pursue services and educational remediation for my daughter, and I have no doubt regarding her sincerity.

As a professional and as a mom of a child who is struggling, I really can only say THANK YOU to Tatyana for the professional, insightful, high quality evaluation. She perfectly and totally captured my daughter’s skills and areas of educational need.

Jeanann Wallace, CCC-SLP, Mom

Professional Consultation Complex Communication Impairment – Adolescent Client

I sought Tatyana’s help when I did a comprehensive evaluation on a student that had multiple, complex diagnoses, some of which I had little prior experience with. Tatyana provided extremely valuable feedback about my report. She also provided me with solid, evidence-based recommendations for intervention. She sent many links and documents, which were also incredibly helpful! As a result of my consultation with Tatyana, I felt totally confident with my report and my recommendations. My feedback session with the parent went great, and I’m confident the student will get the appropriate interventions. Tatyana is warm, professional, and extremely knowledgable. My professional consultation with her gave me the peace of mind I needed. That peace of mind is priceless! I very highly recommend her!

Florence Cannon, MS, CCC-SLP
The Language Group
Atlanta, GA

Professional Consultation Internationally Adopted Adolescent

I recently had the pleasure and privilege of consulting with Tatyana Elleseff regarding the complexities and risks associated with the language development of internationally adopted children and adolescents. Tatyana provided a wealth of insight, knowledge and experience solidly backed by evidence-based research. She welcomed questions and helped me navigate through the issues impacting internationally adopted children. In addition, Tatyana was incredibly organized and generous with resources, ideas and feedback. Consulting with Tatyana proved to be an excellent investment of time and money and as a growing clinician, I hope to work with her again – she is an inspiration!”

Thank you again!!!
Rinda Werner

Comprehensive Independent Language and Literacy Evaluation

My son was diagnosed with ADHD-combined at the very young age of 5. Something was different about him even as a baby. He was precocious and smart as a preschooler reciting the alphabet forward and backward and every state in alphabetical order. His memory is remarkable. We made the difficult decision to start him on medication at age 5. He did well in kindergarten and was compliant, followed the rules, and was liked by his peers. He kept his desk very organized in the classroom. Everything had to be put back in its place and lined up. He managed other materials in the classroom and that of his classmates, putting their supplies away as well. He was rigid in adhering to the schedule of the day, reminding the teacher of what came next as well as policing others.  We tried to get him a 504, but the school denied him.

They said he was doing fine.

We have always tried to be proactive and push on to make sure our child’s needs are met. He was tested for and denied being in the gifted and talented program. We decided to seek a neuropsychological evaluation. This identified strengths and weaknesses that we would not have been aware of had we not pursued it. It confirmed our instinct that he had a very superior IQ. This is bittersweet because while he is truly gifted (2E twice exceptional), he also had decoding and phonics weaknesses amongst other things. The report was given to the Principal, the School Psychologist, the Learning DisabilitiesTeacher Consultant (LDTC), the School Superintendant and they all ignored the report. We brought the doctor that did the neuropsychological exam to plead our case. The school finally agreed to a 504 with classroom accommodations including reading services. The school discontinued reading services after 6 months as the school said he was doing fine.

The journey continued seeking more answers to a difficult child. We sought the opinion of a well-regarded developmental pediatrician. He diagnosed ADHD and High Functioning Autistic Spectrum disorder. He wrote to the school requesting a social skills lunch bunch and speech therapy for pragmatics. They denied speech therapy without doing an evaluation citing the second-grade teacher didn’t deem it necessary.  They said he was doing fine.

We knew through our experts that he needed help in reading, writing, speech for pragmatics, and social skills with social thinking. What else could we do to help our son? Another doctor recommended we consider a comprehensive language and literacy evaluation referring us to Tatyana Elleseff, M.A., CCC-SLP at Smart Speech Therapy LLC.

I’ve learned the value of obtaining independent evaluations. I contacted Ms. Elleseff leaving a message and she promptly returned my call. Ms Elleseff listened to me patiently and helped me understand that my son needed both a language and literacy evaluation. I was so relieved and grateful to finally find someone who understood. She has ALWAYS been prompt and organized. Her system for setting up consultations and evaluations is concise with well-defined contracts as to what services are to be provided, what the process is, and the time frame. She was VERY accommodating setting up the evaluation as we fit it in last minute before school started last fall. Our evaluation was 9 hours, broken up in 4 sessions followed with a school observation. She completed the report promptly and comprehensively.  The report showed strengths, weaknesses, long term goals, short term goals, and detailed intervention recommendations. I must admit, it was hard to take in the problems my son has that she so clearly identified. Early intervention is so critical and I am grateful to had had the chance to work with Tatyana.

Ms. Elleseff truly has a passion for her work and is championing children’s needs. Her credentials are extensive and impressive. We did retain an attorney and are pursuing an IEP. Ms. Elleseff’s report and Curriculum Vitae were sent to the school. The school has finally agreed to evaluate our son to determine eligibility.  I hope our experience will help some of you!

Janet S, Greenbrook, NJ

International Language and Literacy Teleconsulation

My 14 y.o. son has difficulty performing various language-related tasks. He is unable to retell stories and movies, makes grammatical errors when speaking, cannot use complex sentences, and has difficulties expressing his opinion in conversations. Because my son excels in math and science, initially I was not terribly concerned with this as I thought that he might develop skills in reading and writing later in life.

However, as he grew older rather than improving these difficulties only got worse and I became very concerned that it would affect his future life outcomes (e.g., college admission chances in either Israel where we live or in the United States where his older brother currently studies).  So I began to search for a professional who could assist my son in improving his abilities for academics. One of my friends recommended I consult a speech-language pathologist and another friend from the United States recommended Tatyana Elleseff as one of the best specialists in this field.

Still unsure if that was what we truly needed, I still scheduled a teleconsultation with Tatyana for my son and myself and began filling out preliminary intake forms that Tatyana sent me before the meeting.

Right away I noticed that my son was displaying deficits on approximately 80% of questions and began to understand that he does have a real problem, which should be taken seriously. Not only were his academic difficulties a concern but I also realized that his social communication abilities (which I had previously considered to be a completely unrelated problem) were significantly impaired as well and required addressing as well.

Tatyana began her consultation by first interviewing my son for a period of time (he speaks Russian and English besides his native Hebrew, so they understood one other quite well) and I saw him enjoying the conversation. After that Tatyana spoke to me. She highlighted to me in which areas she recommended he be tested and also explained the ramifications of leaving his deficits untreated (he is at risk of developing mental health problems such as anxiety and depression). Since we live in different countries and Tatyana was not available to work with my son in person, she did some research and found reliable speech-language pathologists in Israel who could assist my son and recommended that I contact them for further assistance.

I highly value Tatyana’s professional experience and totally trust her recommendations. I already contacted the suggested therapists and my son will start services shortly. I’m also planning on bringing my son to the United States in April for supplemental therapy sessions with Tatyana in order to strengthen his remediation program. I strongly believe that with Tatyana’s help my son will improve his academic performance, build social skills, gain self-esteem, and overcome emotional instability.  I recommend Tatyana without reservations to any parents of children with language or literacy difficulties living outside of United States for a language and literacy teleconsultation.

O.G., Rishon Lezion, Israel

Comprehensive Independent Language and Literacy Evaluation

We brought our 11-year-old son to Tatyana Elleseff, MA CCC-SLP for an evaluation on the recommendation of another professional working with us to secure an appropriate school placement to address his needs as a learner. Our son has been receiving services since he was an infant through early intervention and then both privately and through an IEP in the public school– so I am not a newcomer to the process.  I must say that our entire experience working with Tatyana has been positive, professional, and impressive.

First, the ease in scheduling the initial appointment was a relief. Often when contacting a new consultant/expert there is a long waiting period and much back and forth before getting started. Tatyana responded promptly when I first called her and provided a very clear explanation of what services she could provide and what the intake process would entail. Scheduling was also very easy. Throughout our initial contact, she was sensitive to our sense of urgency to have the evaluation completed, but also was very reassuring that the process would go smoothly, which helped reduce any apprehensions on our end.

Additionally, Tatyana spread the evaluation over several sessions so that it would not be overwhelming or taxing for our son. When he first met Tatyana, she was warm and welcoming which helped with him significantly with going to yet another evaluation with yet another therapist. In fact, our son really enjoyed spending time with Tatyana.

Finally, the comprehensive report Tatyana generated was excellent in quality. The turn around time and level of meaningful detail was extraordinary. Tatyana’s evaluation and the subsequent report of her findings not only clearly identified our son’s areas of weaknesses and strengths, but also provided specific strategies to best support his academic progress as well as clearly defined the best classroom environment for him.

We were very pleased with the final report as well as the entire process and would highly recommend Tatyana Elleseff’s services.

E and D, Maplewood, NJ

Language and Literacy Consultation Parent Testimonial

“I consulted with Tatyana Elleseff in preparation for a CSE initial eligibility meeting. I had evaluations from the school district and a private psychologist. I needed help connecting the dots in what was a very nuanced case. There was absolutely something going on with my child’s language and learning and understanding the reports and what direction to go in next was essential. Ms. Elleseff analyzed the findings with great attention to detail. Ms. Elleseff gave me specific and evidence based recommendations that finally made sense. She presented possibilities that had not previously been explored. Ms. Elleseff showed extreme expertise in connecting my observation and intuition as a parent with the science of language. She educated me and made recommendations about additional and more specific tests, prepared me for the CSE meeting and gave me suggestions on the types of interventions that I might consider for my child. I highly recommend her for a parent consultation”.

Parent, Westchester County, NY

Forensic Speech and Language Pathologist Testimonial

I am an attorney and my practice is devoted to special education matters in which parents explore whether their child is receiving the free, appropriate public education to which he or she is entitled.  Recently, a client retained me, and Tatyana Elleseff in order to explore whether the student was being appropriately educated with regard to his Dyslexia, also known as Language Based Learning Disability.  The matter is still under advisement, and even if it were not, I would not discuss the outcome.  However, I am able to say that Ms. Elleseff’s observation of the student, and the evaluation report itself, each was of the highest possible quality, as she is comprehensive, pays extraordinary attention to detail, and prepares an in depth assessment of a student.  While highly professional, the writing is also clear enough for a parent to absorb.  If I ever have to proceed to trial against a District, Ms. Elleseff’s professionalism will be difficult if not impossible to impeach, and she would be a passionate advocate for the children she assesses.  Without reservation, I recommend her as a Forensic Speech and Language Pathologist.

Attorney at Law in New Jersey

Independent Evaluation Testimonial

My ten year old son was experiencing tremendous academic difficulties throughout fourth and fifth grade.  His reading and writing in particular were functioning well below grade level and cognitive functioning. We knew that in order to close the gap an in-depth language and literacy evaluation was needed to unearth any undiagnosed learning disabilities. We consulted Tatyana Elleseff of Smart Speech Therapy LLC regarding my son’s current academic complications. Tatyana met with us and based on her customized intake process was able to map out a specific testing plan tailored to my son’s needs. Based on her testing results, Tatyana generated a highly detailed and comprehensive report that uncovered many linguistically based reading and writing disabilities. We will be able to use the goals in that report as building blocks to improve my son’s abilities in all the impaired areas of functioning to foster further academic success. I encourage anyone looking for a highly experienced and detail-oriented evaluator in the field of speech language pathology to utilize Tatyana Elleseff’s services.

WS, Kendall Park, NJ

Therapy Testimonial

It is absolute pleasure for me to recommend Tatyana. She is excellent speech language pathologist as well as an extremely knowledgeable and experienced professional. Our son has always experienced language difficulties along with lack of social skills. We have been through a few speech language pathologists along with several social skills group. But I am so glad that we met Tatyana. She has excellent teaching skills which help my son with problem solving and listening comprehension. Her approach and methods are amazing as she carefully considers Mark’s strengths and weaknesses. It allows Mark to learn in a quick and efficient manner and help him expand his knowledge and social skills. Tatyana manages to build therapy sessions with challenges and interesting tasks, which develop Mark’s curiosity for the subject and match his need. Tatyana teaches Mark skills which help maximize his strengths and compensate for his weaknesses. Tatyana knows how to adapt methods to create maximum results for the child. Due to variety of Tatyana ‘s approaches in therapy Mark is able to enjoy therapy while staying organized and focused. Tatyana exhibits and demonstrates great enthusiasm and I am extremely grateful that I had the honor and pleasure of finding Tatyana.

Jane A, New Providence , NJ

Independent Evaluation Testimonial

I had the pleasure of working with Tatyana recently when she conducted an independent language evaluation of my son. I will always remember this positive experience.  Tatyana is a very dedicated to her profession and cares deeply about her clients.  She made significant findings during the evaluation and I will always be appreciative of the special way she interacted with my son as well as of her evaluation outcomes. She was able to easily identify that despite the fact that my 6th grade son was dismissed from language therapy in 2nd grade, he continued to present with severe social pragmatic language deficits, which continued to adversely impact and significantly exacerbate his functioning in school setting.

Tatyana’s extensive experience allows her the opportunity to work with children with numerous disabilities leading to a very broad knowledge base. She possesses the qualities needed to be an excellent speech-language therapist. She is kind, patient, honest, and student focused. In short, she is an exceptionally dedicated professional and an incredible asset to her field.

F.O., New Brunswick, NJ

Therapy Testimonial

Our daughter age 11 was having trouble in school, struggling with written assignments, keeping track of her homework, following instructions and remembering things, as well as interactions with peers and teachers. As she was progressing through grades 1-5 her grades became progressively “below her level of capacity” as reported by teachers. Her social life was suffering; she was losing her school friends one after one. In the quest seeking help for our child we consulted a psychologist who suggested that our daughter’s problems are rather developmental than psychological and suggested to go for testing with a developmental specialist. Our friends referred us to Tatyana, saying that “she is so much more than a speech therapist”. After a telephone consultation Tatyana took our case, explaining that K’s problems in school may be deeply rooted in her language development issues. She was growing in a bilingual environment and has started talking later than her peers, having difficulty acquiring language skills. She received help from a speech therapist at age 3-4, and it seemed that the issues had resolved. Unfortunately, in school it became apparent that language problems did not disappear, but persisted hindering our daughter’s development. Tatyana conducted a comprehensive assessment and offered individually tailored program of remediation, offering us a hope that our daughter will be able to overcome her difficulties and adjust to demands of the modern life. After a month of therapy, we can see positive changes in K’s ability to verbalize her thoughts, keeping track of her activities and belongings, and her emotional intelligence.

Tatyana is a highly professional, dedicated, knowledgeable specialist and talented speech language pathologist. She manages to keep a fidgety child focused on a task for an hour, and together they accomplish a lot during a session. What they do stays in child’s memory and lays foundation for further work and can be used immediately in her life. She is successful in practice and current on her research methodologies; her reports are thorough and truly comprehensive. I only wish we have found Tatyana sooner!

A.D., New Providence, NJ

Therapy Testimonial

Our son is currently receiving speech language therapy from Tatyana, and we are incredibly happy with the services. We find Tatyana very organised and hard working in preparing and delivering therapy sessions to our son. She is compassionate and available to listen to our concerns and is a great problem solver. She has amazing skills to engage our son in different tasks during the session and provide us, parents, with clear and concise feedback his progress in therapy.
Tatyana is a wonderful speech therapist!

KJ, Dayton, NJ

Therapy Testimonial

Our son has speech delays and has been going to Ms Elleseff for speech therapy for a year. Since he started his sessions we are seeing improvements in his speech. After his initial evaluation, we decided to move forward with sessions and had the confidence that our child is in the right place. He has been learning many new words/sentences and has been making good progress. The thing we like most about Tatyana is that she always tries to create a fun environment and she works with the child depending on the child’s behavior. Our son is always excited to go see Tatyana for his sessions.

P and J, Somerset, NJ

Therapy Testimonial

Our son was 3 when we started with Tatyana. From the initial evaluation we knew we wanted to move forward with her. She was very thorough and even at that first meeting we could see that she was going to make a significant impact on his speech.  Our son will be 5 this month and he has made great strides in all his areas of deficiency. Speech therapy with Tatyana has not only helped him and his communication with us but being able to sit in during the sessions has taught us how to communicate with him and how we should apply the methods at home to enable our son to communicate better.  Tatyana creates a very fun and relaxed environment, but is still able to command the room with a no nonsense approach. Her skills allow her to use any mood or behavior the child is exhibiting for learning and language.

M and T, East Brunswick, NJ

Independent Evaluation Testimonial (International Adoption)

As a  parent of an Internationally Adopted child, I became aware that some professionals including neuropsychologists test our internationally adopted children like biological children. Too many of our kids suffers from being wrongly classified in Special Education by therapists who are unaware of our kids specific developmental paths and trajectories. Tatyana Elleseff’s expertise in assessing and treating language abilities of internationally adopted children helped me target my child’s weaknesses while putting it in the context of his adoption. She helps differentiate developmental delays from disorders and helps with implementation of remediation which involves the parents in addition to other therapists and resources. I highly recommend her to any parents of Internationally Adopted children to assess and treat their language/social emotional development.
Barbara, New York

Independent Social Pragmatic Evaluation Testimonial

Our daughter has always had a difficult time in social settings, how to start a conversation, saying offensive things to peers without the intention of being offensive, and feeling like she doesn’t fit in because she has different interests.

Our school performed a basic pragmatic language test that our psychiatrist disagreed with and felt did not accurately reflect our daughter’s condition.  He recommended having Ms. Elleseff perform a comprehensive social pragmatic language evaluation.

She advocated with the school for our daughter to get the evaluation and thanks to her efforts the school agreed.

Ms.  Elleseff completed a thorough and comprehensive evaluation of our daughter’s social pragmatic language abilities and provided a very detailed report and series of recommendations.

We are very grateful to her and we will be meeting with the school shortly to review and establish necessary accommodations.

P & J, New Jersey

Bilingual Evaluation Testimonial

Tatyana Elleseff performed speech evaluation of my 4 years old son in October 2014. I should say that not only the experience was very pleasant, but also the quality of evaluation process and communication was exceptionally high.

During the assessment, I was allowed to stay in a room with my child, which definitely made him more comfortable and therefore let Tatyana to obtain more adequate respond from him, which is crucial. Tatyana’s approach to evaluation is more complex than you probably would see with other SLPs. She was the first one, who was concerned with processing of verbal information by my son’s brain and his executive functions, connected to that, whereas couple of other specialists did not put emphasis on it at all.

The report I received from her was easy to read and understand to non-professional, which I am. I guess this is very important too, since if you got the report full of professional vocabulary and was not able to decipher it, it leaves you with the feeling that everything is even worse than you expected about your precious child. Tatyana’s report made the effect just the opposite. I clearly saw where we have problems and that there are ways to work on them.

On top of everything, I have to mention that I have chosen Tatyana because of her web site that provides tons of useful information; her academic work with Rutgers University, that implies she is a very educated professional and her ability to provide service in Russian, since my child does not speak any English.

In the end, I have to say that I am very grateful for the chance to work with Tatyana and definitely recommend her to anyone who needs this kind of specialist.

 Sincerely, Katrina R., New Jersey.

Independent Evaluation Testimonial

Ms. Elleseff recently completed an independent evaluation of our 7 year old severely communication impaired daughter.  The report was incredibly comprehensive and based on thorough assessments across multiple areas of speech, language and behavior.  Not only did she incorporate highly relevant information found in the recent speech-language research publications, but Tatyana also thoroughly reviewed and synthesized our daughter’s school and medical records.  Now we have a single highly valuable document that “connects the dots” and can be presented to highly credential experts, who we are considering to treat and/or educate our daughter.  Most importantly, Tatyana is not only highly professional but also very easy to work with, and out daughter enjoys visits to her office.

 T & N, Bridgewater, NJ

Independent Evaluation Testimonial

We are grateful to Tatyana Elleseff for everything she has done to help our son receive proper speech and language help in his school.  She  utilized multiple assessments in order for us to understand clearly our son’s speech and language deficits, and at the same time she listed in her report the exact accommodations he will need at school to help him feel more successful.   Thank You!

Santiago Family.. Middlesex County, NJ

Consultation Testimonial (International Adoption)

I found Tatyana and Smart Speech Therapy online while searching for information about internationally adopted kids and speech evaluations. We’d already taken our three year old son to a local SLP but were very unsatisfied with her opinion, and we just didn’t know where to turn. Upon finding the articles and blogs written by Tatyana, I felt like I’d finally found someone who understood the language learning process unique to adopted kids, and whose writings could also help me in my meetings with the local school system as I sought special education services for my son.

I could have never predicted then just how much Tatyana and Smart Speech Therapy would help us. I used the online contact form on her website to see if Tatyana could offer us any services or recommendations, even though we are in Virginia and far outside her typical service area. She offered us an in-depth phone consultation that was probably one of the most informative, supportive and helpful phone calls I’ve had in the eight months since adopting my son. Through a series of videos, questionnaires, and emails, she was better able to understand my son’s speech difficulties and background than any of the other sources I’d sought help from. She was able to explain to me, a lay person, exactly what was going on with our son’s speech, comprehension, and learning difficulties in a way that a) added urgency to our situation without causing us to panic, b) provided me with a ton of research-orientated information for our local school system to review, and c) validated all my concerns and gut instincts that had previously been brushed aside by other physicians and professionals who kept telling us to “wait and see”.

After our phone call, we contracted Tatyana to provide us with an in-depth consultation report that we are now using with our local school and child rehab center to get our son the help he needs. Without that report, I don’t think we would have had the access to these services or the backing we needed to get people to seriously listen to us. It’s a terrible place to be in when you think something might be wrong, but you’re not sure and no one around you is listening. Tatyana listened to us, but more importantly, she looked at our son as a specific kid with a specific past and specific needs. We were more than just a number or file to her – and we’ve never even actually met in person! The best move we’ve could’ve made was sending her that email that day. We are so appreciative.

Kristen, P. Charlottesville, VA

Therapy Testimonial

Tatyana is a talented therapist who, unlike many other providers, is capable of creating a unique stimulating environment to meet the child’s needs. Using her energy and advanced experience she offers all the required psychological and physical incentives that naturally trigger child’s developmental progress.

Ilya K. Edison, NJ

Independent Evaluation Testimonial (Autism Spectrum Disorder)

Our son was diagnosed with autism spectrum disorder one year ago.  He has significant developmental delays especially with communication and speech.  Since starting his therapy we have seen 4 speech therapists and at least a dozen physical, occupational and developmental therapists.

Each therapist had a different opinion on his expressive, receptive and pragmatic skills, but none where able to clearly identify what his weaknesses are in these areas. As parents, we became very frustrated because our son is able to speak, but his verbal communication with us is poor. Finally, we were referred to Tatyana.

My son is very high functioning and has learned how to compensate for his delays.  He can fool the most trained evaluator, but Tatyana has the expertise and skill to be able to see if he knew the answers to her questions or if he was just guessing.  In my experience, very few therapists have the time or ability to do this.  Tatyana spent almost three hours with my son, identifying both his weaknesses and strengths along with giving me a lot of insight on his current communication level.

Tatyana thoroughly and systematically evaluated our son.  For the first time I left an evaluation feeling like I had answers to my questions that have been lingering for the past year.  Her love for children and work was apparent throughout the entire examination.  Through her in depth evaluation, Tatyana was able to identify where his communication deficits are and she set goals to strengthen these areas.  I can honestly say, to date, I have not met a therapist as enthusiastic and compassionate as Tatyana.

I have already recommended friends and will continue to recommend individuals in search of an excellent speech pathologist to Tatyana.  She has been a great help to both my son and our family.

Family of a son with ASD in Union County NJ.

Independent Evaluation Testimonial (International Adoption)

Our daughter Kristina was adopted 4 years ago from a small village of Kulabki, Russia. We have noticed that she was struggling in school and didn’t know where to turn. Being she is our only child adopted internationally and knowing no English when she arrived in New York, we just thought she needed time. Kristina was in therapy for R.A.D. issues. Her psychologist had pointed out that she really does not understand us all the time and has trouble communicating to us. We have become very frustrated with her and she with us. Dr. Lynne suggested that she be tested and recommended Tatyana Elleseff to us.  After reading Tatyana’s background and schooling on her website I was confident that she can help Kristina. Upon contacting her our first conversation was so informative. I made a 2 day evaluation appointment and was amazed how much Tatyana was able to accomplish during the evaluation.  Kristina’s issues are consistent with children who had been neglected in there most important growth years. (1 through 4). She also had not had formal schooling until the age of 8. Tatyana has recognized these issues and more. Tatyana gave us a very detailed 19 page evaluation in very timely manner. I will use her report to present to Kristina’s school so she could get appropriate help. We are so impressed with Tatyana’s skills that we are considering the 65 mile drive to receive outside therapy with her.

Donna S. Perkasie, PA

Therapy Testimonial  

Our daughter Ava was adopted internationally at the age of 18 months and had a diagnosis of Fetal Alcohol Syndrome at birth. She came to us with significant hearing, feeding (couldn’t eat or suck a bottle properly) and sleeping problems as well as significant speech and language deficits. She’s 5 now, and we’ve spent the past 3 and 1/2 years going through the state’s Early Intervention program, numerous evaluations and therapists, as well as the public school system’s learning disabled program.

We started working with Tatyana privately about 8 weeks ago and she has made more progress in 8 weeks than we’ve seen in the past 3 years! In our first sessions Tatyana evaluated Ava and found every issue we’ve been dealing with, plus some that weren’t even diagnosed by any of the other therapists we’ve seen. She even had recommendations for some of the OT sensory integration/processing issues that Ava faces. She has been right on the money with each of her observations and suggestions for working with Ava on her issues.

Tatyana has an amazing intuitiveness for helping Ava overcome the roadblocks she encounters, and is incredibly detail oriented. However, Tatyana doesn’t cut Ava any slack and makes her work pretty hard, and we’ve seen amazing results already in our weekly sessions in a pretty short time.

She is the best thing that has happened for Ava, and I only wish we would have come to her much sooner! ”

Keith and Debra, Southampton NJ

Independent Evaluation Testimonial (International Adoption)

We are immensely grateful to Tatyana Elleseff for her outstanding work in evaluating our internationally adopted child. She administered multiple instruments to appropriately and comprehensively assess our son’s relative strengths and weaknesses. The mere process itself of watching her assess our son provided us with new insights into his language, emotional, and behavioral needs. Furthermore, we also witnessed how his language ability developed simply through the experience of her assessment sessions. Tatyana’s written report integrated and synthesized a mass of assessment and behavioral information. She created a clear, detailed, vivid, impressively comprehensive and coherent picture of our son’s relative strengths and weaknesses both in his behaviors while being assessed as well as in his actual language skills. Her report also provided very specific and targeted recommendations that facilitates the creation of an appropriate individualized educational plan for our son and gives teachers and support staff clear direction in meeting the complex needs of an internationally adopted older child, without which we believe he would not reach his full potential. In addition, we greatly appreciated that she sincerely listened to us and our concerns, and respected our knowledge, observations and insights as adoptive parents. She is obviously a very talented, gifted and dedicated speech language therapist. We could not be more pleased. Thank you, Tatyana!

W & K, New Jersey

Therapy Testimonial

We have been using the services of Smart Speech Therapy and Ms. Tatyana Elleseff for approximately three years.  During this time, our Internationally Adopted daughter has made tremendous improvement with issued related to Auditory Processing, Word Finding, Social Pragmatic , as well as Executive Function Difficulties.  These were conditions we did not even realize existed and were not remotely prepared to handle.  When we were referred to Tatyana Elleseff we had no idea what our daughter was struggling with, we only knew that she wasstruggling.  We had tried for years with her teachers to point out her difficulties, only to be told over and over again that she was fine.  She did not qualify for any type of extra help and that she was “just a little behind”.  When our daughter’s anxiety level regarding school went through the roof, we knew we had a problem that was not going to be recognized or treated by the school district.  We were referred to Tatyana at the end of 2nd grade.  Tatyana went straight to work to determine what exactly the problems were and how best to proceed.  But in addition to the Auditory Processing issues, Tatyana uncovered several other “hidden” deficits (see above) and began designing interventions on how to best help our daughter function in school.  Tatyana also spent much time helping our daughter with her anxiety about school, and taught her how to ask for what she needed from her teachers and how to cope with her everyday struggles.   Since then, we have been working with Tatyana every week.  Our daughter has made tremendous progress with in all of her areas of difficulty and feels much better about going to school and her performance while there.   Tatyana constantly evaluates and tailors her sessions to exactly where the difficulties lay.   Tatyana is a well-informed, structured and prepared therapist.  Her sessions are custom tailored to our daughter’s specific needs and Tatyana clearly puts time and effort into that preparation. Tatyana also has an excellent understanding to the specific challenges Internationally Adopted children often face.  Many school staff, although well meaning, just do not understand these specific challenges.  In fact, many of us adoptive parents sort of “learn as we go along” regarding these issues.  However, armed with the information that Tatyana provides us, we are better able to obtain the support in school that our daughter needs. We are still in therapy with Tatyana and our daughter is doing well.  She is no longer scared to ask questions and really feels better about being able to keep up with her class.  Tatyana is the third speech therapist we have been to, but the first who took the time to evaluate and treat the whole problem, the whole child.

Mike and Anna, East Brunswick, NJ

Therapy Testimonial

At 18 months, we were concerned with our son’s lack of language and communication skills.  After contacting friends and family and numerous experts and professionals, we were recommended, Ms Elleseff.   She was so friendly and understanding of our concerns but she didn’t sugar coat that our son did lack in certain areas.  Her initial evaluation was so detailed and specific and picked up on things, we as parents noticed but thought were not unusual, that needed corrections.  We have been going for one hour sessions once a week for 6 months, but we noticed significant changes after only 2 or 3 months.  His frustration level is down, he is using words and signs to communicate rather than frantically looking for visual cues and pointing/yelling.    Tatyana expects our son to work at his sessions; he does not get away with tears and tantrums.  She praises him, and us, on our progress but always tells us what needs work and what to do at home.  She also goes above and beyond our sessions, working with other professionals as well as taking the time to clarify health insurance questions.  As a parent, you will do anything for your child, and you question yourself constantly.  We have written tearful correspondence filled with worry and she has always answered our questions with compassion, setting our minds at ease with her expertise and taking action on our concerns.  Our now two year old uses words to identify actions, things in his environment, feelings and preferences.  He is making such strides now that family and friends that go for a short time without seeing him comment on his progress.  He is much clearer and we are finding we have to answer the “What did he say?” question less and less.  This weekend he sang songs for us, with words we all understood.  We can’t imagine where we would be without Tatyana’s help.

~Melissa and Rich H, Hillsborough, NJ

Therapy Testimonial

In March 2012 we sought the help of Tatyana for our three year old who has a significant speech delay.  Since then, our son is now speaking in longer sentences as well as understands more words and  concepts thanks to Tatyana’s hard work.  She doesn’t let him get away with anything, which is what he needs. She is also professional enough to consult other professionals when she needs it.   She sought advise from a psychologist on how to handle our head strong son and his temper tantrums. We highly recommend her. Thank you Tatyana!
             A & J, Somerset, NJ

Therapy Testimonial

Speech therapy with Ms. Elleseff is not for the faint hearted. She misses nothing. She forgets nothing. Your child will get away with nothing. She is so thorough, the first evaluation was 16 pages and sadly presented such a true portrait of our child’s language deficiencies that we just had to stop for a good cry. We could no longer escape. Our child had needs, which we, her parents did not recognize, did not want to see or could not accept. After a year fighting with the insurance company (which denied coverage) and our child slipping further behind at school, we knew we had to do something. Since finances were a limiting factor, we agreed to try speech for a month or two, even though we knew at it was probably not realistic to see much improvement in such a short time. We were wrong! After only a few months now, the improvement is remarkable.  Our child is now participating in class, answering questions when asked, instead of shutting down, answering more appropriately, and is even reading better, which was an unexpected bonus. Her teachers tell us she is a different child than at the beginning of the semester. At home, she’s more aware of conversations, news, verbal and non-verbal cues. She can explain “what happened at school today?”  In general, she’s just more engaged at home and school, and more responsive to verbal feedback, instructions, encouragement. Ms. Elleseff is a truly gifted professional, whose compassionate awareness of the frustration children feel when they cannot properly communicate, has enabled her to reach them, to relieve them and to enliven them with the gift of language! We cannot thank her enough!

Andrea and Keith R, South Brunswick, NJ

Client Testimonial

“As parents of a newly adopted toddler from Russia (and as first time parents) we have found Tatyana to be an amazing resource to us on many levels.  Her experience impressed us from the start and with each successive session we feel that we have been seeing some great progress with our son’s speech-language delay. We feel that we get the most out of every minute of each lesson as she has shown us that by varying learning techniques and approaches our son can be challenged to thrive but not in a way where he is stressed. We have had additional early intervention speech therapy services for a few months to supplement our private sessions  with Tatyana but found them not to be as effective by far, as a result of which we chose to just continue with her. We would highly recommend Tatyana to other adoptive parents and we are also willing to speak to others about our experience if interested.”

Tanya and Jonathan H, Old Bridge, NJ

Client Testimonial

“Mrs. Elleseff has been doing an outstanding job at identifying and devising strategies to help out our 7-year old son improve his pragmatic language skills. When other specialists were quick to label him, Mrs. Elleseff took her time to address and dismantle every one of those labels. She truly cares about “her children” and is an advocate for them in situations where the wrong (but quick) diagnosis is made. We have been working with Mrs. Elleseff for approximately 7 months and we are seeing steady progress in our son’s skills. We very much appreciate her efforts!”

Myriam and Richard K, Guttenburg, NJ

Client Testimonial

“We adopted our four year old daughter from Kazakhstan last year and she was significantly delayed in her native language. Tatyana was recommended to us by our doctor and we started seeing her on a weekly basis. During this time our daughter has shown significant improvement in her interpersonal and academic language skills  to the point now, where she is communicating openly and feely with us and her peers as well as participates appropriately in her classroom. We have also noticed an increased confidence in her which she severely lacked prior to this therapy. Tatyana’s approach is very unique and her interaction with children is excellent. She constantly evaluates our daughter progression so we have a benchmark to compare our daughter’s learning. We are so glad that we found Tatyana and are thrilled to recommend her to anyone seeking speech therapy for their children.”

Matthew and Jane C, Monroe NJ

Client Testimonial

“When Tatyana first started working with my son, several years ago, he was 4 and a half, understood very little, was very echolalic and spoke in brief 2-3 word phrases. Michael’s language abilities have improved exponentially during the time Tatyana had been working with him. His comprehension has improved dramatically, he now speaks in long sentences, no longer has echolalia and occasionally uses very sophisticated words in correct form. This makes me very proud of him but also incredibly appreciative of all Tatyana’s hard work with him. Thank you so much for your dedication.”

Marcia, C, East Brunswick NJ

Client Testimonial

“Tatyana Elleseff, a bilingual speech pathologist, worked with my daughter Eva for nine months, starting when Eva was 30 months old. At the start, Eva was not progressing verbally at an appropriate pace, so we sought Tatyana’s help. We were thrilled with her work. She was very professional and accommodating. She worked with Eva in our home, communicated with her effectively, and provided lessons appropriate to Eva’s age and level. It was very important to me that she explained to me what she was doing and taught me as well as Eva, so that we could continue developing Eva’s speech skills outside the lessons. She also gave us detailed and clear information about Eva’s abilities and development, not only in her speech but on other dimensions as well. Eva’s progress under Tatyana’s tutelage has been very impressive. She now speaks easily and, for the most part, quite clearly. Her vocabulary is growing every day and it is wonderful to be able to talk to her. Tatyana’s lessons helped not only with speech but with logic and other skills, so that Eva now tops out on aptitude tests and seems to be progressing even faster than children who began to speak before she did. We owe a large portion of this to Tatyana’s work. I recommend her highly and without reservations.”

Larisa S, Bedminster NJ

Client Testimonial

“Tatyana has been providing speech services for our toddler son who was adopted internationally. Her assessments are extremely thorough and she provides great individualized care based on her client’s needs. She also takes the time to give us coaching and feedback to use at home. She continues to provide excellent care and we truly enjoy working with her.”

Connie and David M, Milstone Township NJ

Client Testimonial

 “Dear Tatyana,

I wanted to inform you how delighted Marie, my wife, and I are with Jack’s performance. Only last year we were told by our school district that they need to hold him back in kindergarten because he was just not ready and too immature for first grade. The strategy, and hope, was that he would grow out of his lack of ability to understand letters, words, and spelling. We weren’t sure that it was the right decision but we didn’t know where to turn and who to turn to. We got one independent speech language evaluation done but it wasn’t detailed enough and offered no solutions or strategies regarding what needed to be done. And then you were recommended to us! After doing comprehensive testing you put together a solid intervention plan and stated that you firmly believe that Jack should go to first grade and that with ongoing support he will do a great job. I need to recognize that your Speech Therapy has provided such great results. Jack’s results have surpassed our expectations and all the professional that deal with Jack agree that the consistent application and delivery of your Speech Therapy program has helped accelerated his progress. Thanks again for all your incredible work with our son”

Lou and Marie R, Bernardsville NJ

Professional Testimonial

“I had first met Tatyana several years ago, when she was recommended to me by a colleague, to conduct a speech language evaluation of a newly arrived internationally adopted child with Fetal Alcohol Spectrum Disorder.   After reading Tatyana’s exemplary assessment report, I’ve become hugely impressed with its thoroughness, technical sophistication, skilled interpretations, practical and comprehensive therapy objectives as well as treatment methodology suggestions.  Since that time I have had countless opportunities to collaborate with Tatyana on a number of mutual complex clinical cases pertaining to internationally adopted, bilingual as well as at risk children with a host of genetic, neurological and medical deficits.  Each time I was enormously impressed not just by the quality of her clinical work, but also by Tatyana’s insights into each case as well as by her dedication and willingness to research and apply the latest evidenced based research methods in order to create highly individualized, unique and effective assessment and intervention for each client.”

Alla Gordina, FAAP,  Clinical Assistant Professor of Pediatrics: UMDNJ, Robert Wood Johnson School of Medicine;  Drexel University College of Medicine

Professional Testimonial

Ms. Elleseff is a highly knowledgeable speech language pathologist with invaluable practical experience in assessing children outside “the bell curve”: those who are adopted internationally or are from immigrant or refugee families. I know that in the speech pathology professional community, Ms. Elleseff’s clinical reports serve as models and learning aids, being appreciated for their depth, thoroughness, clarity, and practicality.  I value her differential diagnostic skills combined with the uncompromised honesty in interpreting clinical data.  She is a also a passionate and dynamic presenter, able to involve her audience emotionally and cognitively, making her point convincingly and eloquently. Ms. Elleseff is an excellent supervisor and a model teacher for young people entering the field of human services. She is a prolific writer who is well known among international adoption parents and professionals alike.  Being a bright and independent individual, Ms. Elleseff is a productive team player. She values colleagues and participates in a number of group projects, professional discussion groups, and professional affiliations.

Boris Gindis, PhD, Chief psychologist at the Center for Cognitive-Developmental Assessment and Remediation

Posted on 4 Comments

Simplifying Testing Results to Understand the Student’s Difficulties

image

Oftentimes explaining testing results in the form of standard scores, percentiles, and charts is labor-intensive for the SLP and confusing for parents and ancillary  professionals. Furthermore, just because you show testing results does not always ensure that the ramifications of testing are fully understood, especially when it comes to performance of high functioning students with deficits in isolated areas, which may significantly impact the student’s functioning in social and academic settings.

So finding an effective method of sharing testing results was fraught with difficulties until recently. In early January, I attended a Sarah Ward executive function conference, where Sarah shared one of her tricks of sharing testing results.  She used a picture of a bell curve and inserted testing results into it. So it looked a little similar to the picture I have below:

BELL CURVE

As you can see the student’s listening comprehension and expressive language performance fell in the average range as denoted on the bottom of the picture. In contrast, the student’s problem solving and social pragmatic testing abilities fell in the below average range as is denoted by both a red bar as well as the caption underneath the picture.

It is a visually simple way to see what areas need to be worked on in one snapshot.

Charts in Action: Students with Social Skills Deficits 

This system is even more effective for displaying testing results of higher functioning students with select deficit areas. To illustrate, I recently performed a comprehensive language assessment on a 12-year-old adolescent with suspected ASD. The student had a superior IQ, excellent vocabulary, and phenomenal memory.

When tested in school setting she did not qualify to receive language intervention. However, her comprehensive language testing with me showed a number of disparities. While the majority of her testing fell in the above average and superior range, in a number of testing areas she performed within average and below average range (combined SLP, ED, and Psych. testing results below).

BELL CURVE 3

When one looked at the student’s overall testing results, they clearly indicated cumulative performance in the average range of functioning. However, after I plotted all of her results on the bell curve her deficit areas became very clearly apparent and her testing discrepancy clearly indicated that intervention in select areas of functioning was needed.

So even though select scores were clearly in the average range of functioning on the bell curve, they were actually BELOW AVERAGE for this student as compared to significant strengths in all other areas.

Many would argue with me pointing out that scores in the average range mean average range. The student doesn’t qualify – end of story!  So let me explain the above scores in REAL-LIFE terms.

Why Students with Average Scores May Still Require Services 

This particular student was referred for a social pragmatic evaluation due to behavioral difficulties in the classroom which included verbal outbursts, difficulty engaging in cooperative group work and verbal confrontations with classmates.

Interactions with the student revealed an engaging adolescent who preferred the company of adults and was very likable. However, throughout testing she made comments indicating cognizance that she was not accepted by typically developing peers. She frustratedly stated that she “doesn’t get” peers, is not interested in the “typical” experiences and has “nothing in common” with peers her age because she “misses the point” of their verbal interchanges.

Due to her exceptional performance on standardized testing, many school-based professionals  believed that because she did so well well she did not have any “true” social learning deficits. In contrast the student’s peer group was able to see her social differences with very little effort.  In school, the student did not qualify for social pragmatic language therapy, on the basis of her challenges being perceived as too “mild” to merit services, however her social deficits were NOT mild as judged by her peers. They were only mild as compared to individuals with severe social learning challenges. Without appropriate intervention, these difficulties would  continue to pervasively impact her academic and social performance, as well as affect future employment and relationship status.

So this is why I now love plotting scores on the bell curve for parents and professionals. A simple picture clearly shows the significance of score distribution, the deficits areas in need of intervention, and is literally worth a 1000 words!

Helpful Resources Related to Social Pragmatic Language Overview, Assessment  and Remediation:

Posted on 6 Comments

Comprehending Reading Comprehension

Image of three books open on a table with stacks of books in the background.How many parents and professionals have experienced the following scenario? The child in question is reading very fluently (Landi & Ryherd, 2017) but comprehending very little of what s/he is reading.  Attempts at remediation follow (oftentimes without the administration of a comprehensive assessment) with a focus on reading texts and answering text-related questions. However, much to everyone’s dismay the problem persists and worsens over time. The child’s mental health suffers as a result since numerous studies show that reading deficits including dyslexia are associated with depression, anxiety, attention, as well as behavioral problems (Arnold et al., 2005; Knivsberg & Andreassen, 2008; Huc-Chabrolle, et al, 2010; Kempe, Gustafson, & Samuelsson, 2011Boyes, et al, 2016;   Livingston et al, 2018). Continue reading Comprehending Reading Comprehension

Posted on 1 Comment

Neuropsychological or Language/Literacy: Which Assessment is Right for My Child?

Related imageSeveral years ago I began blogging on the subject of independent assessments in speech pathology. First, I wrote a post entitled “Special Education Disputes and Comprehensive Language Testing: What Parents, Attorneys, and Advocates Need to Know“, in which I used  4 different scenarios to illustrate the importance of comprehensive language evaluations for children with subtle language and learning needs. Then I wrote about: What Makes an Independent Speech-Language-Literacy Evaluation a GOOD Evaluation?” in order to elucidate on what actually constitutes a good independent comprehensive assessment. Continue reading Neuropsychological or Language/Literacy: Which Assessment is Right for My Child?

Posted on 6 Comments

Comprehensive Assessment of Adolescents with Suspected Language and Literacy Disorders

When many of us think of such labels as “language disorder” or “learning disability”, very infrequently do adolescents (students 13-18 years of age) come to mind. Even today, much of the research in the field of pediatric speech pathology involves preschool and school-aged children under 12 years of age.

The prevalence and incidence of language disorders in adolescents is very difficult to estimate due to which some authors even referred to them as a Neglected Group with Significant Problems having an “invisible disability“.

Far fewer speech language therapists work with middle-schoolers vs. preschoolers and elementary aged kids, while the numbers of SLPs working with high-school aged students is frequently in single digits in some districts while being completely absent in others. In fact, I am frequently told (and often see it firsthand) that some administrators try to cut costs by attempting to dictate a discontinuation of speech-language services on the grounds that adolescents “are far too old for services” or can “no longer benefit from services”.  

But of course the above is blatantly false. Undetected language deficits don’t resolve with age! They simply exacerbate and turn into learning disabilities. Similarly, lack of necessary and appropriate service provision to children with diagnosed language impairments  at the middle-school and high-school levels will strongly affect their academic functioning and hinder their future vocational outcomes.

A cursory look at the Speech Pathology Related  Facebook Groups as well as ASHA forums reveals numerous SLPs in a continual search for best methods of assessment and treatment of older students (~12-18 years of age).  

Consequently, today I wanted to dedicate this post to a review of standardized assessments options available for students 12-18 years of age with suspected language and literacy deficits.

Most comprehensive standardized assessments, “typically focus on semantics, syntax, morphology, and phonology, as these are the performance areas in which specific skill development can be most objectively measured” (Hill & Coufal, 2005, p 35). Very few of them actually incorporate aspects of literacy into its subtests in a meaningful way.  Yet by the time students reach adolescence literacy begins to play an incredibly critical role not just in all the aspects of academics but also social communication.

So when it comes to comprehensive general language testing I highly recommended that SLPs select  standardized measures with a focus on not  language but also literacy.  Presently of all the comprehensive assessment tools   I highly prefer the Test of Integrated Language and Literacy (TILLS) for students up to 18 years of age, (see a comprehensive review HERE),  which covers such literacy areas as phonological awareness, reading fluency, reading comprehension, writing and spelling in addition to traditional language areas as as vocabulary awareness, following directions, story recall, etc. However,  while comprehensive tests have  numerous  uses,  their sole  administration will not constitute an adequate assessment.

So what areas should be assessed during language and literacy testing?  Below are  a few suggestions of standardized testing measures (and informal procedures) aimed at exploring the student abilities in particular areas pertaining to language and literacy.

TESTS OF LANGUAGE

TESTS OF LITERACYscreen-shot-2016-10-09-at-2-29-57-pm

It is understandable how given the sheer amount of assessment choices some clinicians may feel overwhelmed and be unsure regarding the starting point of an adolescent evaluation.   Consequently, the use the checklist prior to the initiation of assessment may be highly useful in order to identify potential language weaknesses/deficits the students might experience. It will also allow clinicians to prioritize the hierarchy of testing instruments to use during the assessment.  

While clinicians are encouraged to develop such checklists for their personal use,  those who lack time and opportunity can locate a number of already available checklists on the market. 

For example, the comprehensive 6-page Speech Language Assessment Checklist for Adolescents (below) can be given to caregivers, classroom teachers, and even older students in order to check off the most pressing difficulties the student is experiencing in an academic setting. 

It is important for several individuals to fill out this checklist to ensure consistency of deficits, prior to determining whether an assessment is warranted in the first place and if so, which assessment areas need to be targeted.

Checklist Categories:

  1. Receptive Languageadolescent checklist
  2. Memory, Attention and Cognition
  3. Expressive Language
  4. Vocabulary
  5. Discourse
  6. Speech
  7. Voice
  8. Prosody
  9. Resonance
  10. Reading
  11. Writing
  12. Problem Solving
  13. Pragmatic Language Skills
  14. Social Emotional Development
  15. Executive Functioning

alolescent pages sample

Based on the checklist administration SLPs can  reliably pinpoint the student’s areas of deficits without needless administration of unrelated/unnecessary testing instruments.  For example, if a student presents with deficits in the areas of problem solving and social pragmatic functioning the administration of a general language test such as the Clinical Evaluation of Language Fundamentals® – Fifth Edition (CELF-5) would NOT be functional (especially if the previous administration of educational testing did not reveal any red flags). In contrast, the administration of such tests as Test Of Problem Solving 2 Adolescent and Social Language Development Test Adolescent would be better reflective of the student’s deficits in the above areas. (Checklist HERE; checklist sample HERE). 

It is very important to understand that students presenting with language and literacy deficits will not outgrow these deficits on their own. While there may be “a time period when the students with early language disorders seem to catch up with their typically developing peers” (e.g., illusory recovery) by undergoing a “spurt” in language learning”(Sun & Wallach, 2014). These spurts are typically followed by a “post-spurt plateau”. 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).  As such many adolescents “may not show academic or language-related learning difficulties until linguistic and cognitive demands of the task increase and exceed their limited abilities” (Sun & Wallach, 2014).  Consequently, SLPs must consider the “underlying deficits that may be masked by early oral language development” and “evaluate a child’s language abilities in all modalities, including pre-literacy, literacy, and metalinguistic skills” (Sun & Wallach, 2014).

References:

  1. Hill, J. W., & Coufal, K. L. (2005). Emotional/behavioral disorders: A retrospective examination of social skills, linguistics, and student outcomes. Communication Disorders Quarterly27(1), 33–46.
  2. Sun, L & Wallach G (2014) Language Disorders Are Learning Disabilities: Challenges on the Divergent and Diverse Paths to Language Learning Disability. Topics in Language Disorders, Vol. 34; (1), pp 25–38.

Helpful Smart Speech Therapy Resources 

  1. Assessment of Adolescents with Language and Literacy Impairments in Speech Language Pathology 
  2. Assessment and Treatment Bundles 
  3. Social Communication Materials
  4. Multicultural Materials