Category: Smart Speech Therapy Article

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Guest Post: Simple Activities to Help Your Child with Language Impairment

If your child has been identified as having a language impairment, there are simple activities you can do at home that facilitate language development. These activities work in conjunction with your child’s formal therapy sessions and the activities he or she may participate in at school, either in the classroom or in an adjunct therapy session.

Such activities have three characteristics:

  • They are fun.

Therapy is almost always more effective for small children if it’s fun. Observe the therapist and note that almost all of the activities during the session are based around something that your child already likes to do.

  • They are part of “ordinary” interactions.

While formal therapy sessions are important, the activities at home don’t need to resemble therapy. Instead, they should be built into the normal course of everyday interactions to facilitate language skills naturally.

  • They build receptive language and vocabulary.

As you help your child develop language at home, the process becomes a natural part of your day together. Instead of being singled out as “language impaired,” your child is a loved and “normal” part of your family, and building his or her language skills becomes something that you do with your child just as you would with anyone. In addition, the interaction as you work together to strengthens your bond as you communicate.

Some simple activities to help your child include:

  • Reading aloud

Every child loves to be read a bedtime story; it’s a special time to snuggle with Mom or Dad and to hear a favorite story, again and again. Children find this repetition comforting; it also helps build both receptive and communicative language because as they learn the familiar words – both what they mean and how to say them – they can repeat them as you read the story together. This is perhaps the most perfect activity to help your child because you can do it every day. In fact, your child will look forward to it and probably even demand that it be done.

  • Telling stories, repeating rhymes, and asking your child to “complete the sentence”

Nursery rhymes and familiar stories are additional fun ways to expose your child to both communicative and receptive language. These activities develop language skills in a playful and non-stressful manner. For example, as your child develops familiarity with a rhyme, story, etc., simply pause at the end of a phrase and have him or her complete it.

  • Singing and listening to songs

Music is a wonderful facilitator of language too, and great to include in activities to help your child with language impairment issues. Spend some time each day singing together or listening to songs while driving, for example.

  • Playing the game, “What comes next?”

The “alphabet song” is a good example of how to play the game, “What comes next?” with your child. Since this song helps most children learn the alphabet, begin by singing the song together, and then as your child learns the alphabet, drop out so he or she sings the next letters alone.

“What comes next?” can also be played with days of the week, months of the year, counting, and more. The beauty of “What comes next?” is its applicability to anything language-based. Customize it to suit your child’s likes and dislikes, and it never gets boring.

  • Providing appropriate language modeling

Among the best activities to help your child is modeling correct language during conversations. Your child will watch, learn, and ultimately respond correctly, with gentle prompting at first.

About the author:

Erica L. Fener, Ph.D., is Vice President, Strategic Growth at Progressus Therapy, a leading provider of school-based therapy and early intervention services.

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FASD and Background History Collection: Asking the Right Questions

Note: This article was originally published in August 2013 Issue of Adoption Today Magazine (pp. 32-35).   

Sometime ago, I interviewed the grandmother of an at-risk 11 year old child in kinship care, whose language abilities I have been asked to assess in order to determine whether he required speech-language therapy services.  The child was attending an outpatient school program in a psychiatric hospital where I worked and his psychiatrist was significantly concerned regarding his listening comprehension abilities as well as social pragmatic skills. Continue reading FASD and Background History Collection: Asking the Right Questions

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Dear Neurodevelopmental Pediatrician: Please Don’t Do That!

Recently I got yet another one of the dreaded phone calls which went a little something like this:

Parent: Hi, I am looking for a speech therapist for my son, who uses PROMPT to treat Childhood Apraxia of Speech (CAS). Are you PROMPT certified?

Me: I am PROMPT trained and I do treat motor speech disorders but perhaps you can first tell me a little bit about your child? What is his age? What type of speech difficulties does he have? Who diagnosed him and recommended the treatment.

Parent: He is turning 3. He was diagnosed by a neurodevelopmental pediatrician a few weeks ago. She recommended speech therapy 4 times a week for 30 minutes sessions, using PROMPT.

Me: And what did the speech therapy evaluation reveal?

Parent: We did not do a speech therapy evaluation yet.

Sadly I get these type of phone calls at least once a month. Frantic parents of toddlers aged 18 months to 3+ years of age call to inquire regarding the availability of PROMPT therapy based exclusively on the diagnosis of the neurodevelopmental pediatrician. In all cases I am told that the neurodevelopmental pediatrician specified speech language diagnosis, method of treatment, and therapy frequency, ALBEIT in a complete absence of a comprehensive speech language evaluation and/or past speech language therapy treatments.

The conversation that follows is often an uncomfortable one. I listen to the parental description of the child’s presenting symptoms and explain to the parents that a comprehensive speech language assessment by a certified speech language pathologist is needed prior to initiation of any therapy services. I also explain to the parents that depending on the child’s age and the assessment findings CAS may or may not be substantiated since there are a number of speech sound disorders which may have symptoms similar to CAS.

Following my ‘spiel’, the parents typically react in a number of ways. Some get offended that I dared to question the judgement of a highly qualified medical professional. Others hurriedly thank me for my time and resoundingly hang up the phone. Yet a number of parents will stay on the line, actually listen to what  I have to say and ask me detailed questions.  Some of them will even become clients and have their children undergo a speech language evaluation.  Still a number of them will find out that  their child never even had CAS! Past misdiagnoses ranged from ASD  (CAS was mistaken due to the presence of imprecise speech and excessive jargon related utterances) to severe phonological disorder to dysarthria secondary to CP.  Thus, prior to performing a detailed speech language evaluation  on the child I had no way of knowing whether the child truly presented with CAS symptoms.

Before I continue I’d like to provide a rudimentary definition of CAS.  Since its identification years ago it has been argued whether CAS is linguistic or motoric in nature with the latest consensus being that CAS is a disorder which disrupts speech motor control and creates difficulty with volitional, intelligible speech production.  Latest research also shows that in addition to having difficulty forming words and sentences at the speech level, children with CAS also experience difficulty in the areas of receptive and expressive language, in other words,  “pure” apraxia of speech is rare (Hammer, 2007).

This condition NEEDS to be  diagnosed by a speech language pathologist! Not only that, due to the disorder’s complexity it is strongly recommended that if parents suspect CAS they should take their child for an assessment with an SLP specializing in assessment and treatment of motor speech disorders. Here’s why.

  • CAS has a number of overlapping symptoms with other speech sound disorders (e.g., severe phonological disorder, dysarthria, etc).
  • Symptoms which may initially appear as CAS may change during the course of intervention by the time the child is older (e.g., 3 years of age) which is why diagnosing toddlers under 3 years of age is very problematic and the use of  “suspected” or “working” diagnosis is recommended (Davis & Velleman, 2000) in order to avoid misdiagnosis
  • Diagnosis of CAS is also problematic due to the fact that there are no valid or reliable standardized assessments sensitive to CAS  (McCauley & Strand, 2008). However, a new instrument Dynamic Evaluation of Motor Speech Skill (DEMSS) (Strand et al, 2013) is showing promise with respect to differential diagnosis of severe speech impairments in children
  • Thus for children with less severe impairments SLPs need to design tasks to assess the child’s:
    • Automatic vs. volitional control
    • Simple vs. complex speech
    • Consistency of productions on repetitions of same word
    • Vowel productions
    • Imitation abilities
    • Prosody
    • Phonetic inventory BEFORE and AFTER intervention
    •  Types and levels of cueing the child is presently stimulable to
      • in order to determine where the breakdown is taking place (Caspari, 2012)

These are just some of the reasons why specialization in CAS is needed and why it is IMPOSSIBLE to make a reliable CAS diagnosis by  simply observing the child for a length of time, from a brief physical exam, and from extensive parental interviews (e.g., a typical neurodevelopmental appointment).

In fact, leading CAS experts state that you DON’t need a neurologist in order to confirm the CAS diagnosis (Hammer, 2007).

Furthermore, “NO SINGLE PROGRAM WORKS FOR ALL CHILDREN WITH APRAXIA!!” (Hammer, 2007). Hence SLPs NEED to individualize not only their approach with each child but also switch approaches with the same child when needed it in order to continue making therapy gains. Given the above the PROMPT approach may not even be applicable to some children.

It goes without saying that MANY developmental pediatricians will NOT do this!

But for those who do, I implore you – if you observe that a young child is having difficulty producing speech, please refer the child for a speech language assessment first. Please specify to the parents your concerns (e.g., restricted sound repertoire for the child’s age, difficulty sequencing sounds to make words, etc) BUT NOT the diagnosis, therapy frequency, as well as therapy approaches.  Allow the assessing speech language pathologist to make these recommendations in order to ensure that the child receives the best possible targeted intervention for his/her disorder.

For more information please visit the Childhood Apraxia of Speech Association of North America (CASANA) website or visit the ASHA website to find a professional specializing in the diagnosis and treatment of CAS near you.

References:

  1. Caspari, S (2012)  Beyond Picture Cards! Practical Assessment and Treatment Methods for Children with Apraxia of Speech. Session presented for New Jersey Speech Language Hearing Association Convention, Long Branch, NJ
  2. Davis, B., & Velleman, S. L. (2000). Differential diagnosis and treatment of developmental apraxia of speech in infants and toddlers. Infant-Toddler Intervention: The Transdisciplinary Journal, 10, 177–192.
  3. Hammer, D (2007) Childhood Apraxia of Speech: Evaluation and Therapy Challenges. Retrieved from http://www.maxshouse.com.au/documents/CAS%20conference%20day%201%20.ppt.
  4. McCauley RJ, Strand EA. (2008). A Review of Standardized Tests of Nonverbal Oral and Speech Motor Performance in Children. American Journal of Speech-Language Pathology, 17,81-91.
  5.  Strand, E, McCauley, R, Weigand, S, Stoeckel, R & Baas, B (2013) A Motor Speech Assessment for Children with Severe Speech Disorders: Reliability and Validity Evidence. Journal of Speech Language and Hearing Research, vol 56; 505-520.
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In case you missed it: The importance of targeted assessments for school aged children

Last week I did a guest post for The Simply Speech Blog. In case you missed it,  below I offer an explanation why targeted speech language assessments are so important, as well as list helpful resources that will aid you in speech language assessment preparation.

In both my hospital based job and in private practice I do a lot of testing. During staff/caregiver interviews I used to get a laundry list of both specific and non-specific problems by the parents and teachers, which did not always accurately reflect the students true deficits.  Experience quickly taught me that administering general comprehensive language testing to every student simply did not work. Oftentimes the administration of such testing revealed one of two things: Continue reading In case you missed it: The importance of targeted assessments for school aged children

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Understanding the risks of social pragmatic deficits in post institutionalized internationally adopted (IA) children.

Image may contain: 1 person, textThis article was originally published in December 24, 2012 issue of Advance for Speech Language Pathologists and Audiologists under the title: “Adoption & Pragmatic Problems” (pp 6-9) 

Photo credits: Leonid Khavin

Cover Model: Bella Critelli

According to U.S. State Department, 233,934 children were adopted internationally between 1999-2011, with a majority 76 percent (or approximately 177,316) of these children being under 3 years of age.

To date a number of studies have come out about various aspects of these children’s language development, including but not limited to, rate of new language acquisition, patterns of typical vs. atypical language acquisition, as well as long-term language outcomes post-institutionalization.

While significant variability was found with respect to language gains and outcomes of internationally adopted children, a number of researchers found a correlation between age of adoption and language outcomes, namely, children adopted at younger ages (under 3 years of age) seem to present with better language/academic outcomes in the long-term vs. children adopted at older ages.1,2,3,4

Indeed, it certainly stands to reason that the less time children spend in an institutional environment, the better off they are in all areas of functioning (cognitive, emotional, linguistic, social, etc.). The longer the child stays in an institutional environment, the greater is the risk of greater delays, including a speech and language delay.

However, children adopted at younger ages, may also present with significant delays in select areas of functioning, many years post-adoption. Continue reading Understanding the risks of social pragmatic deficits in post institutionalized internationally adopted (IA) children.

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Multicultural Considerations in Assessment of Play

As speech language pathologist part of my job is to play! Since play assessment is a routine part of speech language evaluations for preschool and early school-aged children, I often find myself on the carpet in my office racing cars, making sure that all the “Little People” get their turn on the toy Ferris Wheel, and “cooking” elaborate  meals in complete absence of electrical appliances.  In fact, I’ve heard the phrase “I want toy” so many times that I actually began to worry that I might accidentally use it in polite company myself.

The benefits of play are well known and cataloged. Play allows children to use creativity and develop imagination. It facilitates cognition, physical and emotional development, language, and literacy.  Play is great!  However, not every culture values play as much as the Westerners do.

Cultural values affect how children play. Thus play interactions vary significantly across cultures. For instance, many Asian cultures prize education over play, so in these cultures children may engage in educational play activities vs. pretend play activities. To illustrate, Farver and colleagues have found that Korean preschool children engaged in greater parallel play (vs. pretend play), initiated play less frequently, as well as had less frequent social play episodes in contrast to Anglo-American peers. (Farver, Kim & Lee, 1995; Farver and Shinn 1997)

To continue, cultures focused on individualism stress independence and self-reliance.  In such cultures, babies and toddlers are taught to be self sufficient when it comes to sleeping, feeding, dressing, grooming and playing from a very early age. (Schulze, Harwood, and Schoelmerich, 2001) Consequently, in these cultures parents would generally support and encourage child initiated and directed play. However, in many Latin American cultures, parents expect their children to master self-care abilities and function independently at later ages.  Play in these cultures may be more parent directed vs. child directed.   These children may receive more explicit directives from their caregivers with respect to how to act and speak and be more physically positioned or restrained during play. (Harwood, Schoelmerich, & Schulze, 2000)

In Western culture, early choice making is praised and encouraged.  In contrast, traditional collective cultures encourage child obedience and respect over independence (Johnston & Wong, 2002).  Choice making may not be as encouraged since it might seem like it’s giving the child too much power.  It would not be uncommon for a child to be given a toy to play with which is deemed suitable for him/her, instead of being asked to choose.   The children in these cultures may not be encouraged to narrate on their actions during play but expected to play quietly with their toy.  Furthermore, if the parents do not consider play as an activity beneficial to their child’s cognitive and emotional development, but treat it as a leisure activity that helps pass the time, they may not ask the child questions regarding what he/she are doing and will not expect the child to narrate on their actions during play.

Consequently, in our assessments, it is very important to keep in mind that children’s play is affected by a number of variables including: cultural values, family relationships, child rearing practices, toy familiarity as well as developmental expectations (Hwa-Froelich, 2004).  As such, in order to conduct balanced and objective play assessments, we as clinicians need to find a few moments in our busy schedules to interview the caregivers regarding their views on child rearing practices and play interactions, so we could objectively interpret our assessment findings (e.g.,  is it delay/disorder or lack of  exposure and task unfamiliarity).

References:

  •  Farver, J. M., Kim, Y. K., & Lee, Y. (1995). Cultural differences in Korean- and Anglo-American preschoolers’ social interaction and play behaviors. Child Development, 66, 1088- 1099.
  • Farver, J. M., & Shinn, Y. L. (1997). Social pretend play in Korean- and Anglo- American pre-schoolers. Child Development,68 (3), 544-556.
  • Johnston, J.R., & Wong, M.-Y. A. (2002). Cultural differences in beliefs and practices concerning talk to children . Journal of Speech, Language, and Hearing Research, 45 (5), 916-926
  • Harwood, R. L., & Schoelmerich, A and Schulze, P. A. (2000) Homogeneity and heterogeneity in cultural belief systems. New Directions for Child and Adolescent Development 87,  41-57
  • Hwa-Froelich, D. A. (2004). Play Assessment for Children from Culturally and Linguistically Diverse Backgrounds. Perspectives on Language, Learning and Education and on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations, 11(2), 6-10.
  • Hwa-Froelich, D. A., & Vigil, D. C. (2004). Three aspects of cultural influence on communication: A literature review. Communication Disorders Quarterly, 25(3),110-118.
  • Schulze, P. A., Harwood, R. L., & Schoelmerich, A. (2001). Feeding practices and expectations among middle-class Anglo and Puerto Rican mothers of 12-month-old infants. Journal of Cross-Cultural Psychology, 32(4), 397–406.
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Speech-Language Activity Suggestions for Multisensory Stimulation of At-Risk Children

In recent years the percentage of “at-risk children” has been steadily increasing across pediatric speech-language pathology caseloads.  These include adopted and foster care children, medically fragile children (e.g., failure to thrive), abused and neglected children, children from low socioeconomic backgrounds or any children who for any reason lack the adequate support system to encourage them to function optimally socially, emotionally, intellectually, or physically.

At times speech-language pathologists encounter barriers when working with this population, which include low motivation, inconsistent knowledge retention, as well as halting or labored progress in therapy.

As a speech-language pathologist whose caseload consists entirely of at-children, I have spent countless of hours on attempting to enhance service delivery for my clients. One method that I have found to be highly effective for greater knowledge retention as well as for increasing the kids’ motivation is incorporating multisensory stimulation in speech and language activities.

To date, a number of studies have described the advantages of multisensory stimulation for various at risk populations. For example, in 2003 a study published in Journal of Research in Nursing and Health described the advantages of multisensory stimulation for 2 week old Korean orphans who received auditory, tactile, and visual stimulation twice a day, 5 days a week, for 4 weeks. This resulted in significantly fewer illnesses as well as significant gains in weight, length and head circumference, after the 4-week intervention period and at 6 months of age. Another 2009 study by White Traut and colleagues published in the Journal of Obstetric, Gynecologic, & Neonatal Nursing, found that multi sensory stimulation consisting of auditory, tactile, visual, and vestibular intervention contributed to a reduction of infant stress reactivity (steady decline in cortisol levels).   Moreover, multisensory stimulation is not just beneficial for young children. Other studies found benefits of multisensory stimulation for dementia (Milev et al, 2008) and coma patients (Doman & Wilkinson, 1993), indicating the usefulness of multisensory stimulation for a variety of at risk populations of different age groups.

After reviewing some studies and successfully implementing a number of strategies I wanted to share with you some of my favorite multisensory activities for different age-groups.

Before initiating any activities please remember to obtain parental permissions as well as a clearance from the occupational therapist (if the child is receiving related services), particularly if the child presents with significant sensory issues.  It is also very important to ensure that there are no food allergies, or nutritional restrictions, especially when it comes to working with new and unfamiliar clients on your caseload.

Multisensory stimulation for young children does not have to involve stimulation of all the senses at once. However, there are a number of activities which come quite close, especially when one combines “touch ‘n’ feel” books, musical puzzles as well as paper and edible crafts.

Here’s one of my favorite speech language therapy session activities for children 2-4 years of age. I use a board book called Percival Touch ‘n’ Feel Book to teach insect and animal related vocabulary words as well as talk about adjectives describing textures (furry, smooth, bumpy, sticky, etc).  As I help the children navigate the book, they get to touch the pages and talk about various plant and animals parts such as furry caterpillar dots, shiny flower petals, bumpy frog skin, or sticky spider web.   We also work on appropriately producing multisyllabic words and on combining the words into short sentences, depending of course, on the child’s age, skills, and abilities.   With this activity I often use animal and insect musical puzzles so the children can hear and then imitate select animal and insect noises.

Also, since all of Percival’s friends are garden insects and animals, it’s fairly easy to turn the book characters into paper crafts. Color paper templates are available from free websites such as www.dltk-kids.com, and range in complexity based on the child’s age (e.g., 2+, 3+ etc).  While looking innocuously like simple paper cutouts, in reality these crafts are a linguistic treasure trove and can be used for teaching simple and complex directions (e.g., after you glue the frog’s arm, glue on his foot) as well as prepositional concepts (e.g., glue the eyes on top of the head; glue the mouth below the nose, etc).

So far we have combined the tactile with the auditory and the visual but we are still missing the stimulation of a few other senses such as the olfactory and the gustatory.  For these we need a bit more creativity, and that’s where edible crafts come in (inspired by Janell Cannon’s ‘Crickwing’).  The child and I begin by constructing and gluing together a large paper flower and dabbing it’s petals with various food extracts (almond, vanilla, raspberry, lemon, root beer, banana, cherry, coconut, etc).  Then, using the paper flower as a model, we make an edible flower using various foods.  Pretzel sticks serve as stems, snap peas become leaves while mango, tomato, apple, peach and orange slices can serve as petals.  After our food craft is finished the child (and all other therapy participants) are encouraged to take it apart and eat it.  The edible flower is not just useful to stimulate the visual, tactile, gustatory, and olfactory senses but it also encourages picky eaters to trial new foods with a variety of textures and tastes, as well as serves to develop symbolic play and early abstract thinking skills.

It is also important to emphasize that multisensory activities are not just for younger children; they can be useful for school-age children as well (including middle school and high school aged kids). In the past, I have incorporated multisensory activities into thematic language and vocabulary units for older children (see resources below) while working on the topics such as the senses (e.g., edible tasting plate), nutrition (e.g., edible food pyramid), the human body (e.g., computer games such as whack a bone by anatomy arcade), or even biology (building plant and animal cell structures out of jello and candy). From my personal clinical experience I have noticed that when I utilized the multisensory approach to learning vs. auditory and visual approaches alone (such as paper based or computer based tasks only), the children evidenced greater task participation, were able to understand the material much faster and were still able to recall learned information appropriately several therapy sessions later.

I find multisensory stimulation to be a fun and interactive way to increase the child’s learning potential, decrease stress levels, as well as increase retention of relevant concepts.  Try it and let me know how it works for you!

 References:

·         Doman, G & Wilkinson, R (1993) The effects of intense multi-sensory stimulation on coma arousal and recovery. Neuropsychological Rehabilitation. 3 (2): 203-212.

·         Ti, K, Shin YH, & White-Traut, RC (2003), Multisensory intervention improves physical growth and illness rates in Korean orphaned newborn infants. Research in Nursing Health.  26 (6): 424-33.

·         Milev et al (2008) Multisensory Stimulation for Elderly With Dementia: A 24-Week Single-Blind Randomized Controlled Pilot Study. American Journal of Alzheimer’s Disease and Other Dementias. 23 (4): 372-376.

·         Tarullo, A & Gunnar, M (2006). Child Maltreatment and Developing HPA Axis. Hormones and Behavior 50, 632-639.

  • White Traut (1999) Developmental Intervention for Preterm Infants Diagnosed with Periventricular Leukomalacia. Research in Nursing Health.  22: 131-143.

·         White Traut et al (2009) Salivary Cortisol and Behavioral State Responses of Healthy Newborn Infants to Tactile-Only and Multisensory Interventions. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 38(1): 22–34

 Resources:

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Understanding the extent of speech and language delays in older internationally adopted children: Implications for School Based Speech and Language Intervention.

Understanding the extent of speech and language delays in older internationally adopted children: Implications for School Based Speech and Language Intervention.

Tatyana Elleseff MA CCC-SLP

 

Note: This article was first published in October 2011 Issue of Adoption Today Magazine (pp. 32-35) http://www.adoptinfo.net/catalog_g111.html?catId=55347

 According to US State Department statistics, over 11,000 children were adopted internationally in the year 2010, with 2,803 of those children being school-aged (between 5-17 years old). Despite a staggering 50% decline in overall inter-country adoptions in the last 10 years, statistics on adoption of older children continue to remain steady (appropriately 3,000 older children were adopted each year, for the past decade). (Retrieved from http://adoption.state.gov/about_us/statistics.php Jul 29, 2011).

 Subsequent to the school aged child’s arrival to US, one of the first considerations that arises, secondary to health concerns and transitional adjustments, is the issue of schooling and appropriate school based services provision. In contrast to children adopted at younger ages, who typically have an opportunity to acquire some English language skills before an academic placement takes place, older international adoptees lack this luxury. Unfortunately, due to their unique linguistic status, many school districts are at a loss regarding best services options for these children.

 Despite the prevalence of available research on this subject, one myth that continues to persist is that older internationally adopted children are “bilingual” and as such should receive remedial services similar to those received by newly entering the country bilingual children (e.g., ESL classes).

 It is very important to understand that most internationally adopted children rapidly lose their birth language, sometimes in as little as several months post arrival (Gindis, 2005), since they are often adopted by parents who do not speak the child’s first language and as such are unable/unwilling to maintain it. Not only are these 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. Moreover, even during the transition period during which international adoptees are rapidly losing their native language, their birth language is still of no use to them, since it’s not functional in their monolingual, English speaking only, home and school environments. As a result of the above constraints, select researchers have referred to this pattern of language gain, as “second, first language acquisition” (e.g., Roberts, et al., 2005), since the child is acquiring his/her new language literally from scratch.

 This brings me to another myth, that given several years of immersion in a new language rich, home and school environments, most internationally adopted children with (mild) language delays will catch up to their non-adopted monolingual peers academically, without the benefit of any additional services.

 This concept requires clarification, since the majority of parents adopting older children, often have difficulty understanding the extent of their child’s speech and language abilities in their native language at the time of adoption, and the implications for new language transference.

 Research on speech language abilities of older internationally adopted children is still rather limited, despite available studies to date. Some studies (e.g., Glennen & Masters, 2002; Krakow & Roberts, 2003, etc) suggest that age of adoption is strongly correlated with language outcomes. In other words, older internationally adopted children are at risk of having poorer language outcomes than children adopted at younger ages. That is because the longer the child stays in an institutional environment the greater is the risk of a birth language delay. Children in institutional care frequently experience neglect, lack of language stimulation, lack of appropriate play experiences, lack of enriched community activities, as well as inadequate learning settings all of which have long lasting negative impact on their language development. It is also important to understand that language delays in birth language transfer and become language delays in a new language. These delays will typically continue to persist unless appropriate intervention, in the form of speech language services, is provided.

So what are the options available to parents adopting older school age children with respect to determination of their child’s speech and language abilities?

For starters, at the time of adoption, it is very important to gain as much information regarding their child’s birth language abilities (and academic abilities, when applicable) as possible. In many older children (3+ years of age), speech and language delays in birth language (e.g., sound and word mispronunciations, limited vocabulary, grammatical errors, inability to answer simple or abstract questions, short sentence length) can be easily determined based on orphanage staff interviews, observations, and/or review of documentation included in the adoption record. In the Russian Federation, for example, speech language pathologists are assigned to orphanages, so when working with older international adoptees from the Russian Federation, one often finds a short statement in adoption records stating that the child presented with a speech and language delay for which he was receiving services.

If possible, prior to adoption, parents may wish to explore the option of obtaining an independent comprehensive speech language evaluation of the child’s birth language abilities, while the child is still located in the birth country. The above may be significant for a number of reasons. Firstly, it will allow the parents to understand the extent of the child’s language delay in their birth tongue. Secondly, it will increase the parents’ chances of obtaining school based remediation services for their child once they arrive to US.

In the absence of qualified speech pathologists attached to the orphanage or conclusive interviews with medical professionals, paraprofessionals, and teachers (lack of availability, language barrier, time constraints, etc) regarding the child’s speech and language development, it will be very helpful for parents to videotape the child during speaking tasks. Most parents who request pre-adoption consultations are well familiar with videotaping, requested by various pre-adoption professionals (pediatricians, psychologists, etc) in order to review the child’s presenting appearance, fine and gross motor skills, behavior and social skills as well as other areas of functioning. Language video samples should focus on child’s engagement in literacy tasks such as reading a book aloud (if sufficiently literate), and on speaking activities such as telling a story, recalling an episode from daily life or a conversation with familiar person. In the absence of all other data, these samples can later be analyzed and interpreted in order to determine if speech language deficits are present. (Glennen, 2009)

Parents need to understand that internationally adopted children can often be denied special education services in the absence of appropriate documentation. Such denials are often based on misinterpretation of the current IDEA 2004 law. Some denials may be based on the fact that once these children arrive to US, it is very difficult to find a qualified speech language pathologist who can assess the child in their birth language, especially if it’s a less commonly spoken language such as Amharic, Kazakh, or Ukrainian. Additionally, schools may refuse to test internationally adopted children for several years post arrival, on the grounds that these children have yet to attain “adequate language abilities in English” and as such, the testing results will be biased/inadequate, since testing was not standardized on children with similar linguistic abilities. Furthermore, even if the school administers appropriate testing protocols and finds the child’s abilities impaired, testing results may still be dismissed as inaccurate due to the child’s perceived limited English exposure.

Contrastingly, a speech and language report in the child’s birth language will outline the nature and severity of disorder, and state that given the extent of the child’s deficits in his/her birth language, similar pattern will be experienced in English unless intervention is provided. According to one of the leading speech-language researchers, Sharon Glennen, “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)

To continue, some options in locating a speech pathologist in the child’s birth country include consulting with the adoption agency or the local pediatrician, who is providing medical clearance for the child. However, it is very important that the speech language pathologist be licensed and reputable, as unqualified professionals will not be able to make appropriate diagnostic interpretations and suggestions, and may provide erroneous information to the parent.

If the parents are unable to obtain the relevant report in the child’s birth country, the next viable option is to obtain a comprehensive speech language assessment upon arrival to US, from a qualified professional who is well versed in both: the child’s native language as well as speech and language issues unique to assessment of internationally adopted children. Please note that the window of opportunity to assess the school age child in his/her native language is very narrow, as birth language attrition occurs within literally a matter of several months post adoption and is more rapid in children with delayed and disordered speech and language abilities (Gindis, 1999, 2005, 2008).

If the presence of a speech language delay has been confirmed (e.g., documented in adoption paperwork, interpreted through video samples, supported by a psycho-educational assessment, etc) the next step is to request the relevant speech language services for your child through the school system. Typically school administration will ask you to produce such a request in writing. One such letter template is available through the Post Adoption Learning Center (see link below). This template, complete with relevant references, can be modified to each child’s unique circumstances, and submitted along with supporting paperwork (e.g., speech-language, psycho-educational reports) and available video samples. In cases of services denials, an educational attorney specializing in educational policy relevant to international adoptions may need be consulted.

Once the child is qualified for appropriate speech language services in the school system it is also important to understand that language acquisition occurs in a progression, with social language (CLF) preceding cognitive language (CLM) (Gindis, 1999). Communicative Language Fluency (CLF) is language used in social situations for day-to-day social interactions. These skills are used to interact at home, on the playground, in the lunch room, on the school bus, at parties, playing sports and talking on the telephone. Social interactions are usually context embedded. Because they occur in meaningful social contexts they are typically not very demanding cognitively and the language required is not specialized. These language skills usually emerge in internationally adopted children as early as several months post adoption. Once these abilities emerge and solidify it is very important for speech language pathologists not to dismiss the child from services but to continue the treatment and focus it in the realm of cognitive/ academic language.

Cognitive Language Mastery (CLM) refers to 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. Language impaired children adopted at older ages need time and support to become develop cognitive language and become proficient in academic areas, an ability which usually takes a number of years to refine. Before discharging the child from therapy services it is very important that their cognitive/academic language abilities are assessed and are found within average limits.

Understanding the extent of speech language delay in internationally adopted older children AND factors pertaining to appropriate remediation are crucial for delivery of relevant (and meaningful to the child) speech language services as well as ensuring their continued academic success in school setting.

References:

• 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

• 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 (2008) Abrupt Native Language Loss in International Adoptees Advance for Speech/Language Pathologists and Audiologists Dec 22.

• Glennen, S. & Masters, G. (2002). Typical and atypical language development in infants and toddlers adopted from Eastern Europe. American Journal of Speech-LanguagePathology, 44, 417-433

• Glennen, S., & Bright, B. J. (2005). Five years later: Language in school-age internationally adopted children. Seminars in Speech and Language, 26, 86-101.

• .Glennen, S (2009) Speech and Language Guidelines for Children Adopted from Abroad at Older Ages. Topics in language Disorders 29, 50-64.

• Intercountry Adoption Bureau of Consular Affairs US Department of State Retrieved on Jul 29, 2011 from http://adoption.state.gov/about_us/statistics.php

• Krakow, R. A., & Roberts, J. (2003). Acquisitions of English vocabulary by young Chinese adoptees. Journal of Multilingual Communication Disorders, 1, 169-176.

• Muchnik, M. How to request speech/language services for your child. Retrieved on Aug 2, 2011 from http://www.bgcenterschool.org/FreePresentations/P8-Speech-language-support.shtml

• Roberts, et al, (2005). Language development in preschool-aged children adopted from China. Journal of Speech, Language and Hearing Research, 48, 93-107.

Bio: Tatyana Elleseff MA CCC-SLP is a bilingual speech language pathologist with a full-time affiliation with University of Medicine and Dentistry of New Jersey and a private practice in Somerset, NJ. She received her Master’s Degree from New York University and her Bilingual Extension Certification from Columbia University. Currently she is licensed by the states of New Jersey and New York and holds a Certificate of Clinical Competence from American Speech Language and Hearing Association. She specializes in working with bilingual, multicultural, internationally and domestically adopted at risk children with complex medical, developmental, neurogenic, psychogenic, and acquired communication disorders. For more information about her services call 917-916-7487 or visit her website: www.smartspeechtherapy.com

Cite as: Elleseff, Tatyana (2011, October) Understanding the extent of speech and language delays in older internationally adopted children: Implications for School Based Speech and Language Intervention. Adoption Today.

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What are social pragmatic language deficits and how do they impact international adoptees years post adoption?

What are social pragmatic language deficits and how do they impact international adoptees years post adoption?

Tatyana Elleseff MA CCC-SLP

Scenario:   John is a bright 11 year old boy who was adopted at the age of 3 from Russia by American parents. John’s favorite subject is math, he is good at sports but his most dreaded class is language arts. John has trouble understanding abstract information or summarizing what he has seen, heard or read. John’s grades are steadily slipping and his reading comprehension is below grade level. He has trouble retelling stories and his answers often raise more questions due to being very confusing and difficult to follow. John has trouble maintaining friendships with kids his age, who consider him too immature and feel like he frequently “misses the point” due to his inability to appropriately join play activities and discussions, understand non-verbal body language, maintain conversations on age-level topics, or engage in perspective taking (understand other people’s ideas, feelings, and thoughts). John had not received speech language services immediately post adoption despite exhibiting a severe speech and language delay at the time of adoption. The parents were told that “he’ll catch up quickly”, and he did, or so it seemed, at the time. John is undeniably bright yet with each day he struggles just a little bit more with understanding those around him and getting his point across. John’s scores were within normal limits on typical speech and language tests administered at his school, so he did not qualify for school based speech language therapy. Yet John clearly needs help.

John’s case is by no means unique. Numerous adopted children begin to experience similar difficulties; years post adoption, despite seemingly appropriate early social and academic development. What has many parents bewildered is that often times these difficulties are not glaringly pronounced in the early grades, which leads to delayed referral and lack of appropriate intervention for prolonged period of time.

The name for John’s difficulty is pragmatic language impairment, a diagnosis that has been the subject of numerous research debates since it was originally proposed in 1983 by Rapin and Allen. 

So what is pragmatic language impairment and how exactly does it impact the child’s social and academic language abilities? 

In 1983, Rapin and Allen proposed a classification of children with developmental language disorders. As part of this classification they described a syndrome of language impairment which they termed ‘semantic–pragmatic deficit syndrome’. Children with this disorder were described as being overly verbose, having poor turn–taking skills, poor discourse and narrative skills as well as having difficulty with topic initiation, maintenance and termination. Over the years the diagnostic label for this disorder has changed several times, until it received its current name “pragmatic language impairment” (Bishop, 2000).

Pragmatic language ability involves the ability to appropriately use language (e.g., persuade, request, inform, reject), change language (e.g., talk differently to different audiences, provide background information to unfamiliar listeners, speak differently in different settings, etc) as well as follow conversational rules (e.g., take turns, introduce topics, rephrase sentences, maintain appropriate physical distance during conversational exchanges, use facial expressions and eye contact, etc) all of which culminate into the child’s general ability to appropriately interact with others in a variety of settings.

For most typically developing children, the above comes naturally. However, for children with pragmatic language impairment appropriate social interactions are not easy. Children with pragmatic language impairment often misinterpret social cues, make inappropriate or off-topic comments during conversations, tell stories in a disorganized way, have trouble socially interacting with peers, have difficulty making and keeping friends, have difficulty understanding why they are being rejected by peers, and are at increased risk for bullying.

So why do adopted children experience social pragmatic language deficits many years post adoption? 

Well for one, many internationally adopted children are at high risk for developmental delay because of their exposure to institutional environments. Children in institutional care often experience neglect, lack of language stimulation, lack of appropriate play experiences, lack of enriched community activities, as well as inadequate learning settings all of which has long lasting negative impact on their language development including the development of their pragmatic language skills (especially if they are over 3 years of age). Furthermore, other, often unknown, predisposing factors such as medical, genetic, and family history can also play a negative role in pragmatic language development, since at the time of adoption very little information is known about the child’s birth parents or maternal prenatal care.

Difficulty with detection as well as mistaken diagnoses of pragmatic language impairment 

Whereas detecting difficulties with language content and form is relatively straightforward, pragmatic language deficits are more difficult to detect, because pragmatics are dependent on specific contexts and implicit rules. While many children with pragmatic language impairment will present with poor reading comprehension, low vocabulary, and grammar errors (pronoun reversal, tense confusion) in addition to the already described deficits, not all the children with pragmatic language impairment will manifest the above signs. Moreover, while pragmatic language impairment is diagnosed as one of the primary difficulties in children on autistic spectrum, it can manifest on its own without the diagnosis of autism. Furthermore, due to its complicated constellation of symptoms as well as frequent coexistence with other disorders, pragmatic language impairment as a standalone diagnosis is often difficult to establish without the multidisciplinary team involvement (e.g., to rule out associated psychiatric and neurological impairment).

It is also not uncommon for pragmatic language deficits to manifest in children as challenging behaviors (and in severe cases be misdiagnosed due to the fact that internationally adopted children are at increased risk for psychiatric disorders in childhood, adolescence and adulthood). Parents and teachers often complain that these children tend to “ignore” presented directions, follow their own agenda, and frequently “act out inappropriately”. Unfortunately, since children with pragmatic language impairment rely on literal communication, they tend to understand and carry out concrete instructions and tasks versus understanding indirect requests which contain abstract information. Additionally, since perspective taking abilities are undeveloped in these children, they often fail to understand and as a result ignore or disregard other people’s feelings, ideas, and thoughts, which may further contribute to parents’ and teachers’ beliefs that they are deliberately misbehaving.

Due to difficulties with detection, pragmatic language deficits can persist undetected for several years until they are appropriately diagnosed. What may further complicate detection is that a certain number of children with pragmatic language deficits will perform within the normal range on typical speech and language testing. As a result, unless a specific battery of speech language tests is administered that explicitly targets the identification of pragmatic language deficits, some of these children may be denied speech and language services on the grounds that their total language testing score was too high to qualify them for intervention.

How to initiate an appropriate referral process if you suspect that your school age child has pragmatic language deficits? 

When a child is presenting with a number of above described symptoms, it is recommended that a medical professional such as a neurologist or a psychologist be consulted in order to rule out other more serious diagnoses. Then, the speech language pathologist can perform testing in order to confirm the presence of pragmatic language impairment as well as determine whether any other linguistically based deficits coexist with it. Furthermore, even in cases when the pragmatic language impairment is a secondary diagnosis (e.g. Autism) the speech language pathologist will still need to be involved in order to appropriately address the social linguistic component of this deficit.

To obtain appropriate speech and language testing in a school setting, the first step that parents can take is to consult with the classroom teacher. For the school age child (including preschool and kindergarten) the classroom teacher can be the best parental ally. After all both parents and teachers know the children quite well and can therefore take into account their behavior and functioning in a variety of social and academic contexts. Once the list of difficulties and inappropriate behaviors has been compiled, and both parties agree that the “red flags” merit further attention, the next step is to involve the school speech language pathologist (make a referral) to confirm the presence and/or severity of the impairment via speech language testing.

When attempting to confirm/rule out pragmatic language impairment, the speech language pathologist has the option of using a combination of formal and informal assessments including parental questionnaires, discourse and narrative analyses as well as observation checklists.

Below is the list of select formal and informal speech language assessment instruments which are sensitive to detection of pragmatic language impairment in children as young as 4-5 years of age.

1. Children’s Communication Checklist-2 (CCC–2) (Available: Pearson Publication)
2. Test of Narrative Development (TNL) (Available: Linguisystems Publication)
3. Test of Language Competence Expanded Edition (TLC-E) (Available: Pearson Publication)
4. Test of Pragmatic Language-2 (TOPL-2) (Available: Linguisystems Publication)
5. Social Emotional Evaluation (SEE) (Available: Super Duper Publication)
6. Dynamic Informal Social Thinking Assessment (www.socialthinking.com)
7. Social Language Development Test -Elementary (SLDT-E) (Available: Linguisystems Publication)
8. Social Language Development Test -Adolescent (SLDT-A) (Available: Linguisystems Publication)

It is also very important to note that several formal and informal instruments and analyses need to be administered/performed in order to create a complete diagnostic picture of the child’s deficits.

When to seek private pragmatic language evaluation and therapy services?

Unfortunately, the process of obtaining appropriate social pragmatic assessment in a school setting is often fraught with numerous difficulties. For one, due to financial constraints, not all school districts possess the appropriate, up to date pragmatic language testing instruments.

Another issue is the lack of time. To administer comprehensive assessment which involves 2-3 different assessment instruments, an adequate amount of time (e.g., 2+ hours) is needed in order to create the most comprehensive pragmatic profile for the child. School based speech language pathologists often lack this valuable commodity due to increased case load size (often seeing between 45 to 60 students per week), which leaves them with very limited time for testing.

Further complicating the issue are the special education qualification rules, which are different not just from state to state but in some cases from one school district to the next within the same state. Some school districts strictly stipulate that the child’s performance on testing must be 1.5-2 standard deviations below the normal limits in order to qualify for therapy services.
But what if the therapist is not in possession of any formal assessment instruments and can only do informal assessment?

And what happens to the child who is “not impaired enough” (e.g., 1 SD vs. 1.5 SD)?

Consequently, in recent years more and more parents are opting for private pragmatic language assessments and therapy for their children.

Certainly, there are numerous advantages for going via the private route. For one, parents are directly involved and directly influence the quality of care their children receive.

One advantage to private therapy is that parents can request to be present during the evaluation and therapy sessions. As such, not only do the parents get to understand the extent of the child’s impairment but they also learn valuable techniques and strategies they can utilize in home setting to facilitate carryover and skill generalization (how to ask questions, provide choices, etc).

Another advantage is the provision of individual therapy services in contrast to school based services which are generally attended by groups as large as 4-5 children per session. Here, some might disagree and state that isn’t the point of pragmatic therapy is for the child to practice his/her social skills with other children?

Absolutely! However, before a skill can be generalized it needs to be taught! Most children with pragmatic language impairment initially require individual sessions, in some of which it may be necessary to use drill work to teach a specific skill. Once the necessary skills are taught, only then can children be placed into social groups where they can practice generalizing their skills. Moreover, many of these children greatly benefit from being in group or play settings with typical peers and/or sibling tutors who may facilitate the generalization of the desired skill more naturally, all of which can be arranged within private therapy settings.

Yet another advantage to obtaining private therapy services is that there are some private clinics which are almost exclusively devoted to teaching social pragmatic communication and which offer a variety of therapeutic services including individual therapy, group therapy and even summer camps that target the improvement of pragmatic language and social communication skills.

The flexibility offered by private therapy is also important if a parent is seeking a specific social skills curriculum for their child (e.g., “Socially Speaking”) or if they are interested in social skill training that is based on the methods of specific researchers/authors (e.g., Michelle Garcia Winner MACCC-SLP; Dr. Jed Baker PhD, etc), which may not be offered by their child’s school.

There are many routes open for parents to pursue when it comes to their child’s pragmatic language assessment and intervention. However, the first step in that process is parental education!

To learn more about pragmatic language impairment please visit the ASHA website at www.asha.org and type in your query in the search window located in the upper right corner of the website. To find a professional specializing in assessment and treatment of pragmatic language disorders in your area please visit http://asha.org/proserv/.

References

Adams, C. (2001). “Clinical diagnostic and intervention studies of children with semantic-pragmatic language disorder.” International Journal of Language and Communication Disorders 36(3): 289-305.

Bishop, D. V. (1989). “Autism, Asperger’s syndrome and semantic-pragmatic disorder: Where are the boundaries?” British Journal of Disorders of Communication 24(2): 107-121.

Bishop, D. V. M. and G. Baird (2001). “Parent and teacher report of pragmatic aspects of communication: Use of the Children’s Communication Checklist in a clinical setting.” Developmental Medicine and Child Neurology 43(12): 809-818.

Botting, N., & Conti-Ramsden, G. (1999). Pragmatic language impairment without autism: The children in question. Autism, 3, 371–396.[

Brackenbury, T., & Pye, C. (2005). Semantic deficits in children with language impairments: Issues for clinical assessment. Language, Speech, and Hearing Services in Schools, 36, 5–16.

Burgess, S., & Turkstra, L. S. (2006). Social skills intervention for adolescents with autism spectrum disorders: A review of the experimental evidence. EBP Briefs, 1(4), 1–21.

Camarata, S., M., and T. Gibson (1999). “Pragmatic Language Deficits in Attention-Deficit Hyperactivity Disorder (ADHD).” Mental Retardation and Developmental Disabilities 5: 207-214.

Ketelaars, M. P., Cuperus, J. M., Jansonius, K., & Verhoeven, L. (2009). Pragmatic language impairment and associated behavioural problems. International Journal of Language and Communication Disorders, 45, 204–214.

Ketelaars, M. P., Cuperus, J. M., Van Daal, J., Jansonius, K., & Verhoeven, L. (2009). Screening for pragmatic language impairment: The potential of the Children’s Communication Checklist. Research in Developmental Disabilities, 30, 952–960.

Miniscalco, C., Hagberg, B., Kadesjö, B., Westerlund, M., & Gillberg, C. (2007). Narrative skills, cognitive profiles and neuropsychiatric disorders in 7-8-year-old children with late developing language. International Journal of Language and Communication Disorders, 42, 665–681.
Rapin I, Allen D (1983). Developmental language disorders: Nosologic considerations. In U. Kirk (Ed.), Neuropsychology of language, reading, and spelling (pp. 155–184). : Academic Press.

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How to select the right speech language pathologist for your adopted child?


How to select the right speech language pathologist for your adopted child?

You have decided to consult a private speech language pathologist because of concerns over your adopted child’s developing speech and language. But how do you choose the right one? There are many speech therapists out there and not all of them are alike in experience and skills. On top of it all, you are also looking for a bilingual therapist, one who is not only proficient in your child’s native language but is also knowledgeable regarding the speech and language issues of international adoptees. That is not an easy decision to make, especially for many parents who until now have not had any direct contact with a speech language pathologist.
Not to worry, below is a list of simple guidelines designed to assist you in the right therapist selection.

Let’s begin with something basic: educational and professional credentials. A speech language pathologist must possess a Master’s Degree (or its equivalent) from a reputable academic institution of higher learning. They must also have a Certificate of Clinical Competence from the American Speech Language Hearing Association as well as an appropriate licensure from the state in which they maintain their practice. Additionally, it is highly recommended that they have Bilingual Certification as it indicates that they have completed the necessary academic coursework and are proficient in the issues surrounding normal and disordered speech-language acquisition of bilingual children in dual languages.

Now we are ready to proceed to experience. Here its gets a little tricky. The traditional approach: “I want the therapist with a gazillion years of experience” is just not going to be all that useful. It can’t be just any experience; it has to be the right experience! After all do you really want a therapist with 30 years of experience in exclusively treating articulation deficits when your child needs help with feeding and swallowing or with developing augmentative/alternative communication?

It is important to choose a therapist who has a rich and varied experience from multiple settings, total years of experience may not be as important as the qualitative value of that experience. A good therapist has probably spent a considerable portion of his/her time in a variety of settings from schools and early intervention agencies to hospitals and rehabilitation clinics. As the result of working in these diverse environments that therapist is much more likely to come up with innovative ideas and solutions to your child’s problems as opposed to just using the same old remediation strategies that they have learned way back then. It is also a good idea to inquire regarding the areas of specialization of the therapist in order to find out whether he/she has successfully treated children with similar problems to your child’s.

Typically, private speech language pathologists who maintain some type of pediatric hospital affiliation (e.g. per diem or part-time employees) are up to date regarding the current methodologies, which they apply to practice on daily basis. The reasons for that are twofold:

Speech departments in hospitals deal with diverse caseloads, with patients ranging in ages, diagnoses (some of which can be quite unusual), and levels of severity. In an average inpatient department staff SLP’s are expected to carry caseloads of 12-16 patients per day.
In order to keep up with the caseload diversity and with the latest treatment trends, hospitals require these SLP’s to actively take professional development courses in order to provide their patients with the best quality of care.
This brings us to another important consideration: professional development. To maintain their state licensure and national certification all therapists are required to take professional education courses in order to stay up to date with all the relevant research and new treatments developed in our field. The minimum requirement is to accumulate 30 professional education hours every 3 years whether by attending courses in person, taking them online through qualified providers, or by conducting workshops and presenting at conferences. Professional development provides the speech therapists with an opportunity to use evidence based techniques supported and tested by research to treat a variety of communication disorders. Consequently, when selecting your therapist it is important to find out just how up to date are they on the current treatment methods and methodologies pertaining to your child speech and language deficits. You can always find out this information by politely questioning the therapist regarding their background and “resume highlights.”

It is also important to find out whether you understand and agree with the therapist’s methods and approaches. For example, if your child is a toddler, it probably does not make sense for him/her to spend most sessions doing worksheets and drills when he/she needs to be engaged in play based, child centered therapy. Don’t be intimidated by the therapist’s credentials and your lack of knowledge, if something they said doesn’t make sense, ask follow up questions and/or look up pertinent information online. While you should not use the internet to diagnose your child’s problems, it can be used as a valuable learning tool to look up information and to share ideas with other parents who experience similar difficulties.

Now that we have specified general selection criteria, let’s talk about how to initiate your search for the right SLP. The best way is again to go online. Start your search by going to the ASHA website and clicking on the ‘Find Professional Button’ located in the top of the page and then follow the instructions on the screen. Fill out your search criteria carefully but don’t be too specific. For example, don’t look for a Russian speaking SLP in Blue Creek, California as you will probably not find one. Instead try typing in the first 3 digits of your zipcode or your state of residence (if it’s small enough) and don’t forget to specify the language of the practitioner. That will get you the optimum results.

Once you have located several candidates, you can narrow down the search by trying to learn something about them online. Google the clinician’s name (or the name of their practice) to see whether they have their own website, have written any articles or have been profiled by any organizations. To make sure that your practitioner’s licensure is up to date, visit your state’s speech language accreditation website and type in the last name of the professional. Typically, a window will pop up listing the therapists’ names alphabetically, find the one you are looking for and check if their license is active. Finally, armed with your research, create a list of questions that you might have for the practitioners and start making phone calls. Find out all the pertinent information and don’t forget to ask about rates which may differ depending on what services the practitioner is providing.

Please note that many private practitioners refuse to deal with insurance companies directly due to the hassle of multiclient billing as well as extended wait for reimbursement. They will instead provide you with a letter for your insurance company, containing the necessary diagnosis and treatment codes, incurred fees as well as a brief description of services provided, and will expect you to apply for reimbursement on your own.

Now that we have gone over the selection process in some detail, please keep in mind that you can always learn more information on this and any other speech pathology related topic by visiting the ASHA website and clicking on the ‘Public’ tab located at the top of the screen.

Best of luck in your search and happy hunting!

Useful websites:
Find a Professional SLP on the ASHA website: http://www.asha.org/proserv/
State Contacts & Licensure Requirements: http://www.asha.org/about/legislation-advocacy/state/