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 February 16, 2015March 15, 2022 by Tatyana Elleseff — 14 Comments

Components of Comprehensive Dyslexia Testing: Part I- Introduction and Language Testing

Image result for dyslexia laws With the passing of dyslexia laws in the state of New Jersey in 2014, there has been an increased focus on reading disabilities and dyslexia particularly in the area of effective assessment and remediation. More and more parents and health related professionals are looking to understand the components of effective dyslexia testing and who is qualified to perform it. So I decided to write a multi-part series regarding the components of comprehensive dyslexia testing in order to assist parents and professionals to better understand the steps of the testing process.

In this particular post I would like to accomplish two things: dispel several common myths regarding dyslexia testing as well as discuss the first step of SLP based testing which is a language assessment.

Myth 1: Dyslexia can be diagnosed based on a single test!

DYSLEXIA CANNOT BE CONFIRMED BY THE ADMINISTRATION OF ONE SPECIFIC TEST. A comprehensive battery of tests from multiple professionals including neuropsychologists, psychologists, learning specialists, speech-language pathologists and even occupational therapists needs to actually be administered in order to confirm the presence of reading based disabilities.

Myth 2: A doctor can diagnose dyslexia!

A doctor does not have adequate training to diagnose learning disabilities, the same way as a doctor cannot diagnose speech and language problems. Both lie squarely outside of their scope of practice! A doctor can listen to parental concerns and suggest an appropriate plan of action (recommend relevant assessments) but they couldn’t possibly diagnose dyslexia which is made on the basis of team assessments.

Myth 3: Speech Pathologists cannot perform dyslexia testing!

SPEECH-LANGUAGE PATHOLOGISTS TRAINED IN IDENTIFICATION OF READING AND WRITING DISORDERS ARE FULLY QUALIFIED TO PERFORM SIGNIFICANT PORTIONS OF DYSLEXIA BATTERY.

So what are the dyslexia battery components?

Prior to initiating an actual face to face assessment with the child, we need to take down a thorough case history (example HERE) in order to determine any pre-existing risk factors. Dyslexia risk factors may include (but are not limited to):

History of language and learning difficulties in the family
History of language delay (impaired memory, attention, grammar, syntax, sentence repetition ability, etc) as well as
History of impaired phonological awareness skills (difficulty remembering children’s songs, recognizing and making rhymes, confusing words that sound alike, etc).

After that, we need to perform language testing to determine whether the child presents with any deficits in that area. Please note that while children with language impairments are at significant risk for dyslexia not all children with dyslexia present with language impairments. In other words, the child may be cleared by language testing but still present with significant reading disability, which is why comprehensive language testing is only the first step in the dyslexia assessment battery.

LANGUAGE TESTING

Here we are looking to assess the child’s listening comprehension. processing skills, and verbal expression in the form of conversational and narrative competencies. Oral language is the prerequisite to reading and writing. So a single vocabulary test, a grammar completion task, or even a sentence formulation activity is simply not going to count as a part of a comprehensive assessment.

In children without obvious linguistic deficits such as limited vocabulary, difficulty following directions, or grammatical/syntactic errors (which of course you’ll need to test) I like to use the following tasks, which are sensitive to language impairment:

Listening Comprehension (with a verbal response component)

Here it is important to assess the student’s ability to listen to short passages and answer a variety of story related questions vs. passively point at 1 of 4 pictures depicting a particular sentence structure (e.g., Point to the picture which shows: “The duck was following the girl”). I personally like to use the Listening Comprehension Tests for this task but any number of subtests from other tests have similar components.

Semantic Flexibility

Here it is important to assess the student’s vocabulary ability via manipulation of words to create synonyms, antonyms, multiple meaning words, definitions, etc. For this task I like to use the WORD Tests (3-Elementary and 2-Adolescent).

Narrative Production:

A hugely important part of a language assessment is an informal spontaneously produced narrative sample, which summarizes a book or a movie. Just one few minute narrative sample can yield information on the following:
Sequencing Ability
Working Memory
Grammar
Vocabulary
Pragmatics and perspective taking
Story grammar (Stein & Glenn, 1979)

Usually I don’t like to use any standardized testing for assessment of this skill but use the parameters from the materials I created myself based on existing narrative research (click HERE).

Social Pragmatic Language

Given my line of work (school in an outpatient psychiatric setting), no testing is complete without some for of social pragmatic language assessment in order to determine whether the student presents with hidden social skill deficits. It is important to note that I’ve seen time and time again students acing the general language testing only to bomb on the social pragmatic tasks which is why this should be a mandatory part of every language test in my eyes. Here, a variety of choices exists. For quick results I typically tends to use the Social Language Development Tests as well as portions of the Social Thinking Dynamic Assessment Protocol®.

Not sure what type of linguistic deficits your student is displaying? Grab a relevant checklist and ask the student’s teacher and parent fill it out (click HERE to see types of available checklists)

So there you have it! The first installment on comprehensive dyslexia testing is complete.

READ part II which discusses components of Phonological Awareness and Word Fluency testing HERE.

Read part III of this series which discusses components of Reading Fluency and Reading Comprehension testing HERE.

Helpful Links

Posted on February 10, 2015January 5, 2022 by Tatyana Elleseff — 4 Comments

What if Its More Than Just “Misbehaving”?

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

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

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

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

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

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

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

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

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

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

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

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

Seeking Attention/Reward
Seeking Sensory Stimulation
Seeking Control

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

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

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

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

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

Here are just a few antecedent examples:

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

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

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

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

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

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

References:

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

Posted on February 6, 2015January 5, 2022 by Tatyana Elleseff — 4 Comments

Simplifying Testing Results to Understand the Student’s Difficulties

Oftentimes explaining testing results in the form of standard scores, percentiles, and charts is labor-intensive for the SLP and confusing for parents and ancillary professionals. Furthermore, just because you show testing results does not always ensure that the ramifications of testing are fully understood, especially when it comes to performance of high functioning students with deficits in isolated areas, which may significantly impact the student’s functioning in social and academic settings.

So finding an effective method of sharing testing results was fraught with difficulties until recently. In early January, I attended a Sarah Ward executive function conference, where Sarah shared one of her tricks of sharing testing results. She used a picture of a bell curve and inserted testing results into it. So it looked a little similar to the picture I have below:

As you can see the student’s listening comprehension and expressive language performance fell in the average range as denoted on the bottom of the picture. In contrast, the student’s problem solving and social pragmatic testing abilities fell in the below average range as is denoted by both a red bar as well as the caption underneath the picture.

It is a visually simple way to see what areas need to be worked on in one snapshot.

Charts in Action: Students with Social Skills Deficits

This system is even more effective for displaying testing results of higher functioning students with select deficit areas. To illustrate, I recently performed a comprehensive language assessment on a 12-year-old adolescent with suspected ASD. The student had a superior IQ, excellent vocabulary, and phenomenal memory.

When tested in school setting she did not qualify to receive language intervention. However, her comprehensive language testing with me showed a number of disparities. While the majority of her testing fell in the above average and superior range, in a number of testing areas she performed within average and below average range (combined SLP, ED, and Psych. testing results below).

When one looked at the student’s overall testing results, they clearly indicated cumulative performance in the average range of functioning. However, after I plotted all of her results on the bell curve her deficit areas became very clearly apparent and her testing discrepancy clearly indicated that intervention in select areas of functioning was needed.

So even though select scores were clearly in the average range of functioning on the bell curve, they were actually BELOW AVERAGE for this student as compared to significant strengths in all other areas.

Many would argue with me pointing out that scores in the average range mean average range. The student doesn’t qualify – end of story! So let me explain the above scores in REAL-LIFE terms.

Why Students with Average Scores May Still Require Services

This particular student was referred for a social pragmatic evaluation due to behavioral difficulties in the classroom which included verbal outbursts, difficulty engaging in cooperative group work and verbal confrontations with classmates.

Interactions with the student revealed an engaging adolescent who preferred the company of adults and was very likable. However, throughout testing she made comments indicating cognizance that she was not accepted by typically developing peers. She frustratedly stated that she “doesn’t get” peers, is not interested in the “typical” experiences and has “nothing in common” with peers her age because she “misses the point” of their verbal interchanges.

Due to her exceptional performance on standardized testing, many school-based professionals believed that because she did so well well she did not have any “true” social learning deficits. In contrast the student’s peer group was able to see her social differences with very little effort. In school, the student did not qualify for social pragmatic language therapy, on the basis of her challenges being perceived as too “mild” to merit services, however her social deficits were NOT mild as judged by her peers. They were only mild as compared to individuals with severe social learning challenges. Without appropriate intervention, these difficulties would continue to pervasively impact her academic and social performance, as well as affect future employment and relationship status.

So this is why I now love plotting scores on the bell curve for parents and professionals. A simple picture clearly shows the significance of score distribution, the deficits areas in need of intervention, and is literally worth a 1000 words!

Helpful Resources Related to Social Pragmatic Language Overview, Assessment and Remediation:

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

For the Love of Speech Blog Hop: February Edition

Today I am very excited to participate along with 27 other talented SLPs in the For the Love of Speech Blog Hop. I love being an SLP, and to spread that love around from February 1-4 I am giving away a Valentine’s Day Product: “The Origins of Valentine’s Day: At thematic language activity packet for middle and high school students” .

This thematic packet was created to target listening and reading comprehension of middle and high school students diagnosed with language impairments and learning disabilities. The packet contains Response to Intervention (RTI) Tier 2 vocabulary words in story context. Expressive language activities for the packet include production of synonyms and antonyms, fill-in the blank, as well as sentence formulation using story vocabulary. Comprehension questions pertaining to story are provided in an open ended question format. It is great for teaching reading comprehension and sophisticated vocabulary in a thematic context related to familiar to the student events.

You can grab this product for free for a limited time only in my online store (HERE) and then head on over to Teach Speech 365 to grab her freebie as well. Collect all freebies by the time the blog hop ends on February 4th!

For more useful FREE and PAID products check out my online store by clicking HERE or on the picture below

Posted on January 9, 2015January 5, 2022 by Tatyana Elleseff — Leave a comment

The Frenzied SLPs Jan ’15 Edition: Investing Wisely

I am thrilled to be a part of The Frenzied SLPs, which is a group of talented SLP bloggers and TPT sellers who each month bring you a variety of suggestions on how to simplify the life of the frenzied SLPs. At the beginning of each year, many of us try to make a variety of resolutions on how to live better. These may involve changes in our personal lifestyles or changes in our work routines and schedules. This month I’d like to talk about investments, namely investments, which can make our work load more manageable.

If your schedule is anything like mine, then you are very heavily inundated with paperwork. Evaluation reports, progress summaries, session notes, lesson plans, presentations, articles, it all piles up until you absolutely dread looking at your planner since it highlights all the looming deadlines and not enough time to complete all the paperwork.

That is why recently I decided to invest in some dictation software. After a bit of research I settled on Dragon Naturally Speaking software, which I installed on my PC at work as well as on my Mac at home. For me it was an investment that definitely paid off within a very short period of time. Almost immediately I started noticing how much faster I was able to complete my reports, reply to emails, as well as write blog posts and articles. I also noticed how much easier revising and editing process was on my eyes.

So what has improved?
Well, I’ve definitely noticed a huge improvement in my productivity. Even though I wasn’t the slowest typist, dictating became a huge time saver, since now I am able to produce 3x as much written output in the same period of time.

I also noticed that the use of dictation software allowed me to better organize my thoughts out loud and significantly decrease oral revisions when dictating.

However while dictation software is an excellent investment it needs to be made wisely keeping a few things in mind.

For starters the cost of software may be problematic for some. While Nuance, which is the company that sells the software has a variety of decently priced packages, this software is still not cheap. Buying a wireless Bluetooth headset, a professional package, or the licensing software for several different computers, may further significantly increase the price.

Secondly you do need to train the software especially because we a speech pathologist use a lot of esoteric and specialized language to describe our clients’ assessment and treatment needs. The training period take anywhere from several days to several weeks depending on how quickly you’ll learn to navigate the in’s and out’s of all the commands.

Personally I find the Mac version not as user-friendly as the PC version despite the fact that it does not require the usage of a headset in contrast to the PC version.

However, all in all, for a busy professional inundated with paperwork, this investment truly is a valuable time saver that can significantly reduce the time spent on paperwork as well as the amount of strain and effort you put into report writing and editing.

Posted on November 13, 2014January 5, 2022 by Tatyana Elleseff — 1 Comment

Dear School Professionals Please Be Aware of This

I frequently get emails, phone calls, and questions from parents and professionals regarding academic functioning of internationally adopted post institutionalized children. Unfortunately despite the fact that there is a fairly large body of research on this topic there still continue to be numerous misconceptions regarding how these children’s needs should be addressed in academic settings.

Perhaps one of the most serious and damaging misconceptions is that internationally adopted children are bilingual/multicultural children with Limited English Proficiency who need to be treated as ESL speakers. This erroneous belief often leads to denial or mismanagement of appropriate level of services for these children not only with respect to their language processing and verbal expression but also their social pragmatic language abilities.

Even after researchers published a number of articles on this topic, many psychologists, teachers and speech language pathologists still don’t know that internationally adopted children rapidly lose their little birth language literally months post their adoption by English-speaking parents/families. Gindis (2005) found that children adopted between 4-7 years of age lose expressive birth language abilities within 2-3 months and receptive abilities within 3-6 months post- adoption. This process is further expedited in children under 4, whose language is delayed or impaired at the time of adoption (Gindis, 2008). Even school-aged children of 10-12 years of age who were able to read and write in their birth language, rapidly lose their comprehension and expression of birth language within their first year post adoption, if adopted by English-speaking parents who are unable to support their birth language.

So how does this translate into appropriate provision of speech language services you may ask? To begin with, I often see posts on the ASHA forums or in Facebook speech pathology and special education groups seeking assistance with finding interpreters fluent in various exotic languages. However, unless the child is “fresh off the boat” (several months post arrival to US) schools shouldn’t be feverishly trying to locate interpreters to assist with testing in the child’s birth language. They will not be able to obtain any viable results especially if the child had been residing in the United States for several years.

So if the post-institutionalized, internationally adopted child is still struggling with academics several years post adoption, one should not immediately jump to the conclusion that this is an “ESL” issue, but get relevant professionals (e.g., speech pathologists, psychologists) to perform thorough testing in order to determine whether it’s the lack of foundational abilities due to institutionalization which is adversely impacting the child’s academic abilities.

Furthermore, ESL itself is often not applicable as an educational method to internationally adopted children. Here’s why:

Let’s literally take the first definition of ESL which pops-up on Google when you put in a query: “What is ESL?” “English as a Second Language (ESL) is an instructional program for students whose dominant language is not English. The purpose of the program is to increase the English language proficiency of eligible students so they can attain academic standards and achieve success in the classroom.”

Here is our first problem. These students don’t have a dominant language. They are typically adopted by parents who do not speak their birth language and that are unable to support them in their birth language. So upon arrival to US, IA children will typically acquire English via the subtractive model of language acquisition (birth language is replaced and eliminated by English), which is a direct contrast to bilingual children, many of whom learn via the additive model (adding English to the birth language (Gindis, 2005). As a result, of subtractive language acquisition IA children experience very rapid birth language attrition (loss) post-adoption (Gindis, 2003; Glennen, 2009). Thus they will literally undergo what some researchers have called: “second-first language acquisition” (Scott et al., 2011) and their first language will “become completely obsolete as English is learned” (Nelson, 2012, p. 2).

This brings us to our second problem: the question of “eligibility”. Historically, ESL programs have been designed to assist children of immigrant families acquire academic readiness skills. This methodology is based on the fact that skills from first language was ultimately transfer to the second language. However, since post-institutionalized children don’t technically have a “first language” and their home language is English, how could they technically be eligible for ESL services? Furthermore, because of frequent lack of basic foundational skills in the birth language internationally adopted post-institutionalized children will not benefit the same way from ESL instruction the same way bilingual children of immigrant families do. So instead of focusing on these children’s questionable eligibility for ESL services it is important to perform detailed review of their pre-adoption records in order to determine birth language deficits and consider eligibility for speech language services with the emphasis on improving these children’s foundational skills.

If the child’s pre-adoption records specifically state that s/he has birth language delay then it should be taken seriously (Gindis, 1999) since language delays in the birth language transfer and affect the new language (McLaughlin, Gesi, & Osani, 1995). These delays will not “go away” without appropriate interventions. “Any child with a known history of speech and language delays in the sending country should be considered to have true delays or disorders and should receive speech and language services after adoption.” (Glennen, 2009, p.52)

Now that we have discussed the issue of ESL services, lets touch upon social pragmatic language abilities of internationally adopted children. Here’s how erroneous beliefs can contribute to mismanagement of appropriate services in this area.

Different cultures have different pragmatic conventions, therefore we are taught to be very careful when labeling certain behaviors of children from other cultures as atypical, just because they are not consistent with the conventions and behaviors of children from the mainstream culture. Here’s a recent example. A mainstream American parent consulted an SLP regarding the inappropriate social pragmatic skills of her teenaged daughter adopted almost a decade ago from Southeast Asia. The SLP was under the impression that some of the child’s deficits were due to multicultural differences and had to do with the customs and traditions of the child’s country of origin. She was considering advising the parent regarding requesting an evaluation by a SLP who spoke the child’s birth language.

Here are two problems with the above scenario. Firstly, any internationally adopted post-institutionalized child who was adopted by American parents who were not part of the culture from which the child was adopted, the child will quickly become acculturated and immersed in the American culture. These children “need functional English for survival”, and thus have a powerful incentive to acquire English (Gindis, 2005; p. 299). consequently, any unusual or atypical behaviors they exhibit in social interactions and in academic setting with other individuals cannot be attributed to customs and traditions of another culture.

Secondly, It is very important to understand that institutionalization and orphanage care have been closely linked to increase in mental health disorders and psychiatric impairments. As a result, internationally adopted children have a high incidence of social pragmatic deficits as compared to non-adopted peers as well as post-institutionalized children adopted at younger ages, (under 3). Given this, if parents present with concerns regarding their internationally adopted post-institutionalized children’s social pragmatic and behavioral functioning it is very important not to jump to erroneous conclusion pertaining to these children’s birth countries but rather preform comprehensive evaluations in order to determine whether these children can be assisted further in the realm of social pragmatic functioning in a variety of settings.

In order to develop a clear picture regarding appropriate service delivery for IA children, school based professionals need to educate themselves regarding the fundamental differences between development and learning trajectories of internationally adopted children and multicultural/bilingual children. Children, who struggle academically, after years of adequate schooling exposure, do not deserve a “wait and see” approach. They should start receiving appropriate intervention as soon as possible (Hough & Kaczmarek, 2011; Scott & Roberts, 2007).

Posted on November 3, 2014January 5, 2022 by Tatyana Elleseff — 3 Comments

Review of Social Language Development Test Adolescent: What SLPs Need to Know

A few weeks ago I reviewed the Social Language Development Test Elementary (SLDTE) and today I am reviewing the Social Language Development Test Adolescent (SLDTA) currently available from PRO-ED.

Basic overview

Release date: 2010
Age Range: 12-18
Authors:Linda Bowers, Rosemary Huisingh, Carolyn LoGiudice
Publisher: Linguisystems (PRO-ED as of 2014)

The Social Language Development Test: Adolescent (SLDT-A) assesses adolescent students’ social language competence. The test addresses the students ability to take on someone else’s perspective, make correct inferences, interpret social language, state and justify logical solutions to social problems, engage in appropriate social interactions, as well as interpret ironic statements.

The Making Inferences subtest of the SLDT-A assesses students’ ability to infer what someone in the picture is thinking as well as state what visual cues aided him/her in the making of that inference.

The first question asks the student to pretend to be a person in the photo and then to tell what the person is thinking by responding as a direct quote. The quote must be relevant to the person’s situation and the emotional expression portrayed in the photo.The second question asks the student to identify the relevant visual clues that he used to make the inference.

Targeted Skills include:

detection of nonverbal and context clues
assuming the perspective of a specific person
inferring what the person is thinking and expressing the person’s thought
stating the visual cues that aided with response production

A score of 1 or 0 is assigned to each response, based on relevancy and quality. However, in contrast to the SLDTE student must give a correct response to both questions to achieve a score of 1.

Errors can result due to limited use of direct quotes (needed for correct responses to indicate empathy/attention to task), poor interpretation of provided visual clues (attended to irrelevant visuals) as well as vague, imprecise, and associated responses.

The Interpreting Social Language subtest of the SLDT-A assesses students’ ability to demonstrate actions (including gestures and postures), tell a reason or use for an action, think and talk about language and interpret figurative language including idioms.

A score of 1 or 0 is assigned to each response, based on relevancy and quality. Student must give a correct response to both questions to achieve a score of 1.

Targeted Skills:

Ability to demonstrate actions such as gestures and postures
Ability to explain appropriate reasons or use for actions
Ability to think and talk about language
Ability to interpret figurative language (e.g., idioms)

Errors can result due to vague, imprecise (off-target), or associated responses as well as lack of responses. Errors can result due to lack of knowledge of correct nonverbal gestures to convey meaning of messages. Finally errors can result due to literal interpretations of idiomatic
expressions.

The Problem Solving subtest of the SLDT-A assesses students’ ability to offer a logical solution to a problem and explain why that would be a good way to solve the problem.

To receive a score of 1, the student has to provide an appropriate solution with relevant justification. A score of 0 is given if any of the responses to either question were incorrect or inappropriate.

Targeted Skills:

Taking perspectives of other people in various social situations
Attending to and correctly interpreting social cues
Quickly and efficiently determining best outcomes
Coming up with effective solutions to social problems
Effective conflict negotiation

Errors can result due to illogical or irrelevant responses, restatement of the problem, rude solutions, or poor solution justifications.

The Social Interaction subtest of the SLDT-A assesses students’ ability to socially interact with others.

A score of 1 is given for an appropriate response that supports the situation. A score of 0 is given for negative, unsupportive, or passive responses as well as for ignoring the situation, or doing nothing.

Targeted Skills:

Provision of appropriate, supportive responses
Knowing when to ignore the situation

Errors can result due to inappropriate responses that were negative, unsupportive or illogical.

The Interpreting Ironic Statements subtest of the SLDT-A assesses sudents’ ability to recognize sarcasm and interpret ironic statements.

To get a score of 1, the student must give a response that shows s/he understands that the speaker is being sarcastic and is saying the opposite of what s/he means. A score of 0 is given if the response is literal and ignores the irony of the situation.

Errors can result due to consistent provision of literal idiom meanings indicating lack of
understanding of the speaker’s intentions as well as “missing” the context of the situation. errors also can result due the the student identifying that the speaker is being sarcastic but being unable to explain the reason behind the speaker’s sarcasm (elaboration).

For example, one student was presented with a story of a brother and a sister who extensively labored over a complicated recipe. When their mother asked them about how it came out, the sister responded to their mother’s query: “Oh, it was a piece of cake”. The student was then asked: What did she mean?” Instead of responding that the girl was being sarcastic because the recipe was very difficult, student responded: “easy.” When presented with a story of a boy who refused to help his sister fold laundry under the pretext that he was “digesting his food”, he was then told by her, “Yeah, I can see you have your hands full.” the student was asked: “What did she mean?” student provided a literal response and stated: “he was busy.”

The following goals can be generated based on the performance on this test:

Long Term Goals: Student will improve social pragmatic language skills in order to effectively communicate with a variety of listeners/speakers in all social and academic contexts
Short Term Goals

Student will improve his/her ability to make inferences based on social scenarios
Student will improve his/her interpretation of facial expressions, body language, and gestures
Student will improve his/her ability to interpret social language (demonstrate appropriate gestures and postures, use appropriate reasons for actions, interpret figurative language)
Student will his/her ability to provide multiple interpretations of presented social situations
Student will improve his/her ability to improve social interactions with peers and staff (provide appropriate supportive responses; ignore situations when doing nothing is the best option, etc)
Student will improve his/her ability to interpret abstract language (e.g., understand common idioms, understand speaker’s beliefs, judge speaker’s attitude, recognize sarcasm, interpret irony, etc)

A word of caution regarding testing eligibility:

I would also not administer this test to the following adolescent populations:

Students with social pragmatic impairments secondary to intellectual disabilities (IQ <70)
Students with severe forms of Autism Spectrum Disorders
Students with severe language impairment and limited vocabulary inventories
English Language Learners (ELL) with suspected social pragmatic deficits
Students from low SES backgrounds with suspected pragmatic deficits

I would not administer this test to Culturally and Linguistically Diverse (CLD) students due to significantly increased potential for linguistic and cultural bias, which may result in test answers being marked incorrect due to the following:

Lack of relevant vocabulary knowledge will affect performance
Lack of exposure to certain cultural and social experiences related to low SES status or lack of formal school instruction
- How many of such students would know know the meaning of the word “sneer”?
- How many can actually show it?
Life experiences that the child simply hasn’t encountered yet
- Has an entire subtest devoted to idioms
Select topics may be inappropriate for younger children
- Dieting
- Dating
Culturally biased when it comes to certain questions regarding friendship and personal values
- Individual vs. cooperative culture differences

What I like about this test:

I like the fact that unlike the CELF-5:M, the test is composed of open-ended questions instead of offering orally/visually based multiple choice format as it is far more authentic in its representation of real world experiences
I really like how the select subtests (Making Inferences) require a response to both questions in order for the responder to achieve credit on the total subtest

Overall, when you carefully review what’s available in the area of assessment of social pragmatic abilities of adolescents this is an important test to have in your assessment toolkit as it provides very useful information for social pragmatic language treatment goal purposes.

Have YOU purchased SLDTA yet? If so how do you like using it? Post your comments, impressions and questions below.

Helpful Resources Related to Social Pragmatic Language Overview, Assessment and Remediation:

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

Posted on November 2, 2014January 5, 2022 by Tatyana Elleseff — Leave a comment

Dear Pediatrician: Please Don’t Say That!

Recently, a new client came in for therapy. He was a little over three years of age with limited verbal abilities, and a number of stereotypical behaviors consistent with autism spectrum disorder. During the course of parental interview, the child’s mother mentioned that he had previously briefly received early intervention services but aged out from the early intervention system after only a few months. As we continued to discuss the case, his mother revealed that she had significant concerns regarding her son’s language abilities and behavior from a very early age because it significantly differed from his older sister’s developmental trajectory. However, every time she brought it up to her pediatrician she invariably received the following answers: “Don’t compare him to his sister, they are different children” and “Don’t worry, he will catch up”, which resulted in the child being referred for early intervention services when he was almost 3 years of age, and unable to receive consistent speech therapy services prior to aging out of the program all together.

This is not the first time I heard such a story, and I’m sure it won’t be the last time as well. Sadly, myself and other speech language therapists are very familiar with such cases and that is such a shame. It is a shame, because a parent was absolutely correct in trusting her instincts but was not validated by a medical professional she trusted the most, her child’s pediatrician. Please don’t get me wrong, I am not playing the blame game or trying to denigrate members of another profession. My aim today is rather different and that is along with my colleagues to continue increasing awareness among all health professionals regarding the early identification of communication disorders in children in order for them to receive effective early intervention services to improve their long-term outcomes.

Whenever one “Googles” the term “Language Milestones In Children” or “When do children begin to talk?” Numerous links pop-up, describing developmental milestones in children. Most of them contain fairly typical information such as: first word emerge at approximately 12 months of age, 2 word combinations emerge when the child has a lexicon of approximately 50 words or more, which corresponds to a period between 18 months to 2 years of age, and sentences emerge when a child is approximately 3 years of age. While most of this information is hopefully common knowledge for many healthcare professionals working with children including pediatricians, is also important to understand that when the child comes in for a checkup one should not look at these abilities in isolation but rather look at the child holistically. That means asking the parents the right questions to compare the child’s cognitive, adaptive, social emotional, as well as communicative functioning to that of typically developing peers or siblings in order to determine whether anything is amiss. Thus, rather than to discourage the parent from comparing their child to typically developing children his age, the parents should actually be routinely asked the variation of the following question: “How do your child’s abilities and functioning compare to other typically developing children your child age?”

Whenever I ask this question during the process of evaluation or initiation of therapy services, 90% of the time I receive highly detailed and intuitive responses from well-informed parents. They immediately begin describing in significant detail the difference in functioning between their own delayed child and his/her siblings/peers. That is why in the majority of cases I find the background information provided by the parent to be almost as valuable as the evaluation itself. For example, I recently assessed a 3-5 year-old child due to communication concerns. The pediatrician was very reluctant to refer to the child for services due to the fact that the child was adequately verbal. However, the child’s parents were insistent, a script for services was written, and the child was brought to me for an evaluation. Parents reported that while their child was very verbal and outgoing, most of the time they had significant difficulty understanding what she was trying to tell them due to poor grammar as well as nonsensical content of her messages. They also reported that the child had a brother , who was older than her last several years. However, they stated that they had never experienced similar difficulties with the child’s brother when he was her age, which is why they became so concerned with each passing day regarding the child’s language abilities.

Indeed, almost as soon as the evaluation began, it became apparent that while the child’s verbal output was adequate, the semantic content of those messages as well as the pragmatic use in conversational exchanges was significantly impaired. In other words, the child may have been adequately verbose but the coherence of her discourse left a lot to be desired. This child was the perfect candidate for therapy but had parents not insisted, the extent of her expressive language difficulties may have been overlooked until she was old enough to go to kindergarten. By then many valuable intervention hours would have been lost and the extent of the child deficits have been far greater.

So dear pediatrician, the next time a concerned parent utters the words: “I think something is wrong…” or “His language is nothing like his brother’s/sister’s when s/he was that age” don’t be so hasty in dismissing their concerns. Listen to them, understand that while you are the expert in childhood health and diseases, they are the expert in their own child, and are highly attuned to their child’s functioning and overall abilities. Encourage them to disclose their worries by asking follow-up questions and validating their concerns.

There are significant benefits to receiving early targeted care beyond the improvement in language abilities. These include but are not limited to: reduced chances of behavioral deficits or mental illness, reduced chances of reading, writing and learning difficulties when older, reduced chances of impaired socialization abilities and self-esteem, all of which can affect children with language deficits when appropriate services are delayed or never provided. So please, err on the side of caution and refer the children with suspected deficits to speech language pathologists. Please give us an opportunity to thoroughly assess these children in order to find out whether there truly is speech/language disorder/delay. Because by doing this you truly will be serving the interests of your clients.

Helpful Smart Speech Therapy Resources:

Posted on October 30, 2014March 18, 2022 by Tatyana Elleseff — 1 Comment

Word-Finding Remediation: EBP Resources for SLPs

It’s on the tip of my tongue! How many times have you used this expression or heard it from other people. Oftentimes when we think of word-finding deficits we automatically think of it as an adult affliction, however, you would be surprised how many children including even very young children (4+ years of age) are affected by it. Did you know that “up to 7% of children have specific language needs and around 25% of children attending language support services have word-finding difficulties (WFD; Dockrell et al., 1998)?”

If you participate in various speech language and education related forums you may frequently see a variation on this question: “How would you assess and treat a child with word finding difficulties?” Before I provide some recommendations on this matter I’d like to talk a little bit about what word-finding is as well as what impact untreated word finding issues may have in a child.

So how do word-finding deficits manifest in children? In a vast variety of ways actually! For starters they could occur at the word level, conversational level or both. Below are just a few examples of word-level errors from German, 2005:

Error Pattern 1- Lemma Related Semantic Errors
- “Slips of the tongue” or semantic word substitutions such as fox→ wolf; clown → gnome
Error Pattern 2 – Form Related Blocked Errors
- “Tips of the tongue” or responses characterized by word blocks, pauses, fillers (um, ah, etc), repetitions, metalinguistic or metacognitive comments such as “I know”, “I don’t know”, etc.
Error Pattern 3 – Form & Segment Related Phonologic Errors
- “Twists of the tongue” which include phoneme omissions, substitutions and additions such as cactus → catus; octopus →opotus, etc.

Further complicating the above may be the speed (some delay or no delay) with which they retrieve words as well as accuracy/inaccuracy of their retrieval once the words are retrieved. Additionally, a number of secondary characteristics may also play a role which include gestures (e.g, miming a word, frustration, etc) as well as extra verbalizations (metalinguistic and metacognitive comments).

At discourse level, students with word-finding deficits typically occupy one of two categories: productive vs. insufficiently productive language users. While their narrative language profile may be marked by frequent pauses, word fillers, as well as word and phrase revisions and repetitions.

Moreover, word-retrieval deficits are not limited to discourse, they are also found in reading tasks. There word-finding issues may manifest as omitted words or almost stuttering/cluttering like behaviors. Interestingly German and Newman (2005; 2007) found that students with word retrieval difficulties are able to successfully correctly identify the words they missed during oral reading tasks in silent reading recognition tasks.

Difficulty coherently expressing oneself can have significant detrimental effect on the child’s academic performance, social relationships and ultimately self-esteem, which without appropriate intervention may potentially lead to poor school performance as well as mental issues (e.g., anxiety, depression, etc.)

So how can word-finding deficits be assessed for free? You can assess word-finding at narrative level using the clinical narrative assessment.

At word level you can adapt single word standardazed tests such as the Expressive One Word Picture Vocabulary Test (EOWPVT) in order to test the efficiency of the student’s word retrieval in single word context. Here, the goal is not necessarily to test their expressive vocabulary knowledge but rather to see what type of word finding errors the students are making as they are attempting to correctly recall the visually shown word. Depending on the extent of the child’s word finding deficits you may have some very useful information to derive from the presentation of this test.

To illustrate, I recently informally administered applicable portions of this test to a four-year old Russian speaking preschooler. Based on his performance I was able to determine that his errors are primarily Error Pattern 3 – Form & Segment Related Phonologic Errors or Twists of the tongue”. This was further confirmed when I had the child to participate in the narrative retelling task.

So where can we find reputable evidence-based practice information on effective assessment and treatment strategies for word finding deficits? Start with Dr. Diane German’s website, entitled Word Finding. She has a lot of good information to offer there for free to both speech language professionals as well as parents. Take a look at her recommended materials and resources, they are very helpful when it comes to assessing and treating children with word finding deficits. Now have fun and evidence-base practice on!

PS. Calculating percentage of word-finding difficulties in children.

Dr. German recommends the following procedure: “Obtain a language sample of 50 T-units (kernel sentence + subordinate clause) in length using stimuli of interest to the learner (or use one you have as long as all utterances in the sample are included). Then asses each T unit for the presence of one or more of the following 7 WF behaviors in discourse: repetitions, revisions (reformulations), substitutions, insertions (comment that reflects on the WF process like I cannot think of it, etc. ), time fillers (um, er, uh), delays with in the T unit, and empty words (thing, stuff). Learners with WF difficulties manifest one or more WF behaviors in 33% or more of their T units (often 40% – 50%). Typical language learners display WF behaviors in 19% or less of their T-Units (German, 1991)“ (German, 2015: SIG 16 Topic: Assessing Word-Finding Skills)

Helpful Related Materials:

References:

Dockrell, J.E., Messer, D., George, R. & Wilson, G. (1998). Notes and Discussion Children with word-finding difficulties-prevalence, presentation and naming problems. International Journal of Language & Communication Disorders, 33 (4), 445-454.
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/

Disclaimer: The views expressed in this post are the personal opinion of the author. The author is not affiliated with dr. Diane German nor PRO-ED publications in any way and was not provided by them with any complimentary products or compensation for this post.

Posted on October 19, 2014January 5, 2022 by Tatyana Elleseff — 7 Comments

Review of Social Language Development Test Elementary: What SLPs Need to Know

As the awareness of social pragmatic language disorders continues to grow, more and more speech language pathologists are asking questions regarding various sources of social pragmatic language testing. Today I am reviewing one such test entitled: Social Language Development Test Elementary (SLDTE) currently available from PRO-ED.

Basic overview

Release date: 2008
Age Range: 6:00-11:11
Authors:Linda Bowers, Rosemary Huisingh, Carolyn LoGiudice
Publisher: Linguisystems (PRO-ED as of 2014)

This test assesses the students’ social language competence and addresses their ability to take on someone else’s perspective, make correct inferences, negotiate conflicts with peers, be flexible in interpreting situations and supporting friends diplomatically.

The test is composed of 4 subtests, of which the first two subtests are subdivided into 2 and 3 tasks respectively.

The Making Inferences subtest (composed of 2 tasks) of the SLDT-E is administered to assess student will’s ability to infer what someone in the picture is thinking (task a) as well as state the visual cues that aided the student in the making of that inference (task b).

On task /a/ errors can result due to student’s difficulty correctly assuming first person perspective (e.g., “Pretend you are this person. What are you thinking?”) and infering (guessing) what someone in the picture was thinking. Errors can also result due to vague, associated and unrelated responses which do not take into account the person’s context (surroundings) as well as emotions expressed by their body language.

On task /b/ errors can result due to the student’s inability to coherently verbalize his/her responses which may result in the offer of vague, associated, or unrelated answers to presented questions, which do not take into account facial expressions and body language but instead may focus on people’s feelings, or on the items located in the vicinity of the person in the picture.

The Interpersonal Negotiation subtest (composed of 3 tasks) of the SLDT-E is administered to assess the student’s ability to resolve personal conflicts in the absence of visual stimuli. Student is asked to state the problem (task a) from first person perspective (e.g., pretend the problem is happening with you and a friend), propose an appropriate solution (task b), as well as explain why the solution she was proposing was a good solution (task c).

On task /a/ errors can result due to the student’s difficulty recognizing that a problem exists in the presented scenarios. Errors can also result due to the student’s difficulty stating a problem from a first person perspective, as a result of which they may initiate their responses with reference to other people vs. self (e.g., “They can’t watch both shows”; “The other one doesn’t want to walk”, etc.). Errors also can also result due to the student’s attempt to provide a solution to the presented problem without acknowledging that a problem exists. Here’s an example of how one student responded on this subtest. When presented with: “You and your friend found a stray kitten in the woods. You each want to keep the kitten as a pet. What is the problem?” A responded: “They can’t keep it.” When presented with: “You and your friend are at an afterschool center. You both want to play a computer game that is played by one person, but there’s only one computer. What is the problem?” A responded: “You have to play something else.”

On task /b/ errors can result due to provision of inappropriate, irrelevant, or ineffective solutions, which lack arrival to a mutual decision based on dialog.

On task /c/ errors can result due to vague and inappropriate explanations as to why the solution proposed was a good solution.

The Multiple Interpretations subtest assesses the student’s flexible thinking ability via the provision of two unrelated but plausible interpretations of what is happening in a photo. Here errors can result due to an inability to provide two different ideas regarding what is happening in the pictures. As a result the student may provide vague, irrelevant, or odd interpretations, which do not truly reflect the depictions in the photos.

The Supporting Peers subtest assesses student’s ability to take the perspective of a person involved in a situation with a friend and state a supportive reaction to a friend’s situation (to provide a “white lie” rather than hurt the person’s feelings). Errors on this subtest may result due to the student’s difficulty appropriately complementing, criticizing, or talking with peers. Thus students who as a rule tend to be excessively blunt, tactless, or ‘thoughtless’ regarding the effect their words may have on others will do poorly on this subtest. However, there could be situations when a high score on this subtest may also be a cause for concern (see the details on why that is HERE). That is because simply repeating the phrase “I like your ____” over and over again without putting much thinking into their response will earn the responder an average subtest score according to the SLDT-E subtest scoring guidelines. However, such performance will not be reflective of true subtest competence and needs to be interpreted with significant caution.

The following goals can be generated based on the performance on this test:

Long Term Goals: Student will improve social pragmatic language competence in order to effectively communicate with a variety of listeners/speakers in all conversational and academic contexts

Short Term Goals

Student will improve ability to make inferences based on social scenarios
Student will improve ability to interpret facial expressions, body language, and gestures
Student will improve ability to recognize conflicts from a variety of perspectives (e.g., first person, mutual, etc.)
Student will improve ability to resolve personal conflicts using effective solutions relevant to presented scenarios
Student will improve ability to effectively justify solutions to presented situational conflicts
Student will ability to provide multiple interpretations of presented social situations
Student will provide effective responses to appropriately support peers in social situations
Student will improve ability to engage in perspective taking (e.g., the ability to infer mental states of others and interpret their knowledge, intentions, beliefs, desires, etc.)

A word of caution regarding testing eligibility:

I would also not administer this test to the following populations:

Students with social pragmatic impairments secondary to intellectual disabilities (IQ <70)
Students with severe forms of Autism Spectrum Disorders
Students with severe language impairment and limited vocabulary inventories
English Language Learners (ELL) with suspected social pragmatic deficits
Students from low SES backgrounds with suspected pragmatic deficits

Lack of relevant vocabulary knowledge
Lack of exposure to certain cultural and social experiences related to low SES status or lack of formal school instruction
Life experiences that the child simply hasn’t encountered yet
- For example the format of the Multiple Interpretations subtest may be confusing to students unfamiliar with being “tested” in this manner (asked to provide two completely different reasons for what is happening ina particular photo)

What I like about this test:

I like the fact that the test begins at 6 years of age, so unlike some other related tests such as the CELF-5:M, which begins at 9 years of age or the informal Social Thinking Dynamic Assessment Protocol® which can be used when the child is approximately 8 years of age, you can detect social pragmatic language deficits much earlier and initiate early intervention in order to optimize social language gains.
I like the fact that the test asks open-ended questions instead of offering orally/visually based multiple choice format as it is far more authentic in its representation of real-world experiences
I really like how the select subtests are further subdivided into tasks in order to better determine the students’ error breakdown

Overall, when you carefully review what’s available in the area of assessment of social pragmatic abilities this is an important test to have in your assessment toolkit as it provides very useful information for social pragmatic language treatment goal purposes.

Have YOU purchased SLDTE yet? If so how do you like using it?Post your comments, impressions and questions below.

NEW: Need an SLDTE Template Report? Find it HERE

Helpful Resources Related to Social Pragmatic Language Overview, Assessment and Remediation:

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