
Orofacial Observations of At-Risk Children: Recommendations for Parents and Professionals

Last week I did a guest post for The Simply Speech Blog. In case you missed it, below I offer an explanation why targeted speech language assessments are so important, as well as list helpful resources that will aid you in speech language assessment preparation.
In both my hospital based job and in private practice I do a lot of testing. During staff/caregiver interviews I used to get a laundry list of both specific and non-specific problems by the parents and teachers, which did not always accurately reflect the students true deficits. Experience quickly taught me that administering general comprehensive language testing to every student simply did not work. Oftentimes the administration of such testing revealed one of two things: Continue reading In case you missed it: The importance of targeted assessments for school aged children
In today’s guest post, Natalie Romanchukevich advises readers on how to create opportunities to expand children’s spontaneous communication skills.
Helping young children build speech- language skills is an exciting job that both caregivers and educators try to do every second of the day. We spend so much time giving our children directions to follow, asking them a ton of questions, and modeling words and phrases to shape them into eloquent communicators.
What I find we do NOT do enough, sometimes, is hold back on our never ending “models” of what or how to say things, questions, and directions, instead of allowing our children initiate and engage with us. Greenspan refers to these initiations as opening circles of communication (Weirder & Greenspan “Engaging Autism”, 2006).
Speech- language development can be thought of as having three interacting and equally important domains- Form ,Content, and Use (Lahey, 1988).
Form refers to the grammatical correctness of our words and sentences (eat vs. eat+ ing).
Content is what the we are essentially communicating- the meaning of our words and sentences.
Use (also known as pragmatics) refers to the function of our words or for what purpose we are using them.
The communicative functions that slowly emerge and characterize communication over the course of language acquisition in vary in typically developing young children. Children communicate to greet others, comment on objects/actions, request desired objects, request assistance, protest, deny (a statement), ask questions, regulate others (e.g. “blow!”, “open!”), entertain, and narrate events.
In order for children to be able to express these functions, aside from the intent to communicate, there must also be opportunities to express ideas, wants, needs. For example, why would Timmy request for an object (nonverbally or verbally) if the caregiver hands everything to the child at the slightest sign of a tantrum. Why ask a “where?” question if every toy or beloved object is comfortably in sight? Why ask for help if the caregiver readily assists the child with all activities. The educators describe it as assuming the child’s needs.
Of course we do it out of love and care for the child, and, let’s be honest, sometimes, to save time. However, it is important with both typical and delayed children to be mindful of what (form, content, use) we model, when (timing is crucial in teaching) we model it, how (facial expression, tone of voice, etc) we model it, and why (is it developmentally important to teach it now?) we model it at this very moment.
Just as it is important for kids to comprehend concepts, follow directions, and understand the different wh- questions, it is also paramount that your child is able to initiate communication. After all, communication is the ability to express ideas, thoughts, and wants, not just understand those expressed by others. Answering questions and following commands is not initiating. Language that is elicited by us- is not spontaneous.
To use language spontaneously, effortlessly and creatively, children need opportunities to practice the skill, to experience taking the lead. In order for our children to get there, we must first offer models of how to initiate communication and do so appropriately. We can then create opportunities for the child to speak up.
The most basic strategies you can use to encourage spontaneous initiations (whether nonverbal or verbal) may seem seem initially as counterintuitive. I mean what is the point to introducing attractive new toys or displaying a yummy snack and then putting it away? Yet it is exactly that action which may very much encourage your child to run after you with gestures or words. Even then, you may still choose to play “dumb” and be “unsure” as to what it is your child wants. Does s/he want that bag with new toy or snack “opened?” and “out?”
If the child is nonverbal, his use of gestures to regulate your actions to get the desired item out and open may be the child’s initial step toward sound imitation. If you are working on getting the child to request help (not just objects), here is your opportunity to model “help” if the child can’t open the item independently. On a side note, I often hear educators model “help me please!” when the child is clearly at a single word level. This is not a developmental way of teaching. Yes, it is nice to hear a full sentence but your child may not be ready for it.
While playing with your child and actively commenting on your joint play, you may find it productive to suddenly become quiet and cease all attempts to ask questions. This often works beautifully in my therapy sessions; usually, after I have engaged the child into some sort of cooperative and enjoyable play! But it takes a conscious effort and self-control on the part of the adult, since we are so used to engaging in this adult- directed (telling the child what to do as opposed to letting him/her lead and you follow) approach to teaching.
However, once you are able to contain your speech and actions (I promise you it is possible), you may be surprised to hear some immediate or delayed imitations of words/ phrases as well as spontaneous meaningful language. The language produced, to me, is an indication that the child wants more of the experience- more language enriched play. Use this opportunity to expand on what s/he is already saying.
Here, timing is really important as you want to imitate back everything your child is doing. This is another way to communicate with your child. Build on your child’s language to further describe the objects or people in play without using long sentences. So, allowing nothing to happen for a few minutes at a time may just be the push to help your child come out with some form of communication.
In addition, stopping a novel activity or toy exploration at the very height of your child’s excitement also works well with many children. You don’t have to be confrontational about it, “if you don’t imitate my word/ phrase I just won’t give it back to you”. make sure to create these “obstructions”, as Greenspan refers to them, in a friendly, playful and positive manner. Obstructions or fabricated “problems” are also a big part of social-cognitive and constructivist theories of language learning.
The idea behind these “obstructions” is that the children are forced to problem solve and use resources (language being one of them!) so they can get what they want. Allowing your child to problem solve is critical to overall cognitive development that affects and shapes speech and language. Presenting your child with developmentally appropriate activities that involve thinking and figuring out of how to get X is an invaluable strategy that I always use with all of my children.
In sum, stop access to items that are already loved, tape up containers, close boxes and jars with favorite snack and toys, give your child all but ONE important item that is needed to complete an activity (glue, scissors), give your child the “wrong” item, or offer the “wrong” solution to the problem. All of these “problems” will push the kid to think and figure out what to do next. This, in turn, facilitates spontaneous language use.
Letting go of control and just allowing for things to spill, break, or simply not follow the predictable comfortable routine, too, elicits a ton of speech- language and fun communication. These are the most teachable moments as our children experience all the new words and concepts first hand. Perhaps, this is why many children learn “dirty” or “wet” attributes before they learn their colors. These concepts are more easily learned because they are experiential and bring about relevant words to describe these personally relevant and emotional experiences. Cleaning up and taking turns arranging things back in place is super educational too as our children need to learn responsibility and helping others.
Moreover, exposing children to objects that are completely novel and foreign (but safe!) may help elicit an attempt to ask a question “what this?” because the child wants to know. The motivation is there. Now s/he needs language to get the answer from you. Some children may use a word with a rising intonation, which too is a question form, just not grammatically mature one. For example, “Hat?” is as much of a question as “Is that a hat?!”. If all your child is capable of verbalizing is “wow”, then you can go ahead and model “what IS that?” question a few times. Of course, you want to pair it up with an exaggerated expression of surprise and excitement in your voice.
To sum up, do not be afraid to experiment, get “messy”, stay silent, entice, intrigue and just wait for a few minutes to see what your child will do. Yes, we want to teach our children to attend, sit down for a structured activity, and identify objects, shapes, colors, and actions; but these adult- directed activities do not allow for self- expression or spontaneous language use. You also want to follow your child’s natural interests and inclinations as this is frequently a way into their world. If you show interest in your friend’s ideas and you let him/her speak, will they not want to bond with you even more? Will they not want to communicate with you?
Creative and talented teachers are those who can use unconventional materials presented in unexpected ways while targeting all the skills that must be learned! Learning to manipulate the environment to get the most out of your child’s skills can be difficult but indescribably rewarding.
References:
Natalie Romanchukevich has a MS in Communication Sciences and Disorders from Long Island University (LIU) as well as Bilingual (Russian/English) Certification, which allows her to practice speech- language pathology in both Russian and English. Following graduation, Natalie has been working with both monolingual and bilingual 0- 5 population in New York City, and has been an active advocate for preschoolers with disabilities in her present setting. Natalie’s clinical interests and experience have been focused on early childhood speech- language delays and disorders including speech disorders (e.g., Articulation, Childhood Apraxia of Speech (CAS), Pervasive Developmental Disorders, Autistic Spectrum Disorders, Auditory Processing Disorders, Specific Language Impairment (SLI), as well as Feeding Disorders. Presently she is working on developing her private practice in Brooklyn, NY.
As SLPs we routinely administer a variety of testing batteries in order to assess our students’ speech-language abilities. Grammar, syntax, vocabulary, and sentence formulation get frequent and thorough attention. But how about narrative production? Does it get its fair share of attention when the clinicians are looking to determine the extent of the child’s language deficits? I was so curious about what the clinicians across the country were doing that in 2013, I created a survey and posted a link to it in several SLP-related FB groups. I wanted to find out how many SLPs were performing narrative assessments, in which settings, and with which populations. From those who were performing these assessments, I wanted to know what type of assessments were they using and how they were recording and documenting their findings. Since the purpose of this survey was non-research based (I wasn’t planning on submitting a research manuscript with my findings), I only analyzed the first 100 responses (the rest were very similar in nature) which came my way, in order to get the general flavor of current trends among clinicians, when it came to narrative assessments. Here’s a brief overview of my [limited] findings. Continue reading The Importance of Narrative Assessments in Speech Language Pathology (Revised)
In the past several years, I wrote a series of posts on the topic of improving clinical practices in speech-language pathology. Some of these posts were based on my clinical experience as backed by research, while others summarized key point from articles written by prominent colleagues in our field such as Dr. Alan Kamhi, Dr. David DeBonnis, Dr. Andrew Vermiglio, etc.
In the past, I have highlighted several articles from the 2014 LSHSS clinical forum entitled: Improving Clinical Practice. Today I would like to explicitly summarize another relevant article written by Dr. Wallach in 2014, entitled “Improving Clinical Practice: A School-Age and School-Based Perspective“, which discusses how to change the “persistence of traditional practices” in order to make our language interventions more functional and meaningful for students with language learning difficulties. Continue reading Do Our Therapy Goals Make Sense or How to Create Functional Language Intervention Targets
Today I am reviewing a newly released (2019) kit (instructional guide and cards) from the Learning By Design, Inc. entitled Wordtivities: Word Study Instruction for Spelling, Vocabulary, and Reading.
The 101-page instructional guide was created to address the students’ phonological awareness, spelling, reading, vocabulary, and syntax skills by having them engage with sounds, letters, and meanings of words. The lessons in the book can be used by a variety of instructional personnel (teachers, SLPs, reading specialists, etc.) and even parents as a stand-alone word study program or in conjunction with SPELL-Links to Reading & Writing Word Study Curriculum.
The activity book is divided into two sections. The first section offers K-12 student activities for large groups and classrooms. The second section has picture card activities and is intended for 1:1 and small group instruction. Both sections focus on reinforcing 14 SPELL-Links strategies for reading and spelling to stimulate the associations between sounds, letters, and meanings of words. Continue reading Review of Wordtivities by SPELL-Links
I have been looking for a good articulation assessment instrument for quite some time so when Sunny Articulation Test app came my way I was very excited to put it into action by using it with some of my clients. I wanted to see how this “test” app compared with traditional articulation tests such as Goldman Fristoe Test of Articulation-2 or Photo Articulation Test-3.
So here we go:
When you log in the first thing you do is set up a client profile. The process is very simple all you have to do is add the name and birthday and the app will calculate child child’s exact age in years and months. To protect client privacy you may only do the first name without the last name. Continue reading Articulation Assessment ToolKt
Today due to popular demand I am reviewing The Test of Written Language-4 or TOWL-4. TOWL-4 assesses the basic writing readiness skills of students 9:00-17:11 years of age. The tests consist of two forms – A and B, (which contain different subtest content).
According to the manual, the entire test takes approximately 60-90 minutes to administer and examines 7 skill areas. Only the “Story Composition” subtest is officially timed (the student is given 15 minutes to write it and 5 minutes previous to that, to draft it). However, in my experience, each subtest administration, even with students presenting with mild-moderately impaired writing abilities, takes approximately 10 minutes to complete with average results (can you see where I am going with this yet?)
For detailed information regarding the TOWL-4 development and standardization, validity and reliability, please see HERE. However, please note that the psychometric properties of this test are weak.
Below are my impressions (to date) of using this assessment with students between 11-14 years of age with (known) mild-moderate writing impairments.
Subtests:
1. Vocabulary – The student is asked to write a sentence that incorporates a stimulus word. The student is not allowed to change the word in any way, such as write ‘running’ instead of run’. If this occurs, an automatic loss of points takes place. The ceiling is reached when the student makes 3 errors in a row. While some of the subtest vocabulary words are perfectly appropriate for younger children (~9), the majority are too simplistic to assess the written vocabulary of middle and high schoolers. These words may work well to test the knowledge of younger children but they do not take into the account the challenging academic standards set forth for older students. As a result, students 11+ years of age may pass this subtest with flying colors but still present with a fair amount of difficulty using sophisticated vocabulary words in written compositions.
2/3. Spelling and Punctuation (subtests 2 and 3). These two subtests are administered jointly but scored separately. Here, the student is asked to write sentences dictated by the examiner using appropriate rules for spelling and punctuation and capitalization. Ceiling for each subtest is reached separately. It occurs when the student makes 3 errors in a row in each of the subtests. In other words, if a student uses correct punctuation but incorrect spelling, his/her ceiling on the ‘Spelling’ subtest will be reached sooner then on the ‘Punctuation’ subtest and vise versa. Similar to the ‘Vocabulary‘ subtest I feel that the sentences the students are asked to write are far too simplistic to showcase their “true” grade level abilities.
The requirements of these subtests are also not too stringent. The spelling words are simple and the punctuation requirements are very basic: a question mark here, an exclamation mark there, with a few commas in between. But I was particularly disappointed with the ‘Spelling‘ subtest. Here’s why. I have a 6th-grade client on my caseload with significant well-documented spelling difficulties. When this subtest was administered to him he scored within the average range (Scaled Score of 8 and Percentile Rank of 25). However, an administration of Spelling Performance Evaluation for Language and Literacy – SPELL-2, yielded 3 assessment pages of spelling errors, as well as 7 pages of recommendations on how to remediate those errors. Had he received this assessment as part of an independent evaluation from a different examiner, nothing more would have been done regarding his spelling difficulties since the TOWL-4 revealed an average spelling performance due to its focus on overly simplistic vocabulary.
4. Logical Sentences – The student is asked to edit an illogical sentence so that it makes better sense. Ceiling is reached when the student makes 3 errors in a row. Again I’m not too thrilled with this subtest. Rather than truly attempting to ascertain the student’s grammatical and syntactic knowledge at sentence level a large portion of this subtest deals with easily recognizable semantic incongruities.
5. Sentence Combining – The student integrates the meaning of several short sentences into one grammatically correct written sentence. Ceiling is reached when the student makes 3 errors in a row. The first few items contain only two sentences which can be combined by adding the conjunction “and”. The remaining items are a bit more difficult due to the a. addition of more sentences and b. increase in the complexity of language needed to efficiently combine them. This is a nice subtest to administer to students who present with difficulty effectively and efficiently expressing their written thoughts on paper. It is particularly useful with students who write down a lot of extraneous information in their compositions/essays and frequently overuse run-on sentences.
6. Contextual Conventions – The student is asked to write a story in response to a stimulus picture. S/he earn points for satisfying specific requirements relative to combined orthographic (E.g.: punctuation, spelling) and grammatical conventions (E.g.: sentence construction, noun-verb agreement). The student’s written composition needs to contain more than 40 words in order for the effective analysis to take place.
The scoring criteria ranges from no credit or a score of 0 ( based on 3 or more mistakes), to partial credit, a score of 1 (based on 1-2 mistakes) to full a credit – a score of 3 (no mistakes). There are 21 scoring parameters which are highly useful for younger elementary-aged students who may exhibit significant difficulties in the domain of writing. However, older middle school and high-school aged students as well as elementary aged students with moderate writing difficulties may attain average scoring on this subtest but still present with significant difficulties in this area as compared to typically developing grade level peers. As a result, in addition to this assessment, it is recommended that a functional assessment of grade-level writing also be performed in order to accurately identify the student’s writing needs.
7. Story Composition – The student’s story is evaluated relative to the quality of its composition (E.g.: vocabulary, plot, development of characters, etc.). The examiner first provides the student with an example of a good story by reading one written by another student. Then, the examiner provides the student with an appropriate picture card and tell them that they need to take time to plan their story and make an outline on the (also provided) scratch paper. The student has 5 minutes to plan before writing the actual story. After the 5 minutes, elapses they 15 minutes to write the story. It is important to note that story composition is the very first subtest administered to the student. Once they complete it they are ready to move on to the Vocabulary subtest. There are 11 scoring parameters that are significantly more useful for me to use with younger students as well as significantly impaired students vs. older students or students with mild-moderate writing difficulties. Again if your aim is to get an accurate picture of the older students writing abilities I definitely recommend the usage of clinical writing assessment rubrics based on the student’s grade level in order to have an accurate picture of their abilities.
OVERALL IMPRESSIONS:
Strengths:
Limitations:
Overall, TOWL-4 can be a useful testing measure for ruling out weaknesses in the student’s basic writing abilities, with respect to simple vocabulary, sentence construction, writing mechanics, punctuation, etc. If I identify previously unidentified gaps in basic writing skills I can then readily intervene, where needed, if needed. However, it is important to understand that the TOWL-4 is only a starting point for most of our students with complex literacy needs whose writing abilities are above severe level of functioning. Most students with mild-moderate writing difficulties will pass this test with flying colors but still present with significant writing needs. As a result I highly recommend a functional grade-level writing assessment as a supplement to the above-standardized testing.
References:
Hammill, D. D., & Larson, S. C. (2009). Test of Written Language—Fourth Edition. (TOWL-4). Austin, TX: PRO-ED.
Disclaimer: The views expressed in this post are the personal impressions of the author. This author is not affiliated with PRO-ED in any way and was NOT provided by them with any complimentary products or compensation for the review of this product.
Last week I did a guest post for The Practically Speeching Blog on the topic of multiculturalism. In case you missed it, below I offer some suggestions on how to integrate multiculturalism into your group therapy sessions.
I don’t know about you but I have a number of multicultural students on my caseload who exhibit language deficits in both their birth language as well as English. Even though I am unable to speak their languages (e.g., Spanish, Hindu) I still like to integrate various aspects of multiculturalism into my sessions in order to support their first language as well as educate them about their culture and other cultures around the world as much as possible. Why? Because among other benefits (e.g., cognitive, linguistic, academic, just to name a few) studies have also found a connection between bilingualism/multiculturalism and higher self-esteem in children (Verkuyten, 2009). For me the latter definitely plays a huge part, since children with language impairments already recognize that they are different from their peers when it comes to their abilities and accomplishments in the classroom, which is why I try to support them in any way that I can in this area. Believe it or not it’s not as complicated as it sounds, and with a little ingenuity you can make it happen as well. Below are some suggestions of what you can do in sessions. Continue reading In case you missed it: Integrating aspects of multiculturalism into group language therapy sessions
Lately, I’ve been seeing more and more posts on social media asking for testing suggestions for students who exhibit subtle language-based difficulties. Many of these children are typically referred for initial assessments or reassessments as part of advocate/attorney involved cases, while others are being assessed due to the parental insistence that something “is not quite right” with their language and literacy abilities, even in the presence of “good grades.” Continue reading Comprehensive Assessment of Elementary Aged Children with Subtle Language and Literacy Deficits