Author: Tatyana Elleseff

Tatyana Elleseff MA CCC-SLP is a bilingual speech-language pathologist who specializes in working with multicultural, internationally & domestically adopted as well as at-risk children with complex communication disorders in a hospital, school, and private practice settings. She has been published in several magazines including Adoption Today, Adoption Advocate, Advance for Speech Language Pathologists as well as ASHA Perspectives on School-Based and Global Issues. She has also presented for a number of medical, academic and non-profit organizations as well as speech language hearing associations including Speechpathology.com, American Academy of Pediatrics: Council on Foster Care, Adoption and Kinship, New Jersey Taskforce on Child Abuse and Neglect, New Jersey, Long Island, Pennsylvania, Mississippi, Wayne County, and Illinois Speech-Language-Hearing Associations, New York City Department of Education, Greenwich Public Schools, Speech-Language & Audiology Canada as well as North American Council on Adoptable Children (NACAC).

Posted on April 28, 2016January 5, 2022 by Tatyana Elleseff — 6 Comments

Intervention at the Last Moment or Why We Need Better Preschool Evaluations

“Well, the school did their evaluations and he doesn’t qualify for services” tells me a parent of a 3.5 year old, newly admitted private practice client. “I just don’t get it” she says bemusedly, “It is so obvious to anyone who spends even 10 minutes with him that his language is nowhere near other kids his age!” “How can this happen?” she asks frustratedly?

This parent is not alone in her sentiment. In my private practice I frequently see preschool children with speech language impairments who for all intents and purposes should have qualified for preschool- based speech language services but do not due to questionable testing practices.

To illustrate, several years ago in my private practice, I started seeing a young preschool girl, 3.2 years of age. Just prior to turning 3, she underwent a collaborative school-based social, psychological, educational, and speech language evaluation. The 4 combined evaluators from each field only used one standardized assessment instrument “The Battelle Developmental Inventory – Second Edition (BDI-2)” along with a limited ‘structured observation’, without performing any functional or dynamic assessments and found the child to be ineligible for services on account of a low average total score on the BDI-2.

However, during the first session working 1:1 with this client at the age of 3.2 a number of things became very apparent. The child had very limited highly echolalic verbal output primarily composed of one-word utterances and select two-word phrases. She had highly limited receptive vocabulary and could not consistently point to basic pictures denoting common household objects and items (e.g., chair, socks, clock, sun, etc.) Similarly, expressively she exhibited a number of inconsistencies when labeling simple nouns (e.g., called tree a flower, monkey a dog, and sofa a chair, etc.) Clearly this child’s abilities were nowhere near age level, so how could she possibly not qualify for preschool based services?

Further work with the child over the next several years yielded slow, labored, and inconsistent gains in the areas of listening, speaking, and social communication. I’ve also had a number of concerns regarding her intellectual abilities that I had shared with the parents. Finally, two years after preschool eligibility services were denied to this child, she underwent a second round of re-evaluations with the school district at the age of 5.2.

This time around she qualified with bells on! The same speech language pathologist and psychologist who assessed her first time around two years ago, now readily documented significant communication (Preschool Language Scale-5-PLS-5 scores in the 1st % of functioning) and cognitive deficits (Full Scale Intelligence Quotient-FSIQ in low 50’s).

Here is the problem though. This is not a child who had suddenly regressed in her abilities. This is a child who actually had improved her abilities in all language domains due to private language therapy services. Her deficits very clearly existed at the time of her first school-based assessment and had continued to persist over time. For the duration of two years this child could have significantly benefited from free and appropriate education in school setting, which was denied to her due to highly limited preschool assessment practices.

Today, I am writing this post to shed light on this issue, which I’m pretty certain is not just confined to the state of New Jersey. I am writing this post not simply to complain but to inform parents and educators alike on what actually constitutes an appropriate preschool speech-language assessment.

As per NJAC 6A:14-2.5 Protection in evaluation procedures (pgs. 29-30)

(a) In conducting an evaluation, each district board of education shall:

Use a variety of assessment tools and strategies to gather relevant functional and developmental information, including information:
Provided by the parent that may assist in determining whether a child is a student with a disability and in determining the content of the student’s IEP; and
Related to enabling the student to be involved in and progress in the general education curriculum or, for preschool children with disabilities, to participate in appropriate activities;
Not use any single procedure as the sole criterion for determining whether a student is a student with a disability or determining an appropriate educational program for the student; and
Use technically sound instruments that may assess the relative contribution of cognitive and behavioral factors, in addition to physical or developmental factors.

Furthermore, according to the New Special Education Code: N.J.A.C. 6A:14-3.5(c)10 (please refer to your state’s eligibility criteria to find similar guidelines) the eligibility of a “preschool child with a disability” applies to any student between 3-5 years of age with an identified disabling condition adversely affecting learning/development (e.g., genetic syndrome), a 33% delay in one developmental area, or a 25% percent delay in two or more developmental areas below :

Physical, including gross/fine motor and sensory (vision and hearing)
Intellectual
Communication
Social/emotional
Adaptive

These delays can be receptive (listening) or expressive (speaking) and need not be based on a total test score but rather on all testing findings with a minimum of at least two assessments being performed. A determination of adverse impact in academic and non-academic areas (e.g., social functioning) needs to take place in order for special education and related services be provided. Additionally, a delay in articulation can serve as a basis for consideration of eligibility as well.

Moreover, according to the State Education Agencies Communication Disabilities Council (SEACDC) Consulatent for NJ – Fran Liebner, the BDI-2 is not the only test which can be used to determine eligibility, since the nature and scope of the evaluation must be determined based on parent, teacher and IEP team feedback.

In fact, New Jersey’s Special Education Code, N.J.A.C. 6A:14 prescribes no specific test in its eligibility requirements. While it is true that for NJ districts participating in Indicator 7 (Preschool Outcomes) BDI-2 is a required collection tool it does NOT preclude the team from deciding what other diagnostic tools are needed to assess all areas of suspected disability to determine eligibility.

Speech pathologists have many tests available to them when assessing young preschool children 2 to 6 years of age.

SELECT SPEECH PATHOLOGY TESTS FOR PRESCHOOL CHILDREN (2-6 years of age)

Articulation:

Sunny Articulation Test (SAPT)** Ages: All (nonstandardized)
Clinical Assessment of Articulation and Phonology-2 (CAAP-2) Ages: 2.6+
Linguisystems Articulation Test (LAT) Ages: 3+
Goldman Fristoe Test of Articulation-3 (GFTA-3) Ages: 2+

Fluency:

Stuttering Severity Instrument -4 (SSI-4) Ages: 2+
Test of Childhood Stuttering (TOCS) Ages 4+

General Language:

Preschool Language Assessment Instrument-2 (PLAI-2) Ages: 3+
Clinical Evaluation of Language Fundamentals -Preschool 2 (CELF-P2) Ages: 3+
Test of Early Language Development, Third Edition (TELD-3) Ages: 2+
Test of Auditory Comprehension of Language Third Edition (TACL-4) Ages: 3+
Preschool Language Scale-5 (PLS-5)* (use with extreme caution) Ages: Birth-7:11

Vocabulary

Receptive One-Word Picture Vocabulary Test-4 (ROWPVT-4) Ages 2+
Expressive One-Word Picture Vocabulary Test-4 (EOWPVT-4) Ages 2+
Montgomery Assessment of Vocabulary Acquisition (MAVA) 3+
Test of Word Finding-3 (TWF-3) Ages 4.6+

Auditory Processing and Phonological Awareness

Auditory Skills Assessment (ASA) Ages 3:6+
Test of Auditory Processing Skills-3 (TAPS-3) Ages 4+
Comprehensive Test of Phonological Processing-2 (CTOPP-2) Ages 4+

Pragmatics/Social Communication

Language Use Inventory LUI (O’Neil, 2009) Ages 18-47 months
Children’s Communication Checklist-2 (CCC-2) (Bishop, 2006) Ages 4+

In addition to administering standardized testing SLPs should also use play scales (e.g., Westby Play Scale, 1980) to assess the given child’s play abilities. This is especially important given that “play—both functional and symbolic has been associated with language and social communication ability.” (Toth, et al, 2006, pg. 3)

Finally, by showing children simple wordless picture books, SLPs can also obtain of wealth of information regarding the child’s utterance length, as well as narrative abilities ( a narrative assessment can be performed on a verbal child as young as two years of age).

Comprehensive school-based speech-language assessments should be the norm and not an exception when determining preschoolers eligibility for speech language services and special education classification.

Consequently, let us ensure that our students receive fair and adequate assessments to have access to the best classroom placements, appropriate accommodations and modifications as well as targeted and relevant therapeutic services. Anything less will lead to the denial of Free Appropriate Public Education (FAPE) to which all students are entitled to!

Helpful Smart Speech Therapy Resources Pertaining to Preschoolers:

Posted on April 18, 2016March 12, 2022 by Tatyana Elleseff — 9 Comments

Why Are My Child’s Test Scores Dropping?

“I just don’t understand,” says a parent bewilderingly, “she’s receiving so many different therapies and tutoring every week, but her scores on educational, speech-language, and psychological testing just keep dropping!”

I hear a variation of this comment far too frequently in both my private practice as well as outpatient school in hospital setting, from parents looking for an explanation regarding the decline of their children’s standardized test scores in both cognitive (IQ) and linguistic domains. That is why today I wanted to take a moment to write this blog post to explain a few reasons behind this phenomenon.

Children with language impairments represent a highly diverse group, which exists along a continuum. Some children’s deficits may be mild while others far more severe. Some children may receive very little intervention services and thrive academically, while others can receive inordinate amount of interventions and still very limitedly benefit from them. To put it in very simplistic terms, the above is due to two significant influences – the interaction between the child’s (1) genetic makeup and (2) environmental factors.

There is a reason why language disorders are considered developmental. Firstly, these difficulties are apparent from a young age when the child’s language just begins to develop. Secondly, the trajectory of the child’s language deficits also develops along with the child and can progress/lag based on the child’s genetic predisposition, resiliency, parental input, as well as schooling and academically based interventions.

Let us discuss some of the reasons why standardized testing results may decline for select students who are receiving a variety of support services and interventions.

Ineffective Interventions due to Misdiagnosis

Sometimes, lack of appropriate/relevant intervention provision may be responsible for it. Let’s take an example of a misdiagnosis of alcohol related deficits as Autism, which I have frequently encountered in my private practice, when performing second opinion testing and consultations. Unfortunately, the above is not uncommon. Many children with alcohol-related impairments may present with significant social emotional dysregulation coupled with significant externalizing behavior manifestations. As a result, without a thorough differential diagnosis they may be frequently diagnosed with ASD and then provided with ABA therapy services for years with little to no benefit.

Ineffective Interventions due to Lack of Comprehensive Testing

Let us examine another example of a student with average intelligence but poor reading performance. The student may do well in school up to certain grade but then may begin to flounder academically. Because only the student’s reading abilities ‘seem’ to be adversely impacted, no comprehensive language and literacy evaluations are performed. The student may receive undifferentiated extra reading support in school while his scores may continue to drop.

Once the situation ‘gets bad enough’, the student’s language and literacy abilities may be comprehensively assessed. In a vast majority of situations these type of assessments yield the following results:

The student’s oral language expression as well as higher order language abilities are adversely affected and require targeted language intervention
The undifferentiated reading intervention provided to the student was NOT targeting actual areas of weaknesses

As can be seen from above examples, targeted intervention is hugely important and, in a number of cases, may be responsible for the student’s declining performance. However, that is not always the case.

What if it was definitively confirmed that the student was indeed diagnosed appropriately and was receiving quality services but still continued to decline academically. What then?

Well, we know that many children with genetic disorders (Down Syndrome, Fragile X, etc.) as well as intellectual disabilities (ID) can make incredibly impressive gains in a variety of developmental areas (e.g., gross/fine motor skills, speech/language, socio-emotional, ADL, etc.) but their gains will not be on par with peers without these diagnoses.

The situation becomes much more complicated when children without ID (or with mild intellectual deficits) and varying degrees of language impairment, receive effective therapies, work very hard in therapy, yet continue to be perpetually behind their peers when it comes to making academic gains. This occurs because of a phenomenon known as Cumulative Cognitive Deficit (CCD).

The Effect of Cumulative Cognitive Deficit (CCD) on Academic Performance

According to Gindis (2005) CCD “refers to a downward trend in the measured intelligence and/or scholastic achievement of culturally/socially disadvantaged children relative to age-appropriate societal norms and expectations” (p. 304). Gindis further elucidates by quoting Satler (1992): “The theory behind cumulative deficit is that children who are deprived of enriching cognitive experiences during their early years are less able to profit from environmental situations because of a mismatch between their cognitive schemata and the requirements of the new (or advanced) learning situation” (pp. 575-576).

So who are the children potentially at risk for CCD?

One such group are internationally (and domestically) adopted as well as foster care children. A number of studies show that due to the early life hardships associated with prenatal trauma (e.g., maternal substance abuse, lack of adequate prenatal care, etc.) as well as postnatal stress (e.g., adverse effect of institutionalization), many of these children have much poorer social and academic outcomes despite being adopted by well-to-do, educated parents who continue to provide them with exceptional care in all aspects of their academic and social development.

Another group, are children with diagnosed/suspected psychiatric impairments and concomitant overt/hidden language deficits. Depending on the degree and persistence of the psychiatric impairment, in addition to having intermittent access to classroom academics and therapy interventions, the quality of their therapy may be affected by the course of their illness. Combined with sporadic nature of interventions this may result in them falling further and further behind their peers with respect to social and academic outcomes.

A third group (as mentioned previously) are children with genetic syndromes, neurodevelopmental disorders (e.g., Autism) and intellectual disabilities. Here, it is very important to explicitly state that children with diagnosed or suspected alcohol related deficits (FASD) are particularly at risk due to the lack of consensus/training regarding FAS detection/diagnosis. Consequently, these children may evidence a steady ‘decline’ on standardized testing despite exhibiting steady functional gains in therapy.

Brief Standardized Testing Score Tutorial:

When we look at norm-referenced testing results, score interpretation can be quite daunting. For the sake of simplicity, I’d like to restrict this discussion to two types of scores: raw scores and standard scores.

The raw score is the number of items the child answered correctly on a test or a subtest. However, raw scores need to be interpreted to be meaningful. For example, a 9 year old student can attain a raw score of 12 on a subtest of a particular test (e.g., Listening Comprehension Test-2 or LCT-2). Without more information, the raw score has no meaning. If the test consisted of 15 questions, a raw score of 12 would be an average score. Alternatively, if the subtest had 36 questions, a raw score of 12 would be significantly below-average (e.g., Test of Problem Solving-3 or TOPS-3).

Consequently, the raw score needs to be converted to a standard score. Standard scores compare the student’s performance on a test to the performance of other students his/her age. Many standardized language assessments have a mean of 100 and a standard deviation of 15. Thus, scores between 85 and 115 are considered to be in the average range of functioning.

Now lets discuss testing performance variation across time. Let’s say an 8.6 year old student took the above mentioned LCT-2 and attained poor standard scores on all subtests. That student qualifies for services and receives them for a period of one year. At that time the LCT-2 is re-administered once again and much to the parents surprise the student’s standard scores appear to be even lower than when he had taken the test as an eight year old (illustration below).

Results of The Listening Comprehension Test -2 (LCT-2): Age: 8:4

Subtests	Raw Score	Standard Score	Percentile Rank	Description
Main Idea	5	67	2	Severely Impaired
Details	2	63	1	Severely Impaired
Reasoning	2	69	2	Severely Impaired
Vocabulary	0	Below Norms	Below Norms	Profoundly Impaired
Understanding Messages	0	<61	<1	Profoundly Impaired
Total Test Score	9	<63	1	Profoundly Impaired

(Mean = 100, Standard Deviation = +/-15)

Results of The Listening Comprehension Test -2 (LCT-2): Age: 9.6

Subtests	Raw Score	Standard Score	Percentile Rank	Description
Main Idea	6	60	0	Severely Impaired
Details	5	66	1	Severely Impaired
Reasoning	3	62	1	Severely Impaired
Vocabulary	4	74	4	Moderately Impaired
Understanding Messages	2	54	0	Profoundly Impaired
Total Test Score	20	<64	1	Profoundly Impaired

(Mean = 100, Standard Deviation = +/-15)

However, if one looks at the raw score column on the far left, one can see that the student as a 9 year old actually answered more questions than as an 8 year old and his total raw test score went up by 11 points.

The above is a perfect illustration of CCD in action. The student was able to answer more questions on the test but because academic, linguistic, and cognitive demands continue to steadily increase with age, this quantitative improvement in performance (increase in total number of questions answered) did not result in qualitative improvement in performance (increase in standard scores).

In the first part of this series I have introduced the concept of Cumulative Cognitive Deficit and its effect on academic performance. Stay tuned for part II of this series which describes what parents and professionals can do to improve functional performance of students with Cumulative Cognitive Deficit.

References:

Bowers, L., Huisingh, R., & LoGiudice, C. (2006). The Listening Comprehension Test-2 (LCT-2). East Moline, IL: LinguiSystems, Inc.
Bowers, L., Huisingh, R., & LoGiudice, C. (2005). The Test of Problem Solving 3-Elementary (TOPS-3). East Moline, IL: LinguiSystems.
Gindis, B. (2005). Cognitive, language, and educational issues of children adopted from overseas orphanages. Journal of Cognitive Education and Psychology, 4 (3): 290-315.
Sattler, J. M. (1992). Assessment of Children. Revised and updated 3rd edition. San Diego: Jerome M. Sattler.

Posted on April 1, 2016January 5, 2022 by Tatyana Elleseff — 5 Comments

Test Review: Test of Written Language-4 (TOWL-4)

Today due to popular demand I am reviewing The Test of Written Language-4 or TOWL-4. TOWL-4 assesses the basic writing readiness skills of students 9:00-17:11 years of age. The tests consist of two forms – A and B, (which contain different subtest content).

According to the manual, the entire test takes approximately 60-90 minutes to administer and examines 7 skill areas. Only the “Story Composition” subtest is officially timed (the student is given 15 minutes to write it and 5 minutes previous to that, to draft it). However, in my experience, each subtest administration, even with students presenting with mild-moderately impaired writing abilities, takes approximately 10 minutes to complete with average results (can you see where I am going with this yet?)

For detailed information regarding the TOWL-4 development and standardization, validity and reliability, please see HERE. However, please note that the psychometric properties of this test are weak.

Below are my impressions (to date) of using this assessment with students between 11-14 years of age with (known) mild-moderate writing impairments.

Subtests:

1. Vocabulary – The student is asked to write a sentence that incorporates a stimulus word. The student is not allowed to change the word in any way, such as write ‘running’ instead of run’. If this occurs, an automatic loss of points takes place. The ceiling is reached when the student makes 3 errors in a row. While some of the subtest vocabulary words are perfectly appropriate for younger children (~9), the majority are too simplistic to assess the written vocabulary of middle and high schoolers. These words may work well to test the knowledge of younger children but they do not take into the account the challenging academic standards set forth for older students. As a result, students 11+ years of age may pass this subtest with flying colors but still present with a fair amount of difficulty using sophisticated vocabulary words in written compositions.

2/3. Spelling and Punctuation (subtests 2 and 3). These two subtests are administered jointly but scored separately. Here, the student is asked to write sentences dictated by the examiner using appropriate rules for spelling and punctuation and capitalization. Ceiling for each subtest is reached separately. It occurs when the student makes 3 errors in a row in each of the subtests. In other words, if a student uses correct punctuation but incorrect spelling, his/her ceiling on the ‘Spelling’ subtest will be reached sooner then on the ‘Punctuation’ subtest and vise versa. Similar to the ‘Vocabulary‘ subtest I feel that the sentences the students are asked to write are far too simplistic to showcase their “true” grade level abilities.

The requirements of these subtests are also not too stringent. The spelling words are simple and the punctuation requirements are very basic: a question mark here, an exclamation mark there, with a few commas in between. But I was particularly disappointed with the ‘Spelling‘ subtest. Here’s why. I have a 6th-grade client on my caseload with significant well-documented spelling difficulties. When this subtest was administered to him he scored within the average range (Scaled Score of 8 and Percentile Rank of 25). However, an administration of Spelling Performance Evaluation for Language and Literacy – SPELL-2, yielded 3 assessment pages of spelling errors, as well as 7 pages of recommendations on how to remediate those errors. Had he received this assessment as part of an independent evaluation from a different examiner, nothing more would have been done regarding his spelling difficulties since the TOWL-4 revealed an average spelling performance due to its focus on overly simplistic vocabulary.

4. Logical Sentences – The student is asked to edit an illogical sentence so that it makes better sense. Ceiling is reached when the student makes 3 errors in a row. Again I’m not too thrilled with this subtest. Rather than truly attempting to ascertain the student’s grammatical and syntactic knowledge at sentence level a large portion of this subtest deals with easily recognizable semantic incongruities.

5. Sentence Combining – The student integrates the meaning of several short sentences into one grammatically correct written sentence. Ceiling is reached when the student makes 3 errors in a row. The first few items contain only two sentences which can be combined by adding the conjunction “and”. The remaining items are a bit more difficult due to the a. addition of more sentences and b. increase in the complexity of language needed to efficiently combine them. This is a nice subtest to administer to students who present with difficulty effectively and efficiently expressing their written thoughts on paper. It is particularly useful with students who write down a lot of extraneous information in their compositions/essays and frequently overuse run-on sentences.

6. Contextual Conventions – The student is asked to write a story in response to a stimulus picture. S/he earn points for satisfying specific requirements relative to combined orthographic (E.g.: punctuation, spelling) and grammatical conventions (E.g.: sentence construction, noun-verb agreement). The student’s written composition needs to contain more than 40 words in order for the effective analysis to take place.

The scoring criteria ranges from no credit or a score of 0 ( based on 3 or more mistakes), to partial credit, a score of 1 (based on 1-2 mistakes) to full a credit – a score of 3 (no mistakes). There are 21 scoring parameters which are highly useful for younger elementary-aged students who may exhibit significant difficulties in the domain of writing. However, older middle school and high-school aged students as well as elementary aged students with moderate writing difficulties may attain average scoring on this subtest but still present with significant difficulties in this area as compared to typically developing grade level peers. As a result, in addition to this assessment, it is recommended that a functional assessment of grade-level writing also be performed in order to accurately identify the student’s writing needs.

7. Story Composition – The student’s story is evaluated relative to the quality of its composition (E.g.: vocabulary, plot, development of characters, etc.). The examiner first provides the student with an example of a good story by reading one written by another student. Then, the examiner provides the student with an appropriate picture card and tell them that they need to take time to plan their story and make an outline on the (also provided) scratch paper. The student has 5 minutes to plan before writing the actual story. After the 5 minutes, elapses they 15 minutes to write the story. It is important to note that story composition is the very first subtest administered to the student. Once they complete it they are ready to move on to the Vocabulary subtest. There are 11 scoring parameters that are significantly more useful for me to use with younger students as well as significantly impaired students vs. older students or students with mild-moderate writing difficulties. Again if your aim is to get an accurate picture of the older students writing abilities I definitely recommend the usage of clinical writing assessment rubrics based on the student’s grade level in order to have an accurate picture of their abilities.

OVERALL IMPRESSIONS:

Strengths:

A thorough assessment of basic writing areas for very severely impaired students with writing deficits
Flexible subtest administration (can be done on multiple occasions with students who fatigue easily)

Limitations:

Untimed testing administration (with the exception of story composition subtests) is NOT functional with students who present with significant processing difficulties. One 12-year-old student actually took ~40 minutes to complete each subtest.
Primarily useful for students with severe deficits in the area of written expression
Not appropriate for students with mild-moderate needs (requires suplementation)
Lack of remediation suggestions based on subtest deficits
Weak psychometric properties

Overall, TOWL-4 can be a useful testing measure for ruling out weaknesses in the student’s basic writing abilities, with respect to simple vocabulary, sentence construction, writing mechanics, punctuation, etc. If I identify previously unidentified gaps in basic writing skills I can then readily intervene, where needed, if needed. However, it is important to understand that the TOWL-4 is only a starting point for most of our students with complex literacy needs whose writing abilities are above severe level of functioning. Most students with mild-moderate writing difficulties will pass this test with flying colors but still present with significant writing needs. As a result I highly recommend a functional grade-level writing assessment as a supplement to the above-standardized testing.

References:

Hammill, D. D., & Larson, S. C. (2009). Test of Written Language—Fourth Edition. (TOWL-4). Austin, TX: PRO-ED.

Disclaimer: The views expressed in this post are the personal impressions of the author. This author is not affiliated with PRO-ED in any way and was NOT provided by them with any complimentary products or compensation for the review of this product.

Posted on March 28, 2016January 5, 2022 by Tatyana Elleseff — 1 Comment

Assessing Behaviorally Impaired Students: Why Background History Matters!

As a speech language pathologist (SLP) who works in an outpatient psychiatric school-based setting, I frequently review incoming students previous speech language evaluation reports. There are a number of trends I see in these reports which I have written about in the past as well as planned on writing about in the future.

For example, in the past I wrote about my concern regarding the lack of adequate or even cursory social communication assessments for students with documented psychiatric impairments and emotional behavioral deficits.

This leads many professionals to do the following:

a. Miss vital assessment elements which denies students appropriate school based services and

b. Assume that the displayed behavioral challenges are mere results of misbehaving.

Today however I wanted express my thoughts regarding another disturbing trend I see in numerous incoming speech-language reports in both outpatient school/hospital setting as well as in private practice – and that is lack of background information in the students assessment reports.

Despite its key role in assessment, this section is frequently left bare. Most of the time it contains only the information regarding the students age and grade levels as well as the reasons for the referral (e.g., initial evaluation, triennial evaluation). Some of the better reports will include cursory mention of the student’s developmental milestones but most of the time information will be sorely lacking.

Clearly this problem is not just prevalent in my incoming assessment reports. I frequently see manifestations of it in a variety of speech pathology related social media forums such as Facebook. Someone will pose a question regarding how to distinguish a _____ from ____ (e.g., language difference vs. language disorder, behavioral noncompliance vs. social communication deficits, etc.) yet when they’re questioned further many SLPs will admit that they are lacking any/most information regarding the students background history.

When questioned regarding the lack of this information, many SLPs get defensive. They cite a variety of reasons such as lack of parental involvement (“I can’t reach the parents”), lack of access to records (“it’s a privacy issue”), division of labor (e.g., “it’s the social worker’s responsibility and not mine to obtain this information”) as well as other justifications why this information is lacking.

Now, I don’t know about you, but one of my earliest memories of the ‘diagnostics’ class in graduate school involved collecting data and writing comprehensive ‘Background Information’ section of the report. I still remember multiple professors imparting upon me the vital importance is this section plays in the student’s evaluation report.

Indeed, many years later, I clearly see its vital role in assessment. Unearthing the student’s family history, developmental milestones, medical/surgical history, as well as history of past therapies is frequently the key to a successful diagnosis and appropriate provision of therapy services. This is the information that frequently plays a vital role in subsequent referrals of “mystery” cases to relevant health professionals as well as often leads to resolution of particularly complicated diagnostic puzzles.

Of course I understand that frequently there are legitimate barriers to obtaining this information. However, I also know that if one digs deep enough one will frequently find the information they’re seeking despite the barriers. To illustrate, at the psychiatric hospital level where I work, I frequently encounter a number of barriers to accessing the student’s background information during the assessment process. This may include parental language/education barrier, parental absence, Division of Child Protective Services involvement, etc. Yet I always try to ensure that my reports contain all the background information that I’m able to unearth because I know how vitally important it is for the student in question.

In the past I have been able to use the student’s background information to make important discoveries, which were otherwise missed by other health professionals. This included undocumented history of traumatic brain injuries, history of language and literacy disabilities in the family, history of genetic disorders and/or intellectual disabilities in the family, history of maternal alcohol abuse during pregnancy, and much much more.

So what do I consider to be an adequate Background History section of the assessment report?

For starters, the basics, of course.

I begin by stating the child’s age and grade levels, who referred the child (and for what reason), as well as whether the child previously received any form of speech language assessment/therapy services in the past.

If I am preforming a reassessment (especially if it happens shortly after the last assessment took place) I provide a clear justification why the present reassessment is taking place. Here is an actual excerpt from one of my reevaluation reports. “Despite receiving average language scores on his _______ speech language testing which resulted in the recommendation for speech therapy only, upon his admission to ______, student was referred for a language reassessment in _____, by the classroom staff who expressed significant concerns regarding validity and reliability of past speech and language testing on the ground of the student’s persistent “obvious” listening comprehension and verbal expression deficits.”

For those of you in need of further justification I’ve created a brief list of reasons why a reassessment, closely following recent testing may be needed.

SLP/Parent feels additional testing is needed to create comprehensive goals for child.
Previous testing was inadequate. Here it’s very important to provide comprehensive rationale and list the reasons for it.
A reevaluation was requested due to third party concerns (e.g., psychiatrist, psychologist, etc.)

Secondly, it is important to document all relevant medical history, which includes: prenatal, perinatal, and early childhood diseases, surgical interventions and incidents. It is important to note that if a child has a long standing history of documented psychiatric difficulties, you may want to separate these sections and describe psychiatric history/diagnoses following the section that details the onset of the child’s emotional and behavioral deficits.

Let us now move on to the child’s developmental history, which should include, gross/fine motor, speech/ language milestones, and well as cognitive and socioemotional functioning. This is a section where I typically add information regarding any early intervention services which may have been provided to the child prior to the age of three.

In my next section I discuss the child’s academic functioning to date. Here I mention whether the student qualified for a preschool disabled eligibility category and received services from the age of 3+. I also discuss their educational classification (if one exists), briefly mention the results of previous most recent cognitive and educational testing (if available) as well as mention any academic struggles (if applicable).

After that I move on to the child’s psychiatric history. I briefly document when did the emotional behavioral problems first arose, and what had been done about them to date (out of district placements, variety of psychiatric services, etc.) Here I also document the student’s most recent psychiatric diagnoses (if available) and mention any medication they may be currently on (applicable due to the effect of psychiatric medications on language and memory skills).

The following section is perhaps the most important one in the report. It is the family’s history of genetic disorders, psychiatric impairments, special education placements, as well as language, learning, and literacy deficits. This section plays a vital importance in my determination of the contributions to the student’s language difficulties as well as guides my assessment recommendations in the presence of borderline assessment results.

I finish this section by briefly discussing the student’s Family Composition as well as Language Knowledge and Use.

I discuss family composition due to several factors. For example, lack of consistent caregivers, prolonged absence of parental figures, as well as presence of a variety of people in the home can serve as significant stressor for children with psychiatric impairments and learning difficulties. As a result of this information is pertinent to the report especially when it comes to figuring out the antecedents for the child’s behavior fluctuation on daily basis.

Language knowledge and use is particularly relevant to culturally and linguistically diverse children. It is very important to understand what languages does the child understand and use at home and at school as well as what do the parents think about the child’s language abilities in both languages. These factors will guide my decision making process regarding what type of assessments would be most relevant for this child.

So there you have it. This is the information I include in the background history section of every single one of my reports. I believe that this information contributes to the making of the appropriate and accurate diagnosis of the child’s difficulties.

Please don’t get me wrong. This information is hugely relevant for all students that we SLPs are assessing.

However, the above is especially relevant for such vulnerable populations as children with emotional and behavioral disturbances, whose struggle with social communication is frequently misinterpreted as “it’s just behavior“. As a result, they are frequently denied social communication therapy services, which ultimately leads to denial of Free Appropriate Public Education (FAPE) that they are entitled to.

Let us ensure that this does not happen by doing all that we can to endure that the student receives a fair assessment, correct diagnosis, and can have access to the best classroom placement, appropriate accommodations and modifications as well as targeted and relevant therapeutic services. And the first step of that process begins with obtaining a detailed background history!

Helpful Resources:

Posted on March 24, 2016January 5, 2022 by Tatyana Elleseff — 4 Comments

What’s Memes Got To Do With It?

Today, after a long hiatus, I am continuing my series of blog posts on “Scholars Who do Not Receive Enough Mainstream Exposure” by summarizing select key points from Dr. Alan G. Kamhi’s 2004 article: “A Meme’s Eye View of Speech-Language Pathology“.

Some of you may be wondering: “Why is she reviewing an article that is more than a decade old? The answer is simple. It is just as relevant, if not more so today, as it was 12 years ago, when it first came out.

In this article, Dr. Kamhi, asks a provocative question: “Why do some terms, labels, ideas, and constructs [in the field of speech pathology] prevail whereas others fail to gain acceptance?“

He attempts to answer this question by explaining the vital role the concept of memes play in the evolution and spread of ideas.

A meme (shortened from the Greek mimeme to imitate) is “an idea, behavior, or style that spreads from person to person within a culture”. The term was originally coined by British evolutionary biologist Richard Dawkins in The Selfish Gene (1976) to explain the spread of ideas and cultural phenomena such as tunes, ideas, catchphrases, customs, etc.

‘Selfish’ in this case means that memes “care only about their own self-replication“. Consequently, “successful memes are those that get copied accurately (fidelity), have many copies (fecundity), and last a long time (longevity).” Therefore, “memes that are easy to understand, remember, and communicate to others” have the highest risk of survival and replication (pp. 105-106).

So what were some of the more successful memes which Dr. Kamhi identified in his article, which still persist more than a decade later?

Learning Disability
Auditory Processing Disorder
Sensory Integration Disorder
Dyslexia
Articulation disorder
Speech Therapist/ Pathologist

Interestingly the losers of the “contest” were memes that contained the word language in it:

Language disorder
Language learning disability
Speech-language pathologist (albeit this term has gained far more acceptance in the past decade)

Dr. Kamhi further asserts that ‘language-based disorders have failed to become a recognizable learning problem in the community at large‘ (p.106).

So why are labels with the words ‘language’ NOT successful memes?

According to Dr. Kamhi that is because “language-based disorders must be difficult to understand, remember, and communicate to others“. Professional (SLP) explanations of what constitutes language are lengthy and complex (e.g., ASHA’s comprehensive definition) and as a result are not frequently applied in clinical practice, even when its aspects are familiar to SLPs.

Some scholars have suggested that the common practice of evaluating language with standardized language tools, restricts full understanding of the interactions of all of its domains (“within larger sociocultural context“) because they only examine isolated aspects of language. (Apel, 1999)

Dr. Kamhi, in turn explains this within the construct of the memetic theory: namely “simple constructs are more likely to replicate than complex ones.” In other words: “even professionals who understand language may have difficulty communicating its meaning to others and applying this meaning to clinical practice” (p. 107).

Let’s talk about the parents who are interested in learning the root-cause of their child’s difficulty learning and using language. Based on specific child’s genetic and developmental background as well as presenting difficulties, an educated clinician can explain to the parent the multifactorial nature of their child’s deficits.

However, these informed but frequently complex explanations are certainly in no way simplistic. As a result, many parents will still attempt to seek other professionals who can readily provide them with a “straightforward explanation” of their child’s difficulty. Since parents are “ultimately interested in finding the most effective and efficient treatment for their children” it makes sense to believe/hope that “the professional who knows the cause of the problem will also know the most effective way to treat it“(p. 107).

This brings us back to the concept of successful memes such as Auditory Processing Disorder (C/APD) as well as Sensory Processing Disorder (SPD) as isolated diagnoses.

Here are just some of the reasons behind their success:

They provide a simple solution (which is not necessarily a correct one) that “the learning problem is the result of difficulty processing auditory information or difficulty integrating sensory information“.
The assumption is “improving auditory processing and sensory integration abilities” will improve learning difficulties
Both, “APD and SID each have only one cause“, so “finding an appropriate treatment …seems more feasible because there is only one problem to eliminate“
Gives parents “a sense of relief” that they finally have an “understandable explanation for what is wrong with their child“
Gives parents hope that the “diagnosis will lead to successful remediation of the learning problem“

For more information on why APD and SPD are not valid stand-alone diagnoses please see HERE and HERE respectively.

A note on the lack of success of “phonological” memes:

They are difficult to understand and explain (especially due to a lack of consensus of what constitutes a phonological disorder)
Lack of familiarity with the term ‘phonological’ results in poor comprehension of “phonological bases of reading problems“ since its “much easier to associate reading with visual processing abilities, good instruction, and a literacy rich environment” (p. 108).

Let’s talk about MEMEPLEXES (Blackmore, 1999) or what occurs when “nonprofessionals think they know how children learn language and the factors that affect language learning“ (Kamhi, 2004, p.108).

A memplex is a group of memes, which become much more memorable to individuals (can replicate more efficiently) as a team vs. in isolation.

Why is APD Memeplex So Appealing?

According to Dr. Kamhi, if one believes that ‘a) sounds are the building blocks of speech and language and (b) children learn to talk by stringing together sounds and constructing meanings out of strings of sounds’ (both wrong assumptions) then its quite a simple leap to make with respect to the following fallacies:

Auditory processing are not influenced by language knowledge
You can reliably discriminate between APD and language deficits
You can validly and reliably assess “uncontaminated” auditory processing abilities and thus diagnose stand-alone APD
You can target auditory abilities in isolation without targeting language
Improvements in discrimination and identification of ‘speech sounds will lead to improvements in speech and language abilities‘

For more detailed information, why the above is incorrect, click: HERE

On the success of the Dyslexia Meme:

Most nonprofessionals view dyslexia as visually based “reading problem characterized by letter reversals and word transpositions that affects bright children and adults“
Its highly appealing due to the simple nature of its diagnosis (high intelligence and poor reading skills)
‘The diagnosis of dyslexia has historically been made by physicians and psychologists rather than educators‘, which makes memetic replication highly successful
The ‘dyslexic’ label is far more appealing and desirable than calling self ‘reading disabled’

For more detailed information, why the above is far too simplistic of an explanation, click: HERE and HERE.

Final Thoughts:

As humans we engage in transmission of ideas (good and bad) on constant basis. The popularity of powerful social media tools such as Facebook and Twitter ensure their instantaneous and far reaching delivery and impact. However, “our processing limitations, cultural biases, personal preferences, and human nature make us more susceptible to certain ideas than to others (p. 110).”

As professionals it is important that we use evidence based practices and the latest research to evaluate all claims pertaining to assessment and treatment of language based disorders. However, as Dr. Kamhi points out (p.110):

“Competing theories may be supported by different bodies of evidence, and the same evidence may be used to support competing theories.”
“Reaching a scientific consensus also takes time.”

While these delays may play a negligible role when it comes to scientific research, they pose a significant problem for parents, teachers and health professionals who are seeking to effectively assist these youngsters on daily basis. Furthermore, even when select memes such as APD are beneficial because they allow for a delivery of services to a student who may otherwise be ineligible to receive them, erroneous intervention recommendations (e.g., working on isolated auditory discrimination skills) may further delay the delivery of appropriate and targeted intervention services.

So what are SLPs to do in the presence of persistent erroneous memes?

“Spread our language-based memes to all who will listen” (Kamhi, 2004, 110) of course! Since we are the professionals whose job is to treat any difficulties involving words. Consequently, our scope of practice certainly includes assessment, diagnosis and treatment of children and adults with speaking, listening, reading, writing, and spelling difficulties.

As for myself, I intend to start that task right now by hitting the ‘publish’ button on this post!

References:

Kamhi, A. (2004). A meme’s eye view of speech-language pathology. [PDF] Language, Speech, and Hearing Services in Schools, 35, 105-112.

Posted on August 19, 2015January 5, 2022 by Tatyana Elleseff — 1 Comment

Parent Consultation Services

Today I’d like to officially introduce a new parent consultation service which I had originally initiated with a few out-of-state clients through my practice a few years ago.

The idea for this service came after numerous parents contacted me and initiated dialogue via email and phone calls regarding the services/assessments needed for their monolingual/bilingual internationally/domestically adopted or biological children with complex communication needs. Here are some details about it.

Parent consultations is a service provided to clients who live outside Smart Speech Therapy LLC geographical area (e.g., non-new Jersey residents) who are interested in comprehensive specialized in-depth consultations and recommendations regarding what type of follow up speech language services they should be seeking/obtaining in their own geographical area for their children as well as what type of carryover activities they should be doing with their children at home.

Consultations are provided with the focus on the following specialization areas with a focus on comprehensive assessment and intervention recommendations:

Language and Literacy
Children with Social Communication (Pragmatic) Disorders
Bilingual and Multicultural Children
Post-institutionalized Internationally Adopted Children
Children with Psychiatric and Emotional Disturbances
Children with Fetal Alcohol Spectrum Disorders

The initial consultation length of this service is 1 hour. Clients are asked to forward their child’s records prior to the consultation for review, fill out several relevant intakes and questionnaires, as well as record a short video (3-5 minutes). The instructions regarding video content will be provided to them following session payment.

Upon purchasing a consultation the client will be immediately emailed the necessary paperwork to fill out as well as potential dates and times for the consultation to take place. Afternoon, Evening and Weekend hours are available for the client’s convenience. In cases of emergencies consultations may be rescheduled at the client’s/Smart Speech Therapy’s mutual convenience.

Refunds are available during a 3 day grace period if a mutually convenient time could not be selected for the consultation. Please note that fees will not be refundable from the time the scheduled consultation begins.

Following the consultation the client has the option of requesting a written detailed consultation report at an additional cost, which is determined based on the therapist’s hourly rate. For further information click HERE. You can also call 917-916-7487 or email tatyana.elleseff@smartspeechtherapy.com if you wanted to find out whether this service is right for you.

Below is a past parent consultation testimonial.

International Adoption Consultation Parent Testimonial (11/11/13)

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

Posted on August 18, 2015January 5, 2022 by Tatyana Elleseff — Leave a comment

Creating A Learning Rich Environment for Language Delayed Preschoolers

Today I’m excited to introduce a new product: “Creating A Learning Rich Environment for Language Delayed Preschoolers“. This 40 page presentation provides suggestions to parents regarding how to facilitate further language development in language delayed/impaired preschoolers at home in conjunction with existing outpatient, school, or private practice based speech language services. It details implementation strategies as well as lists useful materials, books, and websites of interest.

It is intended to be of interest to both parents and speech language professionals (especially clinical fellows and graduates speech pathology students or any other SLPs switching populations) and not just during the summer months. SLPs can provide it to the parents of their cleints instead of creating their own materials. This will not only save a significant amount of time but also provide a concrete step-by-step outline which explains to the parents how to engage children in particular activities from bedtime book reading to story formulation with magnetic puzzles.

Product Content:

The importance of daily routines
The importance of following the child’s lead
Strategies for expanding the child’s language
- Self-Talk
- Parallel Talk
- Expansions
- Extensions
- Questioning
- Use of Praise
A Word About Rewards
How to Begin
How to Arrange the environment
Who is directing the show?
Strategies for facilitating attention
Providing Reinforcement
Core vocabulary for listening and expression
A word on teaching vocabulary order
Teaching Basic Concepts
Let’s Sing and Dance
Popular toys for young language impaired preschoolers (3-4 years old)
Playsets
The Versatility of Bingo (older preschoolers)
Books, Books, Books
Book reading can be an art form
Using Specific Story Prompts
Focus on Story Characters and Setting
Story Sequencing
More Complex Book Interactions
Teaching vocabulary of feelings and emotions
Select favorite authors perfect for Pre-K
Finding Intervention Materials Online The Easy Way
Free Arts and Crafts Activities Anyone?
Helpful Resources

Are you a caregiver, an SLP or a related professional? DOES THIS SOUND LIKE SOMETHING YOU CAN USE? if so you can find it HERE in my online store.

Useful Smart Speech Therapy Resources:

References:
Heath, S. B (1982) What no bedtime story means: Narrative skills at home and school. Language in Society, vol. 11 pp. 49-76.

Useful Websites:
http://www.beyondplay.com
http://www.superdairyboy.com/Toys/magnetic_playsets.html
http://www.educationaltoysplanet.com/
http://www.melissaanddoug.com/shop.phtml
http://www.dltk-cards.com/bingo/
http://bogglesworldesl.com/
http://www.childrensbooksforever.com/index.html

Posted on August 17, 2015January 5, 2022 by Tatyana Elleseff — Leave a comment

Professional Consultation Services for Speech Language Pathologists

Today I’d like to officially introduce a new professional consultation service for speech language pathologists (SLPs), which I initiated with select few clinicians through my practice some time ago.

The idea for this service came after numerous SLPs contacted me and initiated dialogue via email and phone calls regarding cases they were working on or asked for advice on how to initiate assessment or therapy services to new clients with complex communication issues. Here are some details about it.

Professional consultation is a service provided to Speech Language Pathologists (SLPs) seeking specialized in-depth assessment and/or treatment recommendations regarding specific client cases or who are looking to further their professional education in the following specialization areas:

Performing Independent Evaluations (IEEs) in Special Education Disputes
Comprehensive Early Intervention Assessments of Monolingual and Bilingual Children
Speech Language Assessment and Treatment of post-institutionalized Internationally Adopted Children
Speech Language Assessment and Treatment of Children with Psychiatric and Emotional Disturbances
Speech and Language Assessment and Treatment of Children with Fetal Alcohol Spectrum Disorders
Assessment and Management of Social Pragmatic Language Disorders
Speech Language Assessment and Treatment of Bilingual and Multicultural Children
Speech Language Assessment and Treatment of Severely Cognitively Impaired Clients
Speech Language Assessment and Treatment of Children with Genetic Disorders

These professional consultation sessions are conducted via GoTo Meeting and includes video conferencing as well as screen sharing.

The goal of this service is to facilitate the SLPs learning process in the desired specialization area. The initial consultation includes extensive literature, material and resource website recommendations, with the exception of Smart Speech Therapy LLC products, which are available separately for purchase through the online store.

The initial consultation length is 1 hour. SLPs are encouraged to forward de-identified client records prior to the consultation for review. In select cases (and with appropriate permissions) forwarding a short video/audio recording (~7 minutes) of the client in question is recommended.

Upon purchasing a consultation the client will be immediately emailed potential dates and times for the consultation to take place. Afternoon, Evening and Weekend hours are available for the client’s convenience. In cases of emergencies consultations may be rescheduled at the client’s/Smart Speech Therapy’s mutual convenience.

While refunds are not available for this type of service, in an unlikely event that the consultation lasts less than 1 hour, leftover time can be banked for future calls without any expiration limits. Call sessions can be requested as needed and conveyed in advance via email. For further information click HERE. You can also call 917-916-7487 or email tatyana.elleseff@smartspeechtherapy.com if you wanted to find out whether this service is right for you.

Below is the recent professional consultation testimonial.

Professional Independent Evaluation Consultation Testimonial (8/20/15)

Tatyana,

I just wanted to thank you from the bottom of my heart for the mentorship consultation with you yesterday. I learned a great deal, and appreciated your straight forward approach, and most of all, your scholarly input. You are a thorough professional. This new service that you offer is invaluable for many reasons, one of which is that it buffers the clinical isolation of solo private practice. I look forward to our next session, about which I will email you in the next week or so. If stars are given, I give you the maximum number of stars possible! The consultations are pure wonderful!

With gratitude,

Aletta Sinoff Ph.D., CCC-SLP, BCBA-D

Licensed Speech-Language Pathologist

Board Certified Behavior Analyst

Beachwood OH 44122

Posted on August 13, 2015March 22, 2022 by Tatyana Elleseff — 8 Comments

What do Auditory Memory Deficits Indicate in the Presence of Average General Language Scores?

I frequently see a variation of the following question on a variety of speech language forums: “My student scored within the average range on all the tested subtests with the exception of working memory and sentence recall. What other testing do you recommend to determine whether these difficulties are impacting their academics?”

First, lets provide a definition of working memory (WM). WM is the memory used for temporarily storing and manipulating information so we can perform a particular task. It’s one of the executive functions (EFs) and contains two important subcomponents: a phonological loop that stores verbal information and a visuo-spatial ‘sketchpad’ which stores visual and spatial information (Baddeley & Hitch, 2007). Together they are responsible for acquisition of sound-letter correspondence, phonemic awareness and ultimately reading comprehension since WM influences the duration the information stays in memory as well as its eventual transfer (or lack of thereof) to long-term memory.

In other words, students with adequate working memory will have enough capacity to appropriately decode, fluently read and adequately comprehend text while students with poor working memory will expend all their capacity on basic tasks such as decoding, which leaves them with very little capacity to devote to comprehension of read material.

Outside of testing, WM deficits typically become glaringly apparent as students move up grade levels and are given challenging subject-specific abstract texts, requiring in-depth analysis. This is when parents and professionals start to see that in addition to experiencing difficulty comprehending the read texts, students with poor WM also tire easily when presented with lengthy texts, and tend to evidence increased frustration and decreased self-efficacy during reading tasks.

Now let’s get back to our original question: “What other testing do you recommend to determine whether these [memory] difficulties are impacting their academics?”

Typically when asked that question I always tend to recommend that a trained SLP performs a series of tests aimed to determine whether the student presents with reading and writing deficits.

In my clinical experience (which is of course substantiated by research) in 99% of cases, reading disabilities are the hidden culprit behind seemingly average oral language skills and working memory deficits. For more information on what testing is recommended to tease out the presence of reading disorders, see my series posts on Comprehensive Dyslexia Testing (HERE) as well as on the validity of (C)APD diagnosis (HERE).

So the next time you encounter this perplexing pattern of strengths and weaknesses don’t just ignore it as inconsequential and not recommend or dismiss the student from language services. Delve into it further! You will often find that it is representative of reading difficulties, the cumulative impact of which may significantly affect the student’s academic performance and ultimately school outcomes, unless appropriate therapeutic interventions are provided.

References:

Baddeley, A. D., & Hitch, G. J. (2007). Working memory: Past, present…and future? In N.Osaka, R. Logie & M. D’Esposito (Eds), Working Memory – Behavioural & Neural Correlates. Oxford University Press.

Useful Resources:

Posted on August 12, 2015January 5, 2022 by Tatyana Elleseff — 3 Comments

Have you Worked on Morphological Awareness Lately?

Last year an esteemed colleague, Dr. Roseberry-McKibbin posed this question in our Bilingual SLPs Facebook Group: “Is anyone working on morphological awareness in therapy with ELLs (English Language Learners) with language disorders?”

Her question got me thinking: “How much time do I spend on treating morphological awareness in therapy with monolingual and bilingual language disordered clients?” The answer did not make me happy!

So what is morphological awareness and why is it important to address when treating monolingual and bilingual language impaired students?

Morphemes are the smallest units of language that carry meaning. They can be free (stand alone words such as ‘fair’, ‘toy’, or ‘pretty’) or bound (containing prefixes and suffixes that change word meanings – ‘unfair’ or ‘prettier’).

Morphological awareness refers to a ‘‘conscious awareness of the morphemic structure of words and the ability to reﬂect on and manipulate that structure’’ (Carlisle, 1995, p. 194). Also referred to as “the study of word structure” (Carlisle, 2004), it is an ability to recognize, understand, and use affixes or word parts (prefixes, suffixes, etc) that “carry significance” when speaking as well as during reading tasks. It is a hugely important skill for building vocabulary, reading fluency and comprehension as well as spelling (Apel & Lawrence, 2011; Carlisle, 2000; Binder & Borecki, 2007; Green, 2009).

So why is teaching morphological awareness important? Let’s take a look at some research.

Goodwin and Ahn (2010) found morphological awareness instruction to be particularly effective for children with speech, language, and/or literacy deficits. After reviewing 22 studies Bowers et al. (2010) found the most lasting effect of morphological instruction was on readers in early elementary school who struggled with literacy.

Morphological awareness instruction mediates and facilitates vocabulary acquisition leading to improved reading comprehension abilities (Bowers & Kirby, 2010; Carlisle, 2003, 2010; Guo, Roehrig, & Williams, 2011; Tong, Deacon, Kirby, Cain, & Parilla, 2011).

Unfortunately as important morphological instruction is for vocabulary building, reading fluency, reading comprehension, and spelling, it is often overlooked during the school years until it’s way too late. For example, traditionally morphological instruction only beings in late middle school or high school but research actually found that in order to be effective one should actually begin teaching it as early as first grade (Apel & Lawrence, 2011).

So now that we know that we need to target morphological instruction very early in children with language deficits, let’s talk a little bit regarding how morphological awareness can be assessed in language impaired learners.

When it comes to standardized testing, both the Test of Language Development: Intermediate – Fourth Edition (TOLD-I:4) and the Test of Adolescent and Adult Language–Fourth Edition (TOAL-4) have subtests which assess morphology as well as word derivations. However if you do not own either of these tests you can easily create non-standardized tasks to assess morphological awareness.

Apel, Diehm, & Apel (2013) recommend multiple measures which include: phonological awareness tasks, word level reading tasks, as well as reading comprehension tasks.

Below are direct examples of tasks from their study:

One can test morphological awareness via production or decomposition tasks. In a production task a student is asked to supply a missing word, given the root morpheme (e.g., ‘‘Sing. He is a great _____.’’ Correct response: singer). A decomposition task asks the student to identify the correct root of a given derivation or inflection. (e.g., ‘‘Walker. How slow can she _____?’’ Correct response: walk).

Another way to test morphological awareness is through completing analogy tasks since it involves both decomposition and production components (provide a missing word based on the presented pattern—crawl: crawled:: fly: ______ (flew).

Still another way to test morphological awareness with older students is through deconstruction tasks: Tell me what ____ word means? How do you know? (The student must explain the meaning of individual morphemes).

Finding the affix: Does the word ______ have smaller parts?

So what are the components of effective morphological instruction you might ask?

Below is an example of a ‘Morphological Awareness Intervention With Kindergarteners and First and Second Grade Students From Low SES Homes’ performed by Apel & Diehm, 2013:

Here are more ways in which this can be accomplished with older children:

Find the root word in a longer word
Fix the affix (an additional element placed at the beginning or end of a root, stem, or word, or in the body of a word, to modify its meaning)
- Affixes at the beginning of words are called “prefixes”
- Affixes at the end of words are called “suffixes
Word sorts to recognize word families based on morphology or orthography
Explicit instruction of syllable types to recognize orthographical patterns
Word manipulation through blending and segmenting morphemes to further solidify patterns

Now that you know about the importance of morphological awareness, will you be incorporating it into your speech language sessions? I’d love to know!

Until then, Happy Speeching!

References:

Apel, K., & Diehm, E. (2013). Morphological awareness intervention with kindergarteners and first and second grade students from low SES homes: A small efficacy study. Journal of Learning Disabilities.
Apel, K., & Lawrence, J. (2011). Contributions of morphological awareness skills to word-level reading and spelling in first-grade children with and without speech sound disorder. Journal of Speech, Language & Hearing Research, 54, 1312–1327.
Apel, K., Brimo, D., Diehm, E., & Apel, L. (2013). Morphological awareness intervention with kindergarteners and first and second grade students from low SES homes: A feasibility study. Language, Speech, and Hearing Services in Schools, 44, 161-173.
Binder, K. & Borecki, C. (2007). The use of phonological, orthographic, and contextualinformation during reading: a comparison of adults who are learning to read and skilled adult readers. Reading and Writing, 21, 843-858.
Bowers, P.N., Kirby, J.R., Deacon, H.S. (2010). The effects of morphological instruction on literacy skills: A systematic review of the literature. Review of Educational Research, 80, 144-179.
Carlisle, J. F. (1995). Morphological awareness and early reading achievement. In L. B. Feldman (Ed.), Morphological aspects of language processing (pp. 189–209). Hillsdale, NJ: Erlbaum.
Carlisle, J. F. (2000). Awareness of the structure and meaning of morphologically complex words: Impact on reading. Reading and Writing: An Interdisciplinary Journal,12,169-190.
Carlisle, J. F. (2004). Morphological processes that influence learning to read. In C. A. Stone, E. R. Silliman, B. J. Ehren, & K. Apel (Eds.), Handbook of language and literacy. NY: Guilford Press.
Carlisle, J. F. (2010). An integrative review of the effects of instruction in morphological awareness on literacy achievement. Reading Research Quarterly, 45(4), 464-487.
Goodwin, A.P. & Ahn, S. (2010). Annals of Dyslexia, 60, 183-208.
Green, L. (2009). Morphology and literacy: Getting our heads in the game. Language, Speech, and Hearing Services in the schools, 40, 283-285.
Green, L., & Wolter, J.A. (2011, November). Morphological Awareness Intervention: Techniques for Promoting Language and Literacy Success. A symposium presentation at the annual American Speech Language Hearing Association, San Diego, CA.
Guo, Y., Roehrig, A. D., & Williams, R. S. (2011). The relation of morphological awareness and syntactic awareness to adults’ reading comprehension: Is vocabulary knowledge a mediating variable? Journal of Literacy Research, 43, 159-183.
Tong, X., Deacon, S. H., Kirby, J. R., Cain, K., & Parrila, R. (2011). Morphological awareness: A key to understanding poor reading comprehension in English. Journal of Educational Psychology, 103 (3), 523-534.

International Adoption Consultation Parent Testimonial (11/11/13)

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