Recently, I’ve participated in various on-line and in-person discussions with both school-based speech language pathologists (SLPs) as well as medical health professionals (e.g., neurologists, pediatricians, etc.) regarding their views on the need of formal diagnosis for school aged children with suspected alcohol related deficits. While their responses differed considerably from: “we do not base intervention on diagnosis, but rather on demonstrated student need” to “with a diagnosis of ASD ‘these children’ would get the same level of services“, the message I was receiving loud and clear was: “Why? What would be the point?” So today I decided to share my views on this matter and explain why I think the diagnosis matters.
Continue reading Why is FASD diagnosis so important?
Category: Smart Speech Therapy Article
Creating Successful Team Collaboration: Behavior Management in the Schools
In March 2014, ASHA SIG 16 Perspectives on School Based Issues, I’ve written an article on how SLPs can collaborate with other school based professionals to successfully work with children exhibiting challenging behaviors secondary to psychiatric diagnoses and emotional and behavioral disturbances. In this post I would like to summarize the key points of my article as well as offer helpful professional resources on this topic. Continue reading Creating Successful Team Collaboration: Behavior Management in the Schools
Addressing Critical Thinking Skills via Picture Books in Therapy
Critical thinking are a set of skills children need to make good independent decisions. Critical thinking abilities involve children analyzing, synthesizing and evaluating information in order to recognize patterns, distinguish right from wrong, offer opinions, anticipate reactions to their actions, compare scenarios to choose favorable outcomes, as well as consider a variety of solutions to the same problem.
Even for typically developing children critical thinking can at times be a bit of a challenge and needs to be nurtured and encouraged through a variety of ways. However, for language impaired children, critical thinking skills hierarchy needs to be explicitly addressed in therapy sessions in order to improve these children’s independent decision-making abilities.
Teaching critical thinking skills to language impaired students is no easy feat especially considering the “seriousness” of the subject matter. One fun way I like to address critical thinking skills is through picture books utilizing the framework outlined in Bloom’s Taxonomy: Cognitive Domain which encompasses the following categories: knowledge, comprehension, application, analysis, synthesis, and evaluation.
Prior to story reading ask the children to flip through the pictures and ask them questions regarding what the story might be about and what could be some potential story problems based on provided pictures.
During story reading actively question the child to ensure that they are not just passive story listeners (e.g., “Why do you think…?). Begin with basic story recall of characters, events, and outcomes (knowledge). Here asking simple -wh- questions will do the trick. Then move on to checking on what the child has done with the knowledge by asking him/her to identify main ideas of the stories as well as associate, compare, contrast and classify information (comprehension).
As you are reading the story as students to compare and contrast different characters as well as different story situations. Children can also critically compare different (satirical) story versions of popular tales like Cinderella, Little Red Riding Hood, Jack and the Beanstalk, etc.
Involve children in active story discussion and analysis by asking questions the answers to which are not directly found in the story (e.g., Who else do you know who also…?; Why do you think the ___did that?) Ask the student to identify each characters motives. When looking at a particular problem in the story ask the student how they would solve a similar real-life problem (application).
Have them weigh in pros and cons of the characters choices. Make a ridiculous statement about a story or character and have the students argue with you and explain constructively why they disagree with it. It will teach them how to find weaknesses in someone else’s reasoning. Ask the children to synthesize the presented story by generalizing it to relate to another story or an episode from their daily life.
Consider covering up story ending to have the students create their own creative alternate story conclusions. Do a shared story reading in group therapy sessions and then have a debate (e.g, Who is your favorite character and why?) in which each child has to provide appropriate rationale in order to successfully defend their point of view.
Teaching children critical thinking skills is an integral part of therapy since children need to use their language skills effectively in order to make informed decisions and function appropriately in social and academic settings.
Looking for suggestions on the hierarchy of addressing analogical problem skills then grab this one page FREEBIE I created entitled “Teaching Hierarchy of Problem Solving Skills to Children with Learning Disabilities” from my online store HERE.
So how are you teaching critical thinking skills in therapy?
Helpful Resources:
- Don’t Buy it PBS kids website which teaches children how to evaluate products and become informed consumers
- Critical Thinking Links For K-3 Educators free resources for incorporating critical thinking concepts for grades K-3
- Critical Thinking Links For 4th To 6th Grade Educators free resources for 4-6 grades
What parents need to know about speech-language assessment of older internationally adopted children
This post is based on Elleseff, T (2013) Changing Trends in International Adoption: Implications for Speech-Language Pathologists. Perspectives on Global Issues in Communication Sciences and Related Disorders, 3: 45-53
Changing Trends in International Adoption:
In recent years the changing trends in international adoption revealed a shift in international adoption demographics which includes more preschool and school-aged children being sent for adoption vs. infants and toddlers (Selman, 2012a; 2010) as well as a significant increase in special needs adoptions from Eastern European countries as well as from China (Selman, 2010; 2012a). Continue reading What parents need to know about speech-language assessment of older internationally adopted children
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.
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
Dear Neurodevelopmental Pediatrician: Please Don’t Do That!
Recently I got yet another one of the dreaded phone calls which went a little something like this:
Parent: Hi, I am looking for a speech therapist for my son, who uses PROMPT to treat Childhood Apraxia of Speech (CAS). Are you PROMPT certified?
Me: I am PROMPT trained and I do treat motor speech disorders but perhaps you can first tell me a little bit about your child? What is his age? What type of speech difficulties does he have? Who diagnosed him and recommended the treatment.
Parent: He is turning 3. He was diagnosed by a neurodevelopmental pediatrician a few weeks ago. She recommended speech therapy 4 times a week for 30 minutes sessions, using PROMPT.
Me: And what did the speech therapy evaluation reveal?
Parent: We did not do a speech therapy evaluation yet.
Sadly I get these type of phone calls at least once a month. Frantic parents of toddlers aged 18 months to 3+ years of age call to inquire regarding the availability of PROMPT therapy based exclusively on the diagnosis of the neurodevelopmental pediatrician. In all cases I am told that the neurodevelopmental pediatrician specified speech language diagnosis, method of treatment, and therapy frequency, ALBEIT in a complete absence of a comprehensive speech language evaluation and/or past speech language therapy treatments.
The conversation that follows is often an uncomfortable one. I listen to the parental description of the child’s presenting symptoms and explain to the parents that a comprehensive speech language assessment by a certified speech language pathologist is needed prior to initiation of any therapy services. I also explain to the parents that depending on the child’s age and the assessment findings CAS may or may not be substantiated since there are a number of speech sound disorders which may have symptoms similar to CAS.
Following my ‘spiel’, the parents typically react in a number of ways. Some get offended that I dared to question the judgement of a highly qualified medical professional. Others hurriedly thank me for my time and resoundingly hang up the phone. Yet a number of parents will stay on the line, actually listen to what I have to say and ask me detailed questions. Some of them will even become clients and have their children undergo a speech language evaluation. Still a number of them will find out that their child never even had CAS! Past misdiagnoses ranged from ASD (CAS was mistaken due to the presence of imprecise speech and excessive jargon related utterances) to severe phonological disorder to dysarthria secondary to CP. Thus, prior to performing a detailed speech language evaluation on the child I had no way of knowing whether the child truly presented with CAS symptoms.
Before I continue I’d like to provide a rudimentary definition of CAS. Since its identification years ago it has been argued whether CAS is linguistic or motoric in nature with the latest consensus being that CAS is a disorder which disrupts speech motor control and creates difficulty with volitional, intelligible speech production. Latest research also shows that in addition to having difficulty forming words and sentences at the speech level, children with CAS also experience difficulty in the areas of receptive and expressive language, in other words, “pure” apraxia of speech is rare (Hammer, 2007).
This condition NEEDS to be diagnosed by a speech language pathologist! Not only that, due to the disorder’s complexity it is strongly recommended that if parents suspect CAS they should take their child for an assessment with an SLP specializing in assessment and treatment of motor speech disorders. Here’s why.
- CAS has a number of overlapping symptoms with other speech sound disorders (e.g., severe phonological disorder, dysarthria, etc).
- Symptoms which may initially appear as CAS may change during the course of intervention by the time the child is older (e.g., 3 years of age) which is why diagnosing toddlers under 3 years of age is very problematic and the use of “suspected” or “working” diagnosis is recommended (Davis & Velleman, 2000) in order to avoid misdiagnosis
- Diagnosis of CAS is also problematic due to the fact that there are no valid or reliable standardized assessments sensitive to CAS (McCauley & Strand, 2008). However, a new instrument Dynamic Evaluation of Motor Speech Skill (DEMSS) (Strand et al, 2013) is showing promise with respect to differential diagnosis of severe speech impairments in children
- Thus for children with less severe impairments SLPs need to design tasks to assess the child’s:
- Automatic vs. volitional control
- Simple vs. complex speech
- Consistency of productions on repetitions of same word
- Vowel productions
- Imitation abilities
- Prosody
- Phonetic inventory BEFORE and AFTER intervention
- Types and levels of cueing the child is presently stimulable to
- in order to determine where the breakdown is taking place (Caspari, 2012)
These are just some of the reasons why specialization in CAS is needed and why it is IMPOSSIBLE to make a reliable CAS diagnosis by simply observing the child for a length of time, from a brief physical exam, and from extensive parental interviews (e.g., a typical neurodevelopmental appointment).
In fact, leading CAS experts state that you DON’t need a neurologist in order to confirm the CAS diagnosis (Hammer, 2007).
Furthermore, “NO SINGLE PROGRAM WORKS FOR ALL CHILDREN WITH APRAXIA!!” (Hammer, 2007). Hence SLPs NEED to individualize not only their approach with each child but also switch approaches with the same child when needed it in order to continue making therapy gains. Given the above the PROMPT approach may not even be applicable to some children.
It goes without saying that MANY developmental pediatricians will NOT do this!
But for those who do, I implore you – if you observe that a young child is having difficulty producing speech, please refer the child for a speech language assessment first. Please specify to the parents your concerns (e.g., restricted sound repertoire for the child’s age, difficulty sequencing sounds to make words, etc) BUT NOT the diagnosis, therapy frequency, as well as therapy approaches. Allow the assessing speech language pathologist to make these recommendations in order to ensure that the child receives the best possible targeted intervention for his/her disorder.
For more information please visit the Childhood Apraxia of Speech Association of North America (CASANA) website or visit the ASHA website to find a professional specializing in the diagnosis and treatment of CAS near you.
References:
- Caspari, S (2012) Beyond Picture Cards! Practical Assessment and Treatment Methods for Children with Apraxia of Speech. Session presented for New Jersey Speech Language Hearing Association Convention, Long Branch, NJ
- Davis, B., & Velleman, S. L. (2000). Differential diagnosis and treatment of developmental apraxia of speech in infants and toddlers. Infant-Toddler Intervention: The Transdisciplinary Journal, 10, 177–192.
- Hammer, D (2007) Childhood Apraxia of Speech: Evaluation and Therapy Challenges. Retrieved from http://www.maxshouse.com.au/documents/CAS%20conference%20day%201%20.ppt.
- McCauley RJ, Strand EA. (2008). A Review of Standardized Tests of Nonverbal Oral and Speech Motor Performance in Children. American Journal of Speech-Language Pathology, 17,81-91.
- Strand, E, McCauley, R, Weigand, S, Stoeckel, R & Baas, B (2013) A Motor Speech Assessment for Children with Severe Speech Disorders: Reliability and Validity Evidence. Journal of Speech Language and Hearing Research, vol 56; 505-520.
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
What to do if you find your copyrighted material posted online
In this day and age, in addition to speech language assessment and intervention, many speech language pathologists are engaged in a number of enterprising endeavors ranging from creating and selling therapeutic materials to public speaking and presenting. As a result of these activities we continuously create numerous digital downloads for primary (e.g., TPT materials) and secondary (handouts to accompany presentations) customer consumption. Of course in these materials we specify exactly how we want them to be used. Typically we place a number of disclaimers on the front page including: “Do Not Copy”, “Do Not Resell”, “For Individual Use Only”, “Do not remove copyright” and so on. But what happens if these disclaimers are disregarded and you find the product you had worked so hard on for a period of days, weeks or even months, publicly posted on an ebook search engine website for all to see and download. Continue reading What to do if you find your copyrighted material posted online
Understanding the risks of social pragmatic deficits in post institutionalized internationally adopted (IA) children.
This 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.