Posted on 16 Comments

The Importance of Narrative Assessments in Speech Language Pathology (Revised)

Unconscious Bias: The Power and Risks of Societal Narratives | by Phillip  Yan | Left | Right | MediumAs SLPs we routinely administer a variety of testing batteries in order to assess our students’ speech-language abilities. Grammar, syntax, vocabulary, and sentence formulation get frequent and thorough attention. But how about narrative production? Does it get its fair share of attention when the clinicians are looking to determine the extent of the child’s language deficits? I was so curious about what the clinicians across the country were doing that in 2013, I created a survey and posted a link to it in several SLP-related FB groups.  I wanted to find out how many SLPs were performing narrative assessments, in which settings, and with which populations.  From those who were performing these assessments, I wanted to know what type of assessments were they using and how they were recording and documenting their findings.   Since the purpose of this survey was non-research based (I wasn’t planning on submitting a research manuscript with my findings), I only analyzed the first 100 responses (the rest were very similar in nature) which came my way, in order to get the general flavor of current trends among clinicians, when it came to narrative assessments. Here’s a brief overview of my [limited] findings. Continue reading The Importance of Narrative Assessments in Speech Language Pathology (Revised)

Posted on 4 Comments

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

Image result for toddlersTo 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:

  1. Peters, Kimberly (2013) Hierarchy of Social/Pragmatic Skills as Related to the Development of Executive Function 
  2. 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

Image result for frog where are youTo 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

Image result for play assessment kidsOf 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.

Image result for language use inventoryFor 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:

  1. Communication w/t gestures
  2. Communication w/t words
  3. 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.

Downloadable DocumentsIn 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):

  1. A bar graph of the client’s skills breakdown in the developed, undecided and undeveloped ranges of the early ToM development scale.
  2. Percentile scores of how the client did in the each of the 14 early ToM measures
  3. Median percentiles of scores
  4. 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:

Posted on 3 Comments

Is it a Difference or a Disorder? Free Resources for SLPs Working with Bilingual and Multicultural Children

Image result for bilingualFor bilingual and monolingual SLPs working with bilingual and multicultural children, the question of: “Is it a difference or a disorder?” arises on a daily basis as they attempt to navigate the myriad of difficulties they encounter in their attempts at appropriate diagnosis of speech, language, and literacy disorders.

For that purpose, I’ve recently created a Checklist for Identification of Speech-Language Disorders in Bilingual and Multicultural Children. Its aim is to assist Speech Language Pathologists (SLPs) and Teachers in the decision-making process of how to appropriately identify bilingual/multicultural children who present with speech-language delay/deficits (vs. a language difference), for the purpose of initiating a formal speech-language-literacy evaluation. The goal is to ensure that educational professionals are appropriately identifying bilingual children for assessment and service provision due to legitimate speech language deficits/concerns, and are not over-identifying students because they speak multiple languages or because they come from low socioeconomic backgrounds. It is very important to understand that true language impairment in bilingual children will be evident in both languages from early childhood onwards, and thus will adversely affect the learning of both languages.

However, today the aim of today’s post is not on the above product but rather on the FREE free bilingual and multicultural resources available to SLPs online in their quest of differentiating between a language difference from a language disorder in bilingual and multicultural children.

Let’s start with an excellent free infographic entitled from the Hola BlogMyth vs. Fact: Bilingual Language Development” which was created by Kelly Ibanez, MS CCC-SLP to help dispel bilingual myths and encourage practices that promote multilingualism.  Clinicians can download it and refer to it themselves, share it with other health and/or educational professionals as well as show it to parents of their clients.

Let us now move on to the typical phonological development of English speaking children. After all, in order to compare other languages to English, SLPs need to be well versed in the acquisition of speech sounds in the English language. Children’s speech acquisitiondeveloped by Sharynne McLeod, Ph.D., of Charles Sturt University, is one such resource. It contains a compilation of data on typical speech development for English speaking children, which is organized according to children’s ages to reflect a typical developmental sequence.

Next up, is a great archive which contains phonetic inventories of the various language spoken around the world for contrastive analysis purposes. The same website also contains a speech accent archive. Native and non-native speakers of English were recorded reading the same English paragraph for teaching and research purposes. It is meant to be used by professionals who are interested in comparing the accents of different English speakers.

Image result for charles sturt universityNow let’s talk about one of my favorite websites, MULTILINGUAL CHILDREN’S SPEECH, also developed by Dr. Mcleod of Charles Stuart University. It contains an AMAZING plethora of resources on bilingual speech development and assessment. To illustrate, its Speech Acquisition Data includes A list of over 200 speech acquisition studies. It also contains a HUGE archive on Speech Assessments in NUMEROUS LANGUAGES as well as select assessment reviews. Finally, the website also lists in detail how aspects of speech (e.g., consonants, vowels, syllables, tones) differ between languages.

The Leader’s Project Website is another highly informative source of FREE information on bilingual assessments, intervention, and FREE CEUS.

Now, I’d like to list some resources regarding language transfer errors.

This chart from Cengage Learning contains a nice, concise Language Guide to Transfer Errors. While it is aimed at multilingual/ESL writers, the information contained on the site is highly applicable to multilingual speakers as well.

You can also find a bonus transfer chart HERE. It contains information on specific structures such as articles, nouns, verbs, pronouns, adverbs, adjectives, word order, questions, commands, and negatives on pages 1-6 and phonemes on pages 7-8.

A final bonus chart entitled: Teacher’s Resource Guide of Language Transfer Issues for English Language Learners containing information on grammar and phonics for 10 different languages can be found HERE.  

Similarly, this 16-page handout: Language Transfers: The Interaction Between English and Students’ Primary Languages also contains information on phonics and grammar transfers for Spanish, Cantonese, Vietnamese, Hmong Korean, and Khmer languages.

Image result for russian languageFor SLPs working with Russian-speaking children the following links pertinent to assessment, intervention and language transference may be helpful:

  1. Working with Russian-speaking clients: implications for speech-language assessment 
  2. Strategies in the acquisition of segments and syllables in Russian-speaking children
  3. Language Development of Bilingual Russian/ English Speaking Children Living in the United States: A Review of the Literature
  4. The acquisition of syllable structure by Russian-speaking children with SLI

To determine information about the children’s language development and language environment, in both their first and second language, visit the CHESL Centre website for  The Alberta Language Development Questionnaire and The Alberta Language Environment Questionnaire

There you have it! FREE bilingual/multicultural SLP resources compiled for you conveniently in one place. And since there are much more FREE GEMS online, I’d love it if you guys contributed to and expanded this modest list by posting links and title descriptions in the comments section below for others to benefit from!

Together we can deliver the most up to date evidence-based assessment and intervention to bilingual and multicultural students that we serve! Click HERE to check out the FREE Resources in the  SLPs for Evidence-Based Practice Group

Helpful Bilingual Smart Speech Therapy Resources:

  1. Checklist for Identification of Speech-Language Disorders in Bilingual and Multicultural Children
  2. Multicultural Assessment Bundle
  3. Best Practices in Bilingual Literacy Assessments and Interventions
  4. Dynamic Assessment of Bilingual and Multicultural Learners in Speech-Language Pathology
  5. Practical Strategies for Monolingual SLPs Assessing and Treating Bilingual Children
  6. Language Difference vs. Language Disorder: Assessment & Intervention Strategies for SLPs Working with Bilingual Children
  7. Impact of Cultural and Linguistic Variables On Speech-Language Services
  8. Assessment of sound and syllable imitation in Russian-speaking infants and toddlers
  9. Russian Articulation Screener 
  10. Creating Translanguaging Classrooms and Therapy Rooms

Posted on Leave a comment

What do Narratives and Pediatric Psychiatric Impairments Have in Common?

High comorbidity between language and psychiatric disorders has been well documented (Beitchman, Cohen, Konstantaras, & Tannock, 1996; Cohen, Barwick, Horodezky, Vallence, & Im, 1998; Toppelberg & Shapiro, 2000). However, a lesser known fact is that there’s also a significant under-diagnosis of language impairments in children with psychiatric disorders.  Continue reading What do Narratives and Pediatric Psychiatric Impairments Have in Common?

Posted on Leave a comment

Dear SLPs, Here’s What You Need to Know About Internationally Adopted Children

In the past several years there has been a sharp decline in international adoptions. Whereas in 2004, Americans adopted a record high of 22,989 children from overseas, in 2015, only 5,647 children  (a record low in 30 years) were adopted from abroad by American citizens.

Primary Data Source: Data Source: U.S. State Department Intercountry Adoption Statistics  

Secondary Data Source: Why Did International Adoption Suddenly End?

Despite a sharp decline in adoptions many SLPs still frequently continue to receive internationally adopted (IA) children for assessment as well as treatment – immediately post adoption as well as a number of years post-institutionalization.

In the age of social media, it may be very easy to pose questions and receive instantaneous responses on platforms such as Facebook and Twitter with respect to assessment and treatment recommendations. However, it is very important to understand that many SLPs, who lack direct clinical experience in international adoptions may chime in with inappropriate recommendations with respect to the assessment or treatment of these children.

Consequently, it is important to identify reputable sources of information when it comes to speech-language assessment of internationally adopted children.

There are a number of researchers in both US and abroad who specialize in speech-language abilities of Internationally Adopted children. This list includes (but is by far not limited to) the following authors:

The works of these researchers can be readily accessed in the ASHA Journals or via ResearchGate.

Meanwhile, here are some basic facts regarding internationally adopted children that all SLPs and parents need to know.

Demographics:

  • —A greater number of older, preschool and school-aged children and fewer number of infants and toddlers are placed for adoption (Selman, 2012).
  • —Significant increase in special needs adoptions from Eastern European countries (e.g., Ukraine, Kazhakstan, etc.) as well as China.  The vast majority of Internationally Adopted children arrive to the United States with significant physical, linguistic, and cognitive disabilities as well as mental health problems. Consequently, it is important for schools to immediately provide the children with a host of services including speech-language therapy, immediately post-arrival.
  • It is also important to know that in the vast majority of cases the child’s linguistic, cognitive, or mental health deficits may not be documented in the adoption records due to poor record keeping, lack of access to adequate healthcare or often to ensure their “adoptability”. As such, parental interviews and anecdotal evidence become the primary source of information regarding these children’s social and academic functioning in their respective birth countries.

The question of bilingualism: 

  • Internationally Adopted children are NOT bilingual children! In fact, the vast majority of internationally adopted children will very rapidly lose their birth language, in a period of 2-3 months post arrival (Gindis, 2005), since they are most often adopted by parents who do not speak the child’s birth language and as such are unable/unwilling to maintain it.
  • IA children do not need to be placed in ESL classes since they are not bilingual children. Not only are IA children not bilingual, they are also not ‘truly’ monolingual since their first language is lost rather rapidly, while their second language has been gained minimally at the time of loss.
  • IA children need to acquire  Cognitive Language Mastery (CLM) which is language needed for formal academic learning. This includes listening, speaking, reading, and writing about subject area content material including analyzing, synthesizing, judging and evaluating presented information. This level of language learning is essential for a child to succeed in school. CLM takes years and years to master, especially because, IA children did not have the same foundation of knowledge and stimulation as bilingual children in their birth countries.

Image result for assessmentAssessment Parameters: 

  • —IA children’s language abilities should be retested and monitored at regular intervals during the first several years post arrival.  —
  • Glennen (2007) recommends 3 evaluations during the first year post arrival, with annual reevaluations thereafter.  —
  • Hough & Kaczmarek (2011) recommend a reevaluation schedule of 3-4 times a year for a period of two years, post arrival because some IA children continue to present with language-based deficits many years (5+) post-adoption.
  • —If an SLP speaking the child’s first language is available the window of opportunity to assess in the first language is very limited (~2-3 months at most).
  • Similarly, an assessment with an interpreter is recommended immediately post arrival from the birth country for a period of approximately the same time.
  • —If an SLP speaking the child’s first language is not available English-speaking SLP should consider assessing the child in English between 3-6 months post arrival (depending on the child and the situational constraints) in order to determine the speed with which s/he are acquiring English language abilities
    • —Children should be demonstrating rapid language gains in the areas of receptive language, vocabulary as well as articulation (Glennen 2007, 2009)
    • Dynamic assessment is highly recommended
  • It is important to remember that language and literacy deficits are not always very apparent and can manifest during any given period post arrival

To treat or NOT to Treat?

  • “Any child with a known history of speech and language delays in the sending country should be considered to have true delays or disorders and should receive speech and language services after adoption.” (Glennen, 2009, p.52)
  • —IA children with medical diagnoses, which impact their speech language abilities should be assessed and considered for S-L therapy services as well (Ladage, 2009).

Helpful Links:

  1. 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
  2. Assessing Behaviorally Impaired Students: Why Background History Matters!
  3. Dear School Professionals Please Be Aware of This
  4. What parents need to know about speech-language assessment of older internationally adopted children
  5. Understanding the risks of social pragmatic deficits in post institutionalized internationally adopted (IA) children
  6. Understanding the extent of speech and language delays in older internationally adopted children

References:

  • Gindis, B. (2005). Cognitive, language, and educational issues of children adopted from overseas orphanages. Journal of Cognitive Education and Psychology, 4 (3): 290-315.
  • Glennen, S (2009) Speech and language guidelines for children adopted from abroad at older ages.  Topics in language Disorders 29, 50-64.
  • —Ladage, J. S. (2009). Medical Issues in International Adoption and Their Influence on Language Development. Topics in Language Disorders , 29 (1), 6-17.
  • Selman P. (2012) Global trends in Intercountry Adoption 2000-2010. New York: National Council for Adoption, 2012.
  • Selman P. The global decline of intercountry adoption: What lies ahead?. Social Policy and Society 2012, 11(3), 381-397.

Additional Helpful References:

  • Abrines, N., Barcons, N., Brun, C., Marre, D., Sartini, C., & Fumadó, V. (2012). Comparing ADHD symptom levels in children adopted from Eastern Europe and from other regions: discussing possible factors involved. Children and Youth Services Review, 34 (9) 1903-1908.
  • Balachova, T et al (2010). Changing physicians’ knowledge, skills and attitudes to prevent FASD in Russia: 800. Alcoholism: Clinical & Experimental Research. 34(6) Sup 2:210A.
  • Barcons-Castel, N, Fornieles-Deu,A, & Costas-Moragas, C (2011). International adoption: assessment of adaptive and maladaptive behavior of adopted minors in Spain. The Spanish Journal of Psychology, 14 (1): 123-132.
  • Beverly, B., McGuinness, T., & Blanton, D. (2008). Communication challenges for children adopted from the former Soviet Union. Language, Speech, and Hearing Services in Schools, 39, 1-11.
  • Cohen, N. & Barwick, M. (1996). Comorbidity of language and social-emotional disorders: comparison of psychiatric outpatients and their siblings. Journal of Clinical Child Psychology, 25(2), 192-200.
  • Croft, C et al, (2007). Early adolescent outcomes of institutionally-deprived and nondeprived adoptees: II. Language as a protective factor and a vulnerable outcome. The Journal of Child Psychology and Psychiatry, 48, 31–44.
  • Dalen, M. (2001). School performances among internationally adopted children in Norway. Adoption Quarterly, 5(2), 39-57.
  • Dalen, M. (1995). Learning difficulties among inter-country adopted children. Nordisk pedagogikk, 15 (No. 4), 195-208
  • Davies, J., & Bledsoe, J. (2005). Prenatal alcohol and drug exposures in adoption. Pediatric Clinics of North America, 52, 1369–1393.
  • Desmarais, C., Roeber, B. J., Smith, M. E., & Pollak, S. D. (2012). Sentence comprehension in post-institutionalized school-age children. Journal of Speech, Language, and Hearing Research, 55, 45-54
  • Eigsti, I. M., Weitzman, C., Schuh, J. M., de Marchena, A., & Casey, B. J. (2011). Language and cognitive outcomes in internationally adopted children. Development and Psychopathology, 23, 629-646.
  • Geren, J., Snedeker, J., & Ax, L. (2005). Starting over:  a preliminary study of early lexical and syntactic development in internationally-adopted preschoolers. Seminars in Speech & Language, 26:44-54.
  • Gindis (2008) Abrupt native language loss in international adoptees.  Advance for Speech/Language Pathologists and Audiologists.  18(51): 5.
  • Gindis, B. (2005). Cognitive, language, and educational issues of children adopted from overseas orphanages. Journal of Cognitive Education and Psychology, 4 (3): 290-315. Gindis, B. (1999) Language-related issues for international adoptees and adoptive families. In: T. Tepper, L. Hannon, D. Sandstrom, Eds. “International Adoption: Challenges and Opportunities.” PNPIC, Meadow Lands , PA. , pp. 98-108
  • Glennen, S (2009) Speech and language guidelines for children adopted from abroad at older ages.  Topics in language Disorders 29, 50-64.
  • Glennen, S. (2007) Speech and language in children adopted internationally at older ages. Perspectives on Communication Disorders in Culturally and Linguistically Diverse Populations, 14, 17–20.
  • Glennen, S., & Bright, B. J.  (2005).  Five years later: language in school-age internally adopted children.  Seminars in Speech and Language, 26, 86-101.
  • Glennen, S. & Masters, G. (2002). Typical and atypical language development in infants and toddlers adopted from Eastern Europe. American Journal of Speech-Language Pathology, 44, 417-433
  • Gordina, A (2009) Parent Handout: The Dream Referral, Unpublished Manuscript.
  • Hough, S., & Kaczmarek, L. (2011). Language and reading outcomes in young children adopted from Eastern European orphanages. Journal of Early Intervention, 33, 51-57.
  • Hwa-Froelich, D (2012) Childhood maltreatment and communication development. Perspectives on School-Based Issues,  13: 43-53;
  • Jacobs, E., Miller, L. C., & Tirella, G. (2010).  Developmental and behavioral performance of internationally adopted preschoolers: a pilot study.  Child Psychiatry and Human Development, 41, 15–29.
  • Jenista, J., & Chapman, D. (1987). Medical problems of foreign-born adopted children. American Journal of Diseases of Children, 141, 298–302.
  • Johnson, D. (2000). Long-term medical issues in international adoptees. Pediatric Annals, 29, 234–241.
  • Judge, S. (2003). Developmental recovery and deficit in children adopted from Eastern European orphanages. Child Psychiatry and Human Development, 34, 49–62.
  • Krakow, R. A., & Roberts, J. (2003). Acquisitions of English vocabulary by young Chinese adoptees. Journal of Multilingual Communication Disorders, 1, 169-176
  • Ladage, J. S. (2009). Medical issues in international adoption and their influence on language development. Topics in Language Disorders , 29 (1), 6-17.
  • Loman, M. M., Wiik, K. L., Frenn, K. A., Pollak, S. D., & Gunnar, M. R. (2009). Post-institutionalized children’s development: growth, cognitive, and language outcomes. Journal of Developmental Behavioral Pediatrics, 30, 426–434.
  • McLaughlin, B., Gesi Blanchard, A., & Osanai, Y.  (1995). Assessing language development in bilingual preschool children.  Washington, D.C.: National Clearinghouse for Bilingual Education.
  • Miller, L., Chan, W., Litvinova, A., Rubin, A., Tirella, L., & Cermak, S. (2007). Medical diagnoses and growth of children residing in Russian orphanages. Acta Paediatrica, 96, 1765–1769.
  • Miller, L., Chan, W., Litvinova, A., Rubin, A., Comfort, K., Tirella, L., et al. (2006). Fetal alcohol spectrum disorders in children residing in Russian orphanages: A phenotypic survey. Alcoholism: Clinical and Experimental Research, 30, 531–538.
  • Miller, L. (2005). Preadoption counseling and evaluation of the referral. In L. Miller (Ed.), The Handbook of International Adoption Medicine (pp. 67-86). NewYork: Oxford.
  • Pollock, K. E.  (2005) Early language growth in children adopted from China: preliminary normative data.  Seminars in Speech and Language, 26, 22-32.
  • Roberts, J., Pollock, K., Krakow, R., Price, J., Fulmer, K., & Wang, P. (2005). Language development in preschool-aged children adopted from China. Journal of Speech, Language, and Hearing Research, 48, 93–107.
  • Scott, K.A., Roberts, J.A., & Glennen, S. (2011).  How well children who are internationally do adopted acquire language? A meta-analysis. Journal of Speech, Language and Hearing Research, 54. 1153-69.
  • Scott, K.A., & Roberts, J. (2011). Making evidence-based decisions for children who are internationally adopted. Evidence-Based Practice Briefs. 6(3), 1-16.
  • Scott, K.A., & Roberts, J. (2007) language development of internationally adopted children: the school-age years.  Perspectives on Communication Disorders in Culturally and Linguistically Diverse Populations, 14: 12-17. 
  • Selman P. (2012a) Global trends in intercountry adoption 2000-2010. New York: National Council for Adoption.
  • Selman P (2012b). The rise and fall of intercountry adoption in the 21st centuryIn: Gibbons, J.L., Rotabi, K.S, ed. Intercountry Adoption: Policies, Practices and Outcomes. London: Ashgate Press.
  • Selman, P. (2010) “Intercountry adoption in Europe 1998–2009: patterns, trends and issues,” Adoption & Fostering, 34 (1): 4-19.
  • Silliman, E. R., & Scott, C. M. (2009). Research-based oral language intervention routes to the academic language of literacy: Finding the right road. In S. A. Rosenfield & V. Wise Berninger (Eds.), Implementing evidence-based academic interventions in school (pp. 107–145). New York: Oxford University Press.
  • Tarullo, A. R., Bruce, J., & Gunnar, M. (2007). False belief and emotion understanding in post-institutionalized children. Social Development, 16, 57-78
  • Tarullo, A. & Gunnar, M. R. (2005). Institutional rearing and deficits in social relatedness: Possible mechanisms and processes. Cognitie, Creier, Comportament [Cognition, Brain, Behavior], 9, 329-342.
  • Varavikova, E. A. & Balachova, T. N. (2010). Strategies to implement physician training in FAS prevention as a part of preventive care in primary health settings: P120.Alcoholism: Clinical & Experimental Research. 34(8) Sup 3:119A.
  • Welsh, J. A., & Viana, A. G. (2012). Developmental outcomes of children adopted internationally. Adoption Quarterly, 15, 241-264.
Posted on Leave a comment

Review and Giveaway of Strategies by Numbers (by SPELL-Links)

Today I am reviewing a fairly recently released (2014) book from the Learning By Design, Inc. team entitled SPELL-Links Strategies by Numbers.   This 57 page instructional guide was created to support the implementation of the SPELL-Links to Reading and Writing Word Study Curriculum as well as to help students “use the SPELL-Links strategies anytime in any setting.’ (p. iii) Its purpose is to enable students to strategize their way to writing and reading rather than overrelying on memorization techniques.

SPELL-Links Strategies by Numbers contains in-depth explanations of SPELL-Links’ 14 strategies for spelling and reading, detailed instructions on how to teach the strategies during writing and reading activities, as well as helpful ideas for supporting students as they further acquire literacy skills.  It can be used by a wide array of professionals including classroom teachers, speech-language pathologists, reading improvement teachers, learning disabilities teachers, aides, tutors, as well as parents for teaching word study lessons or as carryover and practice during reading and writing tasks.

The author includes a list of key terms used in the book as well as a guide with instructional icons screen-shot-2016-09-24-at-10-57-10-amscreen-shot-2016-09-24-at-10-56-46-am

The goal of the 14 strategies listed in the book is to build vocabulary, improve spelling, word decoding, reading fluency, and reading comprehension as well as improve students’ writing skills. While each strategy is presented in isolation under its own section, the end result is for students to fully integrate and apply multiple strategies when reading or writing.

Here’s the list of the 14 strategies in order of appearance as applied to spelling and reading:

  1. Sound It Out
  2. Check the Order
  3. Catch the Beat
  4. Listen Up
  5. A Little Stress Will Help This Mess
  6. No Fouls
  7. Play By the Rules
  8. Use Rhyme This Time
  9. Spell What You Mean and Mean What You Spell
  10. Be Smart About Word Parts
  11. Build on the Base
  12. Invite the Relatives
  13. Fix the Funny Stuff
  14. Look It Up

Each strategy includes highly detailed implementation instructions with students including pictorial support as well as both instructor and student guidance for practice at various levels during writing and reading tasks.  At the end of the book all the strategies are succinctly summarized in handy table, which is also provided to the user separately as a double sided one page insert printed on reinforced paper to be used as a guide when the book is not handy.

There are a number of things I like about the book. Firstly, of course it is based on the latest research in reading, writing, and spelling. Secondly, clinicians can use it the absence  of SPELL-Links to Reading and Writing Word Study Curriculum since the author’s purpose was to have the students  “use the SPELL-Links strategies anytime in any setting.’ (p. iii).  Thirdly, I love the fact that the book is based on the connectionist research model, which views spelling and reading as a “dynamic interplay of phonological, orthographic, and semantic knowledge.” (iii). Consequently, the listed strategies focus on simultaneously developing and strengthening phonological, orthographic, semantic and morphological knowledge during reading and writing tasks.

You can find this book for purchase on the Learning By Design, Inc. Store HERE. Finally, due to the generosity of Jan Wasowicz  PhD the book’s author, you can enter my Rafflecopter giveaway below for a chance to win your own copy!

 

 

a Rafflecopter giveaway

Posted on 4 Comments

What’s Memes Got To Do With It?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Here are just some of the reasons behind their success:

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

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

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

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

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

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

Why is APD Memeplex So Appealing? 

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

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

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

On the success of the Dyslexia Meme:

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

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

Final Thoughts:

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

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

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

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

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

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

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

I am a SLP

 References:

Kamhi, A. (2004). A meme’s eye view of speech-language pathology. [PDFLanguage, Speech, and Hearing Services in Schools35, 105-112.

Posted on 2 Comments

Designing RTI-Based Vocabulary Interventions

Image result for rti vocabulary interventions

Smart Speech Therapy LLC is celebrating #BHSM2015  ASHA Better Hearing and Speech Month. So without further ado, below you will find my recommendations for designing effective vocabulary interventions for struggling students.

This past academic year  I have been delivering vocabulary intervention once a week for an hour in my setting to 5 different classrooms of low achieving students.   This allowed me to research quite a bit regarding the principles of vocabulary teaching as well as  gave me an opportunity to adapt and design my own vocabulary intervention materials.

Vocabulary is of course one of the integral components of reading comprehension  along with phonological awareness, phonics, and reading fluency. Knowledge of vocabulary is especially important for navigation of informational texts.

Who can benefit from explicit vocabulary instruction?

The answer is simple: any child with decreased vocabulary skills!  This may include but not be limited to:

  • Children from low socioeconomic backgrounds
  • Children with Limited English Proficiency
  • Children  with language impairments and learning disabilities

How can we design effective vocabulary interventions?

According to Judy Montgomery “You can never select the wrong words to teach.” Beck et al (2002)  recommends teaching Tier II words, as they would make the most significant impact on a child’s spoken and written expressive capabilities, and are useful across a variety of settings.

 Tips on creating intervention materials:

  • Make vocabulary  words thematic and center them  around current events
  • Select a topic students are learning about in the classroom or center it around a seasonal event/holiday
  • Select no more than 10 words per packet and work on the packet for a period of several weeks to engage in a frequent mass practice
  • Attempt to select vocabulary words used across several domains, which are still applicable to the student’s academic experience

 Packet Layout : 

 1.  Embed the selected vocabulary words in a short thematic text

2.  Create a definitions page with usage tips to assist students with comprehension of vocabulary definitions

3. Have  the students practice  using these vocabulary words  in various activities  such as fill-in the blank, matching,  sentence creation, etc.

water_cycle_diagram

This thematic packet, which can be used all year round, was created to target listening and reading comprehension of older students diagnosed with language impairments and learning disabilities.

The packet contains the following items:

  1. 4 Paragraph Reading Comprehension Passage about the Hyrologic (Water) Cycle
  2. 7  Open ended comprehension questions
  3. 12 Response to Intervention (RTI) Tier 2 vocabulary words in story context
  4. 10 Synonyms and antonyms matching words
  5. 15 Fill-in the blank words to complete sentences
  6.  Open ended sentence formulation utilizing 10 story vocabulary words

You can grab it HERE in my online store. 

Helpful Smart Speech Resources:

Posted on Leave a comment

Assessing and Treating Bilinguals Who Stutter: Facts for Bilingual and Monolingual SLPs

Introduction: When it comes to bilingual children who stutter there is still considerable amount of misinformation regarding the best recommendations on assessment and treatment. The aim of this article is to review best practices in assessment and treatment of bilingual children who stutter, to shed some light on this important yet highly misunderstood area in speech-language pathology.

Types of Bilingualism: Young bilingual children can be broadly divided into two categories: those who are learning several languages simultaneously from birth (simultaneous bilingual), and those who begin to learn a second language after two years of age (sequential bilingual) (De Houwer, 2009b). The language milestones for simultaneous bilinguals may be somewhat uneven but they are not that much different from those of monolingual children (De Houwer, 2009a). Namely, first words emerge between 8 and 15 months and early phrase production occurs around +/-20 months of age, with sentence production following thereafter (De Houwer, 2009b). In contrast, sequential bilinguals undergo a number of stages during which they acquire abilities in the second language, which include preproduction, early production, as well as intermediate and advanced proficiency in the second language.

Stuttering and Monolingual Children: With respect to stuttering in the monolingual children we know that there are certain risk factors associated with stuttering. These include family history (family members who stutter), age of onset (children who begin stuttering before the age of three have a greater likelihood of outgrowing stuttering), time since onset (depending on how long the child have been stuttering certain children may outgrow it), gender (research has shown that girls are more likely to outgrow stuttering than boys), presence of other speech/language factors (poor speech intelligibility, advance language skills etc.) (Stuttering Foundation: Risk Factors).  We also know that the symptoms of stuttering manifest via sound, syllable and word repetitions, sound prolongations as well as sound and word blocks. In addition to overt stuttering characteristics there could also be secondary characteristics including gaze avoidance, word substitutions, anxiety about speaking, muscle tension in the face, jaw and neck, as well as fist clenching, just to name a few.

Stuttering and Bilingual Children: So what do we currently know regarding the manifestations of stuttering in bilingual children?  Here is some information based on existing research. While some researchers believe that stuttering is more common in bilingual versus monolingual individuals, currently there is no data which supports such a hypothesis.  The distribution and severity of stuttering tend to differ from language to language and one language is typically affected more than the other (Van Borsel, Maes & Foulon, 2001). Lim and colleagues (2008) found that language dominance influences the severity but not the types of stuttering behaviors.  They also found that bilingual stutterers exhibit different stuttering characteristics in both languages such as displaying stuttering on content words in L1 and function words in L2 (less-developed language system). According to Watson & Kayser (1994) key features of ‘true’ stuttering include the presence of stuttering in both languages with accompanying self-awareness as well as secondary behaviors.   This is important to understand giving the fact that bilingual children in the process of learning another language may present with pseudo-stuttering characteristics related to word retrieval rather than true stuttering.

Assessment of Bilingual Stutterers: Now let’s talk about aspects of the assessment. Typically assessment should begin with the taking of detailed background history regarding stuttering risk factors, the extent of the child’s exposure and proficiency in each language, age of stuttering onset, the extent of stuttering in each language, as well as presence of any other concomitant concerns regarding the child’s speech and language (e.g., suspicion of language/articulation deficits etc.)  Shenker (2013) also recommends the parental use of perceptual rating scales to assess child’s proficiency in each language.

Assessment procedures, especially those for newly referred children (vs. children whose speech and language abilities were previously assessed), should include comprehensive assessments of speech and language in addition to assessment of stuttering in order to rule out any hidden concomitant deficits.  It is also important to obtain conversational and narrative samples in each language as well as reading samples when applicable.   When analyzing the samples it is very important to understand and make allowance for typical disfluencies (especially when it comes to preschool children) as well as understand the difference between true stuttering and word retrieval deficits (which pertain to linguistic difficulties), which can manifest as fillers, word phrase repetitions, as well as conversational pauses (German, 2005).

When analyzing the child’s conversational speech for dysfluencies it may be helpful to gradually increase linguistic complexity in order to determine at which level (e.g., word, phrase, etc.) dysfluencies take place (Schenker, 2013). To calculate frequency and duration of disfluencies, word-based (vs. syllable-based) counts of stuttering frequency will be more accurate across languages (Bernstein Ratner, 2004).

Finally during the assessment it is also very important to determine the family’s cultural beliefs toward stuttering since stuttering perceptions vary greatly amongst different cultures (Tellis & Tellis, 2003) and may not always be positive. For example, Waheed-Kahn (1998) found that Middle Eastern parents attempted to deal with their children’s stuttering in the following ways: prayed for change, asked them to “speak properly”, completed their sentences, changed their setting by sending them to live with a relative as well as asked them not to talk in public.  Gauging familial beliefs toward stuttering will allow clinicians to: understand parental involvement and acceptance of therapy services, select best treatment models for particular clients as well as gain knowledge of how cultural attitudes may impact treatment outcomes (Schenker, 2013).

 Image courtesy of mnsu.edu 

Treatment of Bilingual Stutterers: With respect to stuttering treatment delivery for bilingual children, research has found that treatment in one language results in spontaneous improvement in fluency in the untreated language (Rousseau, Packman, & Onslow, 2005). This is helpful for monolingual SLPs who often do not have the option of treating clients in their birth language.

For young preschool children both direct and indirect therapy approaches may be utilized.

For example, the Palin (PCI) approach for children 2-7 years of age uses play-based sessions, video feedback, and facilitated discussions to help parents support and increase their child’s fluency. Its primary focus is to modify parent–child interactions via a facilitative rather than an instructive approach by developing and reinforcing parents’ expertise via use of video feedback to set own targets and reinforce progress. In contrast, the Lidcombe Program for children 2-7 years of age is a behavioral treatment with a focus on stuttering elimination.  It is administered by the parents under the supervision of an SLP, who teaches the parents how to control the child’s stuttering with verbal response contingent stimulation (Onslow & Millard, 2012).   While the Palin PCI approach still requires further research to determine its use with bilingual children, the Lidcombe Program has been trialed in a number of studies with bilingual children and was found to be effective in both languages (Schenker, 2013).

For bilingual school-age children with persistent stuttering, it is important to focus on stuttering management vs. stuttering elimination (Reardon-Reeves & Yaruss, 2013).  Here we are looking to reduce frequency and severity of disfluencies, teach the children to successfully manage stuttering moments, as well as work on the student’s emotional attitude toward stuttering. Use of support groups for children who stutter (e.g., “FRIENDS”: http://www.friendswhostutter.org/), may also be recommended.

Depending on the student’s preferences, desires, and needs, the approaches may involve a combination of fluency shaping and stuttering modification techniques.  Fluency shaping intervention focuses on increasing fluent speech through teaching methods that reduce speaking rate such as easy onsets, loose contacts, changing breathing, prolonging sounds or words, pausing, etc. The goal of fluency shaping is to “encourage spontaneous fluency where possible and controlled fluency when it is not” (Ramig & Dodge, 2004). In contrast stuttering modification therapy focuses on modifying the severity of stuttering moments as well as on reduction of fear, anxiety and avoidance behaviors associated with stuttering. Stuttering modification techniques are aimed at assisting the client “to confront the stuttering moment through implementation of pre-block, in-block, and/or post-block corrections, as well as through a change in how they perceive the stuttering experience” (Ramig & Dodge, 2004). While studies on these treatment methods are still very limited it is important to note that each technique as well as a combination of both techniques have been trialed and found successful with bilingual and even trilingual speakers (Conture & Curlee, 2007; Howell & Van Borsel, 2011).

Finally, it is very important for clinicians to account for cultural differences during treatment. This can be accomplished by carefully selecting culturally appropriate stimuli, preparing instructions which account for the parents’ language and culture, attempting to provide audio/video examples in the child’s birth language, as well as finding/creating opportunities for practicing fluency in culturally-relevant contexts and activities (Schenker, 2013).

Conclusion:  Presently, no evidence has been found that bilingualism causes stuttering. Furthermore, treatment outcomes for bilingual children appear to be comparable to those of monolingual children. Bilingual SLPs encountering bilingual children who stutter are encouraged to provide stuttering treatment in the language the child is most proficient in. Monolingual SLPs encountering bilingual children are encouraged to provide stuttering treatment in English with the expectation that the treatment will carry over into the child’s birth language. All clinicians are encouraged to involve the children’s families in the stuttering treatment as well as utilize methods and interventions that are in agreement with the family’s cultural beliefs and values, in order to create optimum treatment outcomes for bilingual children who stutter.

References:

  1. Bernstein Ratner, N. (2004). Fluency and stuttering in bilingual children. In B. Goldstein (ed.). Language Development: a focus on the Spanish-English speaker. Baltimore, MD: Brookes. (287-310).
  2. Conture, E. G., & Curlee, R. F. (2007). Stuttering and related disorders of fl uency. New York, NY: Thieme Medical Publishers.
  3. De Houwer, A. (2009a). Bilingual first language acquisition. Bristol: Multilingual Matters.
  4. De Houwer, A. (2009b). Assessing lexical development in bilingual first language acquisition: What can we learn from monolingual norms? In M. Cruz-Ferreira (Ed.), Multilingual norms (pp. 279-322). Frankfurt: Peter Lang.
  5. German, D.J. (2005) Word-Finding Intervention Program, Second Edition (WFIP-2)Austin Texas: Pro.Ed
  6. Howell, P & Van Borsel, , (2011). Multicultural Aspects of Fluency Disorders, Multilingual Matters, Bristol, UK.
  7. Lim, V. P. C., Rickard Liow, S. J., Lincoln, M., Chan, Y. H., & Onslow, M. (2008). Determining language dominance in English–Mandarin bilinguals: Development of a selfreport classification tool for clinical use. Applied Psycholinguistics, 29, 389–412.
  8. Onslow M, Millard S. (2012). Palin Parent Child Interaction and the Lidcombe Program: Clarifying some issues. Journal of Fluency Disorders37(1 ):1-8.
  9. Tellis, G. & Tellis, C. (2003). Multicultural issues in school settings. Seminars in Speech and Language, 24, 21-26.
  10. Ramig, P. R., & Dodge, D. (2004, September 08). Fluency shaping intervention: Helpful, but why it is important to know more. Retrieved from http://www.mnsu.edu/comdis/isad7/papers/ramig7.html
  11. Reardon-Reeves, N., & Yaruss, J.S. (2013). School-age Stuttering Therapy: A Practical Guide. McKinney, TX: Stuttering Therapy Resources, Inc.
  12. Rousseau, I., Packman, A., & Onslow, M. (2005, June). A trial of the Lidcombe Program with school age stuttering children. Paper presented at the Speech Pathology National Conference, Canberra, Australia.
  13. Shenker, R. C. (2013). Bilingual myth-busters series. When young children who stutter are also bilingual: Some thoughts about assessment and treatment. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse (CLD) Populations, 20(1), 15-23.
  14. Stuttering Foundation website: Stuttering Risk Factors http://www.stutteringhelp.org/risk-factors
  15. Van Borsel, J. Maes, E., & Foulon, S. (2001). Stuttering and bilingualism: A review. Journal of Fluency Disorders, 26, 179-205.
  16. Waheed-Kahn, N. (1998). Fluency therapy with multilingual clients. In Healey, E. C. & Peters, H. F. M. (Eds.),Proceedings of the Second World Congress on Fluency Disorders, San Francisco, August 1822(pp. 195–199). Nijmegen, The Netherlands: Nijmegen University Press.
  17. Watson, J., & Kayser, H. (1994). Assessment of bilingual/bicultural adults who stutter. Seminars in Speech and Language, 15, 149-163.

 

 

 

 

Posted on Leave a comment

Research Tuesday January Edition – Speech Impairment in Down Syndrome: A Review

Research TuesdayOnce again I am joining the ranks of SLPs who are blogging about research related to the field of speech pathology.   Today I am reviewing a 2013 article in the Journal of Speech, Language, and Hearing Research, by Kent and Vorperian, which summarizes research on disorders of speech production in Down syndrome (DS)

Title: Speech Impairment in Down Syndrome: A Review

Purpose: To inform clinical services and guide future research on assessment and treatment of DS. Continue reading Research Tuesday January Edition – Speech Impairment in Down Syndrome: A Review