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Improving Emotional Intelligence of Children with Social Communication Disorders

Our ability to recognize our own and other people’s emotions, distinguish between and correctly identify different feelings, as well as use that information to guide our thinking and behavior is called Emotional Intelligence (EI) (Salovey, et al, 2008).

EI encompasses dual areas of: emotion understanding, which is an awareness and comprehension of one’s and others emotions (Harris, 2008) and emotion regulation, which are internal and external strategies people use to regulate emotions (Thompson, 1994).

Many students with social communication challenges experience problems with all aspects of EI, including the perception, comprehension, and regulation of emotions (Brinton & Fujiki, 2012).

A number of recent studies have found that children with language impairments also present with impaired emotional intelligence including impaired perception of facial expressions (Spackman, Fujiki, Brinton, Nelson, & Allen, 2005), prosodic emotions (Fujiki, Spackman, Brinton, & Illig, 2008) as well as abstract emotion comprehension (Ford & Milosky, 2003).

Children with impaired emotional intelligence will experience numerous difficulties during social interactions due to their difficulty interpreting emotional cues of others (Cloward, 2012).  These may include but not be limited to active participation in cooperative activities, as well as full/competent interactions during group tasks (Brinton, Fujiki, & Powell, 1997)

Many students with social pragmatic deficits and language impairments are taught to recognize emotional states as part of their therapy goals. However, the provided experience frequently does not go beyond the recognition of the requisite “happy”, “mad”, “sad” emotions. At times, I even see written blurbs from others therapists, which state that “the student has mastered the goals of emotion recognition”.  However, when probed further it appears that the student had merely mastered the basic spectrum of simple emotional states, which places the student at a distinct disadvantage  as compared to typically developing peers who are capable of recognition and awareness of a myriad of complex emotional states.

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That is why I developed a product to target abstract emotional states comprehension in children with language impairments and social communication disorders. “Gauging Moods and Interpreting Abstract Emotional States: A Perspective Taking Activity Packet” is a social pragmatic photo/question set,  intended for children 7+ years of age, who present with difficulty recognizing abstract emotional states of others (beyond the “happy, mad, sad” option) as well as appropriately gauging their moods.

Many sets contain additional short stories with questions that focus on making inferencing, critical thinking as well as interpersonal negotiation skills.  Select sets require the students to create their own stories with a focus on the reasons why the person in the photograph might be feeling what s/he are feeling.

There are on average 12-15 questions per each photo.  Each page contains a photograph of a person feeling a particular emotion. After the student is presented with the photograph, they are asked a number of questions pertaining to the recognition of the person’s emotions, mood, the reason behind the emotion they are experiencing as well as what they could be potentially thinking at the moment.  Students are also asked to act out the depicted emotion they use of mirror.

Activities also include naming or finding (in a thesaurus or online) the synonyms and antonyms of a particular word in order to increase students’ vocabulary knowledge. A comprehensive two page “emotions word bank” is included in the last two pages of the packet to assist the students with the synonym/antonym selection, in the absence of a thesaurus or online access.

Students are also asked to use a target word in a complex sentence containing an adverbial (pre-chosen for them) as well as to identify a particular word or phrase associated with the photo or the described story situation.

Since many students with social pragmatic language deficits present with difficulty determining a person’s age (and prefer to relate to either younger or older individuals who are perceived to be “less judgmental of their difficulties”), this concept is also explicitly targeted in the packet.

This activity is suitable for both individual therapy sessions as well as group work.  In addition to its social pragmatic component is also intended to increase vocabulary knowledge and use as well as sentence length of children with language impairments.

Intended Audiences:

  • Clients with Language Impairments
  • Clients with Social Pragmatic Language Difficulties
  • Clients with Executive Function Difficulties
  • Clients with Psychiatric Impairments
    • ODD, ADHD, MD, Anxiety, Depression, etc.
  • Clients with Autism Spectrum Disorders
  • Clients with Nonverbal Learning Disability
  • Clients with Fetal Alcohol Spectrum Disorders
  • Adult and pediatric post-Traumatic Brain Injury (TBI) clients
  • Clients with right-side CVA Damage

Areas covered in this packet:

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

This activity is suitable for both individual therapy sessions as well as group work.  In addition to its social pragmatic component is also intended to increase vocabulary knowledge and use as well as sentence length of children with language impairments. You can find it in my online store (HERE).

Helpful Smart Speech Resources:

References:

  1. Brinton, B., Fujiki, M., & Powell, J. M. (1997). The ability of children with language impairment to manipulate topic in a structured task. Language, Speech and Hearing Services in Schools, 28, 3-11.
  2. Brinton B., & Fujiki, M. (2012). Social and affective factors in children with language impairment. Implications for literacy learning. In C. A. Stone, E. R. Silliman, B. J. Ehren, & K. Apel (Eds.), Handbook of language and literacy: Development and disorders (2nd Ed.). New York, NY: Guilford.
  3. Cloward, R. (2012). The milk jug project: Expression of emotion in children with language impairment and autism spectrum disorder (Unpublished honor’s thesis). Brigham Young University, Provo, Utah.
  4. Ford, J., & Milosky, L. (2003). Inferring emotional reactions in social situations: Differences in children with language impairment. Journal of Speech, Language, and Hearing Research, 46(1), 21-30.
  5. Fujiki, M., Spackman, M. P., Brinton, B., & Illig, T. (2008). Ability of children with language impairment to understand emotion conveyed by prosody in a narrative passage. International Journal of Language & Communication Disorders, 43(3), 330-345
  6. Harris, P. L. (2008). Children’s understanding of emotion. In M. Lewis, J. M. Haviland-Jones, & L. Feldman Barrett, (Eds.), Handbook of emotions (3rd ed., pp. 320–331). New York, NY: Guilford Press.
  7. Salovey, P., Detweiler-Bedell, B. T., Detweiler-Bedell, J. B., & Mayer, J. D. (2008). Emotional intelligence. In M. Lewis, J. M. Haviland-Jones, & L. Feldman Barrett (Eds.), Handbook of Emotions (3rd ed., pp. 533-547). New York, NY: Guilford Press.
  8. Spackman, M. P., Fujiki, M., Brinton, B., Nelson, D., & Allen, J. (2005). The ability of children with language impairment to recognize emotion conveyed by facial expression and music. Communication Disorders Quarterly, 26(3), 131-143.
  9. Thompson, R. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59(2-3), 25-52

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Enough with “grow out”, “grow in” and “it’s normal” or why a differential diagnosis is so important!

If someone asked me today how long I’ve been thinking about writing this post I wouldn’t hesitate and say… 3 years.  I know this because that’s when I encountered my very first case of “it’s normal”. I had been in private practice for several years, when I was contacted by parents who wanted me to evaluate their 4 year old son due to concerns over his language abilities.   When I first opened my office door to let them in I encountered a completely non-verbal child with significant behavioral deficits and limited communicative intent.

I have to confess, as I was conducting an extremely difficult assessment, I was very shocked by the fact that prior to seeing me, the child had not undergone any in-depth assessments with any related professionals despite presenting with pretty significant symptoms, which included: lack of meaningful interaction with toys,  stereotypical behaviors (e.g., rapid flicking of his fingers in front of his eyes for extended period of time, perseverative repetitions of unintelligible sounds out of context, etc), temper tantrums, as well as complete absence of words, phrases and sentences for his age. Very tactfully I broached the subject with the parents only to find out that the parents were concerned regarding their child’s development for quite a while, only to be told by over and over again by their pediatrician that “it’s normal”. I hastily bit back my reply, before I could rudely blurt out: “in which universe?”  Instead, I finished the assessment, wrote my 8 page report with extensive recommendations and referrals, and began treating the client. Luckily, since that time he had received numerous appropriate interventions from a variety of related professionals and made some nice gains. But to this day I wonder: Would his gains have been greater had his intervention was initiated at an earlier age (e.g., 2 instead of 4)?

Of course, this is by far one of the more extreme examples that I have seen during the course of my relatively short career (less than 10 years of practice) as a speech language pathologist.  But I have certainly seen others.

For example, a few years ago through my hospital based job I’ve treated a child with significant unilateral facial weakness, and a host of phonation, articulation, respiration, and resonance symptoms which included: difficulty managing oral secretions, weak voice, hypernasality, dysarthric vocal quality, and a few others. Again, the parent was told by the physician that the child’s facial asymmetry and symptomology was ‘not significant’’ despite the fact that in addition to the above signs, the child also presented with significantly delayed language development, cognitive limitations and severe behavioral manifestations.

Then of course there were a few stutterers with a host of social history red flags who stuttered for a few years well into early school age, each of whose parents were told by their child’s doctor that s/he will grow out of it.

I am not even counting dozens and dozens of phone calls from concerned parents of  language delayed toddlers and preschoolers whose pediatricians told them that they’ll “grow out of it” despite the fact that many of these children ended up receiving speech language services for language delays/disorders for several years afterwards.

I’ve also seen professionals without a specialization in International Adoption diagnosing recently adopted older post-institutionalized children with history of severe trauma, profound language delays, alcohol related deficits and symptoms of institutional autism as Pervasive Developmental Disorder (PDD).

But I don’t want you to think that I am singling out pediatricians in this post. The truth is that if we look closely we will find that this trend of overconfident recommendations is common to a vast majority of both medical and ancillary professionals (e.g., psychologists, occupational therapists, etc) with speech language pathologists not exempt from the above.

I’ve read a psychiatrist’s report, which diagnosed a child with Asperger’s based on a 15 minute conversation with the child, coupled with a brief physical examination (as documented in the child’s clinical record).  At my urging (based on the child’s adaptive behavior, linguistic profile and rather superior social pragmatic functioning) the parents sought a second opinion with another psychiatrist, which revealed that the child wasn’t even on the spectrum but had a anxiety disorder, some of which symptoms mimicked Asperger’s (e.g., perseveration on topics of interest).

I’ve read numerous neurological and neuropsychological reports which diagnosed children with ADD based on the symptoms of inattention and impulsivity in select settings (e.g., school only) without a differential diagnosis to rule out language deficits, auditory processing deficits, medical conditions, or acquired syndromes such as Fetal Alcohol Spectrum Disorders.

I’ve reviewed occupational therapy evaluations which reported on the language abilities of children vs. fine and gross motor function and sensory integration skills.

One parent even told me that when she asked a speech language therapist (who was treating her child for articulation difficulties) regarding her 10 year old son’s “ginormous” (parent’s words not mine) overbite she was told “he’ll grow into it”. I was told that the pediatric orthodontist did not appreciate that opinion and vigorously voiced his own as he was fitting the child for braces.

So when exactly did some of us decide that a differential diagnosis doesn’t matter? I’d be very curious to know what prompts professionals, who upon seeing some ‘garden variety’ symptoms, which could have a multitude of causes (e.g., inattention, echolalia, lack of speech, etc) decide that there could be only one definitive diagnosis or who merely shrug the displayed signs and accompanying parental concerns aside, expecting both to disappear on their own volition, given the passage of time.

Is it carelessness?

Is it overconfidence in own abilities?

Is it fear of losing face in front of the parent if you don’t have a ready answer?

Is it misguided belief that the child is displaying “textbook” behavior?

Is it “jadedness” or I’ve seen it all, so I know what it is, attitude?

I can venture hundreds more guesses, but it would be merely pointless speculation. Rather I prefer to focus on the intent of this post which is to outline why a differential diagnosis is so important!

1. Differential diagnosis saves lives!

Yes, I know I am only a speech pathologist and it’s true that I have yet to hear from anyone “I need a speech pathologist stat!” After all I don’t specialize in pediatric dysphagia and treat preemies in NICU.

But imagine the following scenario. A young preschool child shows up to your office with a hoarse vocal quality and a history of behavior tantrums. No problem you think, textbook vocal nodules, I got this, case closed! But what if the child was displaying additional symptoms such as stridor, coughing and difficulty breathing when sleeping? What if a few days after you’ve initiated voice therapy or told the parent that the child is too young for it, the child was rushed into the hospital because his airway was obstructed due to a laryngeal papilloma, which almost caused the child to asphyxiate. Still feel confident in your first diagnosis? Yet some speech language therapists routinely accept children into voice therapy without first referring them for an ENT consult that involves endoscopic imaging.  Some of you may scoff and tell me, common, when does thing ever happen? Wouldn’t a doctor have picked up on something like that well before a child seen an SLP? Guess what … not necessarily!

Although it may be hard to believe but an EI or school-based SLP may be the first diagnostic professional many children from at-risk backgrounds come in contact with. Obstacles to receiving appropriate early medical care and ancillary services like early intervention may include limited financial means, lack of education or information, and cultural and linguistic barriers.  Bilingual, multicultural, domestically adopted and foster care children from low-income households are particularly at risk since their deficits may not be detected until they begin receiving services in EI or preschool. After all, specialized medical care and related services must be sought out and paid for, which may be very hard to do for families from low SES households if they don’t have medical insurance or are having difficulty applying for Medicaid or state health insurance.

Similarly internationally adopted children are also at significant risk of despite the fact that most are adopted by middle class, financially solvent and highly educated parents. With this particular group the barriers to early identification are pre-adoption environmental risk factors (length of institutionalization and quality of medical care in that setting), combined with limited access to information (paucity of prenatal, medical and developmental history details in the adoption records).

2. Sometimes diagnosis DOES matter!  

I know, I know, a number of you will try to convince me that we need to treat the symptoms and NOT the label!  But humor me for a second! Let’s say you are a medical/ancillary professional (depending whom the child get’s to see first and for what reason) who gets to assess a new preschool patient/client, let’s call him Johnny.  So little 4 year old Johnny walk into your office with the following symptoms:

  • aggressive /inappropriate behaviors
  • odd fine and gross motor movements
  • clumsiness
  • blunted affect (facial expression)
  • inconsistent eye contact
  • speech/language deficits
  • picky eater with a history of stomach issues (e.g., nausea, vomiting, belly pain)

Everything you observe points to the diagnosis of Autism, after all you are the professional, and you’ve seen hundreds of such cases. It’s textbook, right? WRONG! I’ve just described to you some of the symptoms of Wilson’s disease.  It’s a genetic disorder in which large amounts of copper build up in the liver and brain. This disorder has degrees of severity ranging from mild/progressive to acute/severe.  It can cause brain and nervous system damage, hence the psychiatric and neuromuscular symptoms.  The bad news is that this condition can be fatal if misdiagnosed/undiagnosed! The good news is that it is also VERY treatable and can be easily managed with medication, dietary changes, and of course relevant therapies (e.g, PT, OT, ST, etc)!

3. Correct Diagnosis can lead to Appropriate Treatment!

So we all know that ADHD diagnosis is currently being doled out like candy to practically every child with the symptoms of Inattention, Hyperactivity and Impulsivity. But can you actually GUESS how many children are misdiagnosed with it?

Elder (2010), found that nearly 1 million children in US are potentially misdiagnosed with ADHD simply because they are the youngest and most immature in their kindergarten class. Here’s what he has to say on the subject: “A child’s birth date relative to the eligibility cutoff … strongly influences teachers’ assessments of whether the child exhibits ADHD symptoms but is only weakly associated with similarly measured parental assessments, suggesting that many diagnoses may be driven by teachers’ perceptions of poor behavior among the youngest children in a classroom. These perceptions have long-lasting consequences: the youngest children in fifth and eighth grades are nearly twice as likely as their older classmates to regularly use stimulants prescribed to treat ADHD.”  (Elder, 2010, 641)

Here are a few examples of ADHD misdiagnosis straight from my caseload.

Case A:  9 year old girl, Internationally Adopted at the age of 16 months diagnosed with ADHD based on the following symptoms:

  • Inattentive
  • Frequently misheard verbal messages
  • Difficulty following verbal directions
  • Very distractible
  • Blurted things out impulsively
  • Constantly forgot what had been told to her
  • Made careless mistakes on school/home work

Prior to medicating the child, the parents sought a language evaluation at the advice of a private social worker. My assessment revealed a language processing disorder and a recommendation for a comprehensive APD assessment with an audiologist. Comprehensive audiological assessment revealed the diagnosis of APD with recommendations for language intervention. After language therapy with a focus on improving the child’s auditory processing skills was initiated, her symptoms improved dramatically. The recommendations for medication were scrapped.

Case B: 12 year old boy attending outpatient school in a psychiatric hospital diagnosed with ADHD and medicated unsuccessfully for it for several years based on the following symptoms:

  • Severely Impulsive and Inattentive
  • Occasional tantrums, opposition and aggressive  behaviors
  • Difficulty with transitions
  • Odd Behaviors/Inappropriate Statements
  • Off-topic/Unrelated Comments
  • Topic Perseverations
  • Poor memory
  • Poor ability to follow directions

Detailed case history interview performed prior to initiation of a comprehensive language assessment revealed a history of Traumatic Brain Injury (TBI) at 18 months of age. Apparently the child was dropped on concrete floor head first by his biological father. However, no medical follow up took place at the time due to lack of household stability. The child was in and out of shelter with mother due to domestic abuse in the home perpetrated by biological father.

The child’s mother reported that he developed speech and language early without difficulties but experienced a significant skills regression around 1.5-2 years of age (hint, hint).  Comprehensive language assessment revealed numerous language difficulties, many of which were in the areas of memory, comprehension as well as social pragmatic language. Following the language assessment, relevant medical referrals at the age of 12 substantiated the diagnosis of TBI (better late than never). So no wonder the medication had no effect!

So what can parents do to ensure that their child is being diagnosed appropriately and receives the best possible services from various health professionals?

For starters, make sure to carefully describe all the symptoms that your child presents with (write them down to keep track of them if necessary). It is important to understand that many conditions are dynamic in nature and may change symptoms over time. For example, children with alcohol related disorders may display feeding deficits as infants, delayed developmental milestones as toddlers, good conversational abilities but poor social behavior and abstract thinking skills as school aged children and low academic achievement as adolescents.

Ensure that the professional spends adequate period of time with the child prior to generating a report or rendering a diagnosis.  We’ve all been in situations when reports/diagnoses were generated based on a 15 minute cursory visit, which did not involve any follow up testing or when the report was generated based on parental interview vs. actual face to face contact and interaction with the child.  THIS IS NOT HOW IT’S SUPPOSED TO WORK! THIS IS HOW MISDIAGNOSES HAPPEN!

Don’t be afraid to ask follow up questions or request rationale for the professionals’ decisions.  If you don’t understand something or are skeptical of the results, don’t be afraid to question the findings in a professional way.  If the information provided to you seems inadequate or poorly justified consider getting a second opinion with another professional.

Make sure that your child is being treated as a unique individual and not as a textbook subject.  Don’t you just hate it when you are trying to describe something to a professional and they look like they are listening but in reality they are not really ‘hearing’ you because they already “know what you have”.  Or they are looking at your child but they are not really seeing him/her, because he/she is just another ‘textbook case’ in a long cue of clients.  THIS IS NOT THE TREATMENT YOU ARE SUPPOSED TO GET FROM PROFESSIONALS! If this is how your child being treated then maybe it’s time to switch providers!

And another thing there are NO textbook clients! All clients are unique! I currently have about 10 post institutionalized Internationally Adopted children on my caseload with similar deficits but completely different symptom presentation, degrees of severely, as well as overall functioning. Even though some are around the same age, they are so dramatically different from one another that I need to use completely different approaches when I am planning their respective interventions.

Here’s how we as health professionals can better serve our clients/patients needs

It’s all in the details! Carefully collect the client’s background history without leaving anything out.  No piece of information is too small/inconsequential! You never know what might be relevant.

Get down to the nitty gritty by asking specific questions.  If you ask general questions you’ll get general responses.  For example, numerous health care professionals in various fields (doctors, psychiatrists, psychologists, SLPs, etc) routinely ask biological, adoptive and foster parents and adoptive caregivers whether substance abuse of drugs/alcohol took place before and during pregnancy (that they know of with respect to the latter two).   A number will respond that yes it took place during pregnancy but stopped as soon as the mother found out she was pregnant. Many professionals will leave it at that and move on to the next line of questioning. However, the follow up question to the above response should always be: “How many months along was the biological mother when she found out she was pregnant?” You’d be surprised at the responses you’ll get, which may significantly clarify the “mystery” of the child’s current symptomology.

Pretend that each new case is your very first case! Remember how you were fresh out of grad school/residency? How much enthusiasm, time, and effort you’ve put in leaving no stone unturned to diagnose your clients? That’s the passion and dedication the parents are looking for.

It’s always fun to play a detective! How cool was “House” when it first came out?  House and his team left no stone unturned in trying to correctly diagnose their patients. At times they even went to their houses or places of work in order to find any shred of information that would lead them on the right path. Admittedly you don’t have to go quite that far, but a consultation with a related professional might do the trick if a client is exhibiting certain symptoms outside your experience.

Turn your weakness into strength! No one likes to admit that they don’t have the answer. Many of us worry that our clients (those who work with adults) or their parents (those who work with children) may lose confidence in us and go elsewhere for services.  But everything depends on how you frame it! If you simply explain to the parent the rationale for the referral and why you want them to see another specialist prior to formulating the final diagnosis, they will only THANK YOU! It will show them that rather than making a casual decision, you want to make the best decision in their child’s case and they will only appreciate your candor as to them it shows your commitment to the care of their child.

It doesn’t matter how well educated and well trained many medical and related professionals are, the fact remains – no one knows everything! That is why each of us has our own unique scope of practice! That is why we should operate within our scope of practice and referral clients for additional assessments when needed.  Differential diagnosis should not be an exception; it should be a rule for any patient who does not show ‘unique’ symptoms indicative of very specific disorders/conditions! It should be performed with far greater frequency than it is done right now by medical and related health professionals!

After all: “When you have excluded all possibilities, then what remains -however improbable – must be the truth”. ~Sherlock Holmes

References:

  1. Elder, T (2010).  The Importance of Relative Standards in ADHD Diagnoses: Evidence Based on a Child’s Date of Birth, Journal of Health Economics, 29(5): 641-656.
  2. Zacharisen, M & Conley, S (2006) Recurrent Respiratory Papillomatosis in Children: Masquerader of Common Respiratory Diseases. Pediatrics 118 (5): 1925-1931.
  3. Gow P, Smallwood R, Angus P, Smith A, Wall A, Sewell R. (2000) Diagnosis of Wilson’s disease: an experience over three decades. GUT: International Journal of Gastroenterology and Hepatology, 46: 415–419.

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Testimonials

Click HERE to download a pdf containing client testimonials for the time period from January 2009 – June 2018

Teleassessment Testimonial

Our family engaged Tatyana Elleseff, M.A., CCC-SLP of Smart Speech Therapy LLC to administer an independent SLP assessment to our ten-year-old 5th-grader. Our child was identified as twice-exceptional (2e); i.e., superior gifted IQ with ADHD-Combined type. Ms. Elleseff was highly recommended by several private-sector clinical psychologists across the country as having the skill to assess and diagnose 2e children. We have only high praise for the work she continues to do for our child.

For the prior 3 years, we, the parents, have struggled and advocated to get help for our son. Multiple assessments by outside assessors have continued to show a significant gap between our son’s achievement and his cognitive abilities. However, our school district asserted that his academic performance was average and therefore he didn’t need an IEP.

This year, our child psychologist recommended an SLP assessment to explore and possibly rule out speech and language impairments (SLI). It was hypothesized that the child’s giftedness and high level of functioning enabled him to partially mask his learning deficits. Ms. Elleseff’s assessment revealed pronounced speech and language impairments that had completely escaped detection before.

Ms. Elleseff administered her assessments via teleassessment because we are located in California and she in New Jersey. Teleassessment was comprised of live GoToMeeting sessions augmented by audio/video recordings forwarded to her.

Ms. Elleseff has met and exceeded our expectations in 3 key areas:

  1. She demonstrated tremendous skill in telemedicine. She maintained our child’s attention and kept him engaged throughout the multi-hour two-day assessment process. For a child with ADHD combined-type, this was no small feat.
  2. She produced a comprehensive SLP assessment report that uncovered language and literacy impairments that had been overlooked by other experts. Her insight has helped connect the dots between twice-exceptionality, ADHD and language symptoms.
  3. Her assessment methodology has been praised by several experts and attorneys for its multidimensionality and thoroughness.

As parents, we value answers to the following questions.

Would we recommend Ms. Elleseff to other parents? Absolutely.

Why do we recommend Ms. Elleseff? Her work is stellar. Her report organization is detailed and accessible to professional SLPs, psychologists, attorneys, educators, parents, and others. She was able to definitively identify the SLI needs of our 2e child help others connect the dots between his SLI needs and current achievement performance.

How has Ms. Elleseff’s work helped our child? Her work has enabled us to add speech and language treatments that target child’s areas of need.

Ms. Elleseff is highly responsive. She is available by phone and e-mail to consult with all the professionals engaged in our child’s care to ensure all the various providers understand the nuances of servicing the learning needs of this 2e child.

Please do not hesitate to ask Ms. Elleseff for our contact information.

Sincerely,

Southern California Parent of a 2e child

November 25th, 2018

Post Treatment Therapy Testimonial (Internationally Adopted Child)

In 2010 we brought home our adopted daughter from Kazakhstan.  We were initially worried about the hurdles that we would face with adopting a four year old that didn’t understand English and had no formal schooling.  We went to Tatyana based on a recommendation from a psychologist and started sessions in the Fall of 2010.   From the very start, we knew we made the right decision.  She did an initial evaluation that was very thorough and gave us a step by step overview of the process that we would follow together once a week.

Tatyana has a very pleasant demeanor working with internationally adopted children, but also knows how to push them so that they get the most out of themselves.  As a parent with so many worries initially, it was very calming to sit in on each session and see her development from week to week.  It really helps when you have someone that you can voice your concerns to and get a well thought out and practical approach to your needs.  Needless to say, our daughter picked up English very quickly and was able to get much needed help with reading comprehension as well as other skills that many of us use without even realizing, like the use of figurative and ambiguous language (e.g., idioms, synonyms, antonyms), etc..  Tatyana also reviewed our child’s progress regularly to pinpoint areas that needed more concentration.

We continued for several years, and we felt that the instruction she had received at Smart Speech Therapy, laid a solid foundation for her future development.  Our daughter will be turning thirteen this fall.  We can honestly say that the time invested in these sessions has given her the opportunity to flourish in school.   Her favorite subject now is Language Arts, and she has currently made the honor roll at her middle school.  She loves to read books and her vocabulary has expanded exponentially.  Sometimes when we are just sitting around, our daughter will come over and sit with us, with a book in hand, and just read.  My wife and smile at each other and think about how blessed we’ve been, to have given her this opportunity.

Thank You so much for your devotion Tatyana, we couldn’t have done it without you!

M & J, Monroe NJ

Comprehensive Independent Language and Literacy Evaluation

I retained Tatyana to do a Comprehensive Language and Literacy Evaluation for my teenage son.  As he has always struggled with reading and writing, and has had an IEP since third grade, I was no newcomer to evaluations.  He has had educational, psychological, neuropsychological and language/literacy evaluations.  Despite all of these inquiries into his needs, as well as the provision of special education services, he was still struggling in his school placement.  I decided to look for a professional who could delve deeper, to help me understand why my son struggled so, and what, if anything, could be done to help him.  Well, I certainly found that professional in Tatyana!  And her Comprehensive Language and Literacy evaluation was exactly that: comprehensive.  She spent more than nine hours with my son and administered a variety of tests that he had never before faced.  I found them fascinating because the results replicated the academic struggles he has, and gave us a link to the foundation of them.  Interestingly, they also gave us some insight to how he thinks, and how he approaches problems and social interactions, which are areas that had not previously been explored from a linguistic perspective.  To be sure, she did not simply go through the motions of administering tests.  She made observations about his behavior that added to her test results and provided a comprehensive picture of my son’s strengths, weaknesses and needs.  In addition, her work product was completed in a timely manner, and she responds promptly to phone calls and emails.  I found my experience working with Tatyana to be a positive one, and the product to be an indispensable part of my quest to find the right education for my son.

NJ Parent

Language and Literacy Teleconsultation

Tatyana has recently provided me with a teleconsultation regarding my 13-year-old son with respect to the potential testing needed to tease out the extent of his language and literacy difficulties. I am a speech-language pathologist myself, but I had a very hard time pinpointing the exact nature and extent of his deficits. All previous educational and neuropsychological assessments showed him to be within average limits on a select battery of tests yet he was significantly struggling in social and academic areas.

It takes years of experience and additional study to accurately assess a child like my son who has an average IQ but a subtle pattern of language and literacy weaknesses. After reviewing all records of the previous testing and speaking to my son for a short period of time via teleconferencing, Tatyana was able to quite effortlessly articulate my child’s language and literacy difficulties as well as explicitly indicate exactly which formal and informal language assessments my son would need  in order to showcase his present strengths and ongoing social and academic challenges. It truly was amazing! Tatyana is remarkably good at her job. I have not met a more skilled diagnostician in all my years as an SLP. I look forward to having her complete a comprehensive assessment for my son in the near future. We have waited thirteen years but we have finally found the right diagnostician for the job. Thank you, Tatyana!

Grateful SLP mom from Illinois.

Comprehensive Independent Language and Literacy Evaluation

I am a CCC-SLP mom of an intellectually gifted 7-year-old girl, who is on the verge of academic failure and has been since Kindergarten. The school system has not been interested in identifying a cause, as my daughter manages to squeak by to a passing standard. I did not believe that the Independent Evaluations I previously had done were in-depth enough to pinpoint where her breakdowns are occurring.  Fortunately, I became aware of Tatyana through social media and initiated my contact with her via Facebook.  Tatyana was so kind to answer questions through private messages. After several months of following her blog and Facebook group, I had the epiphany that Tatyana would be the perfect clinician to evaluate my child.  Tatyana is professional and thorough beyond belief, from the initial contact regarding the evaluation she will conduct.  She sent the most thorough intake document I’ve ever seen and requested to see all previous evaluations, to research my daughter my see if she could clinically add information to what had already been tested. It was our good fortune that Tatyana saw there was so much information missing from the previous evaluations I had done for my daughter.

Prior to testing, Tatyana provided a detailed outline of what she would be testing for, a specific timeframe for the evaluation broken down into multiple sessions, the protocols she would be using, the amount of time it would take for testing within each domain, clinical hours evaluating her data and summarizing into a report.   From the initial evaluation session, she was welcoming, friendly and put my daughter and myself at ease. At the end of each testing session, plenty of time was taken to explain some of the findings of the session, and any adjustments to the proposed plan based on results to date were discussed.  The final report is an in-depth evaluation/summary of my daughter’s skills and weaknesses in every area related to Expressive Communication skills, Social Pragmatic communication skills, Literacy skills (inclusive of all domains within reading and writing).  The schools try to avoid service initiation or to provide the most simplistic approach to remediation…. They will not be able to get away with that model given the evaluation report I have received. Tatyana perfectly outlined my daughter’s deficit areas, along with the future educational implications throughout the report. Tatyana provided very specific Long Term and Short Term objectives, personally tailored for my daughter within all the domains she evaluated. It’s a gift for the future treating clinician.

Tatyana says don’t hesitate to contact her in the future if she can be of assistance as I pursue services and educational remediation for my daughter, and I have no doubt regarding her sincerity.

As a professional and as a mom of a child who is struggling, I really can only say THANK YOU to Tatyana for the professional, insightful, high quality evaluation. She perfectly and totally captured my daughter’s skills and areas of educational need.

Jeanann Wallace, CCC-SLP, Mom

Professional Consultation Complex Communication Impairment – Adolescent Client

I sought Tatyana’s help when I did a comprehensive evaluation on a student that had multiple, complex diagnoses, some of which I had little prior experience with. Tatyana provided extremely valuable feedback about my report. She also provided me with solid, evidence-based recommendations for intervention. She sent many links and documents, which were also incredibly helpful! As a result of my consultation with Tatyana, I felt totally confident with my report and my recommendations. My feedback session with the parent went great, and I’m confident the student will get the appropriate interventions. Tatyana is warm, professional, and extremely knowledgable. My professional consultation with her gave me the peace of mind I needed. That peace of mind is priceless! I very highly recommend her!

Florence Cannon, MS, CCC-SLP
The Language Group
Atlanta, GA

Professional Consultation Internationally Adopted Adolescent

I recently had the pleasure and privilege of consulting with Tatyana Elleseff regarding the complexities and risks associated with the language development of internationally adopted children and adolescents. Tatyana provided a wealth of insight, knowledge and experience solidly backed by evidence-based research. She welcomed questions and helped me navigate through the issues impacting internationally adopted children. In addition, Tatyana was incredibly organized and generous with resources, ideas and feedback. Consulting with Tatyana proved to be an excellent investment of time and money and as a growing clinician, I hope to work with her again – she is an inspiration!”

Thank you again!!!
Rinda Werner

Comprehensive Independent Language and Literacy Evaluation

My son was diagnosed with ADHD-combined at the very young age of 5. Something was different about him even as a baby. He was precocious and smart as a preschooler reciting the alphabet forward and backward and every state in alphabetical order. His memory is remarkable. We made the difficult decision to start him on medication at age 5. He did well in kindergarten and was compliant, followed the rules, and was liked by his peers. He kept his desk very organized in the classroom. Everything had to be put back in its place and lined up. He managed other materials in the classroom and that of his classmates, putting their supplies away as well. He was rigid in adhering to the schedule of the day, reminding the teacher of what came next as well as policing others.  We tried to get him a 504, but the school denied him.

They said he was doing fine.

We have always tried to be proactive and push on to make sure our child’s needs are met. He was tested for and denied being in the gifted and talented program. We decided to seek a neuropsychological evaluation. This identified strengths and weaknesses that we would not have been aware of had we not pursued it. It confirmed our instinct that he had a very superior IQ. This is bittersweet because while he is truly gifted (2E twice exceptional), he also had decoding and phonics weaknesses amongst other things. The report was given to the Principal, the School Psychologist, the Learning DisabilitiesTeacher Consultant (LDTC), the School Superintendant and they all ignored the report. We brought the doctor that did the neuropsychological exam to plead our case. The school finally agreed to a 504 with classroom accommodations including reading services. The school discontinued reading services after 6 months as the school said he was doing fine.

The journey continued seeking more answers to a difficult child. We sought the opinion of a well-regarded developmental pediatrician. He diagnosed ADHD and High Functioning Autistic Spectrum disorder. He wrote to the school requesting a social skills lunch bunch and speech therapy for pragmatics. They denied speech therapy without doing an evaluation citing the second-grade teacher didn’t deem it necessary.  They said he was doing fine.

We knew through our experts that he needed help in reading, writing, speech for pragmatics, and social skills with social thinking. What else could we do to help our son? Another doctor recommended we consider a comprehensive language and literacy evaluation referring us to Tatyana Elleseff, M.A., CCC-SLP at Smart Speech Therapy LLC.

I’ve learned the value of obtaining independent evaluations. I contacted Ms. Elleseff leaving a message and she promptly returned my call. Ms Elleseff listened to me patiently and helped me understand that my son needed both a language and literacy evaluation. I was so relieved and grateful to finally find someone who understood. She has ALWAYS been prompt and organized. Her system for setting up consultations and evaluations is concise with well-defined contracts as to what services are to be provided, what the process is, and the time frame. She was VERY accommodating setting up the evaluation as we fit it in last minute before school started last fall. Our evaluation was 9 hours, broken up in 4 sessions followed with a school observation. She completed the report promptly and comprehensively.  The report showed strengths, weaknesses, long term goals, short term goals, and detailed intervention recommendations. I must admit, it was hard to take in the problems my son has that she so clearly identified. Early intervention is so critical and I am grateful to had had the chance to work with Tatyana.

Ms. Elleseff truly has a passion for her work and is championing children’s needs. Her credentials are extensive and impressive. We did retain an attorney and are pursuing an IEP. Ms. Elleseff’s report and Curriculum Vitae were sent to the school. The school has finally agreed to evaluate our son to determine eligibility.  I hope our experience will help some of you!

Janet S, Greenbrook, NJ

International Language and Literacy Teleconsulation

My 14 y.o. son has difficulty performing various language-related tasks. He is unable to retell stories and movies, makes grammatical errors when speaking, cannot use complex sentences, and has difficulties expressing his opinion in conversations. Because my son excels in math and science, initially I was not terribly concerned with this as I thought that he might develop skills in reading and writing later in life.

However, as he grew older rather than improving these difficulties only got worse and I became very concerned that it would affect his future life outcomes (e.g., college admission chances in either Israel where we live or in the United States where his older brother currently studies).  So I began to search for a professional who could assist my son in improving his abilities for academics. One of my friends recommended I consult a speech-language pathologist and another friend from the United States recommended Tatyana Elleseff as one of the best specialists in this field.

Still unsure if that was what we truly needed, I still scheduled a teleconsultation with Tatyana for my son and myself and began filling out preliminary intake forms that Tatyana sent me before the meeting.

Right away I noticed that my son was displaying deficits on approximately 80% of questions and began to understand that he does have a real problem, which should be taken seriously. Not only were his academic difficulties a concern but I also realized that his social communication abilities (which I had previously considered to be a completely unrelated problem) were significantly impaired as well and required addressing as well.

Tatyana began her consultation by first interviewing my son for a period of time (he speaks Russian and English besides his native Hebrew, so they understood one other quite well) and I saw him enjoying the conversation. After that Tatyana spoke to me. She highlighted to me in which areas she recommended he be tested and also explained the ramifications of leaving his deficits untreated (he is at risk of developing mental health problems such as anxiety and depression). Since we live in different countries and Tatyana was not available to work with my son in person, she did some research and found reliable speech-language pathologists in Israel who could assist my son and recommended that I contact them for further assistance.

I highly value Tatyana’s professional experience and totally trust her recommendations. I already contacted the suggested therapists and my son will start services shortly. I’m also planning on bringing my son to the United States in April for supplemental therapy sessions with Tatyana in order to strengthen his remediation program. I strongly believe that with Tatyana’s help my son will improve his academic performance, build social skills, gain self-esteem, and overcome emotional instability.  I recommend Tatyana without reservations to any parents of children with language or literacy difficulties living outside of United States for a language and literacy teleconsultation.

O.G., Rishon Lezion, Israel

Comprehensive Independent Language and Literacy Evaluation

We brought our 11-year-old son to Tatyana Elleseff, MA CCC-SLP for an evaluation on the recommendation of another professional working with us to secure an appropriate school placement to address his needs as a learner. Our son has been receiving services since he was an infant through early intervention and then both privately and through an IEP in the public school– so I am not a newcomer to the process.  I must say that our entire experience working with Tatyana has been positive, professional, and impressive.

First, the ease in scheduling the initial appointment was a relief. Often when contacting a new consultant/expert there is a long waiting period and much back and forth before getting started. Tatyana responded promptly when I first called her and provided a very clear explanation of what services she could provide and what the intake process would entail. Scheduling was also very easy. Throughout our initial contact, she was sensitive to our sense of urgency to have the evaluation completed, but also was very reassuring that the process would go smoothly, which helped reduce any apprehensions on our end.

Additionally, Tatyana spread the evaluation over several sessions so that it would not be overwhelming or taxing for our son. When he first met Tatyana, she was warm and welcoming which helped with him significantly with going to yet another evaluation with yet another therapist. In fact, our son really enjoyed spending time with Tatyana.

Finally, the comprehensive report Tatyana generated was excellent in quality. The turn around time and level of meaningful detail was extraordinary. Tatyana’s evaluation and the subsequent report of her findings not only clearly identified our son’s areas of weaknesses and strengths, but also provided specific strategies to best support his academic progress as well as clearly defined the best classroom environment for him.

We were very pleased with the final report as well as the entire process and would highly recommend Tatyana Elleseff’s services.

E and D, Maplewood, NJ

Language and Literacy Consultation Parent Testimonial

“I consulted with Tatyana Elleseff in preparation for a CSE initial eligibility meeting. I had evaluations from the school district and a private psychologist. I needed help connecting the dots in what was a very nuanced case. There was absolutely something going on with my child’s language and learning and understanding the reports and what direction to go in next was essential. Ms. Elleseff analyzed the findings with great attention to detail. Ms. Elleseff gave me specific and evidence based recommendations that finally made sense. She presented possibilities that had not previously been explored. Ms. Elleseff showed extreme expertise in connecting my observation and intuition as a parent with the science of language. She educated me and made recommendations about additional and more specific tests, prepared me for the CSE meeting and gave me suggestions on the types of interventions that I might consider for my child. I highly recommend her for a parent consultation”.

Parent, Westchester County, NY

Forensic Speech and Language Pathologist Testimonial

I am an attorney and my practice is devoted to special education matters in which parents explore whether their child is receiving the free, appropriate public education to which he or she is entitled.  Recently, a client retained me, and Tatyana Elleseff in order to explore whether the student was being appropriately educated with regard to his Dyslexia, also known as Language Based Learning Disability.  The matter is still under advisement, and even if it were not, I would not discuss the outcome.  However, I am able to say that Ms. Elleseff’s observation of the student, and the evaluation report itself, each was of the highest possible quality, as she is comprehensive, pays extraordinary attention to detail, and prepares an in depth assessment of a student.  While highly professional, the writing is also clear enough for a parent to absorb.  If I ever have to proceed to trial against a District, Ms. Elleseff’s professionalism will be difficult if not impossible to impeach, and she would be a passionate advocate for the children she assesses.  Without reservation, I recommend her as a Forensic Speech and Language Pathologist.

Attorney at Law in New Jersey

Independent Evaluation Testimonial

My ten year old son was experiencing tremendous academic difficulties throughout fourth and fifth grade.  His reading and writing in particular were functioning well below grade level and cognitive functioning. We knew that in order to close the gap an in-depth language and literacy evaluation was needed to unearth any undiagnosed learning disabilities. We consulted Tatyana Elleseff of Smart Speech Therapy LLC regarding my son’s current academic complications. Tatyana met with us and based on her customized intake process was able to map out a specific testing plan tailored to my son’s needs. Based on her testing results, Tatyana generated a highly detailed and comprehensive report that uncovered many linguistically based reading and writing disabilities. We will be able to use the goals in that report as building blocks to improve my son’s abilities in all the impaired areas of functioning to foster further academic success. I encourage anyone looking for a highly experienced and detail-oriented evaluator in the field of speech language pathology to utilize Tatyana Elleseff’s services.

WS, Kendall Park, NJ

Therapy Testimonial

It is absolute pleasure for me to recommend Tatyana. She is excellent speech language pathologist as well as an extremely knowledgeable and experienced professional. Our son has always experienced language difficulties along with lack of social skills. We have been through a few speech language pathologists along with several social skills group. But I am so glad that we met Tatyana. She has excellent teaching skills which help my son with problem solving and listening comprehension. Her approach and methods are amazing as she carefully considers Mark’s strengths and weaknesses. It allows Mark to learn in a quick and efficient manner and help him expand his knowledge and social skills. Tatyana manages to build therapy sessions with challenges and interesting tasks, which develop Mark’s curiosity for the subject and match his need. Tatyana teaches Mark skills which help maximize his strengths and compensate for his weaknesses. Tatyana knows how to adapt methods to create maximum results for the child. Due to variety of Tatyana ‘s approaches in therapy Mark is able to enjoy therapy while staying organized and focused. Tatyana exhibits and demonstrates great enthusiasm and I am extremely grateful that I had the honor and pleasure of finding Tatyana.

Jane A, New Providence , NJ

Independent Evaluation Testimonial

I had the pleasure of working with Tatyana recently when she conducted an independent language evaluation of my son. I will always remember this positive experience.  Tatyana is a very dedicated to her profession and cares deeply about her clients.  She made significant findings during the evaluation and I will always be appreciative of the special way she interacted with my son as well as of her evaluation outcomes. She was able to easily identify that despite the fact that my 6th grade son was dismissed from language therapy in 2nd grade, he continued to present with severe social pragmatic language deficits, which continued to adversely impact and significantly exacerbate his functioning in school setting.

Tatyana’s extensive experience allows her the opportunity to work with children with numerous disabilities leading to a very broad knowledge base. She possesses the qualities needed to be an excellent speech-language therapist. She is kind, patient, honest, and student focused. In short, she is an exceptionally dedicated professional and an incredible asset to her field.

F.O., New Brunswick, NJ

Therapy Testimonial

Our daughter age 11 was having trouble in school, struggling with written assignments, keeping track of her homework, following instructions and remembering things, as well as interactions with peers and teachers. As she was progressing through grades 1-5 her grades became progressively “below her level of capacity” as reported by teachers. Her social life was suffering; she was losing her school friends one after one. In the quest seeking help for our child we consulted a psychologist who suggested that our daughter’s problems are rather developmental than psychological and suggested to go for testing with a developmental specialist. Our friends referred us to Tatyana, saying that “she is so much more than a speech therapist”. After a telephone consultation Tatyana took our case, explaining that K’s problems in school may be deeply rooted in her language development issues. She was growing in a bilingual environment and has started talking later than her peers, having difficulty acquiring language skills. She received help from a speech therapist at age 3-4, and it seemed that the issues had resolved. Unfortunately, in school it became apparent that language problems did not disappear, but persisted hindering our daughter’s development. Tatyana conducted a comprehensive assessment and offered individually tailored program of remediation, offering us a hope that our daughter will be able to overcome her difficulties and adjust to demands of the modern life. After a month of therapy, we can see positive changes in K’s ability to verbalize her thoughts, keeping track of her activities and belongings, and her emotional intelligence.

Tatyana is a highly professional, dedicated, knowledgeable specialist and talented speech language pathologist. She manages to keep a fidgety child focused on a task for an hour, and together they accomplish a lot during a session. What they do stays in child’s memory and lays foundation for further work and can be used immediately in her life. She is successful in practice and current on her research methodologies; her reports are thorough and truly comprehensive. I only wish we have found Tatyana sooner!

A.D., New Providence, NJ

Therapy Testimonial

Our son is currently receiving speech language therapy from Tatyana, and we are incredibly happy with the services. We find Tatyana very organised and hard working in preparing and delivering therapy sessions to our son. She is compassionate and available to listen to our concerns and is a great problem solver. She has amazing skills to engage our son in different tasks during the session and provide us, parents, with clear and concise feedback his progress in therapy.
Tatyana is a wonderful speech therapist!

KJ, Dayton, NJ

Therapy Testimonial

Our son has speech delays and has been going to Ms Elleseff for speech therapy for a year. Since he started his sessions we are seeing improvements in his speech. After his initial evaluation, we decided to move forward with sessions and had the confidence that our child is in the right place. He has been learning many new words/sentences and has been making good progress. The thing we like most about Tatyana is that she always tries to create a fun environment and she works with the child depending on the child’s behavior. Our son is always excited to go see Tatyana for his sessions.

P and J, Somerset, NJ

Therapy Testimonial

Our son was 3 when we started with Tatyana. From the initial evaluation we knew we wanted to move forward with her. She was very thorough and even at that first meeting we could see that she was going to make a significant impact on his speech.  Our son will be 5 this month and he has made great strides in all his areas of deficiency. Speech therapy with Tatyana has not only helped him and his communication with us but being able to sit in during the sessions has taught us how to communicate with him and how we should apply the methods at home to enable our son to communicate better.  Tatyana creates a very fun and relaxed environment, but is still able to command the room with a no nonsense approach. Her skills allow her to use any mood or behavior the child is exhibiting for learning and language.

M and T, East Brunswick, NJ

Independent Evaluation Testimonial (International Adoption)

As a  parent of an Internationally Adopted child, I became aware that some professionals including neuropsychologists test our internationally adopted children like biological children. Too many of our kids suffers from being wrongly classified in Special Education by therapists who are unaware of our kids specific developmental paths and trajectories. Tatyana Elleseff’s expertise in assessing and treating language abilities of internationally adopted children helped me target my child’s weaknesses while putting it in the context of his adoption. She helps differentiate developmental delays from disorders and helps with implementation of remediation which involves the parents in addition to other therapists and resources. I highly recommend her to any parents of Internationally Adopted children to assess and treat their language/social emotional development.
Barbara, New York

Independent Social Pragmatic Evaluation Testimonial

Our daughter has always had a difficult time in social settings, how to start a conversation, saying offensive things to peers without the intention of being offensive, and feeling like she doesn’t fit in because she has different interests.

Our school performed a basic pragmatic language test that our psychiatrist disagreed with and felt did not accurately reflect our daughter’s condition.  He recommended having Ms. Elleseff perform a comprehensive social pragmatic language evaluation.

She advocated with the school for our daughter to get the evaluation and thanks to her efforts the school agreed.

Ms.  Elleseff completed a thorough and comprehensive evaluation of our daughter’s social pragmatic language abilities and provided a very detailed report and series of recommendations.

We are very grateful to her and we will be meeting with the school shortly to review and establish necessary accommodations.

P & J, New Jersey

Bilingual Evaluation Testimonial

Tatyana Elleseff performed speech evaluation of my 4 years old son in October 2014. I should say that not only the experience was very pleasant, but also the quality of evaluation process and communication was exceptionally high.

During the assessment, I was allowed to stay in a room with my child, which definitely made him more comfortable and therefore let Tatyana to obtain more adequate respond from him, which is crucial. Tatyana’s approach to evaluation is more complex than you probably would see with other SLPs. She was the first one, who was concerned with processing of verbal information by my son’s brain and his executive functions, connected to that, whereas couple of other specialists did not put emphasis on it at all.

The report I received from her was easy to read and understand to non-professional, which I am. I guess this is very important too, since if you got the report full of professional vocabulary and was not able to decipher it, it leaves you with the feeling that everything is even worse than you expected about your precious child. Tatyana’s report made the effect just the opposite. I clearly saw where we have problems and that there are ways to work on them.

On top of everything, I have to mention that I have chosen Tatyana because of her web site that provides tons of useful information; her academic work with Rutgers University, that implies she is a very educated professional and her ability to provide service in Russian, since my child does not speak any English.

In the end, I have to say that I am very grateful for the chance to work with Tatyana and definitely recommend her to anyone who needs this kind of specialist.

 Sincerely, Katrina R., New Jersey.

Independent Evaluation Testimonial

Ms. Elleseff recently completed an independent evaluation of our 7 year old severely communication impaired daughter.  The report was incredibly comprehensive and based on thorough assessments across multiple areas of speech, language and behavior.  Not only did she incorporate highly relevant information found in the recent speech-language research publications, but Tatyana also thoroughly reviewed and synthesized our daughter’s school and medical records.  Now we have a single highly valuable document that “connects the dots” and can be presented to highly credential experts, who we are considering to treat and/or educate our daughter.  Most importantly, Tatyana is not only highly professional but also very easy to work with, and out daughter enjoys visits to her office.

 T & N, Bridgewater, NJ

Independent Evaluation Testimonial

We are grateful to Tatyana Elleseff for everything she has done to help our son receive proper speech and language help in his school.  She  utilized multiple assessments in order for us to understand clearly our son’s speech and language deficits, and at the same time she listed in her report the exact accommodations he will need at school to help him feel more successful.   Thank You!

Santiago Family.. Middlesex County, NJ

Consultation Testimonial (International Adoption)

I found Tatyana and Smart Speech Therapy online while searching for information about internationally adopted kids and speech evaluations. We’d already taken our three year old son to a local SLP but were very unsatisfied with her opinion, and we just didn’t know where to turn. Upon finding the articles and blogs written by Tatyana, I felt like I’d finally found someone who understood the language learning process unique to adopted kids, and whose writings could also help me in my meetings with the local school system as I sought special education services for my son.

I could have never predicted then just how much Tatyana and Smart Speech Therapy would help us. I used the online contact form on her website to see if Tatyana could offer us any services or recommendations, even though we are in Virginia and far outside her typical service area. She offered us an in-depth phone consultation that was probably one of the most informative, supportive and helpful phone calls I’ve had in the eight months since adopting my son. Through a series of videos, questionnaires, and emails, she was better able to understand my son’s speech difficulties and background than any of the other sources I’d sought help from. She was able to explain to me, a lay person, exactly what was going on with our son’s speech, comprehension, and learning difficulties in a way that a) added urgency to our situation without causing us to panic, b) provided me with a ton of research-orientated information for our local school system to review, and c) validated all my concerns and gut instincts that had previously been brushed aside by other physicians and professionals who kept telling us to “wait and see”.

After our phone call, we contracted Tatyana to provide us with an in-depth consultation report that we are now using with our local school and child rehab center to get our son the help he needs. Without that report, I don’t think we would have had the access to these services or the backing we needed to get people to seriously listen to us. It’s a terrible place to be in when you think something might be wrong, but you’re not sure and no one around you is listening. Tatyana listened to us, but more importantly, she looked at our son as a specific kid with a specific past and specific needs. We were more than just a number or file to her – and we’ve never even actually met in person! The best move we’ve could’ve made was sending her that email that day. We are so appreciative.

Kristen, P. Charlottesville, VA

Therapy Testimonial

Tatyana is a talented therapist who, unlike many other providers, is capable of creating a unique stimulating environment to meet the child’s needs. Using her energy and advanced experience she offers all the required psychological and physical incentives that naturally trigger child’s developmental progress.

Ilya K. Edison, NJ

Independent Evaluation Testimonial (Autism Spectrum Disorder)

Our son was diagnosed with autism spectrum disorder one year ago.  He has significant developmental delays especially with communication and speech.  Since starting his therapy we have seen 4 speech therapists and at least a dozen physical, occupational and developmental therapists.

Each therapist had a different opinion on his expressive, receptive and pragmatic skills, but none where able to clearly identify what his weaknesses are in these areas. As parents, we became very frustrated because our son is able to speak, but his verbal communication with us is poor. Finally, we were referred to Tatyana.

My son is very high functioning and has learned how to compensate for his delays.  He can fool the most trained evaluator, but Tatyana has the expertise and skill to be able to see if he knew the answers to her questions or if he was just guessing.  In my experience, very few therapists have the time or ability to do this.  Tatyana spent almost three hours with my son, identifying both his weaknesses and strengths along with giving me a lot of insight on his current communication level.

Tatyana thoroughly and systematically evaluated our son.  For the first time I left an evaluation feeling like I had answers to my questions that have been lingering for the past year.  Her love for children and work was apparent throughout the entire examination.  Through her in depth evaluation, Tatyana was able to identify where his communication deficits are and she set goals to strengthen these areas.  I can honestly say, to date, I have not met a therapist as enthusiastic and compassionate as Tatyana.

I have already recommended friends and will continue to recommend individuals in search of an excellent speech pathologist to Tatyana.  She has been a great help to both my son and our family.

Family of a son with ASD in Union County NJ.

Independent Evaluation Testimonial (International Adoption)

Our daughter Kristina was adopted 4 years ago from a small village of Kulabki, Russia. We have noticed that she was struggling in school and didn’t know where to turn. Being she is our only child adopted internationally and knowing no English when she arrived in New York, we just thought she needed time. Kristina was in therapy for R.A.D. issues. Her psychologist had pointed out that she really does not understand us all the time and has trouble communicating to us. We have become very frustrated with her and she with us. Dr. Lynne suggested that she be tested and recommended Tatyana Elleseff to us.  After reading Tatyana’s background and schooling on her website I was confident that she can help Kristina. Upon contacting her our first conversation was so informative. I made a 2 day evaluation appointment and was amazed how much Tatyana was able to accomplish during the evaluation.  Kristina’s issues are consistent with children who had been neglected in there most important growth years. (1 through 4). She also had not had formal schooling until the age of 8. Tatyana has recognized these issues and more. Tatyana gave us a very detailed 19 page evaluation in very timely manner. I will use her report to present to Kristina’s school so she could get appropriate help. We are so impressed with Tatyana’s skills that we are considering the 65 mile drive to receive outside therapy with her.

Donna S. Perkasie, PA

Therapy Testimonial  

Our daughter Ava was adopted internationally at the age of 18 months and had a diagnosis of Fetal Alcohol Syndrome at birth. She came to us with significant hearing, feeding (couldn’t eat or suck a bottle properly) and sleeping problems as well as significant speech and language deficits. She’s 5 now, and we’ve spent the past 3 and 1/2 years going through the state’s Early Intervention program, numerous evaluations and therapists, as well as the public school system’s learning disabled program.

We started working with Tatyana privately about 8 weeks ago and she has made more progress in 8 weeks than we’ve seen in the past 3 years! In our first sessions Tatyana evaluated Ava and found every issue we’ve been dealing with, plus some that weren’t even diagnosed by any of the other therapists we’ve seen. She even had recommendations for some of the OT sensory integration/processing issues that Ava faces. She has been right on the money with each of her observations and suggestions for working with Ava on her issues.

Tatyana has an amazing intuitiveness for helping Ava overcome the roadblocks she encounters, and is incredibly detail oriented. However, Tatyana doesn’t cut Ava any slack and makes her work pretty hard, and we’ve seen amazing results already in our weekly sessions in a pretty short time.

She is the best thing that has happened for Ava, and I only wish we would have come to her much sooner! ”

Keith and Debra, Southampton NJ

Independent Evaluation Testimonial (International Adoption)

We are immensely grateful to Tatyana Elleseff for her outstanding work in evaluating our internationally adopted child. She administered multiple instruments to appropriately and comprehensively assess our son’s relative strengths and weaknesses. The mere process itself of watching her assess our son provided us with new insights into his language, emotional, and behavioral needs. Furthermore, we also witnessed how his language ability developed simply through the experience of her assessment sessions. Tatyana’s written report integrated and synthesized a mass of assessment and behavioral information. She created a clear, detailed, vivid, impressively comprehensive and coherent picture of our son’s relative strengths and weaknesses both in his behaviors while being assessed as well as in his actual language skills. Her report also provided very specific and targeted recommendations that facilitates the creation of an appropriate individualized educational plan for our son and gives teachers and support staff clear direction in meeting the complex needs of an internationally adopted older child, without which we believe he would not reach his full potential. In addition, we greatly appreciated that she sincerely listened to us and our concerns, and respected our knowledge, observations and insights as adoptive parents. She is obviously a very talented, gifted and dedicated speech language therapist. We could not be more pleased. Thank you, Tatyana!

W & K, New Jersey

Therapy Testimonial

We have been using the services of Smart Speech Therapy and Ms. Tatyana Elleseff for approximately three years.  During this time, our Internationally Adopted daughter has made tremendous improvement with issued related to Auditory Processing, Word Finding, Social Pragmatic , as well as Executive Function Difficulties.  These were conditions we did not even realize existed and were not remotely prepared to handle.  When we were referred to Tatyana Elleseff we had no idea what our daughter was struggling with, we only knew that she wasstruggling.  We had tried for years with her teachers to point out her difficulties, only to be told over and over again that she was fine.  She did not qualify for any type of extra help and that she was “just a little behind”.  When our daughter’s anxiety level regarding school went through the roof, we knew we had a problem that was not going to be recognized or treated by the school district.  We were referred to Tatyana at the end of 2nd grade.  Tatyana went straight to work to determine what exactly the problems were and how best to proceed.  But in addition to the Auditory Processing issues, Tatyana uncovered several other “hidden” deficits (see above) and began designing interventions on how to best help our daughter function in school.  Tatyana also spent much time helping our daughter with her anxiety about school, and taught her how to ask for what she needed from her teachers and how to cope with her everyday struggles.   Since then, we have been working with Tatyana every week.  Our daughter has made tremendous progress with in all of her areas of difficulty and feels much better about going to school and her performance while there.   Tatyana constantly evaluates and tailors her sessions to exactly where the difficulties lay.   Tatyana is a well-informed, structured and prepared therapist.  Her sessions are custom tailored to our daughter’s specific needs and Tatyana clearly puts time and effort into that preparation. Tatyana also has an excellent understanding to the specific challenges Internationally Adopted children often face.  Many school staff, although well meaning, just do not understand these specific challenges.  In fact, many of us adoptive parents sort of “learn as we go along” regarding these issues.  However, armed with the information that Tatyana provides us, we are better able to obtain the support in school that our daughter needs. We are still in therapy with Tatyana and our daughter is doing well.  She is no longer scared to ask questions and really feels better about being able to keep up with her class.  Tatyana is the third speech therapist we have been to, but the first who took the time to evaluate and treat the whole problem, the whole child.

Mike and Anna, East Brunswick, NJ

Therapy Testimonial

At 18 months, we were concerned with our son’s lack of language and communication skills.  After contacting friends and family and numerous experts and professionals, we were recommended, Ms Elleseff.   She was so friendly and understanding of our concerns but she didn’t sugar coat that our son did lack in certain areas.  Her initial evaluation was so detailed and specific and picked up on things, we as parents noticed but thought were not unusual, that needed corrections.  We have been going for one hour sessions once a week for 6 months, but we noticed significant changes after only 2 or 3 months.  His frustration level is down, he is using words and signs to communicate rather than frantically looking for visual cues and pointing/yelling.    Tatyana expects our son to work at his sessions; he does not get away with tears and tantrums.  She praises him, and us, on our progress but always tells us what needs work and what to do at home.  She also goes above and beyond our sessions, working with other professionals as well as taking the time to clarify health insurance questions.  As a parent, you will do anything for your child, and you question yourself constantly.  We have written tearful correspondence filled with worry and she has always answered our questions with compassion, setting our minds at ease with her expertise and taking action on our concerns.  Our now two year old uses words to identify actions, things in his environment, feelings and preferences.  He is making such strides now that family and friends that go for a short time without seeing him comment on his progress.  He is much clearer and we are finding we have to answer the “What did he say?” question less and less.  This weekend he sang songs for us, with words we all understood.  We can’t imagine where we would be without Tatyana’s help.

~Melissa and Rich H, Hillsborough, NJ

Therapy Testimonial

In March 2012 we sought the help of Tatyana for our three year old who has a significant speech delay.  Since then, our son is now speaking in longer sentences as well as understands more words and  concepts thanks to Tatyana’s hard work.  She doesn’t let him get away with anything, which is what he needs. She is also professional enough to consult other professionals when she needs it.   She sought advise from a psychologist on how to handle our head strong son and his temper tantrums. We highly recommend her. Thank you Tatyana!
             A & J, Somerset, NJ

Therapy Testimonial

Speech therapy with Ms. Elleseff is not for the faint hearted. She misses nothing. She forgets nothing. Your child will get away with nothing. She is so thorough, the first evaluation was 16 pages and sadly presented such a true portrait of our child’s language deficiencies that we just had to stop for a good cry. We could no longer escape. Our child had needs, which we, her parents did not recognize, did not want to see or could not accept. After a year fighting with the insurance company (which denied coverage) and our child slipping further behind at school, we knew we had to do something. Since finances were a limiting factor, we agreed to try speech for a month or two, even though we knew at it was probably not realistic to see much improvement in such a short time. We were wrong! After only a few months now, the improvement is remarkable.  Our child is now participating in class, answering questions when asked, instead of shutting down, answering more appropriately, and is even reading better, which was an unexpected bonus. Her teachers tell us she is a different child than at the beginning of the semester. At home, she’s more aware of conversations, news, verbal and non-verbal cues. She can explain “what happened at school today?”  In general, she’s just more engaged at home and school, and more responsive to verbal feedback, instructions, encouragement. Ms. Elleseff is a truly gifted professional, whose compassionate awareness of the frustration children feel when they cannot properly communicate, has enabled her to reach them, to relieve them and to enliven them with the gift of language! We cannot thank her enough!

Andrea and Keith R, South Brunswick, NJ

Client Testimonial

“As parents of a newly adopted toddler from Russia (and as first time parents) we have found Tatyana to be an amazing resource to us on many levels.  Her experience impressed us from the start and with each successive session we feel that we have been seeing some great progress with our son’s speech-language delay. We feel that we get the most out of every minute of each lesson as she has shown us that by varying learning techniques and approaches our son can be challenged to thrive but not in a way where he is stressed. We have had additional early intervention speech therapy services for a few months to supplement our private sessions  with Tatyana but found them not to be as effective by far, as a result of which we chose to just continue with her. We would highly recommend Tatyana to other adoptive parents and we are also willing to speak to others about our experience if interested.”

Tanya and Jonathan H, Old Bridge, NJ

Client Testimonial

“Mrs. Elleseff has been doing an outstanding job at identifying and devising strategies to help out our 7-year old son improve his pragmatic language skills. When other specialists were quick to label him, Mrs. Elleseff took her time to address and dismantle every one of those labels. She truly cares about “her children” and is an advocate for them in situations where the wrong (but quick) diagnosis is made. We have been working with Mrs. Elleseff for approximately 7 months and we are seeing steady progress in our son’s skills. We very much appreciate her efforts!”

Myriam and Richard K, Guttenburg, NJ

Client Testimonial

“We adopted our four year old daughter from Kazakhstan last year and she was significantly delayed in her native language. Tatyana was recommended to us by our doctor and we started seeing her on a weekly basis. During this time our daughter has shown significant improvement in her interpersonal and academic language skills  to the point now, where she is communicating openly and feely with us and her peers as well as participates appropriately in her classroom. We have also noticed an increased confidence in her which she severely lacked prior to this therapy. Tatyana’s approach is very unique and her interaction with children is excellent. She constantly evaluates our daughter progression so we have a benchmark to compare our daughter’s learning. We are so glad that we found Tatyana and are thrilled to recommend her to anyone seeking speech therapy for their children.”

Matthew and Jane C, Monroe NJ

Client Testimonial

“When Tatyana first started working with my son, several years ago, he was 4 and a half, understood very little, was very echolalic and spoke in brief 2-3 word phrases. Michael’s language abilities have improved exponentially during the time Tatyana had been working with him. His comprehension has improved dramatically, he now speaks in long sentences, no longer has echolalia and occasionally uses very sophisticated words in correct form. This makes me very proud of him but also incredibly appreciative of all Tatyana’s hard work with him. Thank you so much for your dedication.”

Marcia, C, East Brunswick NJ

Client Testimonial

“Tatyana Elleseff, a bilingual speech pathologist, worked with my daughter Eva for nine months, starting when Eva was 30 months old. At the start, Eva was not progressing verbally at an appropriate pace, so we sought Tatyana’s help. We were thrilled with her work. She was very professional and accommodating. She worked with Eva in our home, communicated with her effectively, and provided lessons appropriate to Eva’s age and level. It was very important to me that she explained to me what she was doing and taught me as well as Eva, so that we could continue developing Eva’s speech skills outside the lessons. She also gave us detailed and clear information about Eva’s abilities and development, not only in her speech but on other dimensions as well. Eva’s progress under Tatyana’s tutelage has been very impressive. She now speaks easily and, for the most part, quite clearly. Her vocabulary is growing every day and it is wonderful to be able to talk to her. Tatyana’s lessons helped not only with speech but with logic and other skills, so that Eva now tops out on aptitude tests and seems to be progressing even faster than children who began to speak before she did. We owe a large portion of this to Tatyana’s work. I recommend her highly and without reservations.”

Larisa S, Bedminster NJ

Client Testimonial

“Tatyana has been providing speech services for our toddler son who was adopted internationally. Her assessments are extremely thorough and she provides great individualized care based on her client’s needs. She also takes the time to give us coaching and feedback to use at home. She continues to provide excellent care and we truly enjoy working with her.”

Connie and David M, Milstone Township NJ

Client Testimonial

 “Dear Tatyana,

I wanted to inform you how delighted Marie, my wife, and I are with Jack’s performance. Only last year we were told by our school district that they need to hold him back in kindergarten because he was just not ready and too immature for first grade. The strategy, and hope, was that he would grow out of his lack of ability to understand letters, words, and spelling. We weren’t sure that it was the right decision but we didn’t know where to turn and who to turn to. We got one independent speech language evaluation done but it wasn’t detailed enough and offered no solutions or strategies regarding what needed to be done. And then you were recommended to us! After doing comprehensive testing you put together a solid intervention plan and stated that you firmly believe that Jack should go to first grade and that with ongoing support he will do a great job. I need to recognize that your Speech Therapy has provided such great results. Jack’s results have surpassed our expectations and all the professional that deal with Jack agree that the consistent application and delivery of your Speech Therapy program has helped accelerated his progress. Thanks again for all your incredible work with our son”

Lou and Marie R, Bernardsville NJ

Professional Testimonial

“I had first met Tatyana several years ago, when she was recommended to me by a colleague, to conduct a speech language evaluation of a newly arrived internationally adopted child with Fetal Alcohol Spectrum Disorder.   After reading Tatyana’s exemplary assessment report, I’ve become hugely impressed with its thoroughness, technical sophistication, skilled interpretations, practical and comprehensive therapy objectives as well as treatment methodology suggestions.  Since that time I have had countless opportunities to collaborate with Tatyana on a number of mutual complex clinical cases pertaining to internationally adopted, bilingual as well as at risk children with a host of genetic, neurological and medical deficits.  Each time I was enormously impressed not just by the quality of her clinical work, but also by Tatyana’s insights into each case as well as by her dedication and willingness to research and apply the latest evidenced based research methods in order to create highly individualized, unique and effective assessment and intervention for each client.”

Alla Gordina, FAAP,  Clinical Assistant Professor of Pediatrics: UMDNJ, Robert Wood Johnson School of Medicine;  Drexel University College of Medicine

Professional Testimonial

Ms. Elleseff is a highly knowledgeable speech language pathologist with invaluable practical experience in assessing children outside “the bell curve”: those who are adopted internationally or are from immigrant or refugee families. I know that in the speech pathology professional community, Ms. Elleseff’s clinical reports serve as models and learning aids, being appreciated for their depth, thoroughness, clarity, and practicality.  I value her differential diagnostic skills combined with the uncompromised honesty in interpreting clinical data.  She is a also a passionate and dynamic presenter, able to involve her audience emotionally and cognitively, making her point convincingly and eloquently. Ms. Elleseff is an excellent supervisor and a model teacher for young people entering the field of human services. She is a prolific writer who is well known among international adoption parents and professionals alike.  Being a bright and independent individual, Ms. Elleseff is a productive team player. She values colleagues and participates in a number of group projects, professional discussion groups, and professional affiliations.

Boris Gindis, PhD, Chief psychologist at the Center for Cognitive-Developmental Assessment and Remediation

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Embracing ‘Translanguaging’ Practices: A Tutorial for SLPs

Please note that this post was originally published in the Summer 2016 NJSHA’s VOICES (available HERE).  

If you have been keeping up with new developments in the field of bilingualism then you’ve probably heard the term “translanguaging,” increasingly mentioned at bilingual conferences across the nation.  If you haven’t, ‘translanguaging’ is the “ability of multilingual speakers to shuttle between languages, treating the diverse languages that form their repertoire as an integrated system” (Canagarajah, 2011, p. 401).   In other words, translanguaging allows bilinguals to make “flexible use their linguistic resources to make meaning of their lives and their complex worlds” (Garcia, 2011, pg. 1).

Wait a second, you might say! “Isn’t that a definition of ‘code-switching’?” And the answer is: “No!”  The concept of ‘code-switching’ implies that bilinguals use two separate linguistic codes which do not overlap/reference each other.   In contrast, ‘translanguaging’ assumes from the get-go that “bilinguals have one linguistic repertoire from which they select features strategically to communicate effectively” (Garcia, 2012, pg. 1).  Bilinguals engage in translanguaging on an ongoing basis in their daily lives. They speak different languages to different individuals, find ‘Google’ translations of words and compare results from various online sites, listen to music in one language but watch TV in another, as well as watch TV announcers fluidly integrate several languages in their event narratives during news or in infomercials (Celic & Seltzer, 2011).   For functional bilinguals, these practices are such integral part of their daily lives that they rarely realize just how much ‘translanguaging’ they actually do every day.

One of the most useful features of translanguaging (and there are many) is that it assists with further development of  bilinguals’ metalinguistic awareness abilities by allowing them to compare language practices as well as explicitly notice language features.   Consequently, not only do speech-language pathologists (SLPs) need to be aware of translanguaging when working with culturally diverse clients, they can actually assist their clients make greater linguistic gains by embracing translanguaging practices. Furthermore, one does not have to be a bilingual SLP to incorporate translanguaging practices in the therapy room. Monolingual SLPs can certainly do it as well, and with a great degree of success.

Here are some strategies of how this can be accomplished. Let us begin with bilingual SLPs who have the ability to do therapy in both languages. One great way to incorporate translanguaging in therapy is to alternate between English and the desired language (e.g., Spanish) throughout the session. Translanguaging strategies may include: using key vocabulary, grammar and syntax structures in both languages (side to side), alternating between English and Spanish websites when researching specific information (e.g., an animal habitats, etc.), asking students to take notes in both languages or combining two languages in one piece of writing.   For younger preschool students, reading the same book, translated in another language is also a viable option as it increases their lexicon in both languages.

Those SLPs who treat ESL students with language disorders and collaborate with ESL teachers can design thematic intervention with a focus on particular topics of interest. For example, during the month of April there’s increased attention on the topic of ‘human impact on the environment.’  Students can read texts on this topic in English and then use the internet to look up websites containing the information in their birth language. They can also listen to a translation or a summary of the English book in their birth language. Finally, they can make comparisons of human impact on the environment between United States and their birth/heritage countries.

As we are treating culturally and linguistically diverse students it is important to use self-questions such as: “Can we connect a particular content-area topic to our students’ cultures?” or “Can we include different texts or resources in sessions which represent our students’ multicultural perspectives?” which can assist us in making best decisions in their care (Celic & Seltzer, 2011).

We can “Get to know our students” by displaying a world map in our therapy room/classroom and asking them to show us where they were born or came from (or where their family is from). We can label the map with our students’ names and photographs and provide them with the opportunity to discuss their culture and develop cultural connections.  We can create a multilingual therapy room by using multilingual labels and word walls as well as sprinkling our English language therapy with words relevant to the students from their birth/heritage languages (e.g., songs and greetings, etc.).

Monolingual SLPs who do not speak the child’s language or speak it very limitedly, can use multilingual books which contain words from other languages.  To introduce just a few words in Spanish, books such as ‘Maňana Iguana’ by Ann Whitford Paul, ‘Count on Culebra’ by Ann Whitford Paul, ‘Abuela’ by Arthur Doros, or ‘Old man and his door’ by Gary Soto can be used. SLPs with greater proficiency in a particular language (e.g., Russian) they consider using dual bilingual books in sessions (e.g., ‘Goldilocks and the Three Bears’   by Kate Clynes, ‘Giant Turnip’ by Henriette Barkow. All of these books can be found on such websites as ‘Amazon’ (string search: children’s foreign language books), ‘Language Lizard’ or ‘Trilingual Mama’ (contains list of free online multilingual books).

It is also important to understand that many of our language impaired bilingual students have a very limited knowledge of the world beyond the “here and now.”  Many upper elementary and middle school youngsters have difficulty naming world’s continents, and do not know the names and capitals of major countries.  That is why it is also important to teach them general concepts of geography, discuss world’s counties and the people who live there, as well as introduce them to select multicultural holidays celebrated in United States and in other countries around the world.

All students benefit from translanguaging! It increases awareness of language diversity in monolingual students, validates use of home languages for bilingual students, as well as assists with teaching challenging academic content and development of English for emergent bilingual students.  Translanguaging can take place in any classroom or therapy room with any group of children including those with primary language impairments or those speaking different languages from one another. The cognitive benefits of translanguaging are numerous because it allows students to use all of their languages as a resource for learning, reading, writing, and thinking in the classroom (Celic & Seltzer, 2011).

References:

Helpful Smart Speech Therapy Resources:

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Assessing and Treating Bilinguals Who Stutter: Facts for Bilingual and Monolingual SLPs

Introduction: When it comes to bilingual children who stutter there is still considerable amount of misinformation regarding the best recommendations on assessment and treatment. The aim of this article is to review best practices in assessment and treatment of bilingual children who stutter, to shed some light on this important yet highly misunderstood area in speech-language pathology.

Types of Bilingualism: Young bilingual children can be broadly divided into two categories: those who are learning several languages simultaneously from birth (simultaneous bilingual), and those who begin to learn a second language after two years of age (sequential bilingual) (De Houwer, 2009b). The language milestones for simultaneous bilinguals may be somewhat uneven but they are not that much different from those of monolingual children (De Houwer, 2009a). Namely, first words emerge between 8 and 15 months and early phrase production occurs around +/-20 months of age, with sentence production following thereafter (De Houwer, 2009b). In contrast, sequential bilinguals undergo a number of stages during which they acquire abilities in the second language, which include preproduction, early production, as well as intermediate and advanced proficiency in the second language.

Stuttering and Monolingual Children: With respect to stuttering in the monolingual children we know that there are certain risk factors associated with stuttering. These include family history (family members who stutter), age of onset (children who begin stuttering before the age of three have a greater likelihood of outgrowing stuttering), time since onset (depending on how long the child have been stuttering certain children may outgrow it), gender (research has shown that girls are more likely to outgrow stuttering than boys), presence of other speech/language factors (poor speech intelligibility, advance language skills etc.) (Stuttering Foundation: Risk Factors).  We also know that the symptoms of stuttering manifest via sound, syllable and word repetitions, sound prolongations as well as sound and word blocks. In addition to overt stuttering characteristics there could also be secondary characteristics including gaze avoidance, word substitutions, anxiety about speaking, muscle tension in the face, jaw and neck, as well as fist clenching, just to name a few.

Stuttering and Bilingual Children: So what do we currently know regarding the manifestations of stuttering in bilingual children?  Here is some information based on existing research. While some researchers believe that stuttering is more common in bilingual versus monolingual individuals, currently there is no data which supports such a hypothesis.  The distribution and severity of stuttering tend to differ from language to language and one language is typically affected more than the other (Van Borsel, Maes & Foulon, 2001). Lim and colleagues (2008) found that language dominance influences the severity but not the types of stuttering behaviors.  They also found that bilingual stutterers exhibit different stuttering characteristics in both languages such as displaying stuttering on content words in L1 and function words in L2 (less-developed language system). According to Watson & Kayser (1994) key features of ‘true’ stuttering include the presence of stuttering in both languages with accompanying self-awareness as well as secondary behaviors.   This is important to understand giving the fact that bilingual children in the process of learning another language may present with pseudo-stuttering characteristics related to word retrieval rather than true stuttering.

Assessment of Bilingual Stutterers: Now let’s talk about aspects of the assessment. Typically assessment should begin with the taking of detailed background history regarding stuttering risk factors, the extent of the child’s exposure and proficiency in each language, age of stuttering onset, the extent of stuttering in each language, as well as presence of any other concomitant concerns regarding the child’s speech and language (e.g., suspicion of language/articulation deficits etc.)  Shenker (2013) also recommends the parental use of perceptual rating scales to assess child’s proficiency in each language.

Assessment procedures, especially those for newly referred children (vs. children whose speech and language abilities were previously assessed), should include comprehensive assessments of speech and language in addition to assessment of stuttering in order to rule out any hidden concomitant deficits.  It is also important to obtain conversational and narrative samples in each language as well as reading samples when applicable.   When analyzing the samples it is very important to understand and make allowance for typical disfluencies (especially when it comes to preschool children) as well as understand the difference between true stuttering and word retrieval deficits (which pertain to linguistic difficulties), which can manifest as fillers, word phrase repetitions, as well as conversational pauses (German, 2005).

When analyzing the child’s conversational speech for dysfluencies it may be helpful to gradually increase linguistic complexity in order to determine at which level (e.g., word, phrase, etc.) dysfluencies take place (Schenker, 2013). To calculate frequency and duration of disfluencies, word-based (vs. syllable-based) counts of stuttering frequency will be more accurate across languages (Bernstein Ratner, 2004).

Finally during the assessment it is also very important to determine the family’s cultural beliefs toward stuttering since stuttering perceptions vary greatly amongst different cultures (Tellis & Tellis, 2003) and may not always be positive. For example, Waheed-Kahn (1998) found that Middle Eastern parents attempted to deal with their children’s stuttering in the following ways: prayed for change, asked them to “speak properly”, completed their sentences, changed their setting by sending them to live with a relative as well as asked them not to talk in public.  Gauging familial beliefs toward stuttering will allow clinicians to: understand parental involvement and acceptance of therapy services, select best treatment models for particular clients as well as gain knowledge of how cultural attitudes may impact treatment outcomes (Schenker, 2013).

 Image courtesy of mnsu.edu 

Treatment of Bilingual Stutterers: With respect to stuttering treatment delivery for bilingual children, research has found that treatment in one language results in spontaneous improvement in fluency in the untreated language (Rousseau, Packman, & Onslow, 2005). This is helpful for monolingual SLPs who often do not have the option of treating clients in their birth language.

For young preschool children both direct and indirect therapy approaches may be utilized.

For example, the Palin (PCI) approach for children 2-7 years of age uses play-based sessions, video feedback, and facilitated discussions to help parents support and increase their child’s fluency. Its primary focus is to modify parent–child interactions via a facilitative rather than an instructive approach by developing and reinforcing parents’ expertise via use of video feedback to set own targets and reinforce progress. In contrast, the Lidcombe Program for children 2-7 years of age is a behavioral treatment with a focus on stuttering elimination.  It is administered by the parents under the supervision of an SLP, who teaches the parents how to control the child’s stuttering with verbal response contingent stimulation (Onslow & Millard, 2012).   While the Palin PCI approach still requires further research to determine its use with bilingual children, the Lidcombe Program has been trialed in a number of studies with bilingual children and was found to be effective in both languages (Schenker, 2013).

For bilingual school-age children with persistent stuttering, it is important to focus on stuttering management vs. stuttering elimination (Reardon-Reeves & Yaruss, 2013).  Here we are looking to reduce frequency and severity of disfluencies, teach the children to successfully manage stuttering moments, as well as work on the student’s emotional attitude toward stuttering. Use of support groups for children who stutter (e.g., “FRIENDS”: http://www.friendswhostutter.org/), may also be recommended.

Depending on the student’s preferences, desires, and needs, the approaches may involve a combination of fluency shaping and stuttering modification techniques.  Fluency shaping intervention focuses on increasing fluent speech through teaching methods that reduce speaking rate such as easy onsets, loose contacts, changing breathing, prolonging sounds or words, pausing, etc. The goal of fluency shaping is to “encourage spontaneous fluency where possible and controlled fluency when it is not” (Ramig & Dodge, 2004). In contrast stuttering modification therapy focuses on modifying the severity of stuttering moments as well as on reduction of fear, anxiety and avoidance behaviors associated with stuttering. Stuttering modification techniques are aimed at assisting the client “to confront the stuttering moment through implementation of pre-block, in-block, and/or post-block corrections, as well as through a change in how they perceive the stuttering experience” (Ramig & Dodge, 2004). While studies on these treatment methods are still very limited it is important to note that each technique as well as a combination of both techniques have been trialed and found successful with bilingual and even trilingual speakers (Conture & Curlee, 2007; Howell & Van Borsel, 2011).

Finally, it is very important for clinicians to account for cultural differences during treatment. This can be accomplished by carefully selecting culturally appropriate stimuli, preparing instructions which account for the parents’ language and culture, attempting to provide audio/video examples in the child’s birth language, as well as finding/creating opportunities for practicing fluency in culturally-relevant contexts and activities (Schenker, 2013).

Conclusion:  Presently, no evidence has been found that bilingualism causes stuttering. Furthermore, treatment outcomes for bilingual children appear to be comparable to those of monolingual children. Bilingual SLPs encountering bilingual children who stutter are encouraged to provide stuttering treatment in the language the child is most proficient in. Monolingual SLPs encountering bilingual children are encouraged to provide stuttering treatment in English with the expectation that the treatment will carry over into the child’s birth language. All clinicians are encouraged to involve the children’s families in the stuttering treatment as well as utilize methods and interventions that are in agreement with the family’s cultural beliefs and values, in order to create optimum treatment outcomes for bilingual children who stutter.

References:

  1. Bernstein Ratner, N. (2004). Fluency and stuttering in bilingual children. In B. Goldstein (ed.). Language Development: a focus on the Spanish-English speaker. Baltimore, MD: Brookes. (287-310).
  2. Conture, E. G., & Curlee, R. F. (2007). Stuttering and related disorders of fl uency. New York, NY: Thieme Medical Publishers.
  3. De Houwer, A. (2009a). Bilingual first language acquisition. Bristol: Multilingual Matters.
  4. De Houwer, A. (2009b). Assessing lexical development in bilingual first language acquisition: What can we learn from monolingual norms? In M. Cruz-Ferreira (Ed.), Multilingual norms (pp. 279-322). Frankfurt: Peter Lang.
  5. German, D.J. (2005) Word-Finding Intervention Program, Second Edition (WFIP-2)Austin Texas: Pro.Ed
  6. Howell, P & Van Borsel, , (2011). Multicultural Aspects of Fluency Disorders, Multilingual Matters, Bristol, UK.
  7. Lim, V. P. C., Rickard Liow, S. J., Lincoln, M., Chan, Y. H., & Onslow, M. (2008). Determining language dominance in English–Mandarin bilinguals: Development of a selfreport classification tool for clinical use. Applied Psycholinguistics, 29, 389–412.
  8. Onslow M, Millard S. (2012). Palin Parent Child Interaction and the Lidcombe Program: Clarifying some issues. Journal of Fluency Disorders37(1 ):1-8.
  9. Tellis, G. & Tellis, C. (2003). Multicultural issues in school settings. Seminars in Speech and Language, 24, 21-26.
  10. Ramig, P. R., & Dodge, D. (2004, September 08). Fluency shaping intervention: Helpful, but why it is important to know more. Retrieved from http://www.mnsu.edu/comdis/isad7/papers/ramig7.html
  11. Reardon-Reeves, N., & Yaruss, J.S. (2013). School-age Stuttering Therapy: A Practical Guide. McKinney, TX: Stuttering Therapy Resources, Inc.
  12. Rousseau, I., Packman, A., & Onslow, M. (2005, June). A trial of the Lidcombe Program with school age stuttering children. Paper presented at the Speech Pathology National Conference, Canberra, Australia.
  13. Shenker, R. C. (2013). Bilingual myth-busters series. When young children who stutter are also bilingual: Some thoughts about assessment and treatment. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse (CLD) Populations, 20(1), 15-23.
  14. Stuttering Foundation website: Stuttering Risk Factors http://www.stutteringhelp.org/risk-factors
  15. Van Borsel, J. Maes, E., & Foulon, S. (2001). Stuttering and bilingualism: A review. Journal of Fluency Disorders, 26, 179-205.
  16. Waheed-Kahn, N. (1998). Fluency therapy with multilingual clients. In Healey, E. C. & Peters, H. F. M. (Eds.),Proceedings of the Second World Congress on Fluency Disorders, San Francisco, August 18. 22(pp. 195–199). Nijmegen, The Netherlands: Nijmegen University Press.
  17. Watson, J., & Kayser, H. (1994). Assessment of bilingual/bicultural adults who stutter. Seminars in Speech and Language, 15, 149-163.

 

 

 

 

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Speech Language Services and Insurance Coverage: What Parents Need to Know

insurance coverageBased on popular demand I created this 26 slide presentation to provide basic information regarding insurance coverage for common outpatient speech language assessment and therapy services. This handout contains important questions parents must ask when speaking to their insurance representatives regarding service coverage. —It lists common pediatric diagnostic (ICD-9) and therapeutic (CPT) codes as well as discusses common service exclusions in policies. —It also provides some suggestions on how to initiate appeals for denial of services and includes links to helpful resources parents can access to obtain further elaboration on the information provided in this presentation. Continue reading Speech Language Services and Insurance Coverage: What Parents Need to Know

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Normal Sequential Bilingual Language Development and Proficiency Attainment

Normal SequentialToday I am excited to introduce another product aimed at explaining one of the aspects of typical bilingual language development. This 31 page introductory material describes typical sequential bilingual language development. It is part of several comprehensive bilingual assessment materials found HERE as a part of a “Multicultural Assessment and Treatment Bundle”  AND  HERE as an individual product entitled “Language Difference vs. Language Disorder: Assessment & Intervention Strategies for SLPs Working with Bilingual Children“.

Learning objectives:
  • —Discuss types of sequential bilingualism
  • —List stages of bilingual language acquisition
  • —Explain the difference between additive and subtractive bilingualism
  • —Review  academic language functions hierarchy
  • —Describe Unified Competition Model
  • —Discuss differences in L2 acquisition in younger and older learners

Presentation Content

  • Sequential Bilingualism
  • Stages of Sequential Language Acquisition
  • Bilingualism categorizations
  • A Note on Subtractive Bilingualism
  • Maintaining L1 while Learning L2
  • Language Proficiency: Terminology
  • Acquisition Time Frames: L2 vs. IA
  • Second Language Acquisition Model
  • What is Academic Language?
  • Academic Language Functions Hierarchy
  • Is there an optimal period for bilingual language acquisition?
  • What is Unified Competition Model
  • Sensitive period for ‘native-like’ L2 acquisition
  • Who learns faster: younger or older children?
  • Let’s talk about younger L2 learners
  • Let’s talk about older learners (before puberty)
  • Let’s talk about older learners (after puberty)
  • Affect of Age on L2 Acquisition
  • Factors influencing success of older learners
  • Conclusion
  • Helpful Smart Speech Therapy Resources
  • References

Would you like a copy? You can find it HERE in my online store.

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Speech, Language, & Literacy Disorders in School Aged Children with Psychiatric Impairments

Recently I did a presentation for Rutgers University on the subject of  “Speech, Language, & Literacy Disorders in School-Aged Children with Psychiatric Impairments“. The learning objectives for this presentation were as follows:  

  • Explain the comorbidity between language impairments and psychiatric disturbances of school-aged children
  • Describe language and literacy deficits of school-aged children with psychiatric impairments
  • List warning signs of language and literacy deficits in school-aged children that warrant a referral to speech-language pathologists for a potential assessment

Continue reading Speech, Language, & Literacy Disorders in School Aged Children with Psychiatric Impairments