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Multicultural Considerations in Assessment of Play

As speech language pathologist part of my job is to play! Since play assessment is a routine part of speech language evaluations for preschool and early school-aged children, I often find myself on the carpet in my office racing cars, making sure that all the “Little People” get their turn on the toy Ferris Wheel, and “cooking” elaborate  meals in complete absence of electrical appliances.  In fact, I’ve heard the phrase “I want toy” so many times that I actually began to worry that I might accidentally use it in polite company myself.

The benefits of play are well known and cataloged. Play allows children to use creativity and develop imagination. It facilitates cognition, physical and emotional development, language, and literacy.  Play is great!  However, not every culture values play as much as the Westerners do.

Cultural values affect how children play. Thus play interactions vary significantly across cultures. For instance, many Asian cultures prize education over play, so in these cultures children may engage in educational play activities vs. pretend play activities. To illustrate, Farver and colleagues have found that Korean preschool children engaged in greater parallel play (vs. pretend play), initiated play less frequently, as well as had less frequent social play episodes in contrast to Anglo-American peers. (Farver, Kim & Lee, 1995; Farver and Shinn 1997)

To continue, cultures focused on individualism stress independence and self-reliance.  In such cultures, babies and toddlers are taught to be self sufficient when it comes to sleeping, feeding, dressing, grooming and playing from a very early age. (Schulze, Harwood, and Schoelmerich, 2001) Consequently, in these cultures parents would generally support and encourage child initiated and directed play. However, in many Latin American cultures, parents expect their children to master self-care abilities and function independently at later ages.  Play in these cultures may be more parent directed vs. child directed.   These children may receive more explicit directives from their caregivers with respect to how to act and speak and be more physically positioned or restrained during play. (Harwood, Schoelmerich, & Schulze, 2000)

In Western culture, early choice making is praised and encouraged.  In contrast, traditional collective cultures encourage child obedience and respect over independence (Johnston & Wong, 2002).  Choice making may not be as encouraged since it might seem like it’s giving the child too much power.  It would not be uncommon for a child to be given a toy to play with which is deemed suitable for him/her, instead of being asked to choose.   The children in these cultures may not be encouraged to narrate on their actions during play but expected to play quietly with their toy.  Furthermore, if the parents do not consider play as an activity beneficial to their child’s cognitive and emotional development, but treat it as a leisure activity that helps pass the time, they may not ask the child questions regarding what he/she are doing and will not expect the child to narrate on their actions during play.

Consequently, in our assessments, it is very important to keep in mind that children’s play is affected by a number of variables including: cultural values, family relationships, child rearing practices, toy familiarity as well as developmental expectations (Hwa-Froelich, 2004).  As such, in order to conduct balanced and objective play assessments, we as clinicians need to find a few moments in our busy schedules to interview the caregivers regarding their views on child rearing practices and play interactions, so we could objectively interpret our assessment findings (e.g.,  is it delay/disorder or lack of  exposure and task unfamiliarity).

References:

  •  Farver, J. M., Kim, Y. K., & Lee, Y. (1995). Cultural differences in Korean- and Anglo-American preschoolers’ social interaction and play behaviors. Child Development, 66, 1088- 1099.
  • Farver, J. M., & Shinn, Y. L. (1997). Social pretend play in Korean- and Anglo- American pre-schoolers. Child Development,68 (3), 544-556.
  • Johnston, J.R., & Wong, M.-Y. A. (2002). Cultural differences in beliefs and practices concerning talk to children . Journal of Speech, Language, and Hearing Research, 45 (5), 916-926
  • Harwood, R. L., & Schoelmerich, A and Schulze, P. A. (2000) Homogeneity and heterogeneity in cultural belief systems. New Directions for Child and Adolescent Development 87,  41-57
  • Hwa-Froelich, D. A. (2004). Play Assessment for Children from Culturally and Linguistically Diverse Backgrounds. Perspectives on Language, Learning and Education and on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations, 11(2), 6-10.
  • Hwa-Froelich, D. A., & Vigil, D. C. (2004). Three aspects of cultural influence on communication: A literature review. Communication Disorders Quarterly, 25(3),110-118.
  • Schulze, P. A., Harwood, R. L., & Schoelmerich, A. (2001). Feeding practices and expectations among middle-class Anglo and Puerto Rican mothers of 12-month-old infants. Journal of Cross-Cultural Psychology, 32(4), 397–406.
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Apraxia RainbowBee App Review and Giveaway

Today I am reviewing a fun new app Apraxia RainbowBee  developed by Virtual Speech Center  to enhance motor planning for children with speech production difficulties.

Similar to their other apps, on the first screen (featured left) the therapist can choose the option of customizing the app’s settings or viewing the informational video. Continue reading Apraxia RainbowBee App Review and Giveaway

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Clinical Assessment of Reading Abilities of Elementary Aged Children

Image result for kid readingSeveral years ago I wrote a post about how to perform clinical reading assessments of adolescent students. Today I am writing a follow-up post with a focus on the clinical reading assessment of elementary-aged students. For this purpose, I often use the books from the Continental Press series entitled: Content Reading for Geography, Social Studies, & Science.   Texts for grades 2-7 of the series are perfect for assessment of struggling elementary-aged readers. Continue reading Clinical Assessment of Reading Abilities of Elementary Aged Children

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The End of See it, Zap it! Ankyloglossia (Tongue-Tie) Controversies in Research and Clinical Practice

Today it is my pleasure and privilege to interview 3 Australian lactation consultations: Lois Wattis, Renee Kam, and Pamela Douglas, the authors of a March 2017 article in the Breastfeeding Review: “Three experienced lactation consultants reflect upon the oral tie phenomenon” (which can be found HERE).

Tatyana Elleseff: Colleagues, as you very well know, the subject of ankyloglossia or tongue tie affecting breastfeeding and speech production has risen into significant prominence in the past several years. Numerous journal articles, blog posts, as well as social media forums have been discussing this phenomenon with rather conflicting recommendations.  Many health professionals and parents are convinced that “releasing the tie” or performing either a frenotomy or frenectomy will lead to significant improvements in speech and feeding.

Image result for evidence based practicePresently, systematic reviews1-3 demonstrate there is insufficient evidence for the above. However, when many professionals including myself, cite reputable research explaining the lack of support of surgical intervention for tongue tie, there has been a pushback on the part of a number of other health professionals including lactation consultants, nurses, dentists, as well as speech-language pathologists stating that in their clinical experience surgical intervention does resolve issues with tongue tie as related to speech and feeding.

So today, given your 33 combined years of practice as lactation consultants I would love to ask your some questions regarding the tongue tie phenomena.

I would like to begin our discussion with a description of normal breastfeeding and what can interfere with it from an anatomical and physiological standpoint for mothers and babies.

Now, many of this blog’s readers already know that a tongue tie occurs when the connective tissue under the tongue known as a lingual frenulum restricts tongue movement to some degree and adversely affects its function.  But many may not realize that children can present with a normal anatomical variant of “ties” which can be completely asymptomatic. Can you please address that?

Lois Wattis:  “Normal” breastfeeding takes time and skill to achieve. The breastfeeding dyad is multifactorial, influenced by maternal breast and nipple anatomy combined with the infant’s facial and oral structures, all of which are highly variable. Mothers who have successfully breastfed the first baby may encounter problems with subsequent babies due to size (e.g., smaller, larger, etc.), be compromised by birth interventions or drugs during labor, or incur birth injuries – all of which can affect the initiation of breastfeeding and progression to a happy and comfortable feeding relationship. Unfortunately, the overview of each dyad’s story can be lost when tunnel vision of either health provider or parents regarding the baby’s oral anatomy is believed to be the chief influencer of breastfeeding success or failure.

Tatyana Elleseff: Colleagues, what do we know regarding the true prevalence of various ‘tongue ties’? Are there any studies of good quality?

Image result for prevalencePamela Douglas:  In a literature review in 2005, Hall and Renfrew acknowledged that the true prevalence of ankyloglossia remained unknown, though they estimated 3-4% of newborns.4

After 2005, once the diagnosis of posterior tongue-tie (PTT) had been introduced,5, 6 attempts to quantify incidence of tongue-tie have remained of very poor quality, but estimates currently rest at between 4-10%.7

The problem is that there is a lack of definitional clarity concerning the diagnosis of PTT. Consequently, anterior or classic tongue tie CTT is now often conflated with PTT simply as ‘tongue-tie’ (TT).    

Tatyana Elleseff: Thank you for clarifying it.  In addition to the anterior and posterior tongue tie labels, many parents and professionals also frequently hear the terms lip tie and buccal ties. Is there’s reputable research behind these terms indicating that these ties can truly impact speech and feeding?

Pamela Douglas:  Current definitions of ankyloglossia tend to confuse oral and tongue function (which is affected by multiple variables, and in particular by a fit and hold in breastfeeding) with structure (which is highly anatomically variable for both the tongue length and appearance and lingual and maxillary frenula).

For my own purposes, I define CTT as Type 1 and 2 on the Coryllos-Genna-Watson scale.8 In clinical practice, I also find it useful to rate the anterior membrane by the percentage of the undersurface of the tongue into which the membrane connects, applying the first two categories of the Griffiths Classification System.9 

There is a wide spectrum of lingual frenula morphologies and elasticities, and deciding where to draw a line between a normal variant and CTT will depend on the clinical judgment concerning the infant’s capacity for pain-free efficient milk transfer. However, that means we need to have an approach to fit and hold that we are confident does optimize pain-free efficient milk transfer and at the moment, research shows that not only do the old ‘hands on’ approach to fit and hold not work, but that baby-led attachment is also not enough for many women. This is why at the Possums Clinic we’ve been working on developing an approach to fit and hold (gestalt breastfeeding) that builds on baby-led attachment but also integrates the findings of the latest ultrasound studies.

I personally don’t find the diagnoses of posterior tongue tie PTT and upper lip tie ULT helpful, and don’t use them. Lois, Renee and myself find that a wide spectrum of normal anatomic lingual and maxillary frenula variants are currently being misdiagnosed as a PTT and ULT, which has worried us and led Lois to initiate the article with Renee.

Tatyana Elleseff: Segueing from the above question: is there an established criterion based upon which a decision is made by relevant professionals to “release” the tie and if so can you explain how it’s determined?

Image result for release tongue tieLois Wattis: When an anterior frenulum is attached at the tongue tip or nearby and is short enough to cause restriction of lift towards the palate, usually associated with extreme discomfort for the breastfeeding mother, I have no reservations about snipping it to release the tongue to enable optimal function for breastfeeding. If a simple frenotomy is going to assist the baby to breastfeed well it is worth doing, and as soon as possible. What I do encounter in my clinical practice are distressed and disempowered mothers whose baby has been labeled as having a posterior tongue tie and/or upper lip tie which is the cause of current and even future problems. Upon examination, the baby has completely normal oral anatomy and breastfeeding upskilling and confidence building of both mother and baby enables the dyad to go forward with strategies which address all elements of their unique story.

Although the Hazelbaker Assessment Tool for Lingual Frenulum Function (ATLFF) is a pioneering contribution, bringing us our first systematized approach to examination of the infant’s tongue and oral connective tissues, it is unreliable as a tool for decision-making concerning frenotomy.10-12 In practice many of the item criteria are highly subjective. Although one study found moderate inter-rater reliability on the ATLFF’s structural items, the authors did not find inter-rater reliability on most of the functional items.13 In my clinical experience, there is no reliable correlation between what the tongue is observed to do during oral examinations and what occurs during breastfeeding, other than in the case of classic tongue-tie (excluding congenital craniofacial abnormalities from this discussion.

In my practice as a Lactation Consultant in an acute hospital setting I use a combination of the available assessment tools mainly for documentation purposes, however, the most important tools I use are my eyes and my ears. Observing the mother and baby physical combination and interactions, and suggesting adjustments where indicated to the positioning and attachment technique used (which  Pam calls fit and hold) can very often resolve difficulties immediately – even if the baby also has an obvious frenulum under his/her tongue. Listening to the mother’s feedback, and observing the baby’s responses are primary indicators of whether further intervention is needed, or not. Watching how the baby achieves and retains the latch is key, then the examination of baby’s mouth to assess tongue mobility and appearance provide final information about whether baby’s ability to breastfeed comfortably is or is not being hindered by a restrictive lingual frenulum.

Tatyana Elleseff: So frenotomy is an incision (cut) of lingual frenum while frenectomy (complete removal) is an excision of lingual frenum.  Both can be performed via various methods of “release”. What effects on breastfeeding have you seen with respect to healing?

Lois Wattis:  The significant difference between both procedures involves the degree of invasiveness and level of pain experienced during and after the procedures, and the differing time it takes for the resumption and/or improvement in breastfeeding comfort and efficacy.

It is commonplace for a baby who has had a simple incision to breastfeed immediately after the procedure and exhibit no further signs of discomfort or oral aversion. Conversely, the baby who has had laser division(s) may breastfeed soon after the procedure while topical anesthetics are still working. However, many infants demonstrate discomfort, extreme pain responses and reluctance to feed for days or weeks following a  laser treatment.  Parents are warned to expect delays resuming feeding and the baby is usually also subjected to wound “stretches” for weeks following the laser treatments. Unfortunately, in my clinical practice I see many parents and babies who are very traumatized by this whole process, and in many cases, breastfeeding can be derailed either temporarily or permanently.

Image result for research studiesTatyana Elleseff: Thank you! This is highly relevant information for both health professionals and parents alike. I truly appreciate your clinical expertise on this topic. While we are on the topic of restrictive lingual frenulums can we discuss several recent articles published on surgical interventions for the above? For example (Ghaheri, Cole, Fausel, Chuop & Mace, 2016), recently published the result of their study which concluded that: “Surgical release of tongue-tie/lip-tie results in significant improvement in breastfeeding outcomes”.  Can you elucidate upon the study design and its findings?

Pamela Douglas:  Pre-post surveys, such as Ghaheri et al’s 2016 study, are notoriously methodologically weak and prone to interpretive bias.14 

Renee Kam:  Research about the efficacy of releasing ULTs to improve breastfeeding outcomes is seriously lacking. There is no reliable assessment tool for upper lip-tie and a lack of evidence to support the efficacy of a frenotomy of labial frenula in breastfed babies. The few studies which have included ULT release have either included very small numbers of babies having upper lip-tie releases or have included babies having a release upper lip ties and tongue ties at the same time, making it impossible to know if any improvements were due to the tongue-tie release, upper lip-tie release or both. Here, to answer your previous question, to date, no research has looked into the treatment of buccal ties for breastfeeding outcomes.

There are various classification scales for labial frenulums such as the Kotlow scale. The title of this scale is misleading as it contains the word ‘tie’. Hence it can give some people the incorrect assumption that a class III or IV labial frenulum is somehow a problem. What this scale actually shows is the normal range of insertion sites for a labial frenulum. And, in normal cases, the vast majority of babies’ labial frenulums insert low down on the upper gum (class III) or even wrap around it (class IV). It’s important to note that, for effective breastfeeding, the upper lip does not have to flange out in order to create a seal. It just has to rest in a neutral position — not flanged out, not tucked in.

Lois Wattis: I entirely agree with Renee’s view about the neutrality of the upper lip, including the labial frenulum, in relation to latch for breastfeeding. Even babies with asymmetrical facial features, cleft lips and other permanent and temporary anomalies only need to achieve a seal with the upper lip to breastfeed successfully.

Image resultTatyana Elleseff: Thank you for that. In addition to studies on tongue tie revisions and breastfeeding outcomes, there has been an increase in studies, specifically Kotlow (2016) and Siegel (2016), which claimed that surgical intervention improves outcomes for acid reflux and aerophagia in babies”.  Can you discuss these studies design and findings?

Renee Kam: The AIR hypothesis has led to reflux being used as another reason to diagnose the oral anatomic abnormalities in infants in the presence of breastfeeding problems. More research with objective indicators and less vested interest is needed in this area. A thorough understanding of normal infant behavior and feeding problems which aren’t tie related are also imperative before any conclusions about AIR can be reached.

Tatyana Elleseff: One final question, colleagues are you aware of any studies which describe long-term outcomes of surgical interventions for tongue ties?

Pamela Douglas:  The systematic reviews note that there is a lack of evidence demonstrating long-term outcomes of surgical interventions. 

Tatyana Elleseff: Thank you for such informative discussion, colleagues.

Related imageThere you have it, readers. Both research and clinical practice align to indicate that:

  • There’s significant normal variation when it comes to most anatomical structures including the frenulum
  • Just because a child presents with restricted frenulum does not automatically imply adverse feeding as well as speech outcomes and immediately necessitates a tongue tie release
  • When breastfeeding difficulties arise, in the presence of restricted frenulum, it is very important to involve an experienced lactation specialist who will perform a differential diagnosis in order to determine the source of the baby’s true breastfeeding difficulties

Now, I’d like to take a moment and address the myth of tongue ties affecting speech production,  which continues to persist among speech-language pathologists despite overwhelming evidence to the contrary.

For that purpose, I will use excerpts from an excellent ASHA Leader December 2005 article written by an esteemed Dr. Kummer who is certainly well qualified to discuss this issue. According to Dr. Kummer, “there is no empirical evidence in the literature that ankyloglossia typically causes speech defects. On the contrary, several authors, even from decades ago, have disputed the belief that there is a strong causal relationship (Wallace, 1963; Block, 1968; Catlin & De Haan, 1971; Wright, 1995; Agarwal & Raina, 2003).”

Related imageSince many children with restricted frenulum do not have any speech production difficulties, Dr Kummer explains why that is the case by discussing the effect of tongue tip positioning for speech production.

“Lingual-alveolar sounds (t, d, n) are produced with the top of the tongue tip and therefore, they can be produced with very little tongue elevation or mobility.

The /s/ and /z/ sounds require the tongue tip to be elevated only slightly but can be produced with little distortion if the tip is down.

The most the tongue tip needs to elevate is to the alveolar ridge for the production of an /l/. However, this sound can actually be produced with the tongue tip down and the dorsum of the tongue up against the alveolar ridge. Even an /r/ sound can be produced with the tongue tip down as long as the back of the tongue is elevated on both sides.

The most the tongue needs to protrude is to the back of the maxillary incisors for the production of /th/. All of these sounds can usually be produced, even with significant tongue tip restriction. This can be tested by producing these sounds with the tongue tip pressed down or against the mandibular gingiva. This results in little, if any, distortion.” (Kummer, 2005, ASHA Leader)

In 2009, Dr. Sharynne McLeod, did research on electropalatography of speech sounds with adults. Her findings (below) which are coronal images of tongue positioning including bracing, lateral contact and groove formation for consonants support the above information provided by Dr. Kummer.

Once again research and clinical practice align to indicate that there’s insufficient evidence to indicate the effect of restricted frenulum on the production of speech sounds.

Finally, I would like to conclude this post with a list of links from recent systematic reviews summarizing the latest research on this topic.

Ankyloglossia/Tongue Tie Systematic Review Summaries to Date (2017):

  1. A small body of evidence suggests that frenotomy may be associated with mother reported improvements in breastfeeding, and potentially in nipple pain, but with small, short-term studies with inconsistent methodology, the strength of the evidence is low to insufficient.
  2. In an infant with tongue-tie and feeding difficulties, surgical release of the tongue-tie does not consistently improve infant feeding but is likely to improve maternal nipple pain. Further research is needed to clarify and confirm this effect.
  3. Data are currently insufficient for assessing the effects of frenotomy on nonbreastfeeding outcomes that may be associated with ankyloglossia
  4. Given the lack of good-quality studies and limitations in the measurement of outcomes, we considered the strength of the evidence for the effect of surgical interventions to improve speech and articulation to be insufficient.
  5. Large temporal increases and substantial spatial variations in ankyloglossia and frenotomy rates were observed that may indicate a diagnostic suspicion bias and increasing use of a potentially unnecessary surgical procedure among infants.

References

  1. Power R, Murphy J. Tongue-tie and frenotomy in infants with breastfeeding difficulties: achieving a balance. Archives of Disease in Childhood 2015;100:489-494.
  2. Francis DO, Krishnaswami S, McPheeters M. Treatment of ankyloglossia and breastfeeding outcomes: a systematic review. Pediatrics. 2015;135(6):e1467-e1474.
  3. O’Shea JE, Foster JP, O’Donnell CPF, Breathnach D, Jacobs SE, Todd DA, et al. Frenotomy for tongue-tie in newborn infants (Review). Cochrane Database of Systematic Reviews. 2017 (3):Art. No.:CD011065.
  4. Hall D, Renfrew M. Tongue tie. Archives of Disease in Childhood. 2005;90:1211-1215.
  5. Coryllos E, Watson Genna C, Salloum A. Congenital tongue-tie and its impact on breastfeeding. Breastfeeding: Best for Mother and Baby, American Academy of Pediatrics. 2004 Summer:1-6.
  6. Coryllos EV, Watson Genna C, LeVan Fram J. Minimally Invasive Treatment for Posterior Tongue-Tie (The Hidden Tongue-Tie). In: Watson Genna C, editor. Supporting Sucking Skills. Burlington, MA: Jones and Bartlett Learning; 2013. p. 243-251.
  7. National Health and Medical Research Council. Infant feeding guidelines: information for health workers. In: Government A, editor. 2012. p. https://www.nhmrc.gov.au/guidelines-publications/n56.
  8. Watson Genna C, editor. Supporting sucking skills in breastfeeding infants. Burlington, MA: Jones and Bartlett Learning; 2016.
  9. Griffiths DM. Do tongue ties affect breastfeeding? . Journal of Human Lactation. 2004;20:411.
  10. Ricke L, Baker N, Madlon-Kay D. Newborn tongue-tie: prevalence and effect on breastfeeding. Journal of American Board of Family Practice. 2005;8:1-8.
  11. Madlon-Kay D, Ricke L, Baker N, DeFor TA. Case series of 148 tongue-tied newborn babies evaluated with the assessment tool for lingual function. Midwifery. 2008;24:353-357.
  12. Ballard JL, Auer CE, Khoury JC. Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics. 2002;110:e63.
  13. Amir L, James JP, Donath SM. Reliability of the Hazelbaker Assessment Tool for Lingual Frenulum Function. International Breastfeeding Journal. 2006;1:3.
  14. Douglas PS. Conclusions of Ghaheri’s study that laser surgery for posterior tongue and lip ties improve breastfeeding are not substantiated. Breastfeeding Medicine. 2017;12(3):DOI: 10.1089/bfm.2017.0008.

Author Bios (in alphabetical order):

Dr. Pamela Douglas  is the founder of a charitable organization, the Possums Clinic, a general practitioner since 1987, an IBCLC (1994-2004; 2012-Present) and researcher. She is an Associate Professor (Adjunct) with the Centre for Health Practice Innovation, Griffith University, and a Senior Lecturer with the Discipline of General Practice, The University of Queensland. Pam enjoys working clinically with families across the spectrum of challenges in early life, many complex (including breastfeeding difficulty) unsettled infant behaviors, reflux, allergies, tongue-tie/oral connective tissue problems, and gut problems. She is author of The discontented little baby book: all you need to know about feeds, sleep and crying (UQP) www.possumsonline.com; www.pameladouglas.com.au

Renee Kam qualified with a Bachelor of Physiotherapy from the University of Melbourne in 2000. She then worked as a physiotherapist for 6 years, predominantly in the areas of women’s health, pediatric and musculoskeletal physiotherapy. She became an Australian Breastfeeding Association Breastfeeding (ABA) counselor in 2010 and obtained the credential of International Board Certified Lactation Consultant (IBCLC) in 2012. In 2013, Renee’s book, The Newborn Baby Manual, was published which covers the topics that Renee is passionate about; breastfeeding, baby sleep and baby behavior. These days, Renee spends most of her time being a mother to her two young daughters, writing breastfeeding content for BellyBelly.com.au, fulfilling her role as national breastfeeding information manager with ABA and working as an IBCLC in private practice and at a private hospital in Melbourne, Australia.

Lois Wattis is a Registered Nurse/Midwife, International Board Certified Lactation Consultant and Fellow of the Australian College of Midwives. Working in both hospital and community settings, Lois has enhanced her midwifery skills and expertise by providing women-centred care to thousands of mothers and babies, including more than 50 women who chose to give birth at home. Lois’ qualifications include Bachelor of Nursing Degree (Edith Cowan University, Perth WA), Post Graduate Diploma in Clinical Nursing, Midwifery (Curtin University, Perth WA), accreditation as Independent Practising Midwife by the Australian College of Midwives in 2002 and International Board Certified Lactation Consultant in 2004. Lois was inducted as a Fellow of the Australian College of Midwives (FACM) in 2005 in recognition of her services to women and midwifery in Australia. Lois has authored numerous articles which have been published internationally in parenting and midwifery journals, and shares her broad experience via her creations “New Baby 101” book, smartphone App, on-line videos and Facebook page. www.newbaby101.com.au Lois has worked for the past 10 years in Qld, Australia in a dedicated Lactation Consultant role as well as in private practice www.birthjourney.com

 

 

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Spotlight on Syndromes: An SLPs Perspective on Spinal Muscle Atrophy

The following is an informational post on the disease SMA (spinal muscle atrophy) by Rose Ann Kesting M.A. CCC-SLP. After reading, please visit her blog post “My Wednesday Morning Wake Up Call,” for a personal account of her experience with a very special boy with Type 1 SMA and his amazingly dedicated family. Continue reading Spotlight on Syndromes: An SLPs Perspective on Spinal Muscle Atrophy

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

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Adolescent Assessments in Action: Clinical Reading Evaluation

Related imageIn the past several years, due to an influx of adolescent students with language and learning difficulties on my caseload, I have begun to research in depth aspects of adolescent language development, assessment, and intervention.

While a number of standardized assessments are available to test various components of adolescent language from syntax and semantics to problem-solving and social communication, etc., in my experience with this age group, frequently, clinical assessments (vs. the standardized tests), do a far better job of teasing out language difficulties in adolescents.

Today I wanted to write about the importance of performing a clinical reading assessment as part of select* adolescent language and literacy evaluations.

There are a number of standardized tests on the market, which presently assess reading. However, not all of them by far are as functional as many clinicians would like them to be. To illustrate, one popular reading assessment is the Gray Oral Reading Tests-5 (GORT-5).  It assesses the student’s rate, accuracy, fluency, and comprehension abilities. While it’s a useful test to possess in one’s assessment toolbox, it is not without its limitations. In my experience assessing adolescent students with literacy deficits, many can pass this test with average scores, yet still present with pervasive reading comprehension difficulties in the school setting. As such, as part of the assessment process, I like to administer clinical reading assessments to students who pass the standardized reading tests (e.g., GORT-5),  in order to ensure that the student does not possess any reading deficits at the grade text level.

So how do I clinically assess the reading abilities of struggling adolescent learners?

First, I select a one-page long grade level/below grade-level text (for very impaired readers). I ask the student to read the text, and I time the first minute of their reading in order to analyze their oral reading fluency or words correctly read per minute (wcpm).

Content Reading: Science Gr6For this purpose, I often use the books from the Continental Press series entitled: Content Reading for Geography, Social Studies, & Science.   Texts for grades 5 – 7 of the series are perfect for assessment of struggling adolescent readers. In some cases using a below grade level text allows me to starkly illustrate the extent of the student’s reading difficulties. Below is an example of one of such a clinical reading assessments in action.

CLINICAL READING ASSESSMENT: 8th Grade Male   

A clinical reading assessment was administered to TS, a 15-5-year-old male, on a supplementary basis in order to further analyze his reading abilities. Given the fact that TS was reported to present with grade-level reading difficulties, the examiner provided TS a 7th-grade text by Continental Press. TS was asked to read aloud the 7 paragraph long text, and then answer factual and inferential questions, summarize the presented information, define select context embedded vocabulary words as well as draw conclusions based on the presented text. (Please note that in order to protect the client’s privacy some portions of the below assessment questions and responses were changed to be deliberately vague).

Image result for reading fluency componentsReading Fluency: TS’s reading fluency (automaticity, prosody, accuracy and speed, expression, intonation, and phrasing) during the reading task was marked by monotone vocal quality, awkward word stress, imprecise articulatory contacts, false-starts, self–revisions, awkward mid-sentential pauses, limited pausing for punctuation, as well as  misreadings and word substitutions, all of which resulted in an impaired reading prosody.

With respect to specific errors, TS was observed to occasionally add word fillers to text (e.g., and, a, etc.), change morphological endings of select words (e.g., read /elasticity/ as /elastic/, etc.) as well as substitute similar looking words (e.g., from/for; those/these, etc.) during reading.  He occasionally placed stress on the first vs. second syllable in disyllabic words, which resulted in distorted word productions (e.g., products, residual, upward, etc.), as well as inserted extra words into text (e.g., read: “until pressure inside the earth starts to build again” as “until pressure inside the earth starts to build up again”). He also began reading a number of his sentences with false starts (e.g., started reading the word “drinking” as ‘drunk’, etc.) and as a result was observed to make a number of self-corrections during reading.

During reading, TS demonstrated adequate tracking movements for text scanning as well as use of context to aid his decoding.  For example, TS was observed to read the phonetic spelling of select unfamiliar words in parenthesis (e.g., equilibrium) and then read them correctly in subsequent sentences. However, he exhibited limited use of metalinguistic strategies and did not always self-correct misread words; dispute the fact that they did not always make sense in the context of the read sentences.

TS’s oral reading rate during today’s reading was judged to be reduced for his age/grade levels. An average 8th grader is expected to have an oral reading rate between 145 and 160 words per minute. In contrast, TS was only able to read 114 words per minute. However, it is important to note that recent research on reading fluency has indicated that as early as by 4th grade reading faster than 90 wcpm will not generate increases in comprehension for struggling readers.  Consequently, TS’s current reading rate of off 114 words per minute was judged to be adequate for reading purposes. Furthermore, given the fact that TS’s reading comprehension is already compromised at this rate (see below for further details) rather than making a recommendation to increase his reading rate further, it is instead recommended that intervention focuses on slowing TS’s rate via relevant strategies as well as improving his reading comprehension abilities. Strategies should focus on increasing his opportunities to learn domain knowledge via use of informational texts; purposeful selection of texts to promote knowledge acquisition and gain of expertise in different domains; teaching morphemic as well as semantic feature analyses (to expand upon already robust vocabulary), increasing discourse and critical thinking with respect to informational text, as well as use of graphic organizers to teach text structure and conceptual frameworks.

Verbal Text Summary: TS’s text summary following his reading was very abbreviated, simplified, and confusing. When asked: “What was this text about?” Rather than stating the main idea, TS nonspecifically provided several vague details and was unable to elaborate further. When asked: “Do you think you can summarize this story for me from beginning to the end?” TS produced the two disjointed statements, which did not adequately address the presented question When asked: “What is the main idea of this text.” TS vaguely responded: “Science,” which was the broad topic rather than the main idea of the story.

Image result for vocabularyText Vocabulary Comprehension:

After that, TS was asked a number of questions regarding story vocabulary.  The first word presented to him was “equilibrium”.  When asked: “What does ‘equilibrium’ mean?” TS first incorrectly responded: “temperature”. Then when prompted: “Anything else?” TS correctly replied: “balance.” He was then asked to provide some examples of how nature leans towards equilibrium from the story. TS nonspecifically produced: “Ah, gravity.” When asked to explain how gravity contributes to the process of equilibrium TS again nonspecifically replied: “gravity is part of the planet”, and could not elaborate further. TS was then asked to define another word from the text provided to him in a sentence: “Scientists believe that this is residual heat remaining from the beginnings of the solar system.” What is the meaning of the word: “residual?” TS correctly identified: “remaining.” Then the examiner asked him to define the term found in the last paragraph of the text: “What is thermal equilibrium?” TS nonspecifically responded: “a balance of temperature”, and was unable to elaborate further.

Image result for reading comprehensionReading Comprehension (with/out text access):

TS was also asked to respond to a number of factual text questions without the benefit of visual support. However, he presented with significant difficulty recalling text details. TS was asked: When asked, “Why did this story mention ____? What did they have to do with ____?” TS responded nonspecifically, “______.” When prompted to tell more, TS produced a rambling response which did not adequately address the presented question. When asked: “Why did the text talk about bungee jumpers? How are they connected to it?” TS stated, “I am ah, not sure really.” 

Finally, TS was provided with a brief worksheet which accompanied the text and asked to complete it given the benefit of written support. While TS’s performance on this task was better, he still achieved only 66% accuracy and was only able to answer 4 out of 6 questions correctly. On this task, TS presented with difficulty identifying the main idea of the third paragraph, even after being provided with multiple choice answers. He also presented with difficulty correctly responding to the question pertaining to the meaning of the last paragraph.

Image result for impressionsImpressions: Clinical below grade-level reading comprehension assessment reading revealed that TS presents with a number of reading related difficulties.   TS’s reading fluency was marked by monotone vocal quality, awkward word stress, imprecise articulatory contacts, false-starts, self–revisions, awkward mid-sentential pauses, limited pausing for punctuation, as well as misreadings and word substitutions, all of which resulted in an impaired reading prosody. TS’s understanding as well as his verbal summary of the presented text was immature for his age and was characterized by impaired gestalt processing of information resulting in an ineffective and confusing summarization.  While TS’s text-based vocabulary knowledge was deemed to be grossly adequate for his age, his reading comprehension abilities were judged to be impaired for his age. Therapeutic intervention is strongly recommended to improve TS’s reading abilities. (See Impressions and Recommendations sections for further details).

There you have it! This is just one of many different types of informal reading assessments, which I occasionally conduct with adolescents who attain average scores on reading fluency and reading comprehension tests such as the GORT-5 or the Test of Reading Comprehension -4 (TORC-4), but still present with pervasive reading difficulties working with grade level text.

You can find more information on the topic of adolescent assessments (including other comprehensive informal write-up examples) in this recently developed product entitled: Assessment of Adolescents with Language and Literacy Impairments in Speech Language Pathology currently available in my online store.

What about you? What type of informal tasks and materials are you using to assess your adolescent students’ reading abilities and why do you like using them?

Helpful Smart Speech Therapy Adolescent Assessment Resources:

 

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Dinner with Friends or the Value of Interdisciplinary Collaboration and Follow Up

Several months ago I had dinner with two of my colleagues, a pediatrician and a clinical social worker, to iron out the details of our upcoming conference presentation. As time went by we managed to discuss every topic under the sun, yet still the subject of our presentation was sadly not on the agenda. Exhausted from working at the hospital a full day and seeing private clients afterwards, I was getting distinctly antsy as the hand clock kept climbing closer to midnight.

The conversation began to feel more productive when we started to touch base on our mutual clients.   Mostly they wanted to hear from me, since they both share an office suite and I was the only one located off-site. So, even though we all individually frequently conferred via phone regarding clients, that was the first time all three of us got together in the same room to discuss them. Quickly, I rattled off each of my clients’ progress in therapy, until I got to D, and paused.  Oh, don’t get me wrong I am very proud of my work with D, whom I’ve been working with for several years, and who went from being limitedly verbal, severely echolalic, and “autistic like” at the age of 4-5 to fluent complex sentence speaker, fledgling problem solver, and a little charmer by the age of 6-5. Yet something was still bothering me regarding D’s performance that I couldn’t put my finger on. Despite the absence of a particular diagnosis (e.g., ASD) and significant gains, his issues with attention and cognition persisted, and his progress was still halting and inconsistent, even with rigorous language therapy and supplementary academic instruction at home 4 times a week.

In my desperation I have already considered and mentally rejected a number of referrals (“No it doesn’t seem to be a psychiatric issue”, “Yes he can benefit from a neurological but should I refer him to a psychological assessment first, could it be an IQ issue?” I pondered out loud as I shared my concerns with my colleagues.  Both of them haven’t seen him for about 6 months so the clinical social worker immediately whipped out his chart busily looking for appropriate information, while the pediatrician started to frown, searching her memory for an “appropriate entry.”  “Wait a second”, she said, “when I last saw him, during his physical exam I saw brown café au lait spots on his skin that I didn’t like at all, so I referred mom to get some blood work done but I haven’t heard from her since that time. Since you see her every week, can you please ask her to call me ASAP so I could remind her to do the blood test, as the information you are telling me makes it even more imperative that she follow up with the lab work.”

Right away, I became alert.  Though the pediatrician was not stating her suspicious explicitly, through years of working with medical professionals I was familiar with the implications of what café au lait spots can potentially represent and that is neurofibromatosis. It is a neurocutaneous syndrome that leads to benign tumor growths in various parts of the body and can affect the brain, spinal cord, nerves, skin, and other body systems.  In additional to all the medical implications of this syndrome (e.g., tumors becoming cancerous), it can also cause cognitive deficits and subsequent learning disabilities that affect appropriate knowledge acquisition and retention.

To me the situation was clear, no matter what the outcome, as the only team professional in contact with the parent at the time, it was my job to counsel the parent that she get in touch with the pediatrician so she can successfully pursue the recommended course of action.  It may not have been the position I wanted to be in but unfortunately I knew that if this matter was left unpursued, I was left with a whole host of unanswered questions regarding further treatment options for this child.

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

However, in our field, even outside of specialty settings (hospital/rehab) we are frequently confronted with speech or language disordered clients who stump our thinking processes, and who require the team approach (including the involvement of specialized medical professionals).  Yet oftentimes that creates a significant challenge for many clinicians who are working contractually (through an agency) in school settings or in private practice.  Being part of a team when one is contractor or a sole practitioner in a private practice is a much more difficult feat, especially when the clinicians are just striking out on their own for the first time.

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

Interestingly, many private speech language practitioners have wide referral networks (e.g., pediatricians, OT’s, PT’s and others who refer clients to them) yet when asked regarding frequency of contact with respect to conferences/discussions about the progress of specific clients, many clinicians draw a blank.

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

In my hospital setting I work as part of a team. However, when I first started out in private practice, in a fairly short period of time I ended up having a number of clients with complex diagnoses and no one to refer them to.  What complicated matters further that in contrast to them being referred to me by a pediatrician, these clients came to me first, since their most “visible issues” at the time were speech language deficits. I had to be the one to initiate the referral process to suggest to their parents relevant medical professionals, which needed to be visited in order to figure out why their children were having such complex language difficulties (among other symptoms) in the first place.

So here are a few suggestions on how to initiate and maintain professional relationships with medical service providers.

Start with doing a little research.  You have worked hard to build your practice and your clients deserve the best, so locate the best medical service providers in your area. In the past I’ve had some excellent recommendations from locally based colleagues who were active on the ASHA discussion forums, other client’s parents who already did the necessary legwork, or hospital based colleagues who recommended peers in private practice. Several times I actually liked the initial medical reports I’ve received on a client so much – that I’ve referred other clients to the same doctor.

When word of mouth fails to do the trick, I turn to “Google” to provide me with desired results.  Surprisingly, simply typing in “best _______in _____(name of state)” frequently does the trick and allows me to locate relevant professionals, after browsing through the multitude of web reviews.

Of course depending on the length of client treatment, you will have different relationships with different medical providers.   I have collaborated for years with some (e.g., pediatrician, psychiatrist), and only infrequently spoken with others (geneticist, otolaryngologist, pediatric ophthalmologist).

Typically, when I refer a client for additional testing or consultation, in my referral letter to the physician, I request to receive the results in writing, asking the physician to also include relevant recommendations (if needed). Oftentimes, I also try to set some time to discuss the findings in a phone call in case I have any additional questions or concerns. Of course, I also send the physician (and other providers working with the child) the information from my end (progress reports, evaluations) so all of us can have a more comprehensive profile of the client’s disorder/deficit.

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

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

Given the above, it is important that speech language pathologists help to coordinate care and maintain relationships with other medical and related professionals who are treating the child.  This will improve decision making, allow the professionals to address the child’s deficits in a holistic manner, an even potentially expedite the child’s length of stay in therapy.

References:

Catlett, C & Halper, A (1992) Team Approaches: Working Together to Improve Quality. ASHA: Quality Improvement Digest. http://www.asha.org/uploadedFiles/aud/TeamApproaches.pdf

National Institute of Neurological Disorders and Stroke (NINDS) Neurofibromatosis Information Page http://www.ninds.nih.gov/disorders/neurofibromatosis/neurofibromatosis.htm

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Review and Giveaway: Test of Semantic Reasoning (TOSR)

Today I am reviewing a new receptive vocabulary measure for students 7-17 years of age, entitled the Test of Semantic Reasoning (TOSR) created by Beth Lawrence, MA, CCC-SLP  and Deena Seifert, MS, CCC-SLP, available via Academic Therapy Publications.

The TOSR assesses the student’s semantic reasoning skills or the ability to nonverbally identify vocabulary via image analysis and retrieve it from one’s lexicon.

According to the authors, the TOSR assesses “breadth (the number of lexical entries one has) and depth (the extent of semantic representation for each known word) of vocabulary knowledge without taxing expressive language skills”.

The test was normed on 1117 students ranging from 7 through 17 years of age with the norming sample including such diagnoses as learning disabilities, language impairments, ADHD, and autism. This fact is important because the manual did indicate how the above students were identified. According to Peña, Spaulding and Plante (2006), the inclusion of children with disabilities in the normative sample can negatively affect the test’s discriminant accuracy (separate typically developing from disordered children) by lowering the mean score, which may limit the test’s ability to diagnose children with mild disabilities.

TOSR administration takes approximately 20 minutes or so, although it can take a little longer or shorter depending on the child’s level of knowledge.  It is relatively straightforward. You start at the age-based point and then calculate a basal and a ceiling. For a basal rule, if the child missed any of the first 3 items, the examiner must go backward until the child retains 3 correct responses in a row. To attain a ceiling, test administration can be discontinued after the student makes 6 out of 8 incorrect responses.

Test administration is as follows. Students are presented with 4 images and told 4 words which accompany the images. The examiner asks the question: “Which word goes with all four pictures? The words are…“

Students then must select the single word from a choice of four that best represents the multiple contexts of the word represented by all the images.

According to the authors, this assessment can provide “information on children and adolescents basic receptive vocabulary knowledge, as well as their higher order thinking and reasoning in the semantic domain.”

My impressions:

During the time I had this test I’ve administered it to 6 students on my caseload with documented history of language disorders and learning disabilities. Interestingly all students with the exception of one had passed it with flying colors. 4 out of 6 received standard scores solidly in the average range of functioning including a recently added to the caseload student with significant word-finding deficits. Another student with moderate intellectual disability scored in the low average range (18th percentile). Finally, my last student scored very poorly (1st%); however, in addition to being a multicultural speaker he also had a significant language disorder. He was actually tested for a purpose of a comparison with the others to see what it takes not to pass the test if you will.

I was surprised to see several children with documented vocabulary knowledge deficits to pass this test. Furthermore, when I informally used the test and asked them to identify select vocabulary words expressively or in sentences, very few of the children could actually accomplish these tasks successfully. As such it is important for clinicians to be aware of the above finding since receptive knowledge given multiple choices of responses does not constitute spontaneous word retrieval. 

Consequently, I caution SLPs from using the TOSR as an isolated vocabulary measure to qualify/disqualify children for services, and encourage them to add an informal expressive administration of this measure in words in sentences to get further informal information regarding their students’ expressive knowledge base.

I also caution test administration to Culturally and Linguistically Diverse (CLD)  students (who are being tested for the first time vs. retesting of CLD students with confirmed language disorders) due to increased potential for linguistic and cultural bias, which may result in test answers being marked incorrect due lack of relevant receptive vocabulary knowledge (in the absence of actual disorder).

Final Thoughts:

I think that SLPs can use this test as a replacement for the Receptive One-Word Picture Vocabulary Test-4 (ROWPVT-4) effectively, as it does provide them with more information regarding the student’s reasoning and receptive vocabulary abilities.  I think this test may be helpful to use with children with word-finding deficits in order to tease out a lack of knowledge vs. a retrieval issue.

You can find this assessment for purchase on the ATP website HERE. Finally, due to the generosity of one of its creators, Deena Seifert, MS, CCC-SLP, you can enter my Rafflecopter giveaway below for a chance to win your own copy!

Disclaimer:  I did receive a complimentary copy of this assessment for review from the publisher. Furthermore, the test creators will be mailing a copy of the test to one Rafflecopter winner. However, all the opinions expressed in this post are my own and are not influenced by the publisher or test developers.

References:

Peña ED, Spaulding TJ, and Plante E. ( 2006) The composition of normative groups and diagnostic decision-making: Shooting ourselves in the foot. American Journal of Speech-Language Pathology 15: 247–54

  a Rafflecopter giveaway