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In Case You’ve Missed it – Multisensory stimulation: using edibles to enhance learning

Last week one of my posts was a part of Speech Snacks Blogiversary . In case you missed it, read below some of my suggestions on how to creatively use edibles to enhance learning.

There are times when we (speech-language pathologists) encounter certain barriers when working with language impaired children. These may include low motivation, inconsistent knowledge retention, as well as halting or labored progress in therapy. Consequently, we spend countless hours on attempting to enhance the service delivery for our clients. One method that I have found to be highly effective for greater knowledge retention as well as for increasing the kids’ motivation is incorporating multisensory stimulation in speech and language activities. Continue reading In Case You’ve Missed it – Multisensory stimulation: using edibles to enhance learning

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Spotlight on Syndromes: An SLPs and OTs Perspective on Williams Syndrome

Today’s guest post on Williams Syndrome comes from Pamela Mandell, M.S. CCC-SLP with a contribution from Priya Deonarain, MA, OTR/L, CKTP.

Overview

Williams syndrome (WS), also known as Williams-Beuren Syndrome, is a rare genetic disorder caused by the deletion of the long arm of chromosome 7 or, more specifically a microdeletion at 7q11.23, which involves the elastin gene. WS occurs in approximately 1 in 10,000 births worldwide. It is characterized by cardiovascular disease, dysmorphic craniofacial features, a characteristic cognitive and personality profile, deficient visuospatial abilities, hyperacusis, growth retardation, developmental delays, feeding difficulties, and learning disabilities. However, many people with WS exhibit strong expressive language skills and an affinity for music. Mild to severe anxieties as well as Attention Deficit Hyperactivity Disorder (ADHD) are also associated with WS. The degree of severity or involvement of these characteristics is variable and no two individuals with WS are alike. WS affects both males and females equally. Sadler, et al. (2001), determined the severity of both supravalvular aortic stenosis (SVAS) and total cardiovascular disease was significantly higher in males than females. There is no cure for WS. Patients must be continually monitored and treated for symptoms throughout their lives. Continue reading Spotlight on Syndromes: An SLPs and OTs Perspective on Williams Syndrome

Testimonials

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

Teleassessment Testimonial

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

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

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

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

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

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

As parents, we value answers to the following questions.

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

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

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

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

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

Sincerely,

Southern California Parent of a 2e child

November 25th, 2018

Post Treatment Therapy Testimonial (Internationally Adopted Child)

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

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

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

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

M & J, Monroe NJ

Comprehensive Independent Language and Literacy Evaluation

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

NJ Parent

Language and Literacy Teleconsultation

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

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

Grateful SLP mom from Illinois.

Comprehensive Independent Language and Literacy Evaluation

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

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

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

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

Jeanann Wallace, CCC-SLP, Mom

Professional Consultation Complex Communication Impairment – Adolescent Client

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

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

Professional Consultation Internationally Adopted Adolescent

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

Thank you again!!!
Rinda Werner

Comprehensive Independent Language and Literacy Evaluation

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

They said he was doing fine.

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

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

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

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

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

Janet S, Greenbrook, NJ

International Language and Literacy Teleconsulation

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

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

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

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

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

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

O.G., Rishon Lezion, Israel

Comprehensive Independent Language and Literacy Evaluation

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

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

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

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

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

E and D, Maplewood, NJ

Language and Literacy Consultation Parent Testimonial

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

Parent, Westchester County, NY

Forensic Speech and Language Pathologist Testimonial

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

Attorney at Law in New Jersey

Independent Evaluation Testimonial

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

WS, Kendall Park, NJ

Therapy Testimonial

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

Jane A, New Providence , NJ

Independent Evaluation Testimonial

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

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

F.O., New Brunswick, NJ

Therapy Testimonial

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

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

A.D., New Providence, NJ

Therapy Testimonial

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

KJ, Dayton, NJ

Therapy Testimonial

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

P and J, Somerset, NJ

Therapy Testimonial

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

M and T, East Brunswick, NJ

Independent Evaluation Testimonial (International Adoption)

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

Independent Social Pragmatic Evaluation Testimonial

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

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

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

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

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

P & J, New Jersey

Bilingual Evaluation Testimonial

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

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

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

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

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

 Sincerely, Katrina R., New Jersey.

Independent Evaluation Testimonial

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

 T & N, Bridgewater, NJ

Independent Evaluation Testimonial

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

Santiago Family.. Middlesex County, NJ

Consultation Testimonial (International Adoption)

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

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

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

Kristen, P. Charlottesville, VA

Therapy Testimonial

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

Ilya K. Edison, NJ

Independent Evaluation Testimonial (Autism Spectrum Disorder)

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

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

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

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

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

Family of a son with ASD in Union County NJ.

Independent Evaluation Testimonial (International Adoption)

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

Donna S. Perkasie, PA

Therapy Testimonial  

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

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

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

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

Keith and Debra, Southampton NJ

Independent Evaluation Testimonial (International Adoption)

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

W & K, New Jersey

Therapy Testimonial

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

Mike and Anna, East Brunswick, NJ

Therapy Testimonial

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

~Melissa and Rich H, Hillsborough, NJ

Therapy Testimonial

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

Therapy Testimonial

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

Andrea and Keith R, South Brunswick, NJ

Client Testimonial

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

Tanya and Jonathan H, Old Bridge, NJ

Client Testimonial

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

Myriam and Richard K, Guttenburg, NJ

Client Testimonial

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

Matthew and Jane C, Monroe NJ

Client Testimonial

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

Marcia, C, East Brunswick NJ

Client Testimonial

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

Larisa S, Bedminster NJ

Client Testimonial

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

Connie and David M, Milstone Township NJ

Client Testimonial

 “Dear Tatyana,

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

Lou and Marie R, Bernardsville NJ

Professional Testimonial

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

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

Professional Testimonial

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

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

Posted on 4 Comments

What if Its More Than Just “Misbehaving”?

Frequently,  I see a variation of the following scenario on many speech and language forums.

The SLP is seeing a client with speech and/or language deficits through early intervention,  in the schools, or in private practice, who is having some kind of behavioral issues.

Some issues are described as mild such as calling out, hyperactivity, impulsivity, or inattention, while others are more severe and include refusal, noncompliance, or aggression such as kicking, biting,  or punching.

An array of advice from well-meaning professionals immediately follows.  Some behaviors may be labeled as “normal” due to the child’s age (toddler),  others may be “partially excused” due to a DSM-5  diagnosis (e.g., ASD).   Recommendations for reinforcement charts (not grounded in evidence) may be suggested. A call for other professionals to deal with the behaviors is frequently made (“in my setting the ______ (insert relevant professional here) deals with these behaviors and I don’t have to be involved”). Specific judgments on the child may be pronounced: “There is nothing wrong with him/her, they’re just acting out to get what they want.” Some drastic recommendations could be made: “Maybe you should stop therapy until the child’s behaviors are stabilized”.

However, several crucial factors often get overlooked. First, a system to figure out why particular set of behaviors takes place and second, whether these behaviors may be manifestations of non-behaviorally based difficulties such as medical issues, or overt/subtle linguistically based deficits.

So what are some reasons kids may present with behavioral deficits? Obviously, there could be numerous reasons: some benign while others serious, ranging from lack of structure and understanding of expectations to manifestations of psychiatric illnesses and genetic syndromes. Oftentimes the underlying issues are incredibly difficult to recognize without a differential diagnosis. In other words, we cannot claim that the child’s difficulties are “just behavior” if we have not appropriately ruled out other causes which may be contributing to the “behavior”.

Here are some possible steps which can ensure appropriate identification of the source of the child’s behavioral difficulties in cases of hidden underlying language disorders (after of course relevant learning, genetic, medical, and psychiatric issues have been ruled out).

Let’s begin by answering a few simple questions. Was a thorough language evaluation with an emphasis on the child’s social pragmatic language abilities been completed? And by thorough, I am not referring to general language tests but to a variety of formal and informal social pragmatic language testing (read more HERE).

Please note that none of the general language tests such as the Preschool Language Scale-5 (PLS-5), Comprehensive Assessment of Spoken Language (CASL-2), the Test of Language Development-4 (TOLD-4) or even the Clinical Evaluation of Language Fundamentals Tests (CELF-P2)/ (CELF-5) tap into the child’s social language competence because they do NOT directly test the child’s social language skills (e.g., CELF-5 assesses them via a parental/teachers questionnaire).  Thus, many children can attain average scores on these tests yet still present with pervasive social language deficits. That is why it’s very important to thoroughly assess social pragmatic language abilities of all children  (no matter what their age is) presenting with behavioral deficits.

But let’s say that the social pragmatic language abilities have been assessed and the child was found/not found to be eligible for services, meanwhile, their behavioral deficits persist, what do we do now?

The first step in establishing a behavior management system is determining the function of challenging behaviors, since we need to understand why the behavior is occurring and what is triggering it (Chandler & Dahlquist, 2006)

We can begin by performing some basic data collection with a child of any age (even with toddlers) to determine behavior functions or reasons for specific behaviors. Here are just a few limited examples:

  • Seeking Attention/Reward
  • Seeking Sensory Stimulation
  • Seeking Control

Most behavior functions typically tend to be positively, negatively or automatically reinforced (Bobrow, 2002). For example, in cases of positive reinforcement, the child may exhibit challenging behaviors to obtain desirable items such as toys, games, attention, etc. If the parent/teacher inadvertently supplies the child with the desired item, they are reinforcing inappropriate behaviors positively and in a way strengthening the child’s desire to repeat the experience over and over again, since it had positively worked for them before.

In contrast, negative reinforcement takes place when the child exhibits challenging behaviors to escape a negative situation and gets his way. For example, the child is being disruptive in classroom/therapy because the tasks are too challenging and is ‘rewarded’ when therapy is discontinued early or when the classroom teacher asks an aide to take the child for a walk.

Finally, automatic reinforcements occur when certain behaviors such as repetitive movements or self-injury produce an enjoyable sensation for the child, which he then repeats again to recreate the sensation.

In order to determine what reinforces the child’s challenging behaviors, we must perform repeated observations and take data on the following:

  • Antecedent or what triggered the child’s behavior?
    • What was happening immediately before behavior occurred?
  • Behavior
    • What type of challenging behavior/s took place as a result?
  • Response/Consequence
    • How did you respond to behavior when it took place?

Here are just a few antecedent examples:

  • Therapist requested that child work on task
  • Child bored w/t task
  • Favorite task/activity taken away
  • Child could not obtain desired object/activity

In order to figure them out we need to collect data, prior to appropriately addressing them. After the data is collected the goals need to be prioritized based urgency/seriousness.  We can also use modification techniques aimed at managing interfering behaviors.  These techniques include modifications of: physical space, session structure, session materials as well as child’s behavior. As we are implementing these modifications we need to keep in mind the child’s maintaining factors or factors which contribute to the maintenance of the problem (Klein & Moses, 1999). These include: cognitive, sensorimotor, psychosocial and linguistic deficits. 

We also need to choose our reward system wisely, since the most effective systems which facilitate positive change actually utilize intrinsic rewards (pride in self for own accomplishments) (Kohn, 2001).  We need to teach the child positive replacement behaviors  to replace the use of negative ones, with an emphasis on self-talk, critical thinking, as well as talking about the problem vs. acting out behaviorally.

Of course it is very important that we utilize a team based approach and involve all the professionals involved in the child’s care including the child’s parents in order to ensure smooth and consistent carryover across all settings. Consistency is definitely a huge part of all behavior plans as it optimizes intervention results and achieves the desired therapy outcomes.

So the next time the client on your caseload is acting out don’t be so hasty in judging their behavior, when you have no idea regarding the reasons for it. Troubleshoot using appropriate and relevant steps in order to figure out what is REALLY going on and then attempt to change the situation in a team-based, systematic way.

For more detailed information on the topic of social pragmatic language assessment and behavior management in speech pathology see if the following Smart Speech Therapy LLC products could be of use:

 

References: 

  1. Bobrow, A. (2002). Problem behaviors in the classroom: What they mean and how to help. Functional Behavioral Assessment, 7 (2), 1–6.
  2. Chandler, L.K., & Dahlquist, C.M. Functional assessment: strategies to prevent and remediate challenging behavior in school settings (2nd ed.). Upper Saddle River, New Jersey: Pearson Education, Inc.
  3. —Klein, H., & Moses, N. (1999). Intervention planning for children with communication disorders: A guide to the clinical practicum and professional practice. (2nd Ed.). Boston, MA.: Allyn & Bacon.
  4. —Kohn, A. (2001, Sept). Five reasons to stop saying “good job!’. Young Children. Retrieved from http://www.alfiekohn.org/parenting/gj.htm
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Making Our Interventions Count or What’s Research Got To Do With It?

Image result for effective interventionTwo years ago I wrote a blog post entitled: “What’s Memes Got To Do With It?” which summarized key points of Dr. Alan G. Kamhi’s 2004 article: “A Meme’s Eye View of Speech-Language Pathology“. It delved into answering the following question: “Why do some terms, labels, ideas, and constructs [in our field] prevail whereas others fail to gain acceptance?”.

Today I would like to reference another article by Dr. Kamhi written in 2014, entitled “Improving Clinical Practices for Children With Language and Learning Disorders“.

This article was written to address the gaps between research and clinical practice with respect to the implementation of EBP for intervention purposes.

Dr. Kamhi begins the article by posing 10 True or False questions for his readers:

  1. Learning is easier than generalization.
  2. Instruction that is constant and predictable is more effective than instruction that varies the conditions of learning and practice.
  3. Focused stimulation (massed practice) is a more effective teaching strategy than varied stimulation (distributed practice).
  4. The more feedback, the better.
  5. Repeated reading of passages is the best way to learn text information.
  6. More therapy is always better.
  7. The most effective language and literacy interventions target processing limitations rather than knowledge deficits.
  8. Telegraphic utterances (e.g., push ball, mommy sock) should not be provided as input for children with limited language.
  9. Appropriate language goals include increasing levels of mean length of utterance (MLU) and targeting Brown’s (1973) 14 grammatical morphemes.
  10. Sequencing is an important skill for narrative competence.

Guess what? Only statement 8 of the above quiz is True! Every other statement from the above is FALSE!

Now, let’s talk about why that is!

First up is the concept of learning vs. generalization. Here Dr. Kamhi discusses that some clinicians still possess an “outdated behavioral view of learning” in our field, which is not theoretically and clinically useful. He explains that when we are talking about generalization – what children truly have a difficulty with is “transferring narrow limited rules to new situations“. “Children with language and learning problems will have difficulty acquiring broad-based rules and modifying these rules once acquired, and they also will be more vulnerable to performance demands on speech production and comprehension (Kamhi, 1988)” (93). After all, it is not “reasonable to expect children to use language targets consistently after a brief period of intervention” and while we hope that “language intervention [is] designed to lead children with language disorders to acquire broad-based language rules” it is a hugely difficult task to undertake and execute.

Next, Dr. Kamhi addresses the issue of instructional factors, specifically the importance of “varying conditions of instruction and practice“.  Here, he addresses the fact that while contextualized instruction is highly beneficial to learners unless we inject variability and modify various aspects of instruction including context, composition, duration, etc., we ran the risk of limiting our students’ long-term outcomes.

After that, Dr. Kamhi addresses the concept of distributed practice (spacing of intervention) and how important it is for teaching children with language disorders. He points out that a number of recent studies have found that “spacing and distribution of teaching episodes have more of an impact on treatment outcomes than treatment intensity” (94).

He also advocates reducing evaluative feedback to learners to “enhance long-term retention and generalization of motor skills“. While he cites research from studies pertaining to speech production, he adds that language learning could also benefit from this practice as it would reduce conversational disruptions and tunning out on the part of the student.

From there he addresses the limitations of repetition for specific tasks (e.g., text rereading). He emphasizes how important it is for students to recall and retrieve text rather than repeatedly reread it (even without correction), as the latter results in a lack of comprehension/retention of read information.

After that, he discusses treatment intensity. Here he emphasizes the fact that higher dose of instruction will not necessarily result in better therapy outcomes due to the research on the effects of “learning plateaus and threshold effects in language and literacy” (95). We have seen research on this with respect to joint book reading, vocabulary words exposure, etc. As such, at a certain point in time increased intensity may actually result in decreased treatment benefits.

His next point against processing interventions is very near and dear to my heart. Those of you familiar with my blog know that I have devoted a substantial number of posts pertaining to the lack of validity of CAPD diagnosis (as a standalone entity) and urged clinicians to provide language based vs. specific auditory interventions which lack treatment utility. Here, Dr. Kamhi makes a great point that: “Interventions that target processing skills are particularly appealing because they offer the promise of improving language and learning deficits without having to directly target the specific knowledge and skills required to be a proficient speaker, listener, reader, and writer.” (95) The problem is that we have numerous studies on the topic of improvement of isolated skills (e.g., auditory skills, working memory, slow processing, etc.) which clearly indicate lack of effectiveness of these interventions.  As such, “practitioners should be highly skeptical of interventions that promise quick fixes for language and learning disabilities” (96).

Now let us move on to language and particularly the models we provide to our clients to encourage greater verbal output. Research indicates that when clinicians are attempting to expand children’s utterances, they need to provide well-formed language models. Studies show that children select strong input when its surrounded by weaker input (the surrounding weaker syllables make stronger syllables stand out).  As such, clinicians should expand upon/comment on what clients are saying with grammatically complete models vs. telegraphic productions.

From there lets us take a look at Dr. Kamhi’s recommendations for grammar and syntax. Grammatical development goes much further than addressing Brown’s morphemes in therapy and calling it a day. As such, it is important to understand that children with developmental language disorders (DLD) (#DevLang) do not have difficulty acquiring all morphemes. Rather studies have shown that they have difficulty learning grammatical morphemes that reflect tense and agreement  (e.g., third-person singular, past tense, auxiliaries, copulas, etc.). As such, use of measures developed by (e.g., Tense Marker Total & Productivity Score) can yield helpful information regarding which grammatical structures to target in therapy.

With respect to syntax, Dr. Kamhi notes that many clinicians erroneously believe that complex syntax should be targeted when children are much older. The Common Core State Standards do not help this cause further, since according to the CCSS complex syntax should be targeted 2-3 grades, which is far too late. Typically developing children begin developing complex syntax around 2 years of age and begin readily producing it around 3 years of age. As such, clinicians should begin targeting complex syntax in preschool years and not wait until the children have mastered all morphemes and clauses (97)

Finally, Dr. Kamhi wraps up his article by offering suggestions regarding prioritizing intervention goals. Here, he explains that goal prioritization is affected by

  • clinician experience and competencies
  • the degree of collaboration with other professionals
  • type of service delivery model
  • client/student factors

He provides a hypothetical case scenario in which the teaching responsibilities are divvied up between three professionals, with SLP in charge of targeting narrative discourse. Here, he explains that targeting narratives does not involve targeting sequencing abilities. “The ability to understand and recall events in a story or script depends on conceptual understanding of the topic and attentional/memory abilities, not sequencing ability.”  He emphasizes that sequencing is not a distinct cognitive process that requires isolated treatment. Yet many SLPs “continue to believe that  sequencing is a distinct processing skill that needs to be assessed and treated.” (99)

Dr. Kamhi supports the above point by providing an example of two passages. One, which describes a random order of events, and another which follows a logical order of events. He then points out that the randomly ordered story relies exclusively on attention and memory in terms of “sequencing”, while the second story reduces demands on memory due to its logical flow of events. As such, he points out that retelling deficits seemingly related to sequencing, tend to be actually due to “limitations in attention, working memory, and/or conceptual knowledge“. Hence, instead of targeting sequencing abilities in therapy, SLPs should instead use contextualized language intervention to target aspects of narrative development (macro and microstructural elements).

Furthermore, here it is also important to note that the “sequencing fallacy” affects more than just narratives. It is very prevalent in the intervention process in the form of the ubiquitous “following directions” goal/s. Many clinicians readily create this goal for their clients due to their belief that it will result in functional therapeutic language gains. However, when one really begins to deconstruct this goal, one will realize that it involves a number of discrete abilities including: memory, attention, concept knowledge, inferencing, etc.  Consequently, targeting the above goal will not result in any functional gains for the students (their memory abilities will not magically improve as a result of it). Instead, targeting specific language and conceptual goals  (e.g., answering questions, producing complex sentences, etc.) and increasing the students’ overall listening comprehension and verbal expression will result in improvements in the areas of attention, memory, and processing, including their ability to follow complex directions.

There you have it! Ten practical suggestions from Dr. Kamhi ready for immediate implementation! And for more information, I highly recommend reading the other articles in the same clinical forum, all of which possess highly practical and relevant ideas for therapeutic implementation. They include:

References:

Kamhi, A. (2014). Improving clinical practices for children with language and learning disorders.  Language, Speech, and Hearing Services in Schools, 45(2), 92-103

Helpful Social Media Resources:

SLPs for Evidence-Based Practice

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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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Functional Strategies for Improving the Language Abilities of Your Adopted School-Age Child

Functional Strategies for Improving the Language Abilities of Your Adopted School-Age Child.

While most internationally adopted children catch up to their peers in language development somewhat quickly, not all internationally adopted children demonstrate equal progress by the time they reach school age. Below are some suggestions on how parents can facilitate their school age child’s language skills and improve their language abilities via fun interactive games that the whole family can enjoy and benefit from.

There are several language functions important for academic success. Typically this hierarchy develops from the most basic to the most complex, with the earliest stages beginning long before the child reaches school age. These functions include the ability to: seek information, inform, compare, order, classify, analyze, infer, justify/persuade, solve problems, synthesize, and evaluate. For some children those abilities come naturally while for others – a creative push in the right direction might just do the trick. Luckily, there are plenty of children’s games on the market that address the above skills in a fun and functional way, oftentimes without the child even realizing that they are doing work.

One of the earliest and important areas of language development is vocabulary knowledge. Good vocabulary skills are essential for communication of thoughts and ideas, interaction with peers, as well as meeting the demands of the classroom. As academic demands increase the importance of good vocabulary comes prominently into play. Vocabulary hierarchy ranges from a simple ability of labeling (providing a name for people, actions and objects) to the advanced descriptions (using attributes, functions, and learned concepts to depict an object/item in a cohesive manner). As children’s vocabulary increases from basic labeling to using sophisticated descriptions it goes through several other important stages outlined below:

• Concept Knowledge – the ability to comprehend and identify qualitative (e.g., same–different, big– little, hot-cold), quantitative (e.g., few-many, more-less), temporal (e.g., before-after, next, first, last), or spatial (e.g., in-on, under-over) concepts
• Associations – knowledge of how words are semantically related/linked (e.g., knowing why a spoon and a knife go together)
• Categorization/Classification – the ability to identify items within a category (divergent naming) and provide labels for groups/classes of objects (convergent naming)

The following are just a few selected examples of available games (a more complete list will be provided at the end of this article) that should help facilitate the development of vocabulary language skills:
A to Z Jr- a game of early categorizations is recommended for players 5 – 10 years of age, but can be used with older children depending on their knowledge base. The object of the game is to cover all letters on your letter board by calling out words in specific categories before the timer runs out. This game can be used to increase word finding abilities in children with weak language skills as the categories range from simple (e.g., colors) to more complicated (e.,. animals with stripes). This game is great for several players of different age groups (e.g., older siblings), since children with weaker knowledge and language skills can answer simpler questions and learn the answers to the harder questions as other players get their turn.

Tribond Jr – is another great game which purpose is to determine how 3 seemingly random items are related to one another. Good for older children 7-12 years of age it’s also great for problem solving and reasoning as some of the answers are not so straight forward (e.g., what do the clock, orange and circle have in common? Psst…they are all round)

Password Jr-is a great game to develop the skills of description. In the game you guess passwords based on the one word clues. This game is designed to play with children ages 7 years and older as long as the parents help the non readers with the cards. It’s great for encouraging children to become both better at describing and at listening. Parents are encouraged to allow their kids to select the word they want to describe in order to boost their confidence in own abilities. Parents are also encouraged to provide visual cheat sheets (listing ways we can describe something such as: what does it do, where does it go, how can we use it etc) to the child as they will be much more likely to provide more complete descriptions of the target words given visual cues.

Blurt – a game for children 10 and up is a game that works on a simple premise. Blurt out as many answers as you can in order to guess what the word is. Blurt provides ready-made definitions that you read off to players so they could start guessing what the word is. Players and teams use squares on the board strategically to advance by competing in various definition challenges that increase language opportunities.

However, vocabulary knowledge alone does not determine academic success. There are other equally valuable language skills which are important as well. One of them is asking and answering questions. Being able to ask and answer questions is an integral part of academic success.

Asking questions is one of the main ways that children obtain knowledge about the world beyond their immediate experience. Children who are unable to ask questions are at a disadvantage when it comes to following directions or understanding difficult concepts since they are unable to request repetition and clarification from speakers. Moreover, the inability to answer questions effectively is an indication that the child will not be understood well by others. Being able to answer concrete and abstract questions is another necessary requirement for success in school. Games such as Guess Who (age 6+), Guess Where (age 6+), and Mystery Garden (age 4+) are great for encouraging students to ask relevant questions in order to be the first to win the game. They are also terrific for encouraging reasoning skills. Questions have to be thought through carefully in order to be the first one to win the game.

Another important ability in the language learning hierarchy is story telling. Being able to tell good stories is a difficult task for many children, even those without language impairment. Consequently, one way of learning to become a good story teller is through the usage of visual cues such as picture cards, or games. When children are very young speech therapists often work on improving their story telling abilities using props such as a variety of toys or puppets. As they get older they transition to picture cards or wordless story books with the final step being spontaneously produced stories with no visual support. One of such games is Fib or Not (ages 10+). The game encourages the players to fool other players by either telling an outlandish true story or a truly believable made up story. For the players who are listening to the story, the objective is to correctly guess if the story teller is fibbing or being truthful. Players advance by fooling the other players or by guessing correctly.

As children grow older, they are required to do more and more tasks that focus on their verbal reasoning and problem solving abilities. If your child’s problem solving skills are on the weaker side consider using events from storybooks that illustrate problems. Talk aloud about the problem and offer a list of choices if your child is having difficulties figuring out the answers. Have your child talk through the process of how they arrived to their conclusions and offer suggestions and guidance along the way. The two popular games that work on improving verbal reasoning and problem solving abilities are: 30 Second Mysteries (ages 8-12) and 20 Questions for Kids (ages 7+).

In 30 Second Mysteries kids need to use critical thinking and deductive reasoning in order to solve mysteriously sounding cases of everyday events. Each clue read aloud reveals more about the mystery and the trick is to solve it given the fewest number of clues in order to gain the most points. In 20 Questions for Kids, a classic guessing game of people, places, and things, children need to generate original questions in order to obtain information. Here again, each clue read aloud reveals more about the secret identity and the trick is to solve it given the fewest number of clues.

A good way of implementing the above games in action is during family fun night. Select a game that focuses on one or more elements that you feel your child needs to work on and then involve your entire family in a game playing activity so the child does not feel that they are being isolated for “work”. For children who are younger or with weaker vocabularies, modify the rules to help to simplify the demands of the game, or play in a team so that the child doesn’t feel overwhelmed. Feel free to provide your own cues and prompts in order to achieve maximum success with all gaming activities.

Now that we have gone over the game description and selection process in some detail, please keep in mind that you can always learn more about children’s games by simply going to a popular internet websites such as Amazon and reading product descriptions in order to figure out whether specific game is right fit for your child.

As always, parents are advised to consult with related professionals (speech and language therapists, psychologists, etc) if they have any serious concerns regarding their child’s communication skills. Early detection and treatment are critical to the process of successful speech and language development not just in early childhood but also during school age, adolescence, and even early adulthood.

Best of luck and have fun playing!

List of Selected Games:
• 20 Questions for Kids
• 30 Second Mysteries
• A to Z Jr.
• Blurt
• Fib or Not
• Guess Where?
• Guess Who?
• Last Word
• Loaded Questions
• Mystery Garden
• Outburst
• Password Junior
• Tribond Junior

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It’s All Due to …Language: How Subtle Symptoms Can Cause Serious Academic Deficits

Scenario: Len is a 7-2-year-old, 2nd-grade student who struggles with reading and writing in the classroom. He is very bright and has a high average IQ, yet when he is speaking he frequently can’t get his point across to others due to excessive linguistic reformulations and word-finding difficulties. The problem is that Len passed all the typical educational and language testing with flying colors, receiving average scores across the board on various tests including the Woodcock-Johnson Fourth Edition (WJ-IV) and the Clinical Evaluation of Language Fundamentals-5 (CELF-5). Stranger still is the fact that he aced Comprehensive Test of Phonological Processing, Second Edition (CTOPP-2), with flying colors, so he is not even eligible for a “dyslexia” diagnosis. Len is clearly struggling in the classroom with coherently expressing self, telling stories, understanding what he is reading, as well as putting his thoughts on paper. His parents have compiled impressively huge folders containing examples of his struggles. Yet because of his performance on the basic standardized assessment batteries, Len does not qualify for any functional assistance in the school setting, despite being virtually functionally illiterate in second grade.

The truth is that Len is quite a familiar figure to many SLPs, who at one time or another have encountered such a student and asked for guidance regarding the appropriate accommodations and services for him on various SLP-geared social media forums. But what makes Len such an enigma, one may inquire? Surely if the child had tangible deficits, wouldn’t standardized testing at least partially reveal them?

Well, it all depends really, on what type of testing was administered to Len in the first place. A few years ago I wrote a post entitled: “What Research Shows About the Functional Relevance of Standardized Language Tests“.  What researchers found is that there is a “lack of a correlation between frequency of test use and test accuracy, measured both in terms of sensitivity/specificity and mean difference scores” (Betz et al, 2012, 141). Furthermore, they also found that the most frequently used tests were the comprehensive assessments including the Clinical Evaluation of Language Fundamentals and the Preschool Language Scale as well as one-word vocabulary tests such as the Peabody Picture Vocabulary Test”. Most damaging finding was the fact that: “frequently SLPs did not follow up the comprehensive standardized testing with domain-specific assessments (critical thinking, social communication, etc.) but instead used the vocabulary testing as a second measure”.(Betz et al, 2012, 140)

In other words, many SLPs only use the tests at hand rather than the RIGHT tests aimed at identifying the student’s specific deficits. But the problem doesn’t actually stop there. Due to the variation in psychometric properties of various tests, many children with language impairment are overlooked by standardized tests by receiving scores within the average range or not receiving low enough scores to qualify for services.

Thus, “the clinical consequence is that a child who truly has a language impairment has a roughly equal chance of being correctly or incorrectly identified, depending on the test that he or she is given.” Furthermore, “even if a child is diagnosed accurately as language impaired at one point in time, future diagnoses may lead to the false perception that the child has recovered, depending on the test(s) that he or she has been given (Spaulding, Plante & Farinella, 2006, 69).”

There’s of course yet another factor affecting our hypothetical client and that is his relatively young age. This is especially evident with many educational and language testing for children in the 5-7 age group. Because the bar is set so low, concept-wise for these age-groups, many children with moderate language and literacy deficits can pass these tests with flying colors, only to be flagged by them literally two years later and be identified with deficits, far too late in the game.  Coupled with the fact that many SLPs do not utilize non-standardized measures to supplement their assessments, Len is in a pretty serious predicament.

But what if there was a do-over? What could we do differently for Len to rectify this situation? For starters, we need to pay careful attention to his deficits profile in order to choose appropriate tests to evaluate his areas of needs. The above can be accomplished via a number of ways. The SLP can interview Len’s teacher and his caregiver/s in order to obtain a summary of his pressing deficits. Depending on the extent of the reported deficits the SLP can also provide them with a referral checklist to mark off the most significant areas of need.

In Len’s case, we already have a pretty good idea regarding what’s going on. We know that he passed basic language and educational testing, so in the words of Dr. Geraldine Wallach, we need to keep “peeling the onion” via the administration of more sensitive tests to tap into Len’s reported areas of deficits which include: word-retrieval, narrative production, as well as reading and writing.

For that purpose, Len is a good candidate for the administration of the Test of Integrated Language and Literacy (TILLS), which was developed to identify language and literacy disorders, has good psychometric properties, and contains subtests for assessment of relevant skills such as reading fluency, reading comprehension, phonological awareness,  spelling, as well as writing  in school-age children.

Given Len’s reported history of narrative production deficits, Len is also a good candidate for the administration of the Social Language Development Test Elementary (SLDTE). Here’s why. Research indicates that narrative weaknesses significantly correlate with social communication deficits (Norbury, Gemmell & Paul, 2014). As such, it’s not just children with Autism Spectrum Disorders who present with impaired narrative abilities. Many children with developmental language impairment (DLD) (#devlangdis) can present with significant narrative deficits affecting their social and academic functioning, which means that their social communication abilities need to be tested to confirm/rule out presence of these difficulties.

However, standardized tests are not enough, since even the best-standardized tests have significant limitations. As such, several non-standardized assessments in the areas of narrative production, reading, and writing, may be recommended for Len to meaningfully supplement his testing.

Let’s begin with an informal narrative assessment which provides detailed information regarding microstructural and macrostructural aspects of storytelling as well as child’s thought processes and socio-emotional functioning. My nonstandardized narrative assessments are based on the book elicitation recommendations from the SALT website. For 2nd graders, I use the book by Helen Lester entitled Pookins Gets Her Way. I first read the story to the child, then cover up the words and ask the child to retell the story based on pictures. I read the story first because: “the model narrative presents the events, plot structure, and words that the narrator is to retell, which allows more reliable scoring than a generated story that can go in many directions” (Allen et al, 2012, p. 207).

As the child is retelling his story I digitally record him using the Voice Memos application on my iPhone, for a later transcription and thorough analysis.  During storytelling, I only use the prompts: ‘What else can you tell me?’ and ‘Can you tell me more?’ to elicit additional information. I try not to prompt the child excessively since I am interested in cataloging all of his narrative-based deficits. After I transcribe the sample, I analyze it and make sure that I include the transcription and a detailed write-up in the body of my report, so parents and professionals can see and understand the nature of the child’s errors/weaknesses.

Now we are ready to move on to a brief nonstandardized reading assessment. For this purpose, I often use the books from the Continental Press series entitled: Reading for Comprehension, which contains books for grades 1-8.  After I confirm with either the parent or the child’s teacher that the selected passage is reflective of the complexity of work presented in the classroom for his grade level, I ask the child to read the text.  As the child is reading, I calculate the correct number of words he reads per minute as well as what type of errors the child is exhibiting during reading.  Then I ask the child to state the main idea of the text, summarize its key points as well as define select text embedded vocabulary words and answer a few, verbally presented reading comprehension questions. After that, I provide the child with accompanying 5 multiple choice question worksheet and ask the child to complete it. I analyze my results in order to determine whether I have accurately captured the child’s reading profile.

Finally, if any additional information is needed, I administer a nonstandardized writing assessment, which I base on the Common Core State Standards for 2nd grade. For this task, I provide a student with a writing prompt common for second grade and give him a period of 15-20 minutes to generate a writing sample. I then analyze the writing sample with respect to contextual conventions (punctuation, capitalization, grammar, and syntax) as well as story composition (overall coherence and cohesion of the written sample).

The above relatively short assessment battery (2 standardized tests and 3 informal assessment tasks) which takes approximately 2-2.5 hours to administer, allows me to create a comprehensive profile of the child’s language and literacy strengths and needs. It also allows me to generate targeted goals in order to begin effective and meaningful remediation of the child’s deficits.

Children like Len will, unfortunately, remain unidentified unless they are administered more sensitive tasks to better understand their subtle pattern of deficits. Consequently, to ensure that they do not fall through the cracks of our educational system due to misguided overreliance on a limited number of standardized assessments, it is very important that professionals select the right assessments, rather than the assessments at hand, in order to accurately determine the child’s areas of needs.

References: