Recently, I’ve participated in various on-line and in-person discussions with both school-based speech language pathologists (SLPs) as well as medical health professionals (e.g., neurologists, pediatricians, etc.) regarding their views on the need of formal diagnosis for school aged children with suspected alcohol related deficits. While their responses differed considerably from: “we do not base intervention on diagnosis, but rather on demonstrated student need” to “with a diagnosis of ASD ‘these children’ would get the same level of services“, the message I was receiving loud and clear was: “Why? What would be the point?” So today I decided to share my views on this matter and explain why I think the diagnosis matters.
Continue reading Why is FASD diagnosis so important?
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Show me the Data or Why I Hate the Phrase: “It’s Not So Bad”
A 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.
This 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:
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:
- Phonemic Awareness
- Phonotactic Knowledge
- Rate
- Accuracy
- Fluency
- Vocabulary
- Comprehension
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!”
Adventures in Word-Finding or is Their Language Comprehension Really THAT Bad?
This summer I am taking an on-line course on word-finding with Dr. Diane German, and I must say, in addition to all the valuable information I have learned so far, this course has given me a brand new outlook on how to judge the language comprehension abilities of my clients with word finding difficulties. It all started with a simple task, to determine the language comprehension abilities of my client with word finding deficits. Based on available evidence I’ve collected over the period of time I’ve been working with him, I had determined that his comprehension was moderately impaired. I was then asked by Dr. German what language tasks I had used to make that determination? She also pointed out that many of the formal language comprehension tasks I’ve listed in my report required an oral response.
That question really got me thinking. The truth of the matter is that many formal tests and informal assessments that probe language comprehension abilities rely on learners oral responses. But as it had been pointed out to me, what of our clients with impaired oral skills or significant word retrieval deficits? Most of the time we judge their language comprehension based on the quality of the oral responses they produce, and if their answers are not to our satisfaction, we make sweeping judgments regarding their comprehension abilities, which as Dr. German rightfully pointed out “is the kiss of death” for learners with word finding difficulties and could potentially result in “a spiral of failure”.
Now, in the case of this particular client in question, his language comprehension abilities were truly moderately impaired. I knew that because I tested him by showing him pictures of situations and asked him questions, which did not rely on oral responses but on him selecting the correct answer from a series of pictures and written sentences.
However, had I not performed the above tasks and simply relied on the “language comprehension” subtests from popular standardized tests alone, I would not have had a defensible answer and would have had to admit that I had no clue whether his language comprehension was truly as impaired as I had described.
Following that discussion I decided to take a “fresh look” at the other expressively impaired clients on my caseload but first I needed to figure out which tasks truly assessed my clients’ language comprehension abilities. I didn’t just want to assess their listening skills and vocabulary knowledge (some of the more “easily” assessed non-verbal skills). I wanted to know whether their memory, problem solving skills, figurative language, perspective taking abilities or knowledge of multiple meaning words were actually better than I had originally judged.
Thus, I set out to compile language comprehension materials (formal or informal), which could be used to assess various aspects of language comprehension (multiple meaning words, problem solving abilities, etc) without relying on the child’s ability to produce verbal responses. However, this task turned out to be far more difficult than I had originally anticipated. For example, when I took a closer look at one of the more popular standardized tests available to me, such as the CELF-4, I realized that there were only two subtests on the first record form 5-8 years (“Concepts and Following Directions” and “Sentence Structure”) and 3 subtests on the second form 9-21 years (“Concepts & Following Directions”, “Sentence Assembly”, and “Semantic Relationships”) that relied on the listener’s ability to point to pictures or use written visuals to answer questions. Moreover, two of the subtests on the second record form (Sentence Assembly”, and “Semantic Relationships”) still required verbal responses. All other subtests testing “listening comprehension abilities” relied purely on oral responses for correct score determination.
As I reviewed other popular tests (TOLD, CASL, OWLS, etc) I quickly realized that few of these tests’ subtests actually satisfied the above requirement. Moreover, tests that actually did considerably rely on nonverbal responses (e.g., pointing) such as the Test for Auditory Comprehension of Language-3 (TACL-3) or the Test of Language Competence- Expanded Ed (TLC-Expanded Ed), were unfortunately not accessible to me at my place of work (although I did manage briefly to borrow both tests to assess some clients).
So, I decided to adapt some of the existing tests as well as create a few of my own materials to target language comprehension abilities in various areas. Surprisingly, it wasn’t as difficult as I imagined it to be, though some tasks did require more creativity than others.
The easiest of course were the assessment of receptive vocabulary for nouns, verbs, and adjectives which was accomplished via standardized testing and story comprehension for which I created picture answers for the younger children and written multiple choice responses for the older children. Assessment of synonyms and antonyms was also doable. I again printed out the relevant pictures and then presented them students. For example, to assess synonym knowledge the student was shown a relevant picture and asked to match it with another similar meaning word: “show me another word for “trail” (requires the student to point to a picture depicting “path”) or “show me another word for “flame” (requires the student to point to a picture depicting “fire”). For recognition of antonyms, the student was presented with pictures of both synonyms and antonyms and told: “show me the opposite of child” or “show me the opposite of happy” and so on.
To assess the student’s understanding of “Multiple Meanings” I borrowed the sentences from the Language Processing Test-3 Elementary (LPT-3E), and printed out a few pictures from the internet. So instead of asking the student to explain what “Rose” means in the following sentences: “Ask Rose to call me”, or “The sun rose over the mountains”, I asked the student to select and point to a corresponding picture from a group of visually related multiple meaning items. For some children, I also increased the complexity by presenting to them pictures which required attention to details in order to answer the question correctly (e.g., differentiating between boy and girl for the first picture or between actual sunrise and sun peeking through the clouds for the second picture). Similarly, to assess their problem solving abilities I again printed out pictures to go with select verbal reasoning questions: “Point to what you would do if …”; “Point to how you would solve the following situation…?”
I do have to admit that one of the more challenging subtests to adapt was the “Recalling Sentences” task. For that I ended up creating similar sounding sentences and asked the child to select the appropriate response given visual multiple choice answers (e.g., point to which sentence did I just say? “The tractor was followed by the bus?” “The bus was followed by the tractor?” “The tractor was followed by the bicycle.”
Again, the point of this exercise was not to prove that the learners’ comprehension skills were indeed impaired but rather to assess whether their comprehension was as significantly impaired as was originally judged. Well the truth of the matter was that most of the children I’ve reassessed using the “pure” auditory comprehension tasks ended up doing much better on these tasks than on those which required verbal responses.
To illustrate, here is a recent case example. I was working with one student on strengthening his knowledge of geography related core vocabulary words (names of the continents and the major bodies of water surrounding them). This boy had profound difficulty recalling the words even with maximal phonemic cues, after multiple sessions of drill instruction. Typically after he was shown a specific continent and asked to name it he produced a semantically related response (“South America” for “North America”, “Arctic” for “Antarctica”, etc), which appeared to indicate that his “knowledge” of the words was impaired or at least highly inconsistent. However, when the verbal naming task was completely eliminated and he was asked to show the examiner specifically named continents and bodies of water on a map (e.g., “Show me Europe”; “Show me Atlantic Ocean”, etc) he was able to do so with 90% accuracy over 3 trials indicating that he did have fairly solid knowledge of where each continent was located visually on a map.
Consequently, as Dr. German has rightly pointed out, when making judgment calls regarding language comprehension abilities of complex clients with severe or at least fairly involved expressive language difficulties, it is very important that SLP’s use tasks that require non verbal responses to questions (e.g., pointing, selecting a picture out of a group, etc), in order not to underestimate these children’s “true” comprehension abilities.
References and Resources:
German, D. J. (2009, Feb. 10). Child Word Finding: Student Voices Enlighten Us. The ASHA Leader, 14 (2), 10-13.
German, D.J. (2005) Word-Finding Intervention Program, Second Edition (WFIP-2) Austin Texas: Pro.Ed
German, D.J. (2001) It’s on the Tip of My Tongue, Word Finding Strategies to Remember Names and Words You Often Forget. Word Finding Materials, Inc.
Dr. German’s Word Finding Website: http://www.wordfinding.com/
Help, My Child is Receiving All These Therapies But It’s NOT Helping
On a daily basis I receive emails and messages from concerned parents and professionals, which read along these lines: “My child/student has been diagnosed with: dyslexia, ADHD, APD etc., s/he has been receiving speech, OT, vision, biofeedback, music therapies, etc. but nothing seems to be working.”
Up until now, I have been providing individualized responses to such queries, however, given the unnerving similarity of all the received messages, today I decided to write this post, so other individuals with similar concerns can see my response. Continue reading Help, My Child is Receiving All These Therapies But It’s NOT Helping
Spotlight on Syndromes: An SPLs Perspective on Monosomy 13q Syndrome
Today’s guest post on Monosomy 13q Syndrome is brought to you by the ever talented Maria Del Duca, M.S. CCC-SLP of Communication Station: Speech Therapy, PLLC, located in southern Arizona.
Overview: Also known as “13q Deletion Syndrome”, this is a chromosomal disorder that results in intellectual disabilities as well as congenital malformations of the skeleton, heart, brain and eyes. The causes of this syndrome can be hereditary or non-hereditary. When the long arm of chromosome 13 (labeled “q”) is missing/deleted or when both parts of chromosome 13 have been lost/deleted and have reconnected to form a ring (called “ring chromosome 13”), and the genetic mutation occurs before conception, during formation of the egg and sperm (gametes), this results in “monosomy 13q” (non-hereditary genetic mutation). However, there are times the cause is due to a parent carrier who passed down an inverted or translocated chromosome to the child subsequently resulting in a hereditary etiology. Risk of 13q Deletion Syndrome to occur in subsequent pregnancies is very low. If mother is the carrier, the risk is 10-15% and if the father is the carrier the risk is 2-4%. Continue reading Spotlight on Syndromes: An SPLs Perspective on Monosomy 13q Syndrome
Why ESL Doesn’t Fit: What Parents of Internationally Adopted Children Need to Know About Language Support
During my recent webinar, Navigating Language Development of Older International Adoptees (April 3, 2025), hosted by Holt International, one of the most frequently asked questions from parents was:
“Why shouldn’t my internationally adopted child attend ESL classes?”
It’s a reasonable question—and one I hear often from well-meaning parents and educators who want to ensure their adopted children receive the support they need. But this question also reveals a widespread misunderstanding about the language needs of post-institutionalized internationally adopted children.
This blog post is my response to that conversation—written for families, educators, and professionals who want to better understand why ESL services are not appropriate for internationally adopted children, and what to do instead.
If you weren’t able to attend the webinar live, the full recording will be available through Holt International’s educational webinar series. You can find it on their website HERE.
Let’s unpack why ESL isn’t the right fit—and what kinds of support internationally adopted children actually need to thrive.
Myth: “My child isn’t fluent in English, so ESL must help.”
Reality: Internationally adopted children are not bilingual learners.
Most ESL programs are designed for children who still use their native language at home and gradually acquire English in school. These kids are developing two languages at once and benefit from strategies that build on both.
But internationally adopted children? They experience something very different.
According to Gindis (2005; 2008), children adopted between ages 4–7 lose their birth language within just a few months of arriving in their new home. They’re immersed in English almost immediately—and their native language is rarely maintained because most adoptive families are monolingual.
So, they’re not truly bilingual. But they’re also not fully fluent in English yet. They’re in a unique in-between state that ESL programs aren’t designed to address.
ESL programs don’t target what IA children actually need
While ESL helps students bridge language barriers tied to cultural and home-language continuity, IA children are dealing with something else entirely: language deprivation and language loss.
Many older adoptees spent years in institutions with:
- Minimal one-on-one interaction
- Low language stimulation
- Unaddressed medical or developmental concerns
This means they’re not just “behind in English”—they often have underlying language delays or disorders that impact comprehension, expression, and even literacy (Scott, Roberts & Glennen, 2011; Desmarais, et al, 2012; Kornilov et al., 2019).
They sound fluent… but can’t keep up academically
A major source of confusion is that many IA kids sound great conversationally. They can talk about their favorite games, pets, or foods. But when it comes to classroom work—reading comprehension, writing essays, understanding abstract language—they start to struggle.
This happens because they develop Communicative Language Fluency (CLF) quickly—but take years to develop Cognitive Language Mastery (CLM), which is necessary for school success (Gindis, 2005).
So even if they “sound fluent,” they may:
- Misunderstand instructions
- Struggle with academic vocabulary
- Fall behind in reading and writing
- Feel overwhelmed and shut down in class
These are not second-language issues. They are language development issues that require specialized intervention.
So what should you do?
Instead of agreeing to an ESL placement, here’s how you can better support your child:
- Get a comprehensive speech-language evaluation—especially if your child had speech or language delays in their birth country, or came from an institutional background.
- Ask about school-based speech services—not ESL. Many IA children qualify under criteria for language disorders rather than language differences.
- Advocate for academic support that targets vocabulary, inferencing, grammar, and literacy.
- Monitor progress over time—some delays won’t show up until years later, especially as school demands increase (Glennen, 2009).
- Be aware of trauma and sensory history—many IA children also have social, emotional, and attentional challenges that impact language.
Bottom line
Your child may not need ESL. But they do need support.
If your internationally adopted child is struggling in school—even if they speak English well—don’t accept a “wait and see” approach. Push for a full language evaluation. Ask for help from a speech-language pathologist who understands adoption, trauma, and language loss. And most of all, trust your instincts.
Because these kids don’t just need English—they need someone who gets the whole picture.
References
- Desmarais, C., Roeber, B. J., Smith, M. E., & Pollak, S. D. (2012). Sentence comprehension in postinstitutionalized school-age children. Journal of Speech, Language, and Hearing Research, 55, 45–54.
- Elleseff, T. (2025, April 3). Navigating language development of older international adoptees [Webinar presentation]. Holt International.
- Gindis, B. (2005). Cognitive, language, and educational issues of children adopted from overseas orphanages. Journal of Cognitive Education and Psychology, 4, 290–315.
- Gindis, B. (2008). Abrupt native language loss in international adoptees. Advance Healthcare Network for Speech/Language Pathologists and Audiologists, 18(51), 5.
- Glennen, S. (2009). Speech and language guidelines for children adopted from abroad at older ages. Topics in Language Disorders, 29(1), 50–64.
- Kornilov, S. A., Zhukova, M. A., Ovchinnikova, I. V., & Grigorenko, E. L. (2019). Language outcomes in adults with a history of institutionalization: Behavioral and neurophysiological characterization. Scientific Reports, 9, 4252.
- Scott, K. A., Roberts, J. A., & Glennen, S. (2011). How well do children who are internationally adopted acquire language? A meta-analysis. Journal of Speech, Language, and Hearing Research, 54(4), 1153–1169.
Birthday Month Extravaganza: Last Days Giveaway Lineup
My birthday month has been great! But all good things must come to an end! So take a look at the Last Days Giveaway Lineup and decide whether you want to enter just one giveaway or all of them, it’s really up to you! Each giveaway will last only one day so you better keep up because if you blink you’ll miss it!
Birthday Month Extravaganza: Week Four Giveaway Lineup
My birthday month has been absolutely fabulous! And its not over yet! So take a look at the Week Four Giveaway Lineup and decide whether you want to enter a few giveaways or all of them, it’s really up to you! Each giveaway will last only one day so you better keep up because if you blink you’ll miss it!
Birthday Month Extravaganza: Week Two Giveaway Lineup
In case you haven’t read my previous post on this topic, my birthday is in October so I decided that it will be fun to give away one product every day of the month (well almost). My SLP colleague bloggers and TPT sellers thought the same, so they donated many exciting materials and products for me to give away all throughout the month of October.
Every 7 days I will be posting a schedule of giveaway products as a jpeg with embedded pdf file containing links to the donor’s blog and product being given away so you’ll know in advance which giveaway you’d like to enter.
Below is a WEEK TWO lineup. Take a look at the posted schedule and decide whether you want to enter a few giveaways or all of them, it’s really up to you! Each giveaway will last only one day so you better keep up because if you blink you’ll miss it!
Birthday Month Extravaganza: Week One Giveaway Lineup
My birthday is in October so I decided that it will be fun to give away one product every day of the month (well almost). My SLP colleague bloggers and TPT sellers thought the same, so they donated many exciting materials and products for me to give away all throughout the month of October.
So every 7 days I will be posting a schedule of giveaway products as a jpeg with embedded pdf file containing links to the blog and product being given away so you’ll have a lead on which giveaway you’d like to enter. You can enter a few or you can enter them all, it’s really up to you! Each giveaway will last only one day so you better keep up because if you blink you’ll miss it!