In recent years there has been an increase in infants, toddlers and preschoolers diagnosed with significant social-emotional and/or behavioral problems. An estimated 10% to 15% of birth-5 year-old population experience serious social-emotional problems which significantly impact their functioning and development in the areas of language, behavior, cognition and school-readiness (Brauner & Stephens, 2006). Continue reading The risk of social-emotional deficits in language-impaired young children
Category: Assessment
New Product Giveaway: Social Pragmatic Deficits Checklist for Preschool Children
When it comes to assessment of social pragmatic abilities, the majority of SLP’s often worry about their school age students. Yet social-emotional disturbances and behavioral abnormalities in preschool children (<5 years of age) are more common than you think.
Egger & Angold (2006) found that “despite the relative lack of research on preschool psychopathology compared with studies of the epidemiology of psychiatric disorders in older children, the current evidence now shows quite convincingly that the rates of the common child psychiatric disorders and the patterns of comorbidity among them in preschoolers are similar to those seen in later childhood. (p. 313)” Continue reading New Product Giveaway: Social Pragmatic Deficits Checklist for Preschool Children
What parents need to know about speech-language assessment of older internationally adopted children
This post is based on Elleseff, T (2013) Changing Trends in International Adoption: Implications for Speech-Language Pathologists. Perspectives on Global Issues in Communication Sciences and Related Disorders, 3: 45-53
Changing Trends in International Adoption:
In recent years the changing trends in international adoption revealed a shift in international adoption demographics which includes more preschool and school-aged children being sent for adoption vs. infants and toddlers (Selman, 2012a; 2010) as well as a significant increase in special needs adoptions from Eastern European countries as well as from China (Selman, 2010; 2012a). Continue reading What parents need to know about speech-language assessment of older internationally adopted children
DI or SP: Why it’s important to know who is treating your child in Early Intervention
Recently on the American Speech Language Hearing Association Early Intervention forum there was a discussion about the shift in several states pertaining to provision of language services to children in the early intervention system. Latest trend seems to be that a developmental interventionists (DI) or early childhood educators are now taking over in providing language intervention services instead of speech language pathologists.
A number of parents reported to SLPs that they were told by select DIs that “they work on same goals as speech therapists”. One parent, whose child received speech therapy privately with me and via EI kept referring to a DI’s as an SLP, during our conversation. This really confused me during my coordination of services phone call with the DI, since I was using terminology the DI was unfamiliar with.
Consequently, since a number of parents have asked me about the difference between DIs and SLPs I decided to write a post on this topic.
So what is the difference between DI and an SLP?
DI or a developmental interventionist is an early childhood education teacher. In order to provide EI services a DI needs to have an undergraduate bachelor’s degree in a related health, human service, or education field. They also need a certificate in Early Childhood Education OR at least six (6) credits in infant or early childhood development and/or special education coursework.
A DI’s job is to create learning activities that promote the child’s acquisition of skills in a variety of developmental areas. DI therapists do not address one specific area of functioning but instead try to promote all skills including: cognition, language and communication, social-emotional functioning and behavior, gross and fine motor skills as well as self-help skills via play based interactions as well as environmental modifications. In other words a DIs are a bit like a jacks of all trades and they focus on a little bit of everything.
SLP or a Speech Language Pathologist is an ancillary health professional. In order to provide EI services, in the state of NJ for example, an SLP needs to have a Masters Degree in Speech Language Pathology or Communication Disorders as well as a State License (and in most cases a certification from ASHA, our national association).
Unlike DIs, pediatric SLPs focus on and have an in-depth specialization in improving children’s communication skills (e.g., speech, language, alternative augmentative communication, etc.). SLPs undergo rigorous training including multiple internships at both undergraduate (BA) and graduate (MA) levels as well as complete a clinical fellowship year prior to receiving relevant licenses and certifications. SLPs are also required to obtain a certain number of professional education hours every year after graduation in order to maintain their license and certifications. Many of them undergo highly specialized trainings and take courses on specialized techniques of speech and language elicitation in order to work with children with severe speech language disorders secondary to a variety of complex medical, neurological and/or genetic diagnoses.
As you can see from the above, even though at first glance it may look like DIs and SLPs do similar work, DIs DON’T have nearly the same level of expertise and training possessed by the SLPs, needed to address TRUE speech-language delays and disorders in children.
What does this all mean to parents?
That depends on why parents/caregivers are seeking early intervention services in the first place. If they are concerned about their child’s speech language development then they definitely want to ensure the following:
- The child undergoes a speech language assessment with a qualified speech language pathologist and
- If speech language therapy is recommended, the child receives it from a qualified speech language pathologist
So if a professional other than an SLP assesses the child than it cannot be called a speech language assessment.
Similarly, if a related professional (e.g., DI) is providing services, they are NOT providing “speech language therapy” services.
They are also NOT providing the ‘SAME‘ level of services as a speech-language pathologist does.
Consequently, if speech language services are recommended for the child and those recommendations are documented in the child’s Individualized Family Service Plan (IFSP) then these services MUST be provided by a speech language pathologist, otherwise it is a direct violation of the child’s IFSP under the IDEA: Part C.
So how can parents ensure their child receives appropriate services from the get-go?
- Find out in advance before the assessment who are the professionals (from which disciplines) coming to evaluate your child
- If you have requested a speech-language evaluation due to concerns over your child’s speech language abilities and the SLP is not scheduled to assess, find out the reason for it and determine whether that reason makes sense to you
- Ask questions during the assessment regarding the child’s performance/future recommendations
- Make sure that an IFSP meeting is scheduled 45 days after the initial referral if the child is found eligible
- Find out in advance which professionals will be attending your child’s IFSP meeting
- Find out if any reports will be available to you prior to the meeting
- If yes, carefully review the assessment report to ensure that you understand and agree with the findings
- If no, make sure you have an adequate period of time to review all documentation prior to signing it and if need to request time to review reports
- If an SLP assessed your child but therapy services are not recommended find out the reason for services denial in order to determine whether you have grounds for appeal (child’s delay was not substantial enough to merit services. vs. lack of SLP availability to provide intervention services)
- If speech-language therapy services are recommended ensure that therapy initiation occurs in a timely manner after the initial IFSP meeting and that all missed sessions (by an SLP) are made-up in a timely manner as well
EI Service Provision in the State of New Jersey: DI vs. SLP
(from Service Guidelines for Speech Therapy in Early Intervention)
The following are the circumstances in which a DI will be assigned to work with the child instead of an SLP (vs. in conjunction with) in the state of NJ (rules are similar in many other states)
- If a child, under 28 months of age, presents with a “late-talker profile” (pg 27)
- If child with speech-language delays also has delayed prelinguistic skills (e.g., joint attention, turn-taking, etc), the DI will work with the child first to establish them (pg 29)
- If a child under 28 months has expressive language delay only and has intact cognition, receptive language, and motor skills
- If the child has a cognitive delay commensurate with a receptive and expressive delay (p 30)
- If a child has a hearing impairment and no other developmental delays, DI services will be provided while information is being obtained and medical intervention is being provided (pg 31)
Understanding who is providing services and the rationale behind why these services are being provided is the first important step in quality early intervention service provision for young children with language delays and disorders. So make sure that you know, who is treating your child!
Useful Resources:
- New Jersey’s Early Intervention System Your Child’s Development Important Milestones: (Birth – 36 months)
- Service Guidelines for Speech Therapy in Early Intervention
- The Early Intervention/IFSP Process
- Steps in the Early Intervention Process
- Procedural Safeguards for Families at Each Step of the EI Process
- What You Can Expect from Speech Therapy: A Guide for Parents
Introduction to the “Need to Know” Disorders in Speech Language Pathology
In a few weeks the school semester will begin and many speech language pathologists will be heading back to school to resume their duties. Seasoned professionals, newly minted clinical fellows, and eager graduate students will embark on assessment and treatment of children with a variety of communication disorders. In the course of the next school year they will encounter, assess, and treat children with a number of diagnoses which result in accompanying speech language deficits. Many of these diagnoses will be familiar, a number will be new, some complex, yet others will be less known or controversial. Continue reading Introduction to the “Need to Know” Disorders in Speech Language Pathology
Forms for Back to School Assessment Preparation
Back to school time is just around the corner and if your job is anything like mine then you are getting ready to perform a number of speech language screenings and assessments after the kids get back to school in September. In order to optimize the assessment process I’ve created a number of checklists and forms for my (and your convenience). They allow for quick and efficient determination of whether the preschool/school age monolingual/bilingual student in question requires any speech language services including: screening, assessment, future follow-up, or on-going monitoring. Please note that for bilingual students it is recommended that parents mark whether the child presents with deficits in one language or in both on the checklists (e.g., mark R, E, or B – Russian, English or both).
- R difficulty following 3+step directions containing concepts of time or location (before/after/to the left)
- E difficulty understanding basic concepts in the classroom
- B difficulty responding appropriately to simple questions (who/what/where/when)
Speech Language Assessment Checklist For A Preschool Child is a 9 page guide created to assist speech language pathologists in the decision making process of how to select assessment instruments and prioritize assessment for preschool children 3:00-5:11 years of age. The goal is to eliminate administration of unnecessary or irrelevant tests and focus on the administration of instruments directly targeting the areas of difficulty that the child presents with.
It contains:
- Page 1 Title
- Page 2 Directions
- Pages 3-5 Checklist
- Pages 6 Suggested Speech-Language Test Selection for Preschool Children
- Page 7 Select Language Testing Battery Suggestions
- Page 8-9 Supplemental Caregiver/Teacher Data Collection Form
Checklist Target Areas:
- Receptive Language
- Memory, Attention and Sequencing
- Expressive Language
- Speech
- Voice
- Resonance
- Phonological Awareness
- Problem Solving
- Pragmatic Language
- Social Emotional Development
- Executive Functions
Speech Language Assessment Checklist For A School-Aged Child is a 12 page guide created to assist speech language pathologists in the decision making process of how to select assessment instruments and prioritize assessment for school age children. The goal is to eliminate administration of unnecessary or irrelevant tests and focus on the administration of instruments directly targeting the areas of difficulty that the child presents with.
It contains:
- Page 1 Title
- Page 2 Directions
- Pages 3-6 Checklist
- Pages 7-8 Suggested Speech-Language Test Selection for School-Aged Children
- Page 9 Select Language Testing Battery Suggestions
- Page 10-12 Supplemental Caregiver/Teacher Data Collection Form
Checklist Target Areas:
- Receptive Language
- Memory, Attention and Sequencing
- Expressive Language
- Vocabulary
- Narrative
- Speech
- Voice
- Resonance
- Phonological Awareness
- Problem Solving
- Pragmatic Language
- Social Emotional Development
- Executive Functions
Auditory Processing Deficits Checklist for School Aged Children was created to assist speech language pathologists (SLPs) with figuring out whether the student presents with auditory processing deficits which require further follow up (e.g., screening, comprehensive assessment). The SLP should provide this form to both teacher and caregiver/s to fill out to ensure that the deficit areas are consistent across all settings and people.
Checklist Categories:
- Listening Skills and Short Term Memory
- Verbal Expression
- Emergent Reading/Phonological Awareness
-
General Organizational Abilities
- Social Emotional Functioning
- Behavior
- Supplemental* Caregiver/Teacher Data Collection Form
- Select assessments sensitive to Auditory Processing Deficits
Social Pragmatic Deficits Checklist for School Aged Children was created to assist speech language pathologists (SLPs) with figuring out whether the student presents with social pragmatic language deficits which require further follow up (e.g., assessment). The SLP should provide this form to both teacher and caregiver/s to fill out to ensure that the deficit areas are consistent across all settings and people.
Checklist Categories:
- Listening/Processing
- Verbal Expression
- Problem Solving
- Pragmatic Language Skills
- Social Emotional Development
- Behavior
- Supplemental* Caregiver/Teacher Data Collection Form
- Select assessments sensitive to Social Pragmatic Deficits
You can find these products by clicking on the individual links above. You can also find many other educational products relevant to assessment and treatment in speech language pathology in my online store by clicking HERE.
Happy and successful new school year everyone!
FASD and Background History Collection: Asking the Right Questions
Note: This article was originally published in August 2013 Issue of Adoption Today Magazine (pp. 32-35).
Sometime ago, I interviewed the grandmother of an at-risk 11 year old child in kinship care, whose language abilities I have been asked to assess in order to determine whether he required speech-language therapy services. The child was attending an outpatient school program in a psychiatric hospital where I worked and his psychiatrist was significantly concerned regarding his listening comprehension abilities as well as social pragmatic skills. Continue reading FASD and Background History Collection: Asking the Right Questions
SLPs Blogging About Research: August Edition -FASD
This month I am joining the ranks of bloggers who are blogging about research related to the field of speech pathology. Click here for more details.
Today I will be reviewing a recently published article in The Journal of Neuroscience on the topic of brain development in children with Fetal Alcohol Spectrum Disorders (FASD), one of my areas of specialty in speech pathology.
Title: Longitudinal MRI Reveals Altered Trajectory of Brain Development during Childhood and Adolescence in Fetal Alcohol Spectrum Disorder
Purpose: Canadian researchers performed advanced MRI brain scans of 17 children with FASD between 5 and 15 years of age and compared them to the scans of 27 children without FASD. Each participant underwent 2-3 scans and each scan took place 2-4 years apart. The multiple scan component over a period of time is what made this research study so unique because no other FASD related study had done it before.
Aim of the study: To better understand how brain abnormalities evolve during key developmental periods of behavioral and cognitive progression via longitudinal examination of within-subject changes in white brain matter (Diffusion Tensor Imaging – DTI) ) in FASD during childhood and adolescence.
Subjects: Experimental subjects had a variety of FASD diagnoses which included fetal alcohol syndrome (FAS), partial FAS (pFAS), static encephalopathy alcohol exposed (SE:AE), neurobehavioral disorder alcohol exposed (NBD:AE), as well as alcohol related neurobehavioral disorder (ARND). Given the small study size the researchers combined all sub diagnoses into one FASD group for statistical analysis.
In addition to the imaging studies, FASD subjects underwent about ∼1.5 h of cognitive testing at each scan, administered by a trained research assistant. The test battery included:
- Woodcock Johnson Quantitative Concepts 18A&B (mathematics)
- Woodcock Reading Mastery Test-Revised (WRMT-R) Word ID
- Comprehensive Expressive and Receptive Vocabulary Test (CREVT)
- Working Memory Test Battery for Children (WMTB-C)
- Behavior Rating Inventory of Executive Function (BRIEF) parent form
- NEPSYI/II (auditory attention and response set; memory for names, narrative memory; arrows).
9/17 participants in the FASD group were also administered the Wide Range Intelligence Test (WRIT) at scan 2.
Control subjects were screened for psychiatric and neurological impairments. Their caregivers were also contacted retrospectively and asked to estimate in utero alcohol exposure for their child. Of the 21 control subject caregivers who were reached, 14/21 reported no exposure, 2/21 unknown, and 5/21 reported minimal alcohol exposure (range: 1–3 drinks; average of two drinks total during pregnancy). Control subjects did not undergo a full battery of cognitive testing, but were administered WRMT-R Word ID at each scan.
Summary of results: The FASD group performed significantly below the controls on most of the academic, cognitive, and executive function measures despite average IQ scores in 53% of the FASD sample. According to one of the coauthors, Sarah Treit, “longitudinal increases in raw cognitive scores (albeit without changes in age-corrected standard scores) suggest that the FASD group made cognitive gains at a typical rate with age, while still performing below average”. For those of us who work with this population these findings are very typical.
Imaging studies revealed that over time subjects in the control group presented with marked increases in brain volume and white matter – growth which was lacking in subjects with FASD. Furthermore, children with FASD who demonstrated the greatest changes in white matter development (on scans) also made the greatest reading gains. Children with the most severe FASD showed the greatest diffusion changes in white matter brain wiring and less overall brain volume.
Implications: “This study suggests alcohol-induced injury with FASD isn’t static – those with FASD have altered brain development, they aren’t developing at the same rate as those without the disorder.” So not only does the brain altering damage exists in children with FASD at birth, but it also continues to negatively affect brain development through childhood and at least through adolescence.
Given these findings, it is very important for SLPs to perform detailed and comprehensive language assessments and engage in targeted treatment planning for these children in order to provide them with specialized individualized services which are based on their rate of development.
Dear Neurodevelopmental Pediatrician: Please Don’t Do That!
Recently I got yet another one of the dreaded phone calls which went a little something like this:
Parent: Hi, I am looking for a speech therapist for my son, who uses PROMPT to treat Childhood Apraxia of Speech (CAS). Are you PROMPT certified?
Me: I am PROMPT trained and I do treat motor speech disorders but perhaps you can first tell me a little bit about your child? What is his age? What type of speech difficulties does he have? Who diagnosed him and recommended the treatment.
Parent: He is turning 3. He was diagnosed by a neurodevelopmental pediatrician a few weeks ago. She recommended speech therapy 4 times a week for 30 minutes sessions, using PROMPT.
Me: And what did the speech therapy evaluation reveal?
Parent: We did not do a speech therapy evaluation yet.
Sadly I get these type of phone calls at least once a month. Frantic parents of toddlers aged 18 months to 3+ years of age call to inquire regarding the availability of PROMPT therapy based exclusively on the diagnosis of the neurodevelopmental pediatrician. In all cases I am told that the neurodevelopmental pediatrician specified speech language diagnosis, method of treatment, and therapy frequency, ALBEIT in a complete absence of a comprehensive speech language evaluation and/or past speech language therapy treatments.
The conversation that follows is often an uncomfortable one. I listen to the parental description of the child’s presenting symptoms and explain to the parents that a comprehensive speech language assessment by a certified speech language pathologist is needed prior to initiation of any therapy services. I also explain to the parents that depending on the child’s age and the assessment findings CAS may or may not be substantiated since there are a number of speech sound disorders which may have symptoms similar to CAS.
Following my ‘spiel’, the parents typically react in a number of ways. Some get offended that I dared to question the judgement of a highly qualified medical professional. Others hurriedly thank me for my time and resoundingly hang up the phone. Yet a number of parents will stay on the line, actually listen to what I have to say and ask me detailed questions. Some of them will even become clients and have their children undergo a speech language evaluation. Still a number of them will find out that their child never even had CAS! Past misdiagnoses ranged from ASD (CAS was mistaken due to the presence of imprecise speech and excessive jargon related utterances) to severe phonological disorder to dysarthria secondary to CP. Thus, prior to performing a detailed speech language evaluation on the child I had no way of knowing whether the child truly presented with CAS symptoms.
Before I continue I’d like to provide a rudimentary definition of CAS. Since its identification years ago it has been argued whether CAS is linguistic or motoric in nature with the latest consensus being that CAS is a disorder which disrupts speech motor control and creates difficulty with volitional, intelligible speech production. Latest research also shows that in addition to having difficulty forming words and sentences at the speech level, children with CAS also experience difficulty in the areas of receptive and expressive language, in other words, “pure” apraxia of speech is rare (Hammer, 2007).
This condition NEEDS to be diagnosed by a speech language pathologist! Not only that, due to the disorder’s complexity it is strongly recommended that if parents suspect CAS they should take their child for an assessment with an SLP specializing in assessment and treatment of motor speech disorders. Here’s why.
- CAS has a number of overlapping symptoms with other speech sound disorders (e.g., severe phonological disorder, dysarthria, etc).
- Symptoms which may initially appear as CAS may change during the course of intervention by the time the child is older (e.g., 3 years of age) which is why diagnosing toddlers under 3 years of age is very problematic and the use of “suspected” or “working” diagnosis is recommended (Davis & Velleman, 2000) in order to avoid misdiagnosis
- Diagnosis of CAS is also problematic due to the fact that there are no valid or reliable standardized assessments sensitive to CAS (McCauley & Strand, 2008). However, a new instrument Dynamic Evaluation of Motor Speech Skill (DEMSS) (Strand et al, 2013) is showing promise with respect to differential diagnosis of severe speech impairments in children
- Thus for children with less severe impairments SLPs need to design tasks to assess the child’s:
- Automatic vs. volitional control
- Simple vs. complex speech
- Consistency of productions on repetitions of same word
- Vowel productions
- Imitation abilities
- Prosody
- Phonetic inventory BEFORE and AFTER intervention
- Types and levels of cueing the child is presently stimulable to
- in order to determine where the breakdown is taking place (Caspari, 2012)
These are just some of the reasons why specialization in CAS is needed and why it is IMPOSSIBLE to make a reliable CAS diagnosis by simply observing the child for a length of time, from a brief physical exam, and from extensive parental interviews (e.g., a typical neurodevelopmental appointment).
In fact, leading CAS experts state that you DON’t need a neurologist in order to confirm the CAS diagnosis (Hammer, 2007).
Furthermore, “NO SINGLE PROGRAM WORKS FOR ALL CHILDREN WITH APRAXIA!!” (Hammer, 2007). Hence SLPs NEED to individualize not only their approach with each child but also switch approaches with the same child when needed it in order to continue making therapy gains. Given the above the PROMPT approach may not even be applicable to some children.
It goes without saying that MANY developmental pediatricians will NOT do this!
But for those who do, I implore you – if you observe that a young child is having difficulty producing speech, please refer the child for a speech language assessment first. Please specify to the parents your concerns (e.g., restricted sound repertoire for the child’s age, difficulty sequencing sounds to make words, etc) BUT NOT the diagnosis, therapy frequency, as well as therapy approaches. Allow the assessing speech language pathologist to make these recommendations in order to ensure that the child receives the best possible targeted intervention for his/her disorder.
For more information please visit the Childhood Apraxia of Speech Association of North America (CASANA) website or visit the ASHA website to find a professional specializing in the diagnosis and treatment of CAS near you.
References:
- Caspari, S (2012) Beyond Picture Cards! Practical Assessment and Treatment Methods for Children with Apraxia of Speech. Session presented for New Jersey Speech Language Hearing Association Convention, Long Branch, NJ
- Davis, B., & Velleman, S. L. (2000). Differential diagnosis and treatment of developmental apraxia of speech in infants and toddlers. Infant-Toddler Intervention: The Transdisciplinary Journal, 10, 177–192.
- Hammer, D (2007) Childhood Apraxia of Speech: Evaluation and Therapy Challenges. Retrieved from http://www.maxshouse.com.au/documents/CAS%20conference%20day%201%20.ppt.
- McCauley RJ, Strand EA. (2008). A Review of Standardized Tests of Nonverbal Oral and Speech Motor Performance in Children. American Journal of Speech-Language Pathology, 17,81-91.
- Strand, E, McCauley, R, Weigand, S, Stoeckel, R & Baas, B (2013) A Motor Speech Assessment for Children with Severe Speech Disorders: Reliability and Validity Evidence. Journal of Speech Language and Hearing Research, vol 56; 505-520.
And Now on the Value of Wordless Picture Books
Today I am writing on one of my favorite topics: how to use wordless picture books for narrative assessment and treatment purposes in speech language pathology. I love wordless picture books (or WLPBs as I refer to them) for a good reason and its not just due to their cute illustrations. WLPBs are so flexible that use can use them for both assessment and treatment of narratives. I personally prefer the Mercer Meyer series: ‘A Boy, a dog, a frog and a friend’ for sentimental reasons (they were the first WLPBs I used in grad school) but some of you may want to use a few others which is why I’ll be proving a few links containing lists of select picture books for you to choose from at the end of this post.
So how do I use them and with which age groups? Well, believe it or not you can start using them pretty early with toddlers and go all the way through upper elementary years. For myself, I found them to be most effective tools for children between 3-9 years of age. During comprehensive language assessments I use WLPBs in the following way. First I read a script based on the book. Depending on which WLPBs you use you can actually find select scripts online instead of creating your own. For example, if you choose to use the “Frog Series” by Mercer Meyer, the folks at SALT SOFTWARE already done the job for you and you can find those scripts HERE in both English and Spanish with audio to boot.
After I read/play the script, I ask the child to retell the story (a modified version of dynamic narrative assessment if you will) to see what their narrative is like. I am also looking to see whether the child is utilizing story telling techniques appropriate for his/her age.
For example, I expect a child between 3-4 years of age to be able to tell a story which contains 3 story grammar components (e.g., Initiating event, Attempt or Action, Consequences), minimally interpret/predict events during story telling, use some pronouns along with references to the characters names as well as discuss the character’s facial expressions, body postures & feelings (utilize early perspective taking) (Hedberg & Westby, 1993 ). By the time the child reaches 7 years of age, I expect him/her to be able to tell a story utilizing 5+ story grammar elements along with a clear ending, which indicates a resolution of the story’s problem, have a well developed plot, characters and a clear sequence of events, as well as keep consistent perspective which focuses around an incident in a story (Hedberg & Westby, 1993 ).
Therefore as children retell their stories based on the book I am keeping an eye on the following elements (as relevant to the child’s age of course):
- Is the child’s story order adequate or all jumbled up?
- Is the child using relevant story details or providing the bare minimum before turning the page?
- How’s the child’s grammar? Are there errors, telegraphic speech or overuse of run-on sentences?
- Is the child using any temporal (first, then, after that) and cohesive markers (and, so, but, etc)?
- Is the child’s vocabulary adequate of immature for his/her age?
- Is there an excessive number of word-retrieval difficulties which interfere with story telling and subsequently its comprehension?
- Is the child’s story coherent and cohesive?
- Is the child utilizing any perspective taking vocabulary and inferring the characters, feeling, ideas, beliefs, and thoughts?
Yes all of the above can be gleaned from a one wordless picture book!
If my assessment reveals that the child’s ability to engage in story telling is impaired for his/her age and I initiate treatment and still continue to use WLPBs in therapy. Depending on the child’s deficits I focus on remediating either elements of macrostructure (use-story organization and cohesion), microstructure (content + form including grammar syntax and vocabulary) or both.
Here are a few examples of story prompts I use in treatment with WLBPs:
- What is happening in this picture?
- Why do you think?
- What are the characters doing?
- Who /what else do you see?
- Does it look like anything is missing from this picture?
- Let’s make up a sentence with __________ (this word)
- Let’s tell the story. You start:
- Once upon a time
- You can say ____ or you can say ______ (teaching synonyms)
- What would be the opposite of _______? (teaching antonyms)
- Do you know that _____(this word) has 2 meanings
- 1st meaning
- 2nd meaning
Below are the questions I ask that focus on Story Characters and Setting
- Who is in this story?
- What do they do?
- How do they go together?
- How do you think s/he feels?
- Why?
- How do you know?
- What do you think s/he thinking?
- Why?
- What do you think s/he saying?
- Where is the story happening?
- Is this inside or outside?
- How do you know?
- Is this inside or outside?
- Did the characters visit different places in the story?
- Which ones?
- How many?
Here are the questions related to Story Sequencing
- What happens at the beginning of the story?
- How do we start a story?
- What happened second?
- What happened next?
- What happened after that?
- What happened last?
- What do we say at the end of a story?
- Was there trouble/problem in the story?
- What happened?
- Who fixed it?
- How did s/he fix it?
- Was there adventure in the story?
- If yes how did it start and end?
As the child advances his/her skills I attempt to engage them in more complex book interactions
- Compare and contrast story characters/items
- (e.g. objects/people/animals)
- Make predictions and inferences about what going to happen in the story
- Ask the child to problem solve the situation for the character
- What do you think he must do to…?
- Ask the child to state his/her likes and dislikes about the story or its characters
- Ask the child to tell the story back
- Based on Pictures
- Without Pictures
Wordless picture books are also terrific for teaching vocabulary of feelings and emotions
- Words related to thinking
- Know, think, remember, guess
- Words related to senses
- See, Hear, Watch, Feel
- Words related to personal wants
- Want, Need, Wish
- Words related to emotions and feelings
- Happy, Mad, Sad
- Words related to emotional behaviors
- Crying, Laughing, Frowning
So this is how I use wordless picture books for the purposes of assessment and therapy. I’d love to know how you use them?
Before I sign off here are a few WDPBs links for you, hope you like them!
- http://www.goodreads.com/shelf/show/wordless-picture-books
- http://nancykeane.com/rl/317.htm
- http://nerdybookclub.wordpress.com/2013/03/30/top-ten-wordless-picture-books-by-kristen-remenar/
Start having fun with your wordless picture books today!
Helpful Smart Speech Therapy Resources: