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How to select the right speech language pathologist for your adopted child?


How to select the right speech language pathologist for your adopted child?

You have decided to consult a private speech language pathologist because of concerns over your adopted child’s developing speech and language. But how do you choose the right one? There are many speech therapists out there and not all of them are alike in experience and skills. On top of it all, you are also looking for a bilingual therapist, one who is not only proficient in your child’s native language but is also knowledgeable regarding the speech and language issues of international adoptees. That is not an easy decision to make, especially for many parents who until now have not had any direct contact with a speech language pathologist.
Not to worry, below is a list of simple guidelines designed to assist you in the right therapist selection.

Let’s begin with something basic: educational and professional credentials. A speech language pathologist must possess a Master’s Degree (or its equivalent) from a reputable academic institution of higher learning. They must also have a Certificate of Clinical Competence from the American Speech Language Hearing Association as well as an appropriate licensure from the state in which they maintain their practice. Additionally, it is highly recommended that they have Bilingual Certification as it indicates that they have completed the necessary academic coursework and are proficient in the issues surrounding normal and disordered speech-language acquisition of bilingual children in dual languages.

Now we are ready to proceed to experience. Here its gets a little tricky. The traditional approach: “I want the therapist with a gazillion years of experience” is just not going to be all that useful. It can’t be just any experience; it has to be the right experience! After all do you really want a therapist with 30 years of experience in exclusively treating articulation deficits when your child needs help with feeding and swallowing or with developing augmentative/alternative communication?

It is important to choose a therapist who has a rich and varied experience from multiple settings, total years of experience may not be as important as the qualitative value of that experience. A good therapist has probably spent a considerable portion of his/her time in a variety of settings from schools and early intervention agencies to hospitals and rehabilitation clinics. As the result of working in these diverse environments that therapist is much more likely to come up with innovative ideas and solutions to your child’s problems as opposed to just using the same old remediation strategies that they have learned way back then. It is also a good idea to inquire regarding the areas of specialization of the therapist in order to find out whether he/she has successfully treated children with similar problems to your child’s.

Typically, private speech language pathologists who maintain some type of pediatric hospital affiliation (e.g. per diem or part-time employees) are up to date regarding the current methodologies, which they apply to practice on daily basis. The reasons for that are twofold:

Speech departments in hospitals deal with diverse caseloads, with patients ranging in ages, diagnoses (some of which can be quite unusual), and levels of severity. In an average inpatient department staff SLP’s are expected to carry caseloads of 12-16 patients per day.
In order to keep up with the caseload diversity and with the latest treatment trends, hospitals require these SLP’s to actively take professional development courses in order to provide their patients with the best quality of care.
This brings us to another important consideration: professional development. To maintain their state licensure and national certification all therapists are required to take professional education courses in order to stay up to date with all the relevant research and new treatments developed in our field. The minimum requirement is to accumulate 30 professional education hours every 3 years whether by attending courses in person, taking them online through qualified providers, or by conducting workshops and presenting at conferences. Professional development provides the speech therapists with an opportunity to use evidence based techniques supported and tested by research to treat a variety of communication disorders. Consequently, when selecting your therapist it is important to find out just how up to date are they on the current treatment methods and methodologies pertaining to your child speech and language deficits. You can always find out this information by politely questioning the therapist regarding their background and “resume highlights.”

It is also important to find out whether you understand and agree with the therapist’s methods and approaches. For example, if your child is a toddler, it probably does not make sense for him/her to spend most sessions doing worksheets and drills when he/she needs to be engaged in play based, child centered therapy. Don’t be intimidated by the therapist’s credentials and your lack of knowledge, if something they said doesn’t make sense, ask follow up questions and/or look up pertinent information online. While you should not use the internet to diagnose your child’s problems, it can be used as a valuable learning tool to look up information and to share ideas with other parents who experience similar difficulties.

Now that we have specified general selection criteria, let’s talk about how to initiate your search for the right SLP. The best way is again to go online. Start your search by going to the ASHA website and clicking on the ‘Find Professional Button’ located in the top of the page and then follow the instructions on the screen. Fill out your search criteria carefully but don’t be too specific. For example, don’t look for a Russian speaking SLP in Blue Creek, California as you will probably not find one. Instead try typing in the first 3 digits of your zipcode or your state of residence (if it’s small enough) and don’t forget to specify the language of the practitioner. That will get you the optimum results.

Once you have located several candidates, you can narrow down the search by trying to learn something about them online. Google the clinician’s name (or the name of their practice) to see whether they have their own website, have written any articles or have been profiled by any organizations. To make sure that your practitioner’s licensure is up to date, visit your state’s speech language accreditation website and type in the last name of the professional. Typically, a window will pop up listing the therapists’ names alphabetically, find the one you are looking for and check if their license is active. Finally, armed with your research, create a list of questions that you might have for the practitioners and start making phone calls. Find out all the pertinent information and don’t forget to ask about rates which may differ depending on what services the practitioner is providing.

Please note that many private practitioners refuse to deal with insurance companies directly due to the hassle of multiclient billing as well as extended wait for reimbursement. They will instead provide you with a letter for your insurance company, containing the necessary diagnosis and treatment codes, incurred fees as well as a brief description of services provided, and will expect you to apply for reimbursement on your own.

Now that we have gone over the selection process in some detail, please keep in mind that you can always learn more information on this and any other speech pathology related topic by visiting the ASHA website and clicking on the ‘Public’ tab located at the top of the screen.

Best of luck in your search and happy hunting!

Useful websites:
Find a Professional SLP on the ASHA website: http://www.asha.org/proserv/
State Contacts & Licensure Requirements: http://www.asha.org/about/legislation-advocacy/state/

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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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Clinical Assessment of Elementary-Aged Students Writing Abilities : Suggestions for SLPs

Image result for child writingRecently I wrote a blog post regarding how SLPs can qualitatively assess writing abilities of adolescent learners. Today due to popular demand, I am offering suggestions regarding how SLPs can assess writing abilities of early-elementary-aged students with suspected learning and literacy deficits. For the purpose of this post, I will focus on assessing writing of second-grade students since by second-grade students are expected to begin producing simple written compositions several sentences in length (CCSS).

So how can we analyze the writing samples of young learners? For starters, it is important to know what the typical writing expectations look like for 2nd-grade students. Here’s is a sampling of typical expectations for second graders as per several sources (e.g., CCSS, Reading Rockets, Time4Writing, etc.)

  • With respect to penmanship, students are expected to write legibly.
  • With respect to grammar, students are expected to identify and correctly use basic parts of speech such as nouns and verbs.
  • With respect to sentence structure students are expected to distinguish between complete and incomplete sentences as well as use correct subject/verb/noun/pronoun agreements and correct verb tenses in simple and compound sentences.
  • With respect to punctuation, students are expected to use periods correctly at the end of sentences. They are expected to use commas in sentences with dates and items in a series.
  • With respect to capitalization, students are expected to capitalize proper nouns, words at the beginning of sentences, letter salutations, months and days of the week, as well as titles and initials of people.
  • With respect to spelling, students are expected to spell CVC (e.g., tap), CVCe (e.g., tape), as well as CCVC words (e.g., trap), high frequency regular and irregular spelled words (e.g., were, said, why, etc),  basic inflectional endings (e.g., –ed, -ing, -s, etc), as well as to recognize select orthographic patterns and rules (e.g., when to spell /k/ or /c/ in CVC and CVCe word, how to drop one vowel (e.g., /y/) and replace it with another /i/, etc.)

Now let’s apply the above expectations to a writing sample of a 2nd-grade student whose parents are concerned with her writing abilities in addition to other language and learning concerns. This student was provided with a  typical second grade writing prompt: “Imagine you are going to the North Pole. How are you going to get there? What would you bring with you? You have 15 minutes to write your story. Please make your story at least 4 sentences long.”

The following is the transcribed story produced by her. “I am going in the north pole. I am going to bring food my mom toy’s stoft (stuffed) animals. I am so icsited (excited). So we are going in a box. We are going to go done (down) the stars (stairs) with the box and wate (wait) intile (until) the male (mail) is hear (here).”

Analysis: The student’s written composition content (thought formulation and elaboration) was judged to be impaired for her grade level.  According to the CCSS, 2d grade students are expected to ‘”write narratives in which recount a well-elaborated event or short sequence of events, include details to describe actions, thoughts, and feelings, use temporal words to signal event order, and provide a sense of closure.” However, the above narrative sample by no means satisfies this requirement.  The student’s writing was excessively misspelled, as well as lacked organization and clarity of message.  While portions of her narrative appropriately addressed the question with respect to whom and what she was going to bring on her travels, her narrative quickly lost coherence by her 4th sentence, when she wrote: “So we are going in a box” with further elaborations regarding what she meant by that sentence.  Second-grade students are expected to engage in basic editing and revision of their work. This student only took four minutes to compose the above-written sample and as such had more than adequate amount of time to review the question as well as her response for spelling and punctuation errors as well as for clarity of message, which she did not do. Furthermore, despite being provided with a written prompt which contained the correct capitalization of a place: “North Pole”, the student was not observed to capitalize it in her writing, which indicates ongoing executive function difficulties with the respect to proofreading and attention to details.  

Impressions: Clinical assessment of the student’s writing revealed difficulties in the areas of spelling, capitalization, message clarity as well as lack of basic proofreading and editing, which require therapeutic intervention.   

Now let us select a few writing goals for this student.

Long-Term Goals:  Student will improve her writing abilities for academic purposes.

  • Short-Term Goals
  1. Student will label parts of speech (e.g., adjectives, adverbs, prepositions, etc.)  in compound sentences.
  2. Student will use declarative and interrogative sentence types for story composition purposes
  3. Student will correctly use past, present, and future verb tenses during writing tasks.
  4. Student will use basic punctuation at the sentence level (e.g., commas, periods, and apostrophes in singular possessives, etc.).
  5. Student will use basic capitalization at the sentence level (e.g., capitalize proper nouns, words at the beginning of sentences, months and days of the week, etc.).
  6. Student will proofread her work via reading aloud for clarity
  7. Student will edit her work for correct grammar, punctuation, and capitalization

Notice the above does not contain any spelling goals. That is because given the complexity of her spelling profile I prefer to tackle her spelling needs in a separate post, which discusses spelling development, assessment, as well as intervention recommendations for students with spelling deficits.

There you have it. A quick and easy qualitative writing assessment for elementary-aged students which can help determine the extent of the student’s writing difficulties as well as establish a few writing remediation targets for intervention purposes.

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

 

 

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Preventing Learned Helplessness in Students with Language Impairments

A few weeks ago in one of my private speech language therapy sessions, I was reviewing the homework  of an 11-year-old student,  part of which involved  synonym and  antonym production describing abstract feelings (e.g., disinterested, furious, etc.). These words were in the client’s lexicon as we had been working on the concept of abstract feelings for a number of weeks. I was feeling pretty confident that the student would do well on this assignment, especially because prior to assigning the homework we had identified the exact emotion which required the generation of antonyms and synonyms. So all was going swimmingly,  until she made the following comment when explaining one of her answers: “I was thinking that this word ____ is not really an appropriate synonym for _________ but I put it anyway because I couldn’t think of any others.”

That gave me a pause because I couldn’t quite believe what I was hearing. So I asked: “I completely understand that you might not have remembered some words but what could you have done to help yourself in this situation?” Without any prompting, the student readily identified a number of strategies including: looking up the words in a thesaurus/dictionary, “Googling” them, or even asking an adult to help her with choosing the best answers from a number of choices.

My follow-up question to her was: “Why didn’t you?” The student just shrugged her shoulders and looked at me in surprise, as though this concept had never occurred to her.

This incident got me thinking regarding the pervasive influence of learned helplessness, and how our students continue to be impacted by it long after they begin receiving the necessary therapies to improve their academic performance.

For those of you unfamiliar with this term, here is a brief overview. This phrase was coined by a US based psychologists Martin Seligman and Steven Maier in 1967. In a series of experiments they exposed dogs to electric shocks that they were unable to escape. After a little while the dogs stopped trying to avoid the aversive stimuli because they became conditioned to the fact that they were helpless to change the situation. However, the most fascinating aspect in these series of experiments was the fact that even after the opportunity to escape became clearly available, the animals still failed to take any action and continue to behave as though they were still helpless.

How does this apply to students with learning disabilities? 

Many students with language impairments and learning disabilities struggle significantly in school setting due to failing academic performance. The older they get, the more academic demands are placed on them.  This includes but is not limited to the amount of homework they asked to complete, the number of long-term projects they’re expected to write, as well as the number of tests they are expected to study for.

Because they are unable to meet the ever increasing academic demands, their parents begin to actively micromanage their academic life by scheduling the times when the students are expected to perform homework, study for tests, do projects, and much much more. As a result, many of the students do not know how to do any of the above activities/tasks independently because they are conditioned  by their parents/teachers to tell them what to do, how to do it, and how to lead their academic life at any given moment.

The students begin believing they they are helpless  to change even the most basic situations (e.g., take an extra step during the homework assignment and look up a vocabulary word without anyone telling them to do it) and continue to behave in this fashion long after they begin receiving the necessary therapies, coaching, or in school assistance. This is especially true of students whose language/learning disabilities are not identified until later in their school career (e.g., late elementary years, middle school, or even high school).

What are the Symptoms of Learned Helplessness in Children?  

The below poster from Dragonfly Forest Blogspot/Forest Alliance Coaching summarizes it quite nicely.

Other symptoms of learned helplessness include:

  • Lack of motivation/task initiation
  • Poor critical thinking abilities
  • Reluctance to make independent choices
  • Low self-esteem
  • Depression
  • Blaming a disability: “I act like this because I have _________”

It is important to note that the above symptoms are most applicable to students with learning disabilities and average cognition.  However, learned helplessness is equally pervasive (if not more so) in students with developmental disabilities (e.g., ASD, genetic syndromes, etc.)

Below are just a few examples of learned helplessness in students with developmental disabilities, which were inadvertently (and/or deliberately) reinforced by the adults in their lives(e.g., family members, educational staff, etc.).

  • Spoon feeding a three-year-old with ASD who has already mastered this particular ADL skill
  • Having a non-verbal eight-year-old correctly identify the PECS card for “open” but then always opening the door for him without giving him an opportunity to do so himself
  • Keeping a 12-year-old with ASD on puréed diet despite multiple MBS and FEES studies indicating that there are no structural abnormalities which would prevent this student from successfully trialing solid foods
  • Not placing basic expectations such as cleanup of toys on a verbal seven-year-old with Down Syndrome, simply because of her condition

Changing the Patterns of Learned Behavior:

According to available literature, when psychologists had tried to change learned helplessness in animal subjects it took them between 30 – 50 times of physically moving the dogs across the barrier before they proceeded to do so independently. Thus, it stands to reason that the process of rewiring the brain in humans with learned helplessness will be a lengthy one as well.

The first task on the part of adults  is active analysis of all the things  we may be doing  as  parents and educators,  which inadvertently  reinforces learned helplessness in our children/students.   Some  things may surprise you.   For example, I frequently ask the  parents of the students on my caseload what chores and responsibilities  they give their children at home.   In an overwhelming majority of the cases  my clients have  very few chores/responsibilities at home.  This  is especially apparent in families  of language  impaired children  with typically developing siblings. Conversations with parents  frequently reveal that many typically developing siblings (who are sometimes younger than my clients)  have far greater responsibilities  when it comes to chores,  assignment completion,  etc.

Did you know that an average 8-9 year-old is expected to remember to do chores for 15-20 min after school (“prospective memory”), independently, plan school projects (select book, do report, present in school), keep track of changing daily schedule, do homework for 1 hour independently as well as keep track of personal effects when away from home? (Peters, 2013)

Did you know that an average —12-14 year old is expected to demonstrate adult level planning abilities, have daily chore responsibilities for 60-90 minute in length, babysit younger siblings, follow complex school schedule, as well as plan and carry out multiple large semester-long school projects independently? (Peters, 2013)

While our language impaired children of the same age may not be capable of some of the above responsibilities they are capable of  more then we give them credit for given appropriate level of support (strategies vs. doing things for them).

Where do we begin?

It is important to recognize the potential of the children that we work with without letting their disabilities to color our subjective perceptions of what they can and cannot do. In other words, just because there are significant physical/cognitive handicaps, it does not mean that given appropriate accommodations, therapies, resources, as well as compensatory strategies that our student will not be able to reach their optimal potential.

Working with Physically/Cognitively Impaired Children: 

  • Uphold accountability 
    • You wouldn’t let a typical four-year-old get away with leaving a mess and not cleaning up their toys, so why would you let a four-year-old with Down syndrome or ASD slide?  It might take a tad longer to teach them what to do and how to do it but it certainly is more then doable
  • Do not excuse inappropriate behaviors and attribute it to a disability
  • Assign responsibility
    • Even in the presence of physical and cognitive disabilities students are still capable of performing a number of tasks and chores. This may include but not be limited to cleaning up own room, making up one bed, loading and unloading the dishwasher, taking out the garbage, vacuuming the floor, pushing the grocery cart in the store, loading and unloading food at the cash register, and much much more.
  • Encourage Hobbies 
  • Explore Adapted Sports 
    • Similar to hobbies adaptive sports can be incredibly beneficial to children with developmental disabilities. Movement helps to rewire the brain! Adaptive sports participation increases the child’s independence as well as fosters socialization with others.  Engagement in adaptive sports can also combat learned helplessness.
  • Support Quality of Life Experiences
    • Unfortunately the quality of life of the children with developmental disabilities that we work with is often compromised. Because there is inordinate focus placed on “just existing” and fitting in all the therapies, frequently joyful experiences are few and far between. If the situation allows it needs to change! There are so many simple activities we take for granted, which can bring true happiness to the children that we work with.
      • Swimming in the pool
      • Visiting a museum
      • Going into an amusement park
      • Picking berries or mushrooms in the woods
      • Going to the beach
      • Bird watching
      • Taking a vacation (if financially doable)
  • Expect more
    • Don’t let the child’s cognitive and/or physical limitations  stop them from reaching their true potential.
      • This may mean disagreeing with well-meaning but limitedly knowledgeable school-based professionals, who may tell you that your child with genetic syndrome such as Down Syndrome or Fragile X will never learn how to read (see Case C) 
      • This may mean finding accommodations and compensatory strategies for a student’s severe disabilities to make that person’s life more meaningful and enjoyable.  To illustrate, many years ago when I just started working for a school for severely medically fragile children, I’ve worked with severely physically impaired nonverbal young adult  (21) who had a limited use of his right arm (gross motor movements]only).  That did not stop us from ‘discussing’ works of literature, studying SAT level vocabulary, as well as learning Greek and Latin Roots of English.   It also didn’t stop his parents from exposing him to a variety of life experiences, aimed to make him feel like an average young adult, such as allowing him to taste a few drops of sake even though he was NPO (lat. for nothing by mouth)

Working with Language Impaired and Learning Disabled Children with Average IQ:

  • Increase their accountability in own education
    • Teach useful compensatory strategies
      • Have the children wear a watch to be more mindful of the passage of time (a child 6+ years of age could be an appropriate candidate)
      • Use of schedules, planners, and timers to be more mindful of time spent on homework, assignments, and test studying
      • Use charts listing various strategies of asking for help to teach children to increase ownership of their learning (FREE HERE)
  • Teach them to speak up regarding needed accommodations
    • Use of software applications
    • Time to prepare for oral responses
    • Use of choices when answering questions of increased complexity
    • Audio recording of newly taught information in the classroom
  • Develop their critical thinking skills and problem solving abilities
  • Change your outlook
    • Replace doing everything for them attitude or finger-pointing and blame attitude with solution- focused constructive criticism by teaching specific strategies which will help the student succeed
  • Encourage perseverance
    • Teach the students positive strategies of not giving up and persisting through the difficult situations

Changing the ingrained patterns of learned helplessness is no easy feat.  It requires time, perseverance, and patience. But it can be done even in children with significant developmental and learning disabilities.  It is a difficult but much needed process, which is instrumental in helping our students/children attain their optimal potential.

References:

  1. Seligman, M. E. P. (1975) Helplessness: On Depression, Development, and Death. San Francisco : Freeman.
  2. Peterson, C., S. Maier, and M. Seligman. (1993). Learned Helplessness. New York: Oxford University Press.
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Language therapy for children with severe cognitive impairments: Focus on Function!

Print, laminate and cut out all cards. There are seven categories for sorting food pictures: DairyGrainsMeatsFruits VegetablesSweetsDrinks...Lately I’ve had a number of children on my caseload with marked cognitive limitations. While I always attempt to integrate curriculum concepts into their therapy sessions, I also focus extensively on doing functional activities with them. These are tasks that pertain to daily living such as ordering food in a restaurant, shopping in supermarket, performing household activities, or looking up information.  This is why I was very happy to come across Figuratively Speeching SLP’s activity: Bundled Supermarket Activities. Continue reading Language therapy for children with severe cognitive impairments: Focus on Function!

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Birthday Month Extravaganza: Week Four Giveaway Lineup

Birthday GraphicMy birthday month has been absolutely fabulous! And its not over yet! So take a look  at the Week Four Giveaway Lineup and decide whether you want to enter a few giveaways or all of them, it’s really up to you!   Each giveaway will last only one day so you better keep up because if you blink you’ll miss it!

week 4

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FASD and Background History Collection: Asking the Right Questions

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

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

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Show me the Data or Why I Hate the Phrase: “It’s Not So Bad”

KEEP CALMA few days ago I was asked by my higher-ups for a second opinion on a consult regarding a psychological evaluation on an 11-year-old boy, which was depicting a certain pattern of deficits without a reasonable justification as to why they were occurring. I had a working hypothesis but needed more evidence to turn it into a viable theory.  So I set out to collect more evidence by interviewing a few ancillary professionals who were providing therapy services to the student.

The first person I interviewed was his OT, whom I asked regarding the quality of his graphomotor skills. She responded: “Oh, they are not so bad”.

I was perplexed to say the least. What does that mean I asked her. She responded back with: “He can write.”

“But I am not asking you whether he can write”, I responded back.  “I am asking you to provide data that will indicate whether his visual perceptual skills, orthographic coding, motor planning and execution, kinesthetic feedback, as well as visual motor coordination,  are on par or below those of his grade level peers.”

Needless to say this student graphomotor abilities were nowhere near those of his peers.  The below “sample” took me approximately 12 minutes to elicit and required numerous prompts from myself as well as self-corrections from the student to produce.

FullSizeRenderThis got me thinking of all the parents and professionals who hear litotes such as “It’s not so bad”, or overgeneralized phrases such as: “Her social skills are fine“,  “He is functioning higher than what the testing showed“,”He can read“, etc., on daily basis, instead of being provided with detailed data regarding the student’s present level of functioning in a particular academic area.

This has to stop, right now!

If you are an educational or health professional who has a habit of making such statements – beware! You are not doing yourself any favors by saying it and you can actually get into some pretty hot water if you are ever involved in a legal dispute.

Here’s why:

SIGNIFY NOTHING

These statements are meaningless! 

They signify nothing!  Let’s use a commonly heard phrase: “He can read.”  Sounds fairly simple, right?

Wrong!

In order to make this “loaded” statement, a professional actually needs to understand what the act of reading entails.  The act of reading contains a number of active components:

In other words if the child can decode all the words on the page, but their reading rate is slow and labored, then they cannot read!

If the child is a fast but inaccurate reader and has trouble decoding new words then they’re not a reader either!

If the child reads everything quickly and accurately but comprehends very little then they are also not a reader!

Let us now examine another loaded statement, I’ve heard recently for a fellow SLP: “His skills are higher than your evaluation depicted.” Again, what does that mean? Do you have audio, video, or written documentation to support your assertion?   No professional should ever make that statement without having detailed data to support it. Otherwise, you will be hearing: “SHOW ME THE DATA!“

These statements are harmful!

They imply to parents that the child is doing relatively well as compared to peers when nothing could be further from the truth! As a good friend and colleague, Maria Del Duca of Communication Station Blog has stated: [By making these comments] “We begin to accept a range of behavior we believe is acceptable for no other reason than we have made that decision. With this idea of mediocrity we limit our client’s potential by unconsciously lowering the bar.”

You might as well be making comments such as: “Well, it’s as good as it going to get”, indicating that the child’s genetic predestination “imposes limits on what a child might achieve” (Walz Garrett, 2012 pg. 30)

These statements are subjective!

They fail to provide any objective evidence such as type of skills addressed within a subset of abilities, percentage of accuracy achieved, number of trials needed, or number of cues and prompts given to the child in order to achieve the aforementioned accuracy.

These statements make you look unprofessional! 

I can’t help but laugh when I review progress reports with the following comments:

Social Communication:  Johnny is a pleasant child who much more readily interacted with his peers during the present progress reporting period.

What on earth does that mean?  What were Johnny’s specific social communication goals? Was he supposed to initiate conversations more frequently with peers? Was he supposed to acknowledge in some way that his peers actually exist on the same physical plane? Your guess is as good as mine!

Reading:  Johnny is more willing to read short stories at this time.

Again, what on earth does that mean? What type of text can Johnny now decode? Which consonant digraphs can he consistently recognize in text? Can he differentiate between long and short vowels in CVC and CVCV words such as /bit/ and /bite/? I have no clue because none of that was included in his report.

These statements can cause legal difficulties! 

I don’t know about your graduate preparation but I’m pretty sure that most diagnostics professors, repeatedly emphasized to the graduate SLP students the importance of professional record-keeping.  Every professor in my acquaintance has that story – the one where they had to go to court and only their detailed scrupulous record-keeping has kept them from crying and cowering from the unrelenting verbal onslaught of the plaintiff’s educational attorney.

Ironically this is exactly what’s going to happen if you keep making these statements and have no data to support your client’s present level of functioning! Legal disputes between parents of developmentally/language impaired children and districts occur at an alarming rate throughout United States; most often over perceived educational deprivation and lack of access to FAPE (Free and Appropriate Education). I would not envy any educational/health related professional who is caught in the middle of these cases lacking data to support appropriate service provision to the student in question.

Conclusion: 

So there you have it! These are just a few (of many) reasons why I loathe the phrase: “It’s Not So Bad”.  The bottom line is that this vague and subjective statement does a huge disservice to our students as individuals and to us as qualified and competent professionals.  So the next time it’s on the tip of your tongue: “Just don’t say it!” And if you are on the receiving end of it, just calmly ask the professional making that statement: “Show me the data!”

 

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Real Vocabulary App Review and Giveaway

Today I am a reviewing a new vocabulary app created by the Virtual Speech Center called Real Vocabulary Pro.  Developed to target the core curriculum vocabulary of K-5th grade students, it has tons tons of pictures and pre-recorded audio to target various vocabulary concepts as well as allows users to add their own words, pictures and audio recordings for a more individualized and targeted therapy sessions. Continue reading Real Vocabulary App Review and Giveaway

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The Limitations of Using Total/Core Scores When Determining Speech-Language Eligibility

In both of the settings where I work, psychiatric outpatient school as well as private practice, I spend a fair amount of time reviewing speech language evaluation reports.  As I’m looking at these reports I am seeing that many examiners choose to base their decision making with respect to speech language services eligibility on the students’ core, index, or total scores, which are composite scores. For those who are not familiar with this term, composite scores are standard scores based on the sum of various test scaled scores.

When the student displays average abilities on all of the presented subtests, use of composite scores clearly indicates that the child does not present with deficits and thereby is not eligible for therapy services.

The same goes for the reverse, when the child is displaying a pattern of deficits which places their total score well below the average range of functioning. Again, it indicates that the child is performing poorly and requires therapy services.

However, there’s also a the third scenario, which presents a cause for concern namely, when the students display a pattern of strengths and weaknesses on a variety of subtests, but end up with an average/low average total scores, making them ineligible for services. 

Results of the Test of Problem Solving -2 Elementary (TOPS-3)

Subtests Raw Score Standard Score Percentile Rank Description
Making Inferences 19 83 12 Below Average
Sequencing 22 86 17 Low Average
Negative Questions 21 95 38 Average
Problem Solving 21 90 26 Average
Predicting 18 92 29 Average
Determining Causes 13 82 11 Below Average
Total Test 114 86 18 Low Average

Results of the Test of Reading Comprehension-Fourth Edition (TORC-4)

Subtests Raw Score Standard Score Percentile Rank Description
Relational Vocabulary 24 9 37 Average
Sentence Completion 25 9 37 Average
Paragraph Construction 41 12 75 Average
Text Comprehension 21 7 16 Below Average
Contextual Fluency 86 6 9 Below Average
Reading Comprehension Index 90 Average

The above tables, taken from different evaluations, perfectly illustrate such a scenario. While we see that their total/index scores are within average range, the first student has displayed a pattern of strengths and weaknesses across various subtests of the TOPS-3, while the second one displayed a similar performance pattern on the TORC-4.

Typically in such cases, clinical judgment dictates a number of options:

  1. Administration of another standardized test further probing into related areas of difficulty (e.g., in such situations the administration of a social pragmatic standardized test may reveal a significant pattern of weaknesses which would confirm student’s eligibility for language therapy services).                                                                                                        
  2. Administration of informal/dynamic assessments/procedures further probing into the student’s critical thinking/verbal reasoning skills.

Image result for follow upHere is the problem though: I only see the above follow-up steps in a small percentage of cases. In the vast majority of cases in which score discrepancies occur, I see the examiners ignoring the weaknesses without follow up. This of course results in the child not qualifying for services.

So why do such practices frequently take place? Is it because SLPs want to deny children services?  And the answer is NOT at all! The vast majority of SLPs, I have had the pleasure interacting with, are deeply caring and concerned individuals, who only want what’s best for the student in question. Oftentimes, I believe the problem lies with the misinterpretation of/rigid adherence to the state educational code.

For example, most NJ SLPs know that the New Jersey State Education Code dictates that initial eligibility must be determined via use of two standardized tests on which the student must perform 1.5 standard deviations below the mean (or below the 10th percentile).  Based on such phrasing it is reasonable to assume that any child who receives the total scores on two standardized tests above the 10th percentile will not qualify for services. Yet this is completely incorrect!

Let’s take a closer look at the clarification memo issued on October 6, 2015, by the New Jersey Department of Education, in response to NJ Edu Code misinterpretation. Here is what it actually states.

“In accordance with this regulation, when assessing for a language disorder for purposes of determining whether a student meets the criteria for communication impaired, the problem must be demonstrated through functional assessment of language in other than a testing situation and performance below 1.5 standard deviations, or the 10th percentile on at least two standardized language tests, where such tests are appropriate, one of which shall be a comprehensive test of both receptive and expressive language.”

“When implementing the requirement with respect to “standardized language tests,” test selection for evaluation or reevaluation of an individual student is based on various factors, including the student’s ability to participate in the tests, the areas of suspected language difficulties/deficits (e.g., morphology, syntax, semantics, pragmatics/social language) and weaknesses identified during the assessment process which require further testing, etc. With respect to test interpretation and decision-making regarding eligibility for special education and related services and eligibility for speech-language services, the criteria in the above provision do not limit the types of scores that can be considered (e.g., index, subtest, standard score, etc.).”

Firstly, it emphasizes functional assessments. It doesn’t mean that assessments should be exclusively standardized rather it emphasizes the best appropriate procedures for the student in question be they standardized and nonstandardized.

Secondly, it does not limit standardized assessment to 2 tests only. Rather it uses though phrase “at least” to emphasize the minimum of tests needed.

It explicitly makes a reference to following up on any weaknesses displayed by the students during standardized testing in order to get to the root of a problem.

It specifies that SLPs must assess all displayed areas of difficulty (e.g., social communication) rather than assessing general language abilities only.

Finally, it explicitly points out that SLPs cannot limit their testing interpretation to the total scores but must to look at the testing results holistically, taking into consideration the student’s entire assessment performance.

The problem is that if SLPs only look at total/core scores then numerous children with linguistically-based deficits will fall through the cracks.  We are talking about children with social communication deficits, children with reading disabilities, children with general language weaknesses, etc.  These students may be displaying average total scores but they may also be displaying significant subtest weaknesses. The problem is that unless these weaknesses are accounted for and remediated as they are not going to magically disappear or resolve on their own. In fact both research and clinical judgment dictates that these weaknesses will exacerbate over time and will continue to adversely impact both social communication and academics.

So the next time you see a pattern of strengths and weaknesses and testing, even if it amounts to a total average score, I urge you to dig deeper. I urge you to investigate why this pattern is displayed in the first place. The same goes for you – parents! If you are looking at average total scores  but seeing unexplained weaknesses in select testing areas, start asking questions! Ask the professional to explain why those deficits are occuring and tell them to dig deeper if you are not satisfied with what you are hearing. All students deserve access to FAPE (Free and Appropriate Public Education). This includes access to appropriate therapies, they may need in order to optimally function in the classroom.

I urge my fellow SLP’s to carefully study their respective state codes as well as know who they are state educational representatives are. These are the professionals SLPs can contact with questions regarding educational code clarification.  For example, the SEACDC Consultant for the state of New Jersey is currently Fran Liebner (phone: 609-984-4955; Fax: 609-292-5558; e-mail: fran.leibner@doe.state.nj.us).

However, the Department of Education is not the only place SLPs can contact in their state.  Numerous state associations worked diligently on behalf of SLPs by liaising with the departments of education in order to have access to up to date information pertaining to school services.  ASHA also helpfully provides contact information by state HERE.

When it comes to score interpretation, there are a variety of options available to SLPs in addition to the detailed reading of the test manual. We can use them to ensure that the students we serve experience optimal success in both social and academic settings.

Helpful Smart Speech Therapy Resources: