Today I am doing a product swap and giveaway with Rose Kesting of Speech Snacks. Rose runs a fun and unique blog. In her posts she combines her interest in nutrition and healthy cooking with her professional knowledge as a speech-language pathologist. I’ve collaborated with Rose in the past on a variety of projects and have always been impressed with the quality of her speech and language products, which are typically aimed at language remediation of older children (upper-elementary, middle school and high school ages). Continue reading Wintertime Wellness Product Swap and Giveaway
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Spotlight on Syndromes: An SLPs Perspective on Hurler Syndrome
Today’s guest post on genetic syndromes comes from Kelly Hungaski, who is contributing an informative piece on the Hurler Syndrome.
Hurler Syndrome is a rare, inherited metabolic disease in which a person can’t break down lengthy chains of sugar molecules called glycosaminoglycans. Hurler syndrome belongs to a group of diseases called mucopolysaccharidoses, or MPS. Continue reading Spotlight on Syndromes: An SLPs Perspective on Hurler Syndrome
Thematic Language Intervention with Language Impaired Children Using Nonfiction Texts
In the past a number of my SLP colleague bloggers (Communication Station, Twin Sisters SLPs, Practical AAC, etc.) wrote posts regarding the use of thematic texts for language intervention purposes. They discussed implementation of fictional texts such as the use of children’s books and fairy tales to target linguistic goals such as vocabulary knowledge in use, sentence formulation, answering WH questions, as well as story recall and production.
Today I would like to supplement those posts with information regarding the implementation of intervention based on thematic nonfiction texts to further improve language abilities of children with language difficulties.
First, here’s why the use of nonfiction texts in language intervention is important. While narrative texts have high familiarity for children due to preexisting, background knowledge, familiar vocabulary, repetitive themes, etc. nonfiction texts are far more difficult to comprehend. It typically contains unknown concepts and vocabulary, which is then used in the text multiple times. Therefore lack of knowledge of these concepts and related vocabulary will result in lack of text comprehension. According to Duke (2013) half of all the primary read-alouds should be informational text. It will allow students to build up knowledge and the necessary academic vocabulary to effectively participate and partake from the curriculum.
So what type of nonfiction materials can be used for language intervention purposes. While there is a rich variety of sources available, I have had great success using Let’s Read and Find Out Stage 1 and 2 Science Series with clients with varying degrees of language impairment.
Here’s are just a few reasons why I like to use this series.
- They can be implemented by parents and professionals alike for different purposes with equal effectiveness.
- They can be implemented with children fairly early beginning with preschool on-wards
- The can be used with the following pediatric populations:
- Language Disordered Children
- Children with learning disabilities and low IQ
- Children with developmental disorders and genetic syndromes (Fragile X, Down Syndrome, Autism, etc.)
- Children with Fetal Alcohol Spectrum Disorders
- Internationally adopted children with language impairment
- Bilingual children with language impairment
- Children with dyslexia and reading disabilities
- Children with psychiatric Impairments
- The books are readily available online (Barnes & Noble, Amazon, etc.) and in stores.
- They are relatively inexpensive (individual books cost about $5-6).
- Parents or professionals who want to continuously use them seasonally can purchase them in bulk at a significantly cheaper price from select distributors (Source: rainbowresource.com)
- They are highly thematic, contain terrific visual support, and are surprisingly versatile, with information on topics ranging from animal habitats and life cycles to natural disasters and space.
- They contain subject-relevant vocabulary words that the students are likely to use in the future over and over again (Stahl & Fairbanks, 1986).
- The words are already pre-grouped in semantic clusters which create schemes (mental representations) for the students (Marzano & Marzano, 1988).
For example, the above books on weather and seasons contain information on:
1. Front Formations
2. Water Cycle
3. High & Low Pressure Systems
Let’s look at the vocabulary words from Flash, Crash, Rumble, and Roll (see detailed lesson plan HERE). (Source: ReadWorks):
Word: water vapor
Context: Steam from a hot soup is water vapor.
Word: expands
Context: The hot air expands and pops the balloon.
Word: atmosphere
Context: The atmosphere is the air that covers the Earth.
Word: forecast
Context: The forecast had a lot to tell us about the storm.
Word: condense
Context: steam in the air condenses to form water drops.
These books are not just great for increasing academic vocabulary knowledge and use. They are great for teaching sequencing skills (e.g., life cycles), critical thinking skills (e.g., What do animals need to do in the winter to survive?), compare and contrast skills (e.g., what is the difference between hatching and molting?) and much, much, more!
So why is use of nonfiction texts important for strengthening vocabulary knowledge and words in language impaired children?
As I noted in my previous post on effective vocabulary instruction (HERE): “teachers with many struggling children often significantly reduce the quality of their own vocabulary unconsciously to ensure understanding” (Excerpts from Anita Archer’s Interview with Advance for SLPs).
The same goes for SLPs and parents. Many of them are under misperception that if they teach complex subject-related words like “metamorphosis” or “vaporization” to children with significant language impairments or developmental disabilities that these students will not understand them and will not benefit from learning them.
However, that is not the case! These students will still significantly benefit from learning these words, it will simply take them longer periods of practice to retain them!
By simplifying our explanations, minimizing verbiage and emphasizing the visuals, the books can be successfully adapted for use with children with severe language impairments. I have had parents observe my intervention sessions using these books and then successfully use them in the home with their children by reviewing the information and reinforcing newly learned vocabulary knowledge.
Here are just a few examples of prompts I use in treatment with more severely affected language-impaired children:
- What do you see in this picture?
- This is a _____ Can you say _____
- What do you know about _____?
- What do you think is happening? Why?
- What do you think they are doing? Why?
- Let’s make up a sentence with __________ (this word)
- You can say ____ or you can say ______ (teaching synonyms)
- What would be the opposite of _______? (teaching antonyms)
- Do you know that _____(this word) has 2 meanings
- 1st meaning
- 2nd meaning
- How do ____ and _____ go together?
Here are the questions related to Sequencing of Processes (Life Cycle, Water Cycle, etc.)
- What happened first?
- What happened second?
- What happened next?
- What happened after that?
- What happened last?
As the child advances his/her skills I attempt to engage them in more complex book interactions
- Compare and contrast items
- (e.g. objects/people/animals)
- Make predictions and inferences about will happen next?
- Why is this book important?
“Picture walks” (flipping through the pages) of these books are also surprisingly effective for activation of the student’s background knowledge (what a student already knows about a subject). This is an important prerequisite skill needed for continued acquisition of new knowledge. It is important because “students who lack sufficient background knowledge or are unable to activate it may struggle to access, participate, and progress through the general curriculum” (Stangman, Hall & Meyer, 2004).
These book allow for :
1.Learning vocabulary words in context embedded texts with high interest visuals
2.Teaching specific content related vocabulary words directly to comprehend classroom-specific work
3.Providing multiple and repetitive exposures of vocabulary words in texts
4. Maximizing multisensory intervention when learning vocabulary to maximize gains (visual, auditory, tactile via related projects, etc.)
To summarize, children with significant language impairment often suffer from the Matthew Effect (“rich get richer, poor get poorer”), or interactions with the environment exaggerate individual differences over time
Children with good vocabulary knowledge learn more words and gain further knowledge by building of these words
Children with poor vocabulary knowledge learn less words and widen the gap between self and peers over time due to their inability to effectively meet the ever increasing academic effects of the classroom. The vocabulary problems of students who enter school with poorer limited vocabularies only worsen over time (White, Graves & Slater, 1990). We need to provide these children with all the feasible opportunities to narrow this gap and partake from the curriculum in a more similar fashion as typically developing peers.
Helpful Smart Speech Therapy Resources:
- Vocabulary Intervention: Working With Disadvantaged Populations
- Creating A Learning-Rich Environment for Language Delayed Preschoolers
- Strategies of Language Facilitation with Picture Books For Parents and Professionals
- The Checklists Bundle
- Narrative Assessment and Treatment Bundle
- Social Pragmatic Assessment and Treatment Bundle
- Assessment Checklist for Preschool Children
- Assessment Checklist for School Children
- Assessment Checklist for Adolescents
- Auditory Processing Deficits Checklist for School Aged Children
- Multicultural Assessment and Treatment Bundle
- Comprehensive Assessment of Monolingual and Bilingual Children with Down Syndrome
- Fetal Alcohol Spectrum Disorders Bundle
References:
Duke, N. K. (2013). Starting out: Practices to Use in K-3. Educational Leadership, 71, 40-44.
Marzano, R. J., & Marzano, J. (1988). Toward a cognitive theory of commitment and its implications for therapy. Psychotherapy in Private Practice 6(4), 69–81.
Stahl, S. A. & Fairbanks, M. M. “The Effects of Vocabulary Instruction: A Model-based Metaanalysis.” Review of Educational Research 56 (1986): 72-110.
Strangman, N., Hall, T., & Meyer, A. (2004). Background knowledge with UDL. Wakefield, MA: National Center on Accessing the General Curriculum.
White, T. G., Graves, M. F., & Slater W. H. (1990). Growth of reading vocabulary in diverse elementary schools: Decoding and word meaning. Journal of Educational Psychology, 82, 281–290.
Creating A Learning Rich Environment for Language Delayed Preschoolers
Early Intervention Part V: Assessing Feeding and Swallowing in Children Under Three
Today I am writing my last installment in the five-part early intervention assessment series. My previous posts on this topic included:
- General speech and language assessments of children under 3 years of age.
- Assessments of toddlers with suspected motor speech disorders
- Assessments of children ~16-18 months of age
- Assessments of Social Pragmatic Abilities of Children Under 3
Today I’d like to talk about the assessment of feeding abilities of children under 3 years of age. Just to be clear, in my post, I am not offering tips on the assessment of medically fragile or neurologically impaired children with complex swallowing and feeding disorders such as severe food selectivity. Rather, I am offering suggestions for routine orofacial and feeding assessments of young children with normal swallowing but slightly immature feeding abilities.
First, let take a look at what the typical feeding development looks like in children 0-3 years of age. For this, I really like to use a resource from Dr. Joan Arvedson entitled: Developmental milestones and feeding skills birth to 36 months from her article Swallowing and feeding in infants and young children which was published online in 2006.
| Age (months) | Development/posture | Feeding/oral sensorimotor |
| Source: Adapted from Arvedson and Brodsky (pp. 62–67). | ||
| Birth to 4–6 | Neck and trunk with balanced flexor and extensor tone Visual fixation and tracking Learning to control body against gravity Sitting with support near 6 months Rolling over Brings hands to mouth |
Nipple feeding, breast, or bottle Hand on bottle during feeding (2–4 months) Maintains semiflexed posture during feeding Promotion of infant–parent interaction |
| 6–9 (transition feeding) | Sitting independently for short time Self-oral stimulation (mouthing hands and toys) Extended reach with pincer grasp Visual interest in small objects Object permanence Stranger anxiety Crawling on belly, creeping on all fours |
Feeding more upright position Spoon feeding for thin, smooth puree Suckle pattern initially Suckle suck Both hands to hold bottle Finger feeding introduced Vertical munching of easily dissolvable solids Preference for parents to feed |
| 9–12 | Pulling to stand Cruising along furniture First steps by 12 months Assisting with spoon; some become independent Refining pincer grasp |
Cup drinking Eats lumpy, mashed food Finger feeding for easily dissolvable solids Chewing includes rotary jaw action |
| 12–18 | Refining all gross and fine motor skills Walking independently Climbing stairs Running Grasping and releasing with precision |
Self-feeding: grasps spoon with whole hand Holding cup with 2 hands Drinking with 4–5 consecutive swallows Holding and tipping bottle |
| >18–24 | Improving equilibrium with refinement of upper extremity coordination. Increasing attention and persistence in play activities Parallel or imitative play Independence from parents Using tools |
Swallowing with lip closure Self-feeding predominates Chewing broad range of food Up–down tongue movements precise |
| 24–36 | Refining skills Jumping in place Pedaling tricycle Using scissors |
Circulatory jaw rotations Chewing with lips closed One-handed cup holding and open cup drinking with no spilling Using fingers to fill spoon Eating wide range of solid food Total self-feeding, using fork |
Now, let’s discuss the importance of examining the child’s facial features and oral structures. During these examinations it is important to document anything out of the ordinary noted in the child’s facial features or oral cavity.
Facial dysmorphia, signs of asymmetry indicative of paresis, unusual spots, nodules, openings, growths, etc, all need to be documented. Note the condition of the child’s mouth. Is there excessive tooth decay? Do you see an unusual absence of teeth? Is there an unusual bite (open, cross, etc.), unusual voice or a cough, in the absence of a documented illness? Here’s an example from a write up on a 2-8-year-old male toddler, below:
Facial observations revealed dysmorphic features: microcephaly (small head circumference), anteriorly rotated ears (wide set), and medially deviated, inward set eyes. A presence of mild-moderate hypotonicity (low tone) of the face [and trunk] was also noted. FA presented with mostly closed mouth posture and appropriate oral postural control at rest but moderate drooling (drool fell on clothes vs. touching chin only) was noted during speech tasks and during play. It’s important to note that the latter might be primarily behavioral in origin since FA was also observed to engage in “drool play” – gathering oral secretions at lip level then slowly and deliberately expelling them in a thin stream from his mouth and onto his shirt.
Articulatory structures including lips, tongue, hard palate and velum appeared to be unremarkable and are adequate for speech purposes. FA’s dentition was adequate for speech purposes as well. Oral motor function was appropriate for lingual lateralization, labial retraction, volitional pucker and lingual elevation. Lingual depression was not achieved. Diadochokinesis for sequential and alternate movements was unremarkable. Overall, FA’s oral structures and function presented to be adequate for speech production purposes.
FA’s prosody, pitch, and loudness were within normal limits for age and gender. No clinical dysfluencies were present during the evaluation. Vocal quality was remarkable for intermittent hoarseness which tended to decrease (clear up) as speech output increased and may be largely due to a cold (he presented with a runny nose during the assessment). Vocal quality should continue to be monitored during therapy sessions for indications of persistent hoarseness in the absence of a cold.
From there I typically segue into a discussion of the child’s feeding and swallowing abilities. Below is an excerpt discussing the strengths and needs of an 18-month-old internationally adopted female.
“During the assessment concerns presented regarding AK’s feeding abilities only. No swallowing concerns were reported or observed during the assessment. As per the parental report, at the age of 18 months, AK is still drinking from the bottle and consuming only puréed foods, which is significantly delayed for a child her age. AK’s feeding skills were assessed at snack time via indirect observation and select direct food administration. The following foods and liquids were presented to AK during the assessment: 2 oz of yogurt, 18 cheerios, 4 banana and 2 apple bites, and 40 ml of water (via cup and straw). AK was observed to accept all of the above foods and liquids readily when offered.
Spoon Stripping and Mouth Closure: During the yogurt presentation, AK’s spoon stripping abilities and mouth closure were deemed good (adequate) when fed by a caregiver and fair when AK fed self (incomplete food stripping from the spoon was observed due to only partial mouth closure). According to parental report, AK’s spoon stripping abilities have improved in recent months. Ms. K was observed to present spoon upwardly in AK’s mouth and hold it still until AK placed her lips firmly around the spoon and initiated spoon stripping. Since this strategy is working adequately for all parties in question no further recommendations regarding spoon feeding are necessary at this time. Skill monitoring is recommended on an ongoing basis for further refinement.
Biting and Chewing Abilities on Solids and Semi-Solids: AK’s chewing abilities were judged to be immature at this time for both solid (e.g., Cheerios) and semi-solid foods (e.g., banana). AK was observed to feed self Cheerios from a plate (1 at a time). She placed a cheerio laterally on lower right molars and attempted to grind it. When the cheerio was presented to AK midline she was observed to anteriorly munch it, or mash it against the hard palate. Notably, when too many cheerios were presented to her, rather than grasping and consuming them AK began to bang on a plate with both hands and throw the cheerios around the room.
During feeding, the most difficulty was observed with biting and chewing solid and semisolid fruit (e.g., apple and banana pieces). When presented with a banana, AK manifested moderate difficulties biting off an adequately sized piece (she bit off too much). Consequently, due to the fact that she was unable to adequately chew on a piece that large, manual extraction of food from the oral cavity was initiated due to choking concerns. It is important to note that during all food presentations AK did not display a diagonal rotary chew, which is below age expectancy for a child her age. Feeding strengths noted during today’s assessment included complete mouth closure (including lack of drooling and anterior food loss) during assisted spoon and finger foods feeding.
Cup and Straw Drinking: AK was also observed to drink 40 mls of water from a cup given parental assistance. Minor anterior spillage was intermittently noted during liquid intake. It is recommended that the parents modify cup presentation by providing AK with a plastic cup with two handles on each side, which would improve her ability to grasp and maintain hold on cup while drinking.
Straw drinking trials were attempted during the assessment as it is a skill which typically emerges between 8-9 months of age and solidifies around 12-13 months of age (Hunt et al, 2000). When AK was presented with a shortened straw placed in cup, she was initially able to create enough intraoral pressure to suck in a small amount of liquid. However, AK quickly lost the momentum and began to tentatively chew on the presented straw as which point the trial was discontinued.
Based on the feeding assessment AK presented with mildly decreased abilities in the oral phase of feeding. It is recommended that she receive feeding therapy with a focus on refining her feeding abilities.”
I follow the above, with a summary of evaluation impressions, recommendations, as well as suggested therapy goals. Finally, I conclude my report with a statement regarding the child’s prognosis (e.g., excellent, good, fair, etc.) as well as list potential maintaining factors affecting the duration of therapy provision.
So what about you? How do you assess the feeding and swallowing of abilities of children under 3 on your caseload? What foods, tasks, and procedures do you use?
APD Update: New Developments on an Old Controversy
In the past two years, I wrote a series of research-based posts (HERE and HERE) regarding the validity of (Central) Auditory Processing Disorder (C/APD) as a standalone diagnosis as well as questioned the utility of it for classification purposes in the school setting.
Once again I want to reiterate that I was in no way disputing the legitimate symptoms (e.g., difficulty processing language, difficulty organizing narratives, difficulty decoding text, etc.), which the students diagnosed with “CAPD” were presenting with.
Rather, I was citing research to indicate that these symptoms were indicative of broader linguistic-based deficits, which required targeted linguistic/literacy-based interventions rather than recommendations for specific prescriptive programs (e.g., CAPDOTS, Fast ForWord, etc.), or mere accommodations.
I was also significantly concerned that overfocus on the diagnosis of (C)APD tended to obscure REAL, language-based deficits in children and forced SLPs to address erroneous therapeutic targets based on AuD recommendations or restricted them to a receipt of mere accommodations rather than rightful therapeutic remediation. Continue reading APD Update: New Developments on an Old Controversy
New Products for the 2017 Academic School Year for SLPs
September is quickly approaching and school-based speech language pathologists (SLPs) are preparing to go back to work. Many of them are looking to update their arsenal of speech and language materials for the upcoming academic school year.
With that in mind, I wanted to update my readers regarding all the new products I have recently created with a focus on assessment and treatment in speech language pathology. Continue reading New Products for the 2017 Academic School Year for SLPs
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2. These Terms may be occasionally updated, so please refer back to them in the future. By using this Website you agree to be bound by the then current version of these Terms. Continue reading Terms and Conditions
Dear Neurodevelopmental Pediatrician: Please Don’t Do That!
Recently I got yet another one of the dreaded phone calls which went a little something like this:
Parent: Hi, I am looking for a speech therapist for my son, who uses PROMPT to treat Childhood Apraxia of Speech (CAS). Are you PROMPT certified?
Me: I am PROMPT trained and I do treat motor speech disorders but perhaps you can first tell me a little bit about your child? What is his age? What type of speech difficulties does he have? Who diagnosed him and recommended the treatment.
Parent: He is turning 3. He was diagnosed by a neurodevelopmental pediatrician a few weeks ago. She recommended speech therapy 4 times a week for 30 minutes sessions, using PROMPT.
Me: And what did the speech therapy evaluation reveal?
Parent: We did not do a speech therapy evaluation yet.
Sadly I get these type of phone calls at least once a month. Frantic parents of toddlers aged 18 months to 3+ years of age call to inquire regarding the availability of PROMPT therapy based exclusively on the diagnosis of the neurodevelopmental pediatrician. In all cases I am told that the neurodevelopmental pediatrician specified speech language diagnosis, method of treatment, and therapy frequency, ALBEIT in a complete absence of a comprehensive speech language evaluation and/or past speech language therapy treatments.
The conversation that follows is often an uncomfortable one. I listen to the parental description of the child’s presenting symptoms and explain to the parents that a comprehensive speech language assessment by a certified speech language pathologist is needed prior to initiation of any therapy services. I also explain to the parents that depending on the child’s age and the assessment findings CAS may or may not be substantiated since there are a number of speech sound disorders which may have symptoms similar to CAS.
Following my ‘spiel’, the parents typically react in a number of ways. Some get offended that I dared to question the judgement of a highly qualified medical professional. Others hurriedly thank me for my time and resoundingly hang up the phone. Yet a number of parents will stay on the line, actually listen to what I have to say and ask me detailed questions. Some of them will even become clients and have their children undergo a speech language evaluation. Still a number of them will find out that their child never even had CAS! Past misdiagnoses ranged from ASD (CAS was mistaken due to the presence of imprecise speech and excessive jargon related utterances) to severe phonological disorder to dysarthria secondary to CP. Thus, prior to performing a detailed speech language evaluation on the child I had no way of knowing whether the child truly presented with CAS symptoms.
Before I continue I’d like to provide a rudimentary definition of CAS. Since its identification years ago it has been argued whether CAS is linguistic or motoric in nature with the latest consensus being that CAS is a disorder which disrupts speech motor control and creates difficulty with volitional, intelligible speech production. Latest research also shows that in addition to having difficulty forming words and sentences at the speech level, children with CAS also experience difficulty in the areas of receptive and expressive language, in other words, “pure” apraxia of speech is rare (Hammer, 2007).
This condition NEEDS to be diagnosed by a speech language pathologist! Not only that, due to the disorder’s complexity it is strongly recommended that if parents suspect CAS they should take their child for an assessment with an SLP specializing in assessment and treatment of motor speech disorders. Here’s why.
- CAS has a number of overlapping symptoms with other speech sound disorders (e.g., severe phonological disorder, dysarthria, etc).
- Symptoms which may initially appear as CAS may change during the course of intervention by the time the child is older (e.g., 3 years of age) which is why diagnosing toddlers under 3 years of age is very problematic and the use of “suspected” or “working” diagnosis is recommended (Davis & Velleman, 2000) in order to avoid misdiagnosis
- Diagnosis of CAS is also problematic due to the fact that there are no valid or reliable standardized assessments sensitive to CAS (McCauley & Strand, 2008). However, a new instrument Dynamic Evaluation of Motor Speech Skill (DEMSS) (Strand et al, 2013) is showing promise with respect to differential diagnosis of severe speech impairments in children
- Thus for children with less severe impairments SLPs need to design tasks to assess the child’s:
- Automatic vs. volitional control
- Simple vs. complex speech
- Consistency of productions on repetitions of same word
- Vowel productions
- Imitation abilities
- Prosody
- Phonetic inventory BEFORE and AFTER intervention
- Types and levels of cueing the child is presently stimulable to
- in order to determine where the breakdown is taking place (Caspari, 2012)
These are just some of the reasons why specialization in CAS is needed and why it is IMPOSSIBLE to make a reliable CAS diagnosis by simply observing the child for a length of time, from a brief physical exam, and from extensive parental interviews (e.g., a typical neurodevelopmental appointment).
In fact, leading CAS experts state that you DON’t need a neurologist in order to confirm the CAS diagnosis (Hammer, 2007).
Furthermore, “NO SINGLE PROGRAM WORKS FOR ALL CHILDREN WITH APRAXIA!!” (Hammer, 2007). Hence SLPs NEED to individualize not only their approach with each child but also switch approaches with the same child when needed it in order to continue making therapy gains. Given the above the PROMPT approach may not even be applicable to some children.
It goes without saying that MANY developmental pediatricians will NOT do this!
But for those who do, I implore you – if you observe that a young child is having difficulty producing speech, please refer the child for a speech language assessment first. Please specify to the parents your concerns (e.g., restricted sound repertoire for the child’s age, difficulty sequencing sounds to make words, etc) BUT NOT the diagnosis, therapy frequency, as well as therapy approaches. Allow the assessing speech language pathologist to make these recommendations in order to ensure that the child receives the best possible targeted intervention for his/her disorder.
For more information please visit the Childhood Apraxia of Speech Association of North America (CASANA) website or visit the ASHA website to find a professional specializing in the diagnosis and treatment of CAS near you.
References:
- Caspari, S (2012) Beyond Picture Cards! Practical Assessment and Treatment Methods for Children with Apraxia of Speech. Session presented for New Jersey Speech Language Hearing Association Convention, Long Branch, NJ
- Davis, B., & Velleman, S. L. (2000). Differential diagnosis and treatment of developmental apraxia of speech in infants and toddlers. Infant-Toddler Intervention: The Transdisciplinary Journal, 10, 177–192.
- Hammer, D (2007) Childhood Apraxia of Speech: Evaluation and Therapy Challenges. Retrieved from http://www.maxshouse.com.au/documents/CAS%20conference%20day%201%20.ppt.
- McCauley RJ, Strand EA. (2008). A Review of Standardized Tests of Nonverbal Oral and Speech Motor Performance in Children. American Journal of Speech-Language Pathology, 17,81-91.
- Strand, E, McCauley, R, Weigand, S, Stoeckel, R & Baas, B (2013) A Motor Speech Assessment for Children with Severe Speech Disorders: Reliability and Validity Evidence. Journal of Speech Language and Hearing Research, vol 56; 505-520.
DI or SP: Why it’s important to know who is treating your child in Early Intervention
Recently on the American Speech Language Hearing Association Early Intervention forum there was a discussion about the shift in several states pertaining to provision of language services to children in the early intervention system. Latest trend seems to be that a developmental interventionists (DI) or early childhood educators are now taking over in providing language intervention services instead of speech language pathologists.
A number of parents reported to SLPs that they were told by select DIs that “they work on same goals as speech therapists”. One parent, whose child received speech therapy privately with me and via EI kept referring to a DI’s as an SLP, during our conversation. This really confused me during my coordination of services phone call with the DI, since I was using terminology the DI was unfamiliar with.
Consequently, since a number of parents have asked me about the difference between DIs and SLPs I decided to write a post on this topic.
So what is the difference between DI and an SLP?
DI or a developmental interventionist is an early childhood education teacher. In order to provide EI services a DI needs to have an undergraduate bachelor’s degree in a related health, human service, or education field. They also need a certificate in Early Childhood Education OR at least six (6) credits in infant or early childhood development and/or special education coursework.
A DI’s job is to create learning activities that promote the child’s acquisition of skills in a variety of developmental areas. DI therapists do not address one specific area of functioning but instead try to promote all skills including: cognition, language and communication, social-emotional functioning and behavior, gross and fine motor skills as well as self-help skills via play based interactions as well as environmental modifications. In other words a DIs are a bit like a jacks of all trades and they focus on a little bit of everything.
SLP or a Speech Language Pathologist is an ancillary health professional. In order to provide EI services, in the state of NJ for example, an SLP needs to have a Masters Degree in Speech Language Pathology or Communication Disorders as well as a State License (and in most cases a certification from ASHA, our national association).
Unlike DIs, pediatric SLPs focus on and have an in-depth specialization in improving children’s communication skills (e.g., speech, language, alternative augmentative communication, etc.). SLPs undergo rigorous training including multiple internships at both undergraduate (BA) and graduate (MA) levels as well as complete a clinical fellowship year prior to receiving relevant licenses and certifications. SLPs are also required to obtain a certain number of professional education hours every year after graduation in order to maintain their license and certifications. Many of them undergo highly specialized trainings and take courses on specialized techniques of speech and language elicitation in order to work with children with severe speech language disorders secondary to a variety of complex medical, neurological and/or genetic diagnoses.
As you can see from the above, even though at first glance it may look like DIs and SLPs do similar work, DIs DON’T have nearly the same level of expertise and training possessed by the SLPs, needed to address TRUE speech-language delays and disorders in children.
What does this all mean to parents?
That depends on why parents/caregivers are seeking early intervention services in the first place. If they are concerned about their child’s speech language development then they definitely want to ensure the following:
- The child undergoes a speech language assessment with a qualified speech language pathologist and
- If speech language therapy is recommended, the child receives it from a qualified speech language pathologist
So if a professional other than an SLP assesses the child than it cannot be called a speech language assessment.
Similarly, if a related professional (e.g., DI) is providing services, they are NOT providing “speech language therapy” services.
They are also NOT providing the ‘SAME‘ level of services as a speech-language pathologist does.
Consequently, if speech language services are recommended for the child and those recommendations are documented in the child’s Individualized Family Service Plan (IFSP) then these services MUST be provided by a speech language pathologist, otherwise it is a direct violation of the child’s IFSP under the IDEA: Part C.
So how can parents ensure their child receives appropriate services from the get-go?
- Find out in advance before the assessment who are the professionals (from which disciplines) coming to evaluate your child
- If you have requested a speech-language evaluation due to concerns over your child’s speech language abilities and the SLP is not scheduled to assess, find out the reason for it and determine whether that reason makes sense to you
- Ask questions during the assessment regarding the child’s performance/future recommendations
- Make sure that an IFSP meeting is scheduled 45 days after the initial referral if the child is found eligible
- Find out in advance which professionals will be attending your child’s IFSP meeting
- Find out if any reports will be available to you prior to the meeting
- If yes, carefully review the assessment report to ensure that you understand and agree with the findings
- If no, make sure you have an adequate period of time to review all documentation prior to signing it and if need to request time to review reports
- If an SLP assessed your child but therapy services are not recommended find out the reason for services denial in order to determine whether you have grounds for appeal (child’s delay was not substantial enough to merit services. vs. lack of SLP availability to provide intervention services)
- If speech-language therapy services are recommended ensure that therapy initiation occurs in a timely manner after the initial IFSP meeting and that all missed sessions (by an SLP) are made-up in a timely manner as well
EI Service Provision in the State of New Jersey: DI vs. SLP
(from Service Guidelines for Speech Therapy in Early Intervention)
The following are the circumstances in which a DI will be assigned to work with the child instead of an SLP (vs. in conjunction with) in the state of NJ (rules are similar in many other states)
- If a child, under 28 months of age, presents with a “late-talker profile” (pg 27)
- If child with speech-language delays also has delayed prelinguistic skills (e.g., joint attention, turn-taking, etc), the DI will work with the child first to establish them (pg 29)
- If a child under 28 months has expressive language delay only and has intact cognition, receptive language, and motor skills
- If the child has a cognitive delay commensurate with a receptive and expressive delay (p 30)
- If a child has a hearing impairment and no other developmental delays, DI services will be provided while information is being obtained and medical intervention is being provided (pg 31)
Understanding who is providing services and the rationale behind why these services are being provided is the first important step in quality early intervention service provision for young children with language delays and disorders. So make sure that you know, who is treating your child!
Useful Resources:
- New Jersey’s Early Intervention System Your Child’s Development Important Milestones: (Birth – 36 months)
- Service Guidelines for Speech Therapy in Early Intervention
- The Early Intervention/IFSP Process
- Steps in the Early Intervention Process
- Procedural Safeguards for Families at Each Step of the EI Process
- What You Can Expect from Speech Therapy: A Guide for Parents