Autism | Smart Speech Therapy

Posted on December 30, 2019January 5, 2022 by Tatyana Elleseff — 3 Comments

On the Value of Social Pragmatic Interventions via Video Analysis

As a speech-language pathologist (SLP) working in a psychiatric setting, I routinely address social pragmatic language goals as part of my clinical practice. Finding the right approach to the treatment of social pragmatic language disorders has been challenging to say the least. That is because the efficacy of social communication interventions continues to be quite limited. Studies to date continue to show questionable results and limited carryover, while measurements of improvement are frequently subjective, biased, and subject to a placebo effect, maturation effect, and regression to the mean. However, despite the significant challenges to clinical practice in this area, the usage of videos for treatment purposes shows an emergent promise. Continue reading On the Value of Social Pragmatic Interventions via Video Analysis

Posted on July 17, 2017January 5, 2022 by Tatyana Elleseff — 4 Comments

Early Intervention Evaluations PART IV:Assessing Social Pragmatic Abilities of Children Under 3

To date, I have written 3 posts on speech and language assessments of children under 3 years of age. My first post offered suggestions on what information to include in general speech-language assessments for this age group, my second post specifically discussed assessments of toddlers with suspected motor speech disorders and my third post described what information I tend to include in reports for children ~16-18 months of age.

Today, I’d like to offer some suggestions on the assessment of social emotional functioning and pragmatics of children, ages 3 and under.

For starters, below is the information I found compiled by a number of researchers on select social pragmatic milestones for the 0-3 age group:

Peters, Kimberly (2013) Hierarchy of Social/Pragmatic Skills as Related to the Development of Executive Function
Hutchins & Prelock, (2016) Select Social Cognitive Milestones from the Theory of Mind Atlas

3. Development of Theory of Mind (Westby, 2014)

In my social pragmatic assessments of the 0-3 population, in addition, to the child’s adaptive behavior during the assessment, I also describe the child’s joint attention, social emotional reciprocity, as well as social referencing abilities.

Joint attention is the shared focus of two individuals on an object. Responding to joint attention refers to the child’s ability to follow the direction of the gaze and gestures of others in order to share a common point of reference. Initiating joint attention involves child’s use of gestures and eye contact to direct others’ attention to objects, to events, and to themselves. The function of initiating joint attention is to show or spontaneously seek to share interests or pleasurable experience with others. (Mundy, et al, 2007)

Social emotional reciprocity involves being aware of the emotional and interpersonal cues of others, appropriately interpreting those cues, responding appropriately to what is interpreted as well as being motivated to engage in social interactions with others (LaRocque and Leach,2009).

Social referencing refers to a child’s ability to look at a caregiver’s cues such as facial expressions, body language and tone of voice in an ambiguous situation in order to obtain clarifying information. (Walden & Ogan, 1988)

Here’s a brief excerpt from an evaluation of a child ~18 months of age:

“RA’s joint attention skills, social emotional reciprocity as well as social referencing were judged to be appropriate for his age. For example, when Ms. N let in the family dog from the deck into the assessment room, RA immediately noted that the dog wanted to exit the room and go into the hallway. However, the door leading to the hallway was closed. RA came up to the closed door and attempted to reach the doorknob. When RA realized that he cannot reach to the doorknob to let the dog out, he excitedly vocalized to get Ms. N’s attention, and then indicated to her in gestures that the dog wanted to leave the room.”

If I happen to know that a child is highly verbal, I may actually include a narrative assessment, when evaluating toddlers in the 2-3 age group. Now, of course, true narratives do not develop in children until they are bit older. However, it is possible to limitedly assess the narrative abilities of verbal children in this age group. According to Hedberg & Westby (1993) typically developing 2-year-old children are at the Heaps Stage of narrative development characterized by

Storytelling in the form of a collection of unrelated ideas which consist of labeling and describing events
Frequent switch of topic is evident with lack of central theme and cohesive devices
The sentences are usually simple declarations which contain repetitive syntax and use of present or present progressive tenses
In this stage, children possess limited understanding that the character on the next page is still same as on the previous page

In contrast, though typically developing children between 2-3 years of age in the Sequences Stage of narrative development still arbitrarily link story elements together without transitions, they can:

Label and describe events about a central theme with stories that may contain a central character, topic, or setting

To illustrate, below is a narrative sample from a typically developing 2-year-old child based on the Mercer Mayer’s classic wordless picture book: “Frog Where Are You?”

He put a froggy in there
He’s sleeping
Froggy came out
Where did did froggy go?
Now the dog fell out
Then he got him
You are a silly dog
And then
where did froggy go?
In in there
Up up into the tree
Up there an owl
Froggy
A reindeer caught him
Then he dropped him
Then he went into snow
And then he cleaned up that
Then stopped right there and see what wha wha wha what he found
He found two froggies
They lived happily ever after

Of course, a play assessment for this age group is a must. Since, in my first post, I offered a play skills excerpt from one of my early intervention assessments and in my third blog post, I included a link to the Revised Westby Play Scale (Westby, 2000), I will now move on to the description of a few formal instruments I find very useful for this age group.

While some criterion-referenced instruments such as the Rossetti, contain sections on Interaction-Attachment and Pragmatics, there are other assessments which I prefer for evaluating social cognition and pragmatic abilities of toddlers.

For toddlers 18+months of age, I like using the Language Use Inventory (LUI) (O’Neill, 2009) which is administered in the form of a parental questionnaire that can be completed in approximately 20 minutes. Aimed at identifying children with delay/impairment in pragmatic language development it contains 180 questions and divided into 3 parts and 14 subscales including:

Communication w/t gestures
Communication w/t words
Longer sentences

Therapists can utilize the Automated Score Calculator, which accompanies the LUI in order to generate several pages write up or summarize the main points of the LUI’s findings in their evaluation reports.

Below is an example of a summary I wrote for one of my past clients, 35 months of age.

AN’s ability to use language was assessed via the administration of the Language Use Inventory (LUI). The LUI is a standardized parental questionnaire for children ages 18-47 months aimed at identifying children with delay/impairment in pragmatic language development. Composed of 3 parts and 14 subscales it focuses on how the child communicates with gestures, words and longer sentences.

On the LUI, AN obtained a raw score of 53 and a percentile rank of <1, indicating profoundly impaired performance in the area of language use. While AN scored in the average range in the area of varied word use, deficits were noted with requesting help, word usage for notice, lack of questions and comments regarding self and others, lack of reciprocal word usage in activities with others, humor relatedness, adapting to conversations to others, as well as difficulties with building longer sentences and stories.

Based on above results AN presents with significant social pragmatic language weaknesses characterized by impaired ability to use language for a variety of language functions (initiate, comment, request, etc), lack of reciprocal word usage in activities with others, humor relatedness, lack of conversational abilities, as well as difficulty with spontaneous sentence and story formulation as is appropriate for a child his age. Therapeutic intervention is strongly recommended to improve AN’s social pragmatic abilities.

In addition to the LUI, I recently discovered the Theory of Mind Inventory-2. The ToMI-2 was developed on a normative sample of children ages 2 – 13 years. For children between 2-3 years of age, it offers a 14 question Toddler Screen (shared here with author’s permission). While due to the recency of my discovery, I have yet to use it on an actual client, I did have fun creating a report with it on a fake client.

First, I filled out the online version of the 14 question Toddler Screen (paper version embedded in the link above for illustration purposes). Typically the parents are asked to place slashes on the form in relevant areas, however, the online version requested that I use numerals to rate skill acquisition, which is what I had done. After I had entered the data, the system generated a relevant report for my imaginary client. In addition to the demographic section, the report generated the following information (below):

A bar graph of the client’s skills breakdown in the developed, undecided and undeveloped ranges of the early ToM development scale.
Percentile scores of how the client did in the each of the 14 early ToM measures
Median percentiles of scores
Table for treatment planning broken down into strengths and challenges

I find the information provided to me by the Toddler Screen highly useful for assessment and treatment planning purposes and definitely have plans on using this portion of the TOM-2 Inventory as part of my future toddler evaluations.

Of course, the above instruments are only two of many, aimed at assessing social pragmatic abilities of children under 3 years of age, so I’d like to hear from you! What formal and informal instruments are you using to assess social pragmatic abilities of children under 3 years of age? Do you have a favorite one, and if so, why do you like it?

References:

Hedberg, N.L., & Westby, C.E. (1993). Analyzing story-telling skills: Theory to practice. AZ: Communication Skill Builders.
Mundy P, Block J, Delgado C, Pomares Y, Vaughan Van Hecke A, Parlade MV. (2007) Individual Differences and the Development of Joint Attention in Infancy. Child Development. 78:938–954
LaRocque, M., & Leach, D. (2009). Increasing social reciprocity in young children with Autism. Intervention in School and Clinic, 10(5), 1-7.
O’Neill, D. (2009). Language Use Inventory: An assessment of young children’s pragmatic language development for 18- to 47-month-old children [Manual]. Waterloo, Ontario, Canada Knowledge in Development
Tomasello, M. (1995). Joint attention as social cognition. In C. Moore, & P. J. Dunham (Eds.), Joint attention: It’s origins and role in development (pp. 103–130). Hillsdale, NJ: Erlbaum.
Walden, T., & Ogan, T. (1988). The development of social referencing. Child Development, 59, 1230-1240.
Westby, C. & Robinson, L. (2014). A developmental perspective for promoting theory of mind. Topics in
Language Disorders, 34(4), 362-383.

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

Why Are My Child’s Test Scores Dropping?

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

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

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

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

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

Ineffective Interventions due to Misdiagnosis

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

Ineffective Interventions due to Lack of Comprehensive Testing

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

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

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

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

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

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

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

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

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

So who are the children potentially at risk for CCD?

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

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

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

Brief Standardized Testing Score Tutorial:

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

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

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

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

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

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

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

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

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

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

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

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

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

References:

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

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

Assessing Behaviorally Impaired Students: Why Background History Matters!

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

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

This leads many professionals to do the following:

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

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

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

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

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

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

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

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

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

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

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

For starters, the basics, of course.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Helpful Resources:

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

Professional Consultation Services for Speech Language Pathologists

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

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

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

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

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

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

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

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

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

Below is the recent professional consultation testimonial.

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

Tatyana,

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

With gratitude,

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

Licensed Speech-Language Pathologist

Board Certified Behavior Analyst

Beachwood OH 44122

Posted on August 7, 2015January 5, 2022 by Tatyana Elleseff — 2 Comments

Assessing Social Communication Abilities of School-Aged Children

Recently, I’ve published an article in SIG 16 Perspectives on School Based Issues discussing the importance of social communication assessments of school aged children 2-18 years of age. Below I would like to summarize article highlights.

First, I summarize the effect of social communication on academic abilities and review the notion of the “academic impact”. Then, I go over important changes in terminology and definitions as well as explain the “anatomy of social communication”.

Next I suggest a sample social communication skill hierarchy to adequately determine assessment needs (assess only those abilities suspected of deficits and exclude the skills the student has already mastered).

After that I go over pre-assessment considerations as well as review standardized testing and its limitations from 3-18 years of age.

Finally I review a host of informal social communication procedures and address their utility.

What is the away message?

When evaluating social communication, clinicians need to use multiple assessment tasks to create a balanced assessment. We need to chose testing instruments that will help us formulate clear goals. We also need to add descriptive portions to our reports in order to “personalize” the student’s deficit areas. Our assessments need to be functional and meaningful for the student. This means determining the student’s strengths and not just weaknesses as a starting point of intervention initiation.

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Helpful Smart Speech Resources Related to Assessment and Treatment of Social Communication

Posted on May 28, 2015January 5, 2022 by Tatyana Elleseff — 3 Comments

Improving Emotional Intelligence of Children with Social Communication Disorders

Our ability to recognize our own and other people’s emotions, distinguish between and correctly identify different feelings, as well as use that information to guide our thinking and behavior is called Emotional Intelligence (EI) (Salovey, et al, 2008).

EI encompasses dual areas of: emotion understanding, which is an awareness and comprehension of one’s and others emotions (Harris, 2008) and emotion regulation, which are internal and external strategies people use to regulate emotions (Thompson, 1994).

Many students with social communication challenges experience problems with all aspects of EI, including the perception, comprehension, and regulation of emotions (Brinton & Fujiki, 2012).

A number of recent studies have found that children with language impairments also present with impaired emotional intelligence including impaired perception of facial expressions (Spackman, Fujiki, Brinton, Nelson, & Allen, 2005), prosodic emotions (Fujiki, Spackman, Brinton, & Illig, 2008) as well as abstract emotion comprehension (Ford & Milosky, 2003).

Children with impaired emotional intelligence will experience numerous difficulties during social interactions due to their difficulty interpreting emotional cues of others (Cloward, 2012). These may include but not be limited to active participation in cooperative activities, as well as full/competent interactions during group tasks (Brinton, Fujiki, & Powell, 1997)

Many students with social pragmatic deficits and language impairments are taught to recognize emotional states as part of their therapy goals. However, the provided experience frequently does not go beyond the recognition of the requisite “happy”, “mad”, “sad” emotions. At times, I even see written blurbs from others therapists, which state that “the student has mastered the goals of emotion recognition”. However, when probed further it appears that the student had merely mastered the basic spectrum of simple emotional states, which places the student at a distinct disadvantage as compared to typically developing peers who are capable of recognition and awareness of a myriad of complex emotional states.

That is why I developed a product to target abstract emotional states comprehension in children with language impairments and social communication disorders. “Gauging Moods and Interpreting Abstract Emotional States: A Perspective Taking Activity Packet” is a social pragmatic photo/question set, intended for children 7+ years of age, who present with difficulty recognizing abstract emotional states of others (beyond the “happy, mad, sad” option) as well as appropriately gauging their moods.

Many sets contain additional short stories with questions that focus on making inferencing, critical thinking as well as interpersonal negotiation skills. Select sets require the students to create their own stories with a focus on the reasons why the person in the photograph might be feeling what s/he are feeling.

There are on average 12-15 questions per each photo. Each page contains a photograph of a person feeling a particular emotion. After the student is presented with the photograph, they are asked a number of questions pertaining to the recognition of the person’s emotions, mood, the reason behind the emotion they are experiencing as well as what they could be potentially thinking at the moment. Students are also asked to act out the depicted emotion they use of mirror.

Activities also include naming or finding (in a thesaurus or online) the synonyms and antonyms of a particular word in order to increase students’ vocabulary knowledge. A comprehensive two page “emotions word bank” is included in the last two pages of the packet to assist the students with the synonym/antonym selection, in the absence of a thesaurus or online access.

Students are also asked to use a target word in a complex sentence containing an adverbial (pre-chosen for them) as well as to identify a particular word or phrase associated with the photo or the described story situation.

Since many students with social pragmatic language deficits present with difficulty determining a person’s age (and prefer to relate to either younger or older individuals who are perceived to be “less judgmental of their difficulties”), this concept is also explicitly targeted in the packet.

This activity is suitable for both individual therapy sessions as well as group work. In addition to its social pragmatic component is also intended to increase vocabulary knowledge and use as well as sentence length of children with language impairments.

Intended Audiences:

Clients with Language Impairments
Clients with Social Pragmatic Language Difficulties
Clients with Executive Function Difficulties
Clients with Psychiatric Impairments
- ODD, ADHD, MD, Anxiety, Depression, etc.
Clients with Autism Spectrum Disorders
Clients with Nonverbal Learning Disability
Clients with Fetal Alcohol Spectrum Disorders
Adult and pediatric post-Traumatic Brain Injury (TBI) clients
Clients with right-side CVA Damage

Areas covered in this packet:

Gauging Age (based on visual support and pre-existing knowledge)
Gauging Moods (based on visual clues and context)
Explaining Facial Expressions
Making Social Predictions and Inferences (re: people’s emotions)
Assuming First Person Perspectives
Understanding Sympathy
Vocabulary Knowledge and Use (pertaining to the concept of Emotional Intelligence)
Semantic Flexibility (production of synonyms and antonyms)
Complex Sentence Production
Expression of Emotional Reactions
Problem Solving Social Situations
Friendship Management and Peer Relatedness

Helpful Smart Speech Resources:

References:

Brinton, B., Fujiki, M., & Powell, J. M. (1997). The ability of children with language impairment to manipulate topic in a structured task. Language, Speech and Hearing Services in Schools, 28, 3-11.
Brinton B., & Fujiki, M. (2012). Social and affective factors in children with language impairment. Implications for literacy learning. In C. A. Stone, E. R. Silliman, B. J. Ehren, & K. Apel (Eds.), Handbook of language and literacy: Development and disorders (2nd Ed.). New York, NY: Guilford.
Cloward, R. (2012). The milk jug project: Expression of emotion in children with language impairment and autism spectrum disorder (Unpublished honor’s thesis). Brigham Young University, Provo, Utah.
Ford, J., & Milosky, L. (2003). Inferring emotional reactions in social situations: Differences in children with language impairment. Journal of Speech, Language, and Hearing Research, 46(1), 21-30.
Fujiki, M., Spackman, M. P., Brinton, B., & Illig, T. (2008). Ability of children with language impairment to understand emotion conveyed by prosody in a narrative passage. International Journal of Language & Communication Disorders, 43(3), 330-345
Harris, P. L. (2008). Children’s understanding of emotion. In M. Lewis, J. M. Haviland-Jones, & L. Feldman Barrett, (Eds.), Handbook of emotions (3rd ed., pp. 320–331). New York, NY: Guilford Press.
Salovey, P., Detweiler-Bedell, B. T., Detweiler-Bedell, J. B., & Mayer, J. D. (2008). Emotional intelligence. In M. Lewis, J. M. Haviland-Jones, & L. Feldman Barrett (Eds.), Handbook of Emotions (3rd ed., pp. 533-547). New York, NY: Guilford Press.
Spackman, M. P., Fujiki, M., Brinton, B., Nelson, D., & Allen, J. (2005). The ability of children with language impairment to recognize emotion conveyed by facial expression and music. Communication Disorders Quarterly, 26(3), 131-143.
Thompson, R. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59(2-3), 25-52

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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 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:

Posted on May 30, 2014January 5, 2022 by Tatyana Elleseff — 2 Comments

Why Do I Have to Tell You What’s Wrong with My Child? Or On the Importance of Targeted Assessments

A few days ago I received a phone call from a parent who was seeking a language evaluation for her child. As it is my policy with all assessments, I asked her to fill out an intake and a checklist to identify her child’s specific areas of difficulty in order to compile a comprehensive and targeted testing battery. Her response to me was: “I’ve never heard of this before? Why do I have to tell you what’s wrong with my child? Why can’t you figure it out?” Similarly, last week, another parent has questioned: “So you can’t do the assessment without this form?” Given the above questions, and especially because May is a Better Hearing and Speech Month #BHSM, during which it is important to raise awareness about communication disorders, I want to take this time to explain to parents why performing targeted speech language assessments is SO CRUCIAL.

To begin with it is very important to understand that speech and language can be analyzed in many different ways beyond looking at pronunciation, vocabulary or listening and speaking skills.

Targeted areas within the scope of practice of pediatric school based speech language pathologists include the assessment of:

SPEECH
- The child may have difficulties with pronunciation of sounds in words, stutter, clutter, have a lisp or have difficulties in the areas of voice, prosody, or resonance. For the majority of the above difficulties completely different tests and testing procedures may be needed in order to appropriately assess the child.

LANGUAGE
- Receptive Language
  - Ability to follow directions, answer questions, recall sentences, understand verbal messages, as well as comprehend orally presented text
- Memory and Attention
  - Also see executive function skills
- Expressive Language
  - Vocabulary knowledge and use, formulation of words and sentences as well as production of narratives or stories
- Problem Solving
  - Verbal reasoning and critical thinking skills are very important for successful independent decision making as well as for interpretation of academically based texts and complete assignments
- Pragmatic Language
  - Successful use of language for a variety of communicative purposes
    - Initiate and maintain topics, maintain conversational exchanges, request help, etc
- Social Emotional Competence
  - Effective interpersonal negotiation skills, compromise and negotiation abilities, as well as perspective taking are integral to academic and social success. These abilities are often compromised in children with language disorders and require a thorough assessment
- Executive Functions (EFs)
  - These are higher level cognitive processes involved in inhibition of thought, action and emotion, which are located in the prefrontal cortex of the frontal lobe of the brain.
  - Major EF components include working memory, inhibitory control, planning, and set-shifting. EFs contribute to child’s ability to sustain attention, ignore distractions, and succeed in academic settings.
READING DISABILITIES AND DYSLEXIA
- Phonological Awareness
- Reading Ability
- Writing
- Spelling

One General Language Test Does Not Fit All!

Children with speech and language disorders do not necessarily display weaknesses in all affected areas but may only display difficulties in selected few.

To illustrate, high functioning students on the autistic spectrum may have very strong academic skills related to comprehension and expression of language but may display significant social pragmatic language weaknesses, which will not be apparent on general language testing (e.g., administration of Clinical Evaluation of Language Fundamentals -5). Thus, the administration of a general language test will be contraindicated for these students as it will only show typical performance on these tests and will not qualify them for targeted language based services that they need. However, by administering to them a testing battery composed of tests sensitive to social pragmatic language competence will highlight their areas of difficulty and result in a creation of a targeted intervention plan to improve their abilities in the affected areas.

Similarly, children at risk for reading disabilities will not benefit from the administration of general language testing either, since their deficits may lie in the areas of sound discrimination, isolation, or blending as well as as impaired decoding ability. So the administration of tests sensitive to phonological awareness and emergent reading ability would be much more relevant.

This is exactly why taking an extra step and filling out a simple form will result in a much more targeted and beneficial speech language assessment for the child. The goal of any competent professional assessment is to eliminate the administration of unnecessary and irrelevant tests and focus only on the administration of instruments directly targeting the areas of difficulty that the child presents with. Given the fact that assessment of language covers so many broad areas, it makes perfect sense to ask parents to fill out relevant checklists/intakes as a routine part of a pre-assessment procedure. Otherwise, even after observations in school setting, I would still just be blindly ‘fishing’ for deficits without really knowing whether I will ‘accidentally stumble upon them’ using a general test at hand.

Of course, even checklists need to be targeted by age and areas of functioning. Here’s how I use mine. When performing comprehensive fist time assessments I ask the parent to fill out the comprehensive checklists based on the child’s age. These are broken down as follows:

However, oftentimes when I perform reassessments or second opinion evaluations, I may ask the parent to fill out checklists pertaining to specific, known, areas of difficulty. These currently include:

After the parent fills the checklist out, the child’s areas of difficulty literally jump out from the pages. Now, all I need to do is to choose the appropriate testing instruments, which will BEST help me determine the exact nature and cause of the child’s deficits and I am all set. I administer the testing, interpret the results and write a comprehensive report detailing which therapy goals will be targeted. And this is why pre-assessment checklist administration is so important.

Helpful Resources:

Category: Autism

Why Are My Child’s Test Scores Dropping?

Assessing Behaviorally Impaired Students: Why Background History Matters!

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