Category: Problem Solving and Verbal Reasoning

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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

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Have I Got This Right? Developing Self-Questioning to Improve Metacognitive and Metalinguistic Skills

Image result for ambiguousMany of my students with Developmental Language Disorders (DLD) lack insight and have poorly developed metalinguistic (the ability to think about and discuss language) and metacognitive (think about and reflect upon own thinking) skills. This, of course, creates a significant challenge for them in both social and academic settings. Not only do they have a poorly developed inner dialogue for critical thinking purposes but they also because they present with significant self-monitoring and self-correcting challenges during speaking and reading tasks. Continue reading Have I Got This Right? Developing Self-Questioning to Improve Metacognitive and Metalinguistic Skills

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Speech, Language, and Literacy Fun with Helen Lester’s Picture Books

Picture books are absolutely wonderful for both assessment and treatment purposes! They are terrific as narrative elicitation aids for children of various ages, ranging from pre-K through fourth grade.  They are amazing treatment aids for addressing a variety of speech, language, and literacy goals that extend far beyond narrative production. Continue reading Speech, Language, and Literacy Fun with Helen Lester’s Picture Books

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Assessing Social Pragmatic Abilities in Children with Language Difficulties

You’ve received a referral to assess the language abilities of a school aged child with suspected language difficulties. The child has not been assessed before so you know you’ll need a comprehensive language test to look at the child’s ability to recall sentences, follow directions, name words, as well as perform a number of other tasks showcasing the child’s abilities in the areas of content and form (Bloom & Lahey, 1978).

But how about the area of language use? Will you be assessing the child’s pragmatic and social cognitive abilities as well during your language assessment? After all most comprehensive standardized assessments, “typically focus on semantics, syntax, morphology, and phonology, as these are the performance areas in which specific skill development can be most objectively measured” (Hill & Coufal, 2005, p 35). Continue reading Assessing Social Pragmatic Abilities in Children with Language Difficulties

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Analyzing Discourse Abilities of Adolescents via Peer Conflict Resolution (PCR) Tasks

A substantial portion of my caseload is comprised of adolescent learners. Since standardized assessments possess significant limitations for that age group (as well as in general), I am frequently on the lookout for qualitative clinical measures that can accurately capture their abilities in the areas of discourse, critical thinking, and social communication.

One type of an assessment that I find particularly valuable for this age group is a set of two Peer Conflict Resolution Tasks. First described in a 2007 article by Dr. Marylin Nippold and her colleagues, they assess expository discourse of adolescent learners. Continue reading Analyzing Discourse Abilities of Adolescents via Peer Conflict Resolution (PCR) Tasks

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Back to School SLP Efficiency Bundles™

September is practically here and many speech language pathologists (SLPs) are looking to efficiently prepare for assessing and treating a variety of clients on their caseloads.

With that in mind, a few years ago I created SLP Efficiency Bundles™, which are materials highly useful for SLPs working with pediatric clients. These materials are organized by areas of focus for efficient and effective screening, assessment, and treatment of speech and language disorders.

A.  General Assessment and Treatment Start-Up Bundle contains 5 downloads for general speech language assessment and treatment planning and includes:

  1. Speech Language Assessment Checklist for a Preschool Child
  2. Speech Language Assessment Checklist for a School-Aged Child
  3. Creating a Functional Therapy Plan: Therapy Goals & SOAP Note Documentation
  4. Selecting Clinical Materials for Pediatric Therapy
  5. Types and Levels of Cues and Prompts in  Speech Language Therapy

B. The Checklists Bundle contains 7 checklists relevant to screening and assessment in speech language pathology

  1. Speech Language Assessment Checklist for a Preschool Child 3:00-6:11 years of age
  2. Speech Language Assessment Checklist for a School-Aged Child 7:00-11:11 years of age
  3. Speech Language Assessment Checklist for Adolescents 12-18 years of age
  4. Language Processing Deficits (LPD) Checklist for School Aged Children 7:00-11:11 years of age
  5. Language Processing Deficits (LPD) Checklist for Preschool Children 3:00-6:11 years of age
  6. Social Pragmatic Deficits Checklist for School Aged Children 7:00-11:11 years of age
  7. Social Pragmatic Deficits Checklist for Preschool Children 3:00-6:11 years of age

C. Social Pragmatic Assessment and Treatment Bundle  contains 6 downloads for social pragmatic assessment and treatment planning (from 18 months through school age) and includes:

  1. Recognizing the Warning Signs of Social Emotional Difficulties in Language Impaired Toddlers and Preschoolers
  2. Behavior Management Strategies for Speech Language Pathologists
  3. Social Pragmatic Deficits Checklist for School Aged Children
  4. Social Pragmatic Deficits Checklist for Preschool Children
  5. Assessing Social Pragmatic Skills of School Aged Children
  6. Treatment of Social Pragmatic Deficits in School Aged Children

D. Multicultural Assessment and Treatment Bundle contains 2 downloads relevant to assessment and treatment of bilingual/multicultural children

  1. Language Difference vs. Language Disorder:  Assessment  & Intervention Strategies for SLPs Working with Bilingual Children
  2. Impact of Cultural and Linguistic Variables On Speech-Language Services

E. Narrative Assessment Bundle contains 3 downloads relevant to narrative assessment

  1. Narrative Assessments of Preschool and School Aged Children
  2. Understanding Complex Sentences
  3. Vocabulary Development: Working with Disadvantaged Populations

F. Fetal Alcohol Spectrum Disorders Assessment and Treatment Bundle contains 3 downloads relevant to FASD assessment  and treatment

  1. Orofacial Observations of At-Risk Children
  2. Fetal Alcohol Spectrum Disorder: An Overview of Deficits
  3. Speech Language Assessment and Treatment of Children With Alcohol Related Disorders

G. Psychiatric Disorders Bundle contains 7 downloads relevant to language  assessment  and treatment in psychiatrically impaired children

  1. Recognizing the Warning Signs of Social Emotional Difficulties in Language Impaired Toddlers and Preschoolers
  2. Social Pragmatic Deficits Checklist for School Aged Children
  3. Social Pragmatic Deficits Checklist for Preschool Children
  4. Assessing Social Skills in Children with Psychiatric Disturbances
  5. Improving Social Skills of Children with Psychiatric Disturbances
  6. Behavior Management Strategies for Speech Language Pathologists
  7. Differential Diagnosis Of ADHD In Speech Language Pathology

You can find these bundles on SALE in my online store by clicking on the individual bundle links above. You can also purchase these products individually in my online store by clicking HERE.

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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.

Is this an article which you might find interesting? If so, you can access full article HERE free of charge.

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

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Friend or Friendly: What Does Age Have To Do with It?

In my social pragmatic language groups I target a wide variety of social communication goals for children with varying levels and degrees of impairment with a focus on improving their social pragmatic language competence.  In the past I have written blog posts on a variety of social  pragmatic language therapy topics, including strategies for improving students’ emotional intelligence as well as on how to teach students to develop insight into own strengths and weaknesses.  Today I wanted to discuss the importance of teaching students with social communication impairments, age recognition for friendship and safety purposes.

Now it is important to note that the focus of my sessions is a bit different from the focus of “teaching protective behaviors”, “circles of intimacy and relationships” or “teaching kids to deal with tricky people“. Rather the goal is to teach the students to recognize who it is okay “to hang out” or be friends with, and who is considered to be too old/too young to be a friend.

Why is it important to teach age recognition?

There are actually quite a few reasons.

Firstly, it is a fairly well-known fact that in the absence of age-level peers with similar weaknesses, students with social communication deficits will seek out either much younger or much older children as playmates/friends as these individuals are far less likely to judge them for their perceived social deficits. While this may be a short-term solution to the “friendship problem” it also comes with its own host of challenges.  By maintaining relationships with peers outside of their age group, it is difficult for children with social communication impairments to understand and relate to peers of their age group in school setting. This creates a wider chasm in the classroom and increases the risk of peer isolation and bullying.

Secondly, the difficulty presented by friendships significantly outside of one’s peer group, is  the risk of, for lack of better words, ‘getting into trouble’. This may include but is not limited to exploring own sexuality (which is perfectly normal) with a significantly younger child (which can be problematic) or be instigated by an older child/adolescent in doing something inappropriate (e.g, shoplifting, drinking, smoking, exposing self to peers, etc.).

Thirdly, this difficulty (gauging people’s age) further exacerbates the students’ social communication deficits as it prevents them from effectively understanding such pragmatic parameters such as audience (e.g., with whom its appropriate to use certain language in a certain tone and with whom it is not) and topic (with whom it is appropriate to discuss certain subjects and with whom it is not).

So due to the above reasons I began working on age recognition with the students (6+ years of age) on my caseload diagnosed with social communication and language impairments.   I mention language impairments because it is very important to understand that more and more research is coming out connecting language impairments with social communication deficits. Therefore it’s not just students on the autism spectrum or students with social pragmatic deficits (an official DSM-5 diagnosis) who have difficulties in the area of social communication. Students with language impairments could also benefit from services focused on improving their social communication skills.

I begin my therapy sessions on age recognition by presenting the students with photos of people of different ages and asking them to attempt to explain how old do they think the people in the pictures are and what visual clues and/or prior knowledge assisted them in the formulation of their responses. I typically select the pictures from some of the social pragmatic therapy materials packets that I had created over the years (e.g., Gauging Moods, Are You Being Social?, Multiple Interpretations, etc.).

I make sure to carefully choose my pictures based on the student’s age and experience to ensure that the student has at least some degree of success making guesses.  So for a six-year-old I would select pictures of either toddlers or children his/her age to begin teaching them recognition of concepts: “same” and “younger” (e.g., Social Pragmatic Photo Bundle for Early Elementary Aged Children).

Kids playing in the room

For older children, I vary the photos of different aged individuals significantly.  I also introduce relevant vocabulary words as related to a particular age demographic, such as:

  • Infant (0-1 years of age)
  • Toddler (2-3 years of age)
  • Preschooler (3-5 years of age)
  • Teenager (individual between 13-19 years of age)
  • Early, mid and late 20s, 30s, 40s
  • Middle-aged (individuals around 50 years of age)
  • Senior/senior citizen (individuals ~65+ years of age)

I explain to the students that people of different ages look differently and teach them how to identify relevant visual clues to assist them with making educated guesses about people’s ages.  I also use photos of my own family or ask the students to bring in their own family photos to use for age determination of people in the presented pictures.  When students learn the ages of their own family members, they have an easier time determining the age ranges of strangers.

My next step is to explain to students the importance of understanding people’s ages.  I present to the students a picture of an individual significantly younger or older than them and ask them whether it’s appropriate to be that person’s friend.   Here students with better developed insight will state that it is not appropriate to be that person’s friend because they have nothing in common with them and do not share their interests. In contrast, students with limited insight will state that it’s perfectly okay to be that person’s friend.

This is the perfect teachable moment for explaining the difference between “friend” and “friendly”. Here I again reiterate that people of different ages have significantly different interests as well as have significant differences in what they are allowed to do (e.g., a 16-year-old is allowed to have a driver’s permit in many US states as well as has a later curfew while an 11-year-old clearly doesn’t).  I also explain that it’s perfectly okay to be friendly and polite with older or younger people in social situations (e.g., say hello all, talk, answer questions, etc.) but that does not constitute true friendship.

I also ask students to compile a list of qualities of what they look for in a “friend” as well as have them engage in some perspective taking (e.g, have them imagine that they showed up at a toddler’s house and asked to play with him/her, or that a teenager came into their house, and what their parents reaction would be?).

Finally, I discuss with students the importance of paying attention to who wants to hang out/be friends with them as well as vice versa (individuals they want to hang out with) in order to better develop their insight into the appropriateness of relationships. I instruct them to think critically when an older individual (e.g,  young adult) wants to get particularly close to them.  I use examples from an excellent post written by a colleague and good friend, Maria Del Duca of Communication Station Blog re: dealing with tricky people, in order to teach them to recognize signs of individuals crossing the boundary of being friendly, and what to do about it.

So there you have it. These are some of the reasons why I teach age recognition to clients with social communication weaknesses. Do you teach age recognition to your clients? If so, comment under this post, how do you do it and what materials do you use?

Helpful Smart Speech Resources Related to Assessment and Treatment of Social Pragmatic Disorders 

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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.

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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:

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

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. You can find it in my online store (HERE).

Helpful Smart Speech Resources:

References:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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
  6. 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.
  7. 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.
  8. 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.
  9. 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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SLP Efficiency Bundles™ for Graduating Speech Language Pathologists

Graduation time is rapidly approaching and many graduate speech language pathology students are getting ready to begin their first days in the workforce. When it comes to juggling caseloads and managing schedules, time is money and efficiency is the key to success. Consequently,  a few years ago I created  SLP Efficiency Bundles™, which are materials highly useful for Graduate SLPs working with pediatric clients. These materials are organized by areas of focus for efficient and effective screening, assessment, and treatment of speech and language disorders.   Continue reading SLP Efficiency Bundles™ for Graduating Speech Language Pathologists