Social Communication | Smart Speech Therapy

Posted on February 6, 2015January 5, 2022 by Tatyana Elleseff — 4 Comments

Simplifying Testing Results to Understand the Student’s Difficulties

Oftentimes explaining testing results in the form of standard scores, percentiles, and charts is labor-intensive for the SLP and confusing for parents and ancillary professionals. Furthermore, just because you show testing results does not always ensure that the ramifications of testing are fully understood, especially when it comes to performance of high functioning students with deficits in isolated areas, which may significantly impact the student’s functioning in social and academic settings.

So finding an effective method of sharing testing results was fraught with difficulties until recently. In early January, I attended a Sarah Ward executive function conference, where Sarah shared one of her tricks of sharing testing results. She used a picture of a bell curve and inserted testing results into it. So it looked a little similar to the picture I have below:

As you can see the student’s listening comprehension and expressive language performance fell in the average range as denoted on the bottom of the picture. In contrast, the student’s problem solving and social pragmatic testing abilities fell in the below average range as is denoted by both a red bar as well as the caption underneath the picture.

It is a visually simple way to see what areas need to be worked on in one snapshot.

Charts in Action: Students with Social Skills Deficits

This system is even more effective for displaying testing results of higher functioning students with select deficit areas. To illustrate, I recently performed a comprehensive language assessment on a 12-year-old adolescent with suspected ASD. The student had a superior IQ, excellent vocabulary, and phenomenal memory.

When tested in school setting she did not qualify to receive language intervention. However, her comprehensive language testing with me showed a number of disparities. While the majority of her testing fell in the above average and superior range, in a number of testing areas she performed within average and below average range (combined SLP, ED, and Psych. testing results below).

When one looked at the student’s overall testing results, they clearly indicated cumulative performance in the average range of functioning. However, after I plotted all of her results on the bell curve her deficit areas became very clearly apparent and her testing discrepancy clearly indicated that intervention in select areas of functioning was needed.

So even though select scores were clearly in the average range of functioning on the bell curve, they were actually BELOW AVERAGE for this student as compared to significant strengths in all other areas.

Many would argue with me pointing out that scores in the average range mean average range. The student doesn’t qualify – end of story! So let me explain the above scores in REAL-LIFE terms.

Why Students with Average Scores May Still Require Services

This particular student was referred for a social pragmatic evaluation due to behavioral difficulties in the classroom which included verbal outbursts, difficulty engaging in cooperative group work and verbal confrontations with classmates.

Interactions with the student revealed an engaging adolescent who preferred the company of adults and was very likable. However, throughout testing she made comments indicating cognizance that she was not accepted by typically developing peers. She frustratedly stated that she “doesn’t get” peers, is not interested in the “typical” experiences and has “nothing in common” with peers her age because she “misses the point” of their verbal interchanges.

Due to her exceptional performance on standardized testing, many school-based professionals believed that because she did so well well she did not have any “true” social learning deficits. In contrast the student’s peer group was able to see her social differences with very little effort. In school, the student did not qualify for social pragmatic language therapy, on the basis of her challenges being perceived as too “mild” to merit services, however her social deficits were NOT mild as judged by her peers. They were only mild as compared to individuals with severe social learning challenges. Without appropriate intervention, these difficulties would continue to pervasively impact her academic and social performance, as well as affect future employment and relationship status.

So this is why I now love plotting scores on the bell curve for parents and professionals. A simple picture clearly shows the significance of score distribution, the deficits areas in need of intervention, and is literally worth a 1000 words!

Helpful Resources Related to Social Pragmatic Language Overview, Assessment and Remediation:

Posted on November 13, 2014January 5, 2022 by Tatyana Elleseff — 1 Comment

Dear School Professionals Please Be Aware of This

I frequently get emails, phone calls, and questions from parents and professionals regarding academic functioning of internationally adopted post institutionalized children. Unfortunately despite the fact that there is a fairly large body of research on this topic there still continue to be numerous misconceptions regarding how these children’s needs should be addressed in academic settings.

Perhaps one of the most serious and damaging misconceptions is that internationally adopted children are bilingual/multicultural children with Limited English Proficiency who need to be treated as ESL speakers. This erroneous belief often leads to denial or mismanagement of appropriate level of services for these children not only with respect to their language processing and verbal expression but also their social pragmatic language abilities.

Even after researchers published a number of articles on this topic, many psychologists, teachers and speech language pathologists still don’t know that internationally adopted children rapidly lose their little birth language literally months post their adoption by English-speaking parents/families. Gindis (2005) found that children adopted between 4-7 years of age lose expressive birth language abilities within 2-3 months and receptive abilities within 3-6 months post- adoption. This process is further expedited in children under 4, whose language is delayed or impaired at the time of adoption (Gindis, 2008). Even school-aged children of 10-12 years of age who were able to read and write in their birth language, rapidly lose their comprehension and expression of birth language within their first year post adoption, if adopted by English-speaking parents who are unable to support their birth language.

So how does this translate into appropriate provision of speech language services you may ask? To begin with, I often see posts on the ASHA forums or in Facebook speech pathology and special education groups seeking assistance with finding interpreters fluent in various exotic languages. However, unless the child is “fresh off the boat” (several months post arrival to US) schools shouldn’t be feverishly trying to locate interpreters to assist with testing in the child’s birth language. They will not be able to obtain any viable results especially if the child had been residing in the United States for several years.

So if the post-institutionalized, internationally adopted child is still struggling with academics several years post adoption, one should not immediately jump to the conclusion that this is an “ESL” issue, but get relevant professionals (e.g., speech pathologists, psychologists) to perform thorough testing in order to determine whether it’s the lack of foundational abilities due to institutionalization which is adversely impacting the child’s academic abilities.

Furthermore, ESL itself is often not applicable as an educational method to internationally adopted children. Here’s why:

Let’s literally take the first definition of ESL which pops-up on Google when you put in a query: “What is ESL?” “English as a Second Language (ESL) is an instructional program for students whose dominant language is not English. The purpose of the program is to increase the English language proficiency of eligible students so they can attain academic standards and achieve success in the classroom.”

Here is our first problem. These students don’t have a dominant language. They are typically adopted by parents who do not speak their birth language and that are unable to support them in their birth language. So upon arrival to US, IA children will typically acquire English via the subtractive model of language acquisition (birth language is replaced and eliminated by English), which is a direct contrast to bilingual children, many of whom learn via the additive model (adding English to the birth language (Gindis, 2005). As a result, of subtractive language acquisition IA children experience very rapid birth language attrition (loss) post-adoption (Gindis, 2003; Glennen, 2009). Thus they will literally undergo what some researchers have called: “second-first language acquisition” (Scott et al., 2011) and their first language will “become completely obsolete as English is learned” (Nelson, 2012, p. 2).

This brings us to our second problem: the question of “eligibility”. Historically, ESL programs have been designed to assist children of immigrant families acquire academic readiness skills. This methodology is based on the fact that skills from first language was ultimately transfer to the second language. However, since post-institutionalized children don’t technically have a “first language” and their home language is English, how could they technically be eligible for ESL services? Furthermore, because of frequent lack of basic foundational skills in the birth language internationally adopted post-institutionalized children will not benefit the same way from ESL instruction the same way bilingual children of immigrant families do. So instead of focusing on these children’s questionable eligibility for ESL services it is important to perform detailed review of their pre-adoption records in order to determine birth language deficits and consider eligibility for speech language services with the emphasis on improving these children’s foundational skills.

If the child’s pre-adoption records specifically state that s/he has birth language delay then it should be taken seriously (Gindis, 1999) since language delays in the birth language transfer and affect the new language (McLaughlin, Gesi, & Osani, 1995). These delays will not “go away” without appropriate interventions. “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)

Now that we have discussed the issue of ESL services, lets touch upon social pragmatic language abilities of internationally adopted children. Here’s how erroneous beliefs can contribute to mismanagement of appropriate services in this area.

Different cultures have different pragmatic conventions, therefore we are taught to be very careful when labeling certain behaviors of children from other cultures as atypical, just because they are not consistent with the conventions and behaviors of children from the mainstream culture. Here’s a recent example. A mainstream American parent consulted an SLP regarding the inappropriate social pragmatic skills of her teenaged daughter adopted almost a decade ago from Southeast Asia. The SLP was under the impression that some of the child’s deficits were due to multicultural differences and had to do with the customs and traditions of the child’s country of origin. She was considering advising the parent regarding requesting an evaluation by a SLP who spoke the child’s birth language.

Here are two problems with the above scenario. Firstly, any internationally adopted post-institutionalized child who was adopted by American parents who were not part of the culture from which the child was adopted, the child will quickly become acculturated and immersed in the American culture. These children “need functional English for survival”, and thus have a powerful incentive to acquire English (Gindis, 2005; p. 299). consequently, any unusual or atypical behaviors they exhibit in social interactions and in academic setting with other individuals cannot be attributed to customs and traditions of another culture.

Secondly, It is very important to understand that institutionalization and orphanage care have been closely linked to increase in mental health disorders and psychiatric impairments. As a result, internationally adopted children have a high incidence of social pragmatic deficits as compared to non-adopted peers as well as post-institutionalized children adopted at younger ages, (under 3). Given this, if parents present with concerns regarding their internationally adopted post-institutionalized children’s social pragmatic and behavioral functioning it is very important not to jump to erroneous conclusion pertaining to these children’s birth countries but rather preform comprehensive evaluations in order to determine whether these children can be assisted further in the realm of social pragmatic functioning in a variety of settings.

In order to develop a clear picture regarding appropriate service delivery for IA children, school based professionals need to educate themselves regarding the fundamental differences between development and learning trajectories of internationally adopted children and multicultural/bilingual children. Children, who struggle academically, after years of adequate schooling exposure, do not deserve a “wait and see” approach. They should start receiving appropriate intervention as soon as possible (Hough & Kaczmarek, 2011; Scott & Roberts, 2007).

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