social pragmatic language | Smart Speech Therapy

Posted on January 15, 2013January 5, 2022 by Tatyana Elleseff — Leave a comment

New Webinar: Inattention, Hyperactivity and Impulsivity in At-Risk Children: Differential Diagnosis of ADHD in Speech Language Pathology

Inattentiveness, hyperactivity, and impulsivity are the most common presenting behavioral problems in at-risk children. This workshop will describe select speech language causes of hyperactivity and inattentiveness in children beyond the ADHD diagnosis, including traumatic brain injury, auditory processing disorders, severe language disorders, as well as social pragmatic language deficits.It will review case examples to illustrate the importance of differential diagnosis. Implications for assessment as well as the need for relevant referrals will be discussed.

When: Thursday, January 17, 2013, 4-5 p.m. ET

Where: Your computer*

Presenter: Tatyana Elleseff, MA, CCC-SLP

Cost: FREE

Who Should Attend: Anyone interested in discussing behavioral problems in at-risk children.

How: Register Here

Posted on January 15, 2013January 5, 2022 by Tatyana Elleseff — 3 Comments

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.

Posted on November 28, 2012January 5, 2022 by Tatyana Elleseff — 1 Comment

“Appdapting” Flashcard Apps to Address Social Skills

I have to admit, I don’t really like flashcards. I especially don’t like it when parents or SLPs use flashcards to drill vocabulary in toddlers and preschoolers, much less school aged children. I feel that it produces very limited learnability and generalization. I am personally a proponent of thematic language learning, since it allows me to take a handful of words/concepts and reinforce them in a number of different ways. The clients still get the benefit of information repetition, much like one would get during a typical flashcard drill. However, they are also getting much more. Thematic language learning allows the client to increase word comprehension, make connections to real life scenarios, develop abstract thinking skills, as well as to transfer and generalize knowledge (Morrow, Pressley, Smith, & Smith, 1997; Ramey, 1995).

However, even though I dislike flashcards, I still don’t necessarily want to give up using them completely, especially because nowadays many different type of image based language flashcards can be found for free as both printables as well as Iphone/Ipad apps. Consequently, I decided to pick a free flashcard app and adapt it or rather “appdapt” it (coined by “The Speech Guy”, Jeremy Legaspi, the “Appdapt Guru”) in a meaningful and functional way for my students.

After looking over and rejecting a number of contenders, without a clear plan of action in mind, I stumbled upon a free app, ABA Flash Cards – Actions by kindergarten.com, which is designed to target verb labeling in ASD children. When I saw this app, I immediately knew how I wanted to appdapt it. I especially liked the fact that the app is made for both Ipad and Iphone. Here’s why.

My primary setting is an out of district day school inside a partial psychiatric hospital. So in my line of work I frequently do therapy with students just coming out from “chill out rooms” and “calm down areas”. This is definitely not the time when I want to bring or use a lot of materials in the session, since in a moment’s notice the session’s atmosphere can change from calm and productive into volatile and complicated. I also didn’t want to use a bulky Ipad in sessions with relatively new children on the caseload, since it usually takes a few sessions of careful observations and interaction to learn what makes them “tick”. Consequently, I was looking for an app which could ideally be downloaded onto not just the Ipad but also the Iphone. I reasoned that in unexpected situations I could simply put the phone into my pocket, unlike the Ipad, which in crisis situations can easily become a target or a missile.

Given the fact that many children with psychiatric disorders present with significant social pragmatic language deficits (Hyter, 2003; Hyter et al 2001; Cohen et al., 1998; Bryan, 1991; Goldman, 1987 ), which is certainly the case for the children on my caseload, I planned on adapting this app to target my students’ pragmatic language development, social problem solving skills as well as perspective taking abilities.

So here are just a few examples of how I appdapted the cards. First, I turned off the sound, since the visual images were what I was going after. Then I separated the cards into several categories and formulated some sample questions and scenarios that I was going to ask/pose to the students:

Making Inferences (re: People, Locations and Actions)

What do you think the girl is thinking about?

How do you know what she is thinking?

How do you think she is feeling?

How can you tell?

Where do you think she is?

How do you know?

Multiple Interpretations of Actions and Settings:

What do you think the girl is doing?

What else could she be doing?

How does the boy feel about the flower?

Give me a different explanation of how else can he possibly feel?

Who are the boys in the picture? (relationship)

Who else could they be?

What do you think the boy in a blue shirt is whispering to the boy in a red shirt?

What else could he be saying?

How do you know?

Supporting Empathy/Sympathy and Developing Peer Relatedness:

How does this child feel?

Why do you think he is crying?

What can you ask him/tell him to make things better?

The girl is laughing because someone did something nice for her?

What do you think they did?

Interpreting Ambiguous Situations:

What is the girl doing?

Who do you think is the woman in the picture?

How do you know?

How does she feel about what the girl is doing?

How do you know?

My goal was to help the students how to correctly interpret facial features, body language, and context clues in order to teach them how to appropriately justify their responses. I also wanted to demonstrate to them that many times the situations in which we find ourselves in or the scenes that we are confronted with on daily basis could be interpreted in multiple ways. Moreover, I wanted to teach how appropriately speak to, console, praise, or compliment others in order to improve their ability to relate to peers. Finally, I wanted to provide them with an opportunity to improve their perspective taking abilities so they could comprehend and verbally demonstrate that other people could have feelings, beliefs and desires different from theirs.

Since I knew that many of my students had significant difficulties with even such simple tasks as labeling and identifying feelings, I also wanted to make sure that the students got multiple opportunities to describe a variety of emotions that they saw in the images, beyond offering the rudimentary labels of “happy”, “mad”, “sad”, so I took pictures of Emotions Word Bank as well as Emotion Color Wheel courtesy of the Do2Learn website, to store in my phone, in order to provide them with extra support.

The above allowed me not only to provide them with visual and written illustrations but also to teach them synonyms and antonyms of relevant words. Finally, per my psychotherapist colleagues request, I also compiled a list of vocabulary terms reflecting additional internal states besides emotions (happy, mad) and emotional behaviors (laughing, crying, frowning). These included words related to: Cognition (know, think, remember, guess), Perception (see, hear, watch, feel), and Desire (want, need, wish), (Dodd, 2012) so my students could optimally benefit not just from language related therapy services but also their individual psychotherapy sessions as well.

I’ve only just began trialing the usage of this app with the students but I have to admit, even though its still the early days, so far things have been working pretty well. Looks like there’s hope for flashcards after all!

References:

Bryan, T. (1991). Social problems and learning disabilities. In B. Y. L. Wong (Ed.), Learning about learning disabilities (pp. 195-229). San Diego, CA: Academic Press.

Cohen, N. & Barwick, M. (1996) Comorbidity of Language and Social-Emotional Disorders: Comparison of Psychiatric Outpatients and Their Siblings. Journal of Clinical Child Psychology, 25(2), 192-200.

Goldman, L. G. (1987). Social implications of learning disorders. Reading, Writing and Learning Disabilities, 3, 119-130.

Hyter, Y. D., et al (2001). Pragmatic language intervention for children with language and emotional/behavioral disorders. Communication Disorders Quarterly, 23(1), 4–16.

Hyter, Y. D. (2003). Language intervention for children with emotional or behavioral disorders. Behavioral Disorders, 29, 65–76.

Morrow, L. M., Pressley, M., Smith, J.K., & Smith, M. (1997). The effect of a literature-based program integrated into literacy and science instruction with children from diverse background. Reading Research Quarterly, 32(1), 54-76.

Petersen, D. B., Dodd, J & Finestack, L. H (2012, Oct 9) Narrative Assessment and Intervention: Live Chat. Sponsored by SIG 1: Language Learning and Education. http://www.asha.org/events/live/10-09-2012-narrative-assessment-and-intervention/

Ramey, E. K. (1995). An integrated approach to language arts instruction. The Reading Teacher, 48(5), 418-419.

Posted on August 1, 2012January 5, 2022 by Tatyana Elleseff — 2 Comments

Fun and Educational Summer Board Games: Recommendations for SLPs and Parents

According to the New York Times Article which summarized the results of Johns Hopkins University study: A TYPICAL STUDENT WILL LOSE ABOUT ONE MONTH OF LEARNING OVER THE SUMMER TIME.

“More troubling is that it disproportionately affects low-income students: they lose two months of reading skills, while their higher-income peers — whose parents can send them to enriching camps, take them on educational vacations and surround them with books during the summer — make slight gains.” To continue: “the study of students in Baltimore found that about two-thirds of the achievement gap between lower- and higher-income ninth graders could be explained by summer learning loss during the elementary school years.”

BUMMER!

But then again it is summer and kids do want to have fun!

So with the recent heatwaves across the country, how about combining fun with learning on those sweltering summer days when lazing at the pool or going outside may not be the best option.

Let’s take a look at the few common and readily available board games, which can be used to improve various language abilities: including vocabulary knowledge, problem solving, questioning, storytelling as well as other language related skills.

A to Z Jr– a game of early categorizations is recommended for players 5 – 10 years of age, but can be used with older children depending on their knowledge base. The object of the game is to cover all letters on your letter board by calling out words in specific categories before the timer runs out. This game can be used to increase word finding abilities in children with weak language skills as the categories range from simple (e.g., basic concepts) to more complicated (e.,. attributes). This game is great for several players of different age groups, since younger children or children with weaker knowledge and language skills can answer simpler questions and learn the answers to the harder questions as other players get their turn.

Tribond Jr – is another great game which purpose is to determine how 3 seemingly random items are related to one another. Good for older children 7-12 years of age it’s also great for problem solving and reasoning as some of the answers are not so straight forward (e.g., what do the clock, orange and circle have in common? Psst…they are all round)

Password Jr-is a great game to develop the skills of description. In the game you guess passwords based on the one word clues. This game is designed to play with children ages 7 years and older as long as you help the non readers with the cards. It’s great for encouraging children to become both better at describing and at listening. You may want to allow the children to select the word they want to describe in order to boost their confidence in own abilities. Provide visual cheat sheets (listing ways we can describe something such as: what does it do, where does it go, how can we use it etc) to the child as they will be much more likely to provide more complete descriptions of the target words given visual cues.

Blurt – a game for children 10 and up is a game that works on a simple premise. Blurt out as many answers as you can in order to guess what the word is. Blurt provides ready-made definitions that you read off to players so they could start guessing what the word is. Players and teams use squares on the board strategically to advance by competing in various definition challenges that increase language opportunities.

Games the facilitate asking questions: Guess Who (age 6+), Guess Where (age 6+), and Mystery Garden (age 4+) are great for encouraging students to ask relevant questions in order to be the first to win the game. They are also terrific for encouraging reasoning skills. Questions have to be thought through carefully in order to be the first one to win the game.

Game that facilitates Story Telling as well as Perspective Taking: Fib or Not (ages 10+) encourages the players to fool other players by either telling an outlandish true story or a truly believable made up story. For the players who are listening to the story, the objective is to correctly guess if the story teller is fibbing or being truthful. Players advance by fooling the other players or by guessing correctly.

Games that improve verbal reasoning and problem solving abilities: 30 Second Mysteries (ages 8-12) and 20 Questions for Kids (ages 7+).

In 30 Second Mysteries kids need to use critical thinking and deductive reasoning in order to solve mysteriously sounding cases of everyday events. Each clue read aloud reveals more about the mystery and the trick is to solve it given the fewest number of clues in order to gain the most points.

In 20 Questions for Kids, a guessing game of people, places, and things. Children need to generate original questions in order to obtain information. Here again, each clue read aloud reveals more about the secret identity and the trick is to solve it given the fewest number of clues.

Now that you know which games to play and why, how about you give it a try.

Have fun playing!

References:

Smink, J (2011) This is Your Brain on Summer. New York Times: The Opinion Pages. http://www.nytimes.com/2011/07/28/opinion/28smink.html?_r=1

Posted on June 18, 2012January 5, 2022 by Tatyana Elleseff — Leave a comment

Improving Social Skills in Children With Psychiatric Disturbances Speechpathology.com Webinar

Will be presenting a webinar via speechpathology.com on July 2nd 2012 at 12pm EDT entitled

Improving Social Skills in Children with Psychiatric Disturbances

Course Abstract

This course is aimed at increasing the participants’ knowledge regarding the role of SLPs in the treatment of social pragmatic language disorders of school-age children with psychiatric impairments. It will review social pragmatic treatment approaches which can be used for children with psychiatric impairments, explain the functions of common challenging behaviors, as well as list a number of proactive behavioral intervention approaches professionals can implement to decrease challenging behaviors and increase compliance and cooperation in therapy sessions.

Course Objectives

After this course, participants will be able to identify social pragmatic deficit areas of children with psychiatric impairments.
After this course, participants will be able to describe components and targets of successful social skills treatments.
After this course, participants will be able to list common challenging behavior types and explain proactive behavior strategies used to prevent inappropriate behaviors from occurring.
After this course, participants will be able to describe social pragmatic treatment approaches that can be used for children with psychiatric impairments.
After this course, participants will be able to identify materials that can be used to address relevant social pragmatic treatment goals.

Posted on March 2, 2012January 5, 2022 by Tatyana Elleseff — 2 Comments

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.

Posted on January 18, 2012January 5, 2022 by Tatyana Elleseff — Leave a comment

Upcoming New Jersey Speech Language and Hearing Convention 2012 Presentations

Tatyana Elleseff MA CCC-SLP will be giving 2 presentations at the NJSHA 2012 Convention on April 19-20, 2012

1. Presentation Title: Behavior Management Strategies for School Based Speech Language Pathologists

Time: Thursday, April 19 8:15 AM – 10:15 AM

Summary: In recent years more and more school based speech-language pathologists have to work with children who present with behavioral deficits in conjunction to speech-language delays/impairments. A significant portion of work with these children in therapy sessions involves successful management of inappropriate behaviors such as excessive inattention, hyperactivity, aggression, opposition/non-compliance and/or apathy, which interferes with successful objective completion and goal attainment. This workshop will explain what type of common challenging behaviors can manifest in children with select communication, psychiatric, and neurological disorders. It will outline behavior management strategy hierarchy from most to least intrusive methods for students with differing levels of cognitive functioning (high-average IQ to varying levels of MR). It will list positive proactive behavior management strategies to: prevent inappropriate behaviors from occurring, increase students’ session participation as well as improve compliance and cooperation during therapy sessions.

2. Presentation Title: Social Pragmatic Assessment of Children Diagnosed with Emotional/Psychiatric Disturbances in the Schools

Time: Thursday, April 19 10:45 AM – 12:45 PM

Summary: The number of children who present with non-spectrum emotional, behavioral, and psychiatric disturbances (oppositional defiant disorder, reactive attachment disorder, mood disorder, etc) has been steadily increasing in recent years. Many of these children attend district schools and due to high incidence of communication issues associated with these conditions, speech language pathologists are frequently included on the team of professionals who treat them. This workshop is aimed at increasing the participants knowledge regarding aspects of social pragmatic language. By the end of the workshop participants will be able to list common pediatric psychiatric diagnoses, explain the impact of psychiatric disturbances on language development of children, summarize the role of SLP in assessment of pragmatic language and social cognitive abilities of school-age children, as well as utilize formal and informal assessment instruments to assess pragmatic language and social cognitive abilities of school age children.

Posted on October 21, 2011January 5, 2022 by Tatyana Elleseff — Leave a comment

Dept of Children & Families / NJ Task Force on Child Abuse & Neglect Presentation

October 21, 2011: East Brunswick NJ

The Department of Children and Families and the New Jersey Task Force on Child Abuse and Neglect had a statewide child maltreatment prevention conference today and I had great fun doing today’s presentation:

“Differential Diagnosis of Inattention, Hyperactivity and Impulsivity in At-Risk Children” with our clinical team, Alla Gordina, MD, FAAP and Lydia Shifrin, LCSW.

We had a terrific crowd, who asked great questions and gave excellent feedback.

Presentation Highlights:

Attention Deficit/Hyperactivity Disorder is one of the most common and the most controversial neurobehavioral disorders in children diagnosed today

Core symptoms of ADHD include Inattention, Impulsivity and Hyperactivity

Some ADHD statistics:

Approximately 9.5% or 5.4 million children 4-17 years of age have ever been diagnosed with ADHD, as of 2007.
The percentage of children with a parent-reported ADHD diagnosis increased by 22% between 2003 and 2007.
Rates of ADHD diagnosis increased an average of 3% per year from 1997 to 2006 and an average of 5.5% per year from 2003 to 2007.
Boys (13.2%) were more likely than girls (5.6%) to have ever been diagnosed with ADHD.
The highest rates of parent-reported ADHD diagnosis were noted among children covered by Medicaid and multiracial children.

However, numerous medical, psychiatric, neurological, psychological, speech-language and other disorders are frequently misdiagnosed as ADHD

NEARLY 1 MILLION CHILDREN ARE MISDIAGNOSED WITH ADHD

“Since ADHD is an underlying neurological problem where incidence rates should not change dramatically from one birth date to the next, these results suggest that age relative to peers in class, and the resulting differences in behavior, directly affects a child’s probability of being diagnosed with and treated for ADHD.” (Elder, 2010). Journal of Health Economics

Disorders frequently misdiagnosed as AD/HD :

Respiratory Disorders (e.g., adenoid hypertrophy, asthma, allergic rhinitis)
Metabolic /Endocrine Disorders (e.g., diabetes, hypo/hyperthyroidism)
Hematological Disorders (e.g., anemia)
Immunological Disorders (acquired and congenital immune problems)
Cardiac Disorders (e.g., congenital and acquired heart disease, syncopy)
Digestive Disorders (e.g., irritable bowel syndrome, GERD, etc)
Neurological Disorders (e.g., Traumatic Brain Injuries, Tumors, Encephalopathy, etc)
Sleep Disorders
Genetic Disorders (e.g., FASD, Fragile X Syndrome)
Toxin Exposure (e.g., Lead, Mercury, Drug Exposure)
Infections and Infestations (e.g., yeast overgrowth , intestinal worms/parasites)
Mental Health Disorders (e.g., anxiety, mood disorders, adjustment disorders)
Mental Retardation
Sensory Processing Disorders (vision, hearing, auditory, tactile)
Language Processing Disorders
Auditory processing Disorders

My presentation focused on explaining that having select language based difficulties can cause the child to act as inattentive, hyperactive and impulsive without actually having ADHD

My examples included:

Traumatic Brain Injury
Severe Language Delay
Auditory Processing Disorders
Social Pragmatic Language Deficits

Relevance and Implications for Adoption Professionals:

Multidisciplinary approach to identification, differential diagnosis, and management of disorders with “AD/HD” symptoms is NEEDED
One individual assessment (e.g., psychological) CANNOT reliably determine accurate diagnosis, especially when the diagnostic criteria is based on generalized symptomology
Refer adopted children with behavioral, listening, sensory, and any unusual deficits for multidisciplinary assessments which include in depth assessment of language abilities before making a conclusive diagnosis
Children who receive one assessment ONLY are at risk of misdiagnosis, misidentification, and are delayed in getting appropriate intervention services

Posted on October 17, 2011January 5, 2022 by Tatyana Elleseff — Leave a comment

AAP: Council on Foster Care, Adoption and Kinship Care Presentation

Boston MA- First conference of the Fall 2011 season:

October 17, 2011: Got to co-present with my favorite pediatrician (Alla Gordina, MD, FAAP) an interesting clinical case in front of American Academy Of Pediatrics: Council on Foster Care, Adoption and Kinship Care. Granted my part was via phone and connection wasn’t great but it so nice to see medical professionals being interested in ancillary professionals’ perspective on issues of internationally adopted children.

Presentation Title: A Case of Isolated Social Pragmatic Language Deficits in an Internationally Adopted Child

Presentation Highlights:

Language based deficits may affect internationally adopted children many years post adoption

Even children adopted at very young ages can present with subtle BUT significant delays in select areas of functioning (see below)

One such delay may be in the area of social pragmatic functioning or the use of language

Select examples of social pragmatic deficits include:

Impaired ability to appropriately interpret social situations, events and contexts
Impaired ability to create and convey messages to different audiences (adults vs. children)
Impaired ability to interpret facial expressions, body language and gestures
Difficulty labeling and identifying basic emotions of self and others
Poor or absent perspective taking (understanding thoughts and feelings of others)
Inappropriate initiation of social interactions (e.g., not knowing how to start a conversation or appropriately interrupt a game)
Comprehension of age-level abstract and inferential information (stories, sarcasm, figurative language, etc)
Missing “the big picture” (integrating ideas into a whole, synthesizing and summarizing information)
Poor connection and relatedness to peers

Implications for Professionals:

Very easy to misdiagnose a child with social pragmatic deficits as someone with psychiatric disturbances (e.g., ADHD or Autism) without multidisciplinary differential diagnosis

“Low risk referrals” do carry a significant risk of deprivation-related issues, which can surface years after adoption

Internationally adopted children with behavioral, listening, sensory, and any unusual deficits need a differential diagnosis (including assessment of language abilities before a conclusive diagnosis is made)

References:

Course Abstract

Course Objectives

NEARLY 1 MILLION CHILDREN ARE MISDIAGNOSED WITH ADHD

Relevance and Implications for Adoption Professionals:

Your Cart