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Best Practices in Bilingual Literacy Assessments and Interventions

Speech Language Intervention Approaches for Bilingual Children

Professional Portfolio

Workshops, Lectures, Presentations and Webinars

Elleseff, T (2021, Dec 3). Components of Comprehensive Preschool Evaluations. POWER UP Online Conference, Lavi Institute.
Elleseff, T (2021, Dec 2). Targeted Pragmatic Assessments of School-Aged Children with Psychiatric Diagnoses. POWER UP Online Conference, Lavi Institute.
Elleseff, T (2021, Nov 2). Inattention, Hyperactivity and Impulsivity in At-Risk Children: Differential Diagnosis of ADHD in Speech Language Pathology: Focus on Assessment and Treatment. Webinar for Garfield Public Schools. Garfield, NJ.
Elleseff, T (2021, Oct 20) Reading Disorders 101: A Tutorial for Parents and Professionals. Webinar for the Apraxia Kids, Pittsburg, PA.
Elleseff, T (2021, Sep 30) On the Value of Language Assessments for Children with Confirmed/Suspected Dyslexia. Webinar for the Kansas Speech Language Hearing Association Convention, Wichita, KS.
Elleseff, T (2021, Sep 30) Improving Critical Thinking Skills via Use of Picture Books in Children with Language Disorders. Webinar for the Kansas Speech Language Hearing Association Convention, Wichita, KS.
Elleseff, T (2021, Sep 2). Practical Strategies for Monolingual SLPs Assessing and Treating Bilingual Children. Elmont Union Free School District Webinar, Elmont, NY.
Elleseff, T (2021, Aug 25). A Reading Program is NOT Enough: A Deep Dive into the Dyslexia Diagnosis. International Dyslexia Association Georgia Branch Webinar. Atlanta, GA.
Elleseff, T (2021, Aug 5). Clinical Assessment of Grade-Level Reading Abilities: Focus on Fluency and Comprehension. CEU SmartHub Recorded Webinar, Lavi Institute.
Elleseff, T (2021, Aug 5). Teaching Emergent Readers via the Synthetic Phonics Approach. CEU SmartHub Recorded Webinar, Lavi Institute.
Elleseff, T (2021, Jul 16). Improving Critical Thinking Skills via Use of Picture Books in Children with Language Disorders. The Ohio School Speech Pathology Educational Audiology Coalition Online Webinar
Elleseff, T (2021, Jul 16). Strategies for Monolingual SLPs Assessing and Treating Bilingual Children. The Ohio School Speech Pathology Educational Audiology Coalition Online Webinar
Elleseff, T (2021, Jul 15). Assessing Social Skills in Children with Psychiatric Disturbances. The Ohio School Speech Pathology Educational Audiology Coalition Online Webinar
Elleseff, T (2021, Jun 9). Auditory Processing Disorder Diagnosis: Science or Pseudoscience? International Dyslexia Association Georgia Branch Online Webinar.
Elleseff, T (2021, Mar 5). Accurate Test Selection for Assessment Purposes. POWER UP Online Conference, Lavi Institute.
Elleseff, T (2021, Mar 4). Behavior Management for SLPs. POWER UP Online Conference, Lavi Institute.
Elleseff, T (2021, Mar 4). Background History Matters: Conducting IEEs. POWER UP Online Conference, Lavi Institute.
Elleseff, T (2020, Dec 29). Neuropsychological or Language/Literacy Assessment: Which One is Right for the Student? International Dyslexia Association Georgia Branch Online Webinar.
Elleseff, T (2020, Dec 2). Clinical Assessment of Narrative Skills. POWER UP Online Conference, Lavi Institute.
Elleseff, T (2020, Oct 20) How Language Affects Reading: What Parents and Professionals Need to Know. BUILD Tredyffrin-Easttown. Online Webinar.
Elleseff, T (2020, Aug 27) Measurement and Interpretation of Standardized Reading Assessments for Professionals and Parents (Webinar) EBP REEL TALK, Smart Speech Therapy LLC
Elleseff, T (2020, Aug 04) Components of Effective Reading Intervention. POWER UP Online Conference, Lavi Institute.
Elleseff, T (2020, Aug 03) Improving Critical Thinking Skills via Use of Picture Books in Children with Language Disorders. POWER UP, Online Conference, Lavi Institute.
Elleseff, T (2020, Feb 27) Assessing Preschool Children with Challenging Behaviors. American Speech Language and Hearing Association Online Conference. Rockville, MD
Elleseff, T (2019, Oct 19) On the Value of Language Assessments for Children with Confirmed/Suspected Dyslexia. 41^st Annual Conference of the Pennsylvania Branch, International Dyslexia Association (PBIDA). West Conshohocken, PA
Elleseff, T (2019, Oct 18) Comorbidity of Language and Literacy Disorders in Children With Psychiatric Impairments: What Psychiatrists Need to Know. 66^th Annual Meeting of the American Academy of Child and Adolescent Psychiatry. Chicago, IL
Elleseff, T (2019, Oct 16) Assessing Preschool Children with Challenging Behaviors. American Speech Language and Hearing Association Online Conference. Rockville, MD
Elleseff, T (2019, Jul 19-21) Behavior Management Strategies for SLPs. American Speech Language and Hearing Association Schools Connect Conference. Chicago, IL
Elleseff, T (2019, Jul 19-21) Speech-Language Assessment and Treatment of Children with Alcohol-Related Disorders. American Speech Language and Hearing Association Schools Connect Conference. Chicago, IL
Elleseff, T (2019, Jul 19-21) Language Difference vs. Disorder: Assessment Strategies for Children Who Are Bilingual. American Speech Language and Hearing Association Schools Connect Conference. Chicago, IL
Elleseff, T (2019, Jun 5) From Wordless Picture Books to Reading Instruction: Effective Strategies for SLPs Working with Intellectually Impaired Students. Workshop for the New York City Board of Education – District 9, Brooklyn, NY
Elleseff, T (2019, May 15) Assessing Social Communication from Toddlerhood through Adolescence: What SLPs need to Know. Workshop for the Hamilton County Educational Service Center, Cincinnati, OH.
Elleseff, T & Caruso, C (2019, May 2) Research-Based Treatment Approaches for Childhood Apraxia of Speech Workshop for the New Jersey Speech Language Hearing Association Convention, Long Branch, NJ
Elleseff, T (2019, May 1) Practical Strategies for Monolingual SLPs Assessing Bilingual Children Workshop for the New Jersey Speech Language Hearing Association Convention, Long Branch, NJ
Elleseff, T (2019, Feb 20) Assessing Preschool Children with Challenging Behaviors Presented for the American Speech Language and Hearing Association Online Conference. Rockville, MD
Elleseff, T (2018, Nov 15) Practical Strategies for Monolingual SLPs Assessing Bilingual Children Presented for the American Speech Language and Hearing Association Convention. Boston, MA
Elleseff, T (2018, Oct 25) Behavior Management Strategies for Speech-Language Pathologists. Presented for the Milestone Therapeutic Services, Washington, DC.
Elleseff, T (2018, Oct 19) Behavior Management Strategies for Speech-Language Pathologists. Scheduled presentation for the Clinical Connection Conference of the Maryland Speech Language and Hearing Association, Baltimore, MD
Elleseff, T (2018, Sep 26) Red Flags for Undiagnosed Fetal Alcohol Spectrum Disorders in Children and Adolescents Rutgers Health UBHC Monthly Child Division Lecture Series, Piscataway, NJ
Elleseff, T (2018, May 22) Speech, Language, & Literacy Disorders in School Aged Children with Psychiatric Impairments Rutgers Health UBHC Monthly Child Division Lecture Series, Piscataway, NJ
Elleseff, T (2018, Feb 16) Impact of Cultural and Linguistic Variables On Speech-Language Services presented for the Eatontown Board of Education, Eatontown, NJ
Elleseff, T (2018, Jan 9) Normal Simultaneous Bilingual Language Development and Milestones Acquisition. Webinar presented for the New Jersey Speech Language and Hearing Association. Princeton, NJ.
Elleseff, T (2017, Nov 14) Best Practices in Bilingual Language and Literacy Interventions. Webinar presented for the Speech-Language & Audiology Canada.
Elleseff, T (2017, Nov 11) Practical Strategies for Monolingual SLPs Assessing Bilingual Children Presented for the American Speech Language and Hearing Association Convention. Los Angeles, CA.
Elleseff, T (2017, Nov 7) Assessment and Treatment of Social-Communication Deficits in Children With/out Psychiatric Impairments. Workshop presented for the Butler County Educational Service Center, Hamilton, OH.
Elleseff, T (2017, Oct 19 & 26) From First Words through Preschool: Recognizing the Warning Signs of Language Delay. Development through the Life Cycle Lecture Series. Presented for the Child and Adolescent Psychiatry Medical Residents Rutgers University/Robert Wood Johnson Medical School, Piscataway, NJ
Elleseff, T (2017, Oct 19) Recognizing and Assessing Primary Language Impairment in Bilingual Learners. Webinar presented for the Speech-Language & Audiology Canada.
Elleseff, T (2017, June 15) Behavior Management for SLPs and Assessment of Social Communication in Children with Psychiatric Impairments Workshop presented for the Los Angeles Unified School District, Los Angeles, CA
Elleseff, T; Caruso, C (2017, Apr 28) Bilingualism: Birth to Adulthood. Workshop presented at the New Jersey Speech Language Hearing Association Convention, Long Branch, NJ
Elleseff, T (2017, Apr 24) From Wordless Picture Books to Reading Instruction: Effective Strategies for SLPs Working with Intellectually Impaired Students. Workshop presented for the New York City Board of Education – District 75, NY, NY
Elleseff, T (2017, Mar 24) Best Practices in Bilingual Language and Literacy Interventions. Workshop presented for the Speech-Language & Audiology Canada, Montreal, Canada
Elleseff, T (2016, Dec 7) Best Practices in Bilingual Language and Literacy Interventions. Workshop presented for the New York City Department of Education: Bilingual Providers Conference. Woodside, NY.
Elleseff, T (2016, Nov 8) Narrative Assessments of Preschool and School Aged Children. Webinar presented for the Greenwich Public Schools, Greenwich CT
Elleseff, T (2016, Nov 1). Recognizing the Warning Signs of Social Emotional Difficulties in Language Impaired Toddlers and Preschoolers Workshop presented for the Regional Professional Development Academy. Eatontown, NJ.
Elleseff, T (2016, Oct 13 & 20) From First Words through Preschool: Recognizing the Warning Signs of Language Delay. Development Through the Life Cycle Lecture Series. Presented for the Child and Adolescent Psychiatry Fellows Rutgers University/Robert Wood Johnson Medical School, Piscataway, NJ
Elleseff, T (2016, Oct 11) Psychiatric Impairments and Language Disorders in School Aged Children. Presented for the Child and Adolescent Psychiatry Residents Rutgers University/Robert Wood Johnson Medical School, Piscataway, NJ
Elleseff, T (2016, Oct 10) Introduction to Dyslexia and Learning Disabilities. Lecture presented at Rutgers University Behavioral Health Care: Rutgers Day School. Piscataway, NJ.
Elleseff, T (2016, Oct 5) Differential Assessment and Treatment of Processing Disorders in Speech Language Pathology. Workshop presented for the Wayne County Speech Language Hearing Association, Livonia, MI
Elleseff, T (2016, July 13) Practical Strategies for Monolingual SLPs Assessing and Treating Bilingual Children. Workshop presented for the Long Island Speech Language Hearing Association, Hauppauge, NY
Elleseff, T (2016, May 25) Strategies for Monolingual SLPs Treating Bilingual Children New York City Department of Education: Monolingual Providers Conference. NY, NY.
Wesler, J & Elleseff, T (2016, Apr 14) Overview of NJ Education Mandates: The Law and the SLP Workshop presented at the New Jersey Speech Language Hearing Association Convention, Long Branch, NJ
Elleseff, T (2016, Mar 4) Assessment and Treatment of Non-Verbal Language Disorder (NVLD) in Speech Language Pathology Workshop presented at the Mississippi Speech Language Hearing Association, Jackson, MS.
Elleseff, T (2016, Mar 3) Creating a Functional Therapy Plan and Selecting Clinical Materials for Pediatric Therapy Workshop presented at the Mississippi Speech Language Hearing Association, Jackson, MS.
Elleseff, T (2016, Feb 15) Differential Diagnosis of ADHD (and C/APD) in Speech Language Pathology. Workshop presented for the Montville Public Schools. Montville, NJ.
Elleseff, T (2015, Dec 4) Translanguaging in the classroom: Tips for educators on enrichment multicultural activities. Session presented at the William Paterson University 35^th Bilingual/ESL Conference. Wayne, NJ.
Elleseff, T (2015, Dec 3) Assessing and Treating Bilingual Children: Practical Strategies for SLPs. New York City Department of Education: Bilingual Providers Conference. Woodside, NY.
Elleseff, T (2015, Nov 3) Assessing Social Communication Skills of School Aged Children Workshop presented for the Linden Public Schools, Linden, NJ.
Elleseff, T (2015, Oct 25) Assessment of Children With/Without Psychiatric and Emotional Disturbances from Preschool through Adolescence. Northeastern Speech-Language-Hearing Association of Pennsylvania Pocono Manor, PA.
Elleseff, T (2015, Oct 15) Inattention, Hyperactivity and Impulsivity in At-Risk Children: Differential Diagnosis of ADHD in Speech Language Pathology and Education. Regional Professional Development Academy. Eatontown, NJ.
Elleseff, T (2015, Sept 1) Assessment of Children With/Without Psychiatric and Emotional Disturbances from Preschool through Adolescence Workshop presented for the Rahway Public Schools, Rahway, NJ
Caruso, C & Elleseff, T (2015, April 30) Working with CLD Populations: An Interactive Student Experience. Workshop presented at the New Jersey Speech Language Hearing Association Convention, Long Branch, NJ
Elleseff, T (2015, Feb 13) Assessment and Treatment of Social Pragmatic Deficits in School Aged Children. Workshop presented at the 2015 Annual Illinois Speech Hearing Language Association, Chicago, IL
Elleseff, T (2014, Dec 5) CLD Learners’ Pathway to Success: A Lexical Enhancement Approach. Session presented at the William Paterson University 34^th Bilingual/ESL Conference. Wayne, NJ.
Elleseff, T (2014, Nov 10) Creating a Functional Therapy Plan: Therapy Goals & SOAP Note Documentation. Webinar presented for speechpathology.com, San Antonio, TX
Elleseff, T (2014, Nov 6) Impact of Cultural and Linguistic Variables on Speech-Language Services. Guest lecture presented at Seton Hall University, South Orange, NJ.
Elleseff, T (2014, May 6) Narrative Assessments of Preschool and School Aged Children. Workshop presented at the Union County Speech and Hearing Association, New Providence, NJ.
Elleseff, T (2014, May 2). Speech Language Assessment of Older Internationally Adopted Children. Workshop presented at the New Jersey Speech Language Hearing Association Convention, Long Branch, NJ
Elleseff, T (2014, Mar 21) Assessment and Treatment of Social Pragmatic Deficits in School Aged Children. Lecture presented at the 11th Annual Symposium for Speech Language Specialists. Rowan University, Glassboro, NJ
Elleseff, T (2014, Jan 14) Executive Function Impairment and At-Risk Populations. Webinar presented for Advance for Speech Language Pathologists and Audiologists.
Elleseff, T (2013, Oct 29) Assessing Social Functioning in Language Impaired Young Children. Webinar presented for Advance for Speech Language Pathologists and Audiologists.
Elleseff, T (2013, Oct 17 & 24) From First Words through Preschool: Recognizing the Warning Signs of Language Delay. Development Through the Life Cycle Lecture Series scheduled for the Child and Adolescent Psychiatry Fellows Rutgers University/Robert Wood Johnson Medical School, Piscataway, NJ
Gordina, A, Elleseff, T (2013, Aug 10) Inattention, Hyperactivity and Impulsivity in Adopted and Foster Children. Workshop presented at the 39^th North American Council on Adoptable Children, Toronto, CA.
Elleseff, T (2013, Jul 16) Impact of Cultural and Linguistic Variables on Speech-Language Services. Webinar presented for the New Jersey Speech Language Hearing Association. Princeton, NJ.
Elleseff, T (2013, May 20) Language Difference vs. Language Disorder: An Overview of Assessment and Intervention Strategies for Speech Language Pathologists Working with Bilingual Children. Workshop presented for the Warren County Speech, Language, Hearing Association, Hackettstown, NJ.
Elleseff, T (2013, Mar 25) Fetal Alcohol Spectrum Disorders Part II: Assessment & Intervention. Webinar presented for speechpathology.com, San Antonio, TX
Elleseff, T (2013, Feb 5) Selecting Clinical Materials for Pediatric Therapy. Guest lecture presented at Seton Hall University, South Orange, NJ.
Elleseff, T (2013, Jan 28) Fetal Alcohol Spectrum Disorders Part I: Overview of Deficits. Webinar presented for speechpathology.com, San Antonio, TX
Elleseff, T (2013, Jan 22) Creating a Functional Therapy Plan: Therapy Goals & SOAP Note Documentation. Guest lecture presented at Seton Hall University, South Orange, NJ.
Elleseff, T (2013, Jan 17) Inattention, Hyperactivity and Impulsivity In At Risk Children: Differential Diagnosis of ADHD in Speech Language Pathology. Webinar presented for Advance for Speech Language Pathologists and Audiologists.
Gordina, A, Elleseff, T. (2013, Jan 13). Inattention, Hyperactivity and Impulsivity in Adopted and Foster Children. Workshop presented at the New Jersey’s 31^stAnnual “Let’s Talk Adoption”^sm Conference Piscataway, NJ
Gordina, A, Elleseff, T. (2013, Jan 13). Sobering Thoughts on Attitudes Towards the Fetal Alcohol Spectrum Disorders. Workshop presented at the New Jersey’s 31^st Annual “Let’s Talk Adoption”^sm Conference Piscataway, NJ
Elleseff, T (2013, Nov 15) Language Difference vs. Language Disorder: Assessment & Intervention Strategies for SLPs Working with Bilingual Children. Workshop presented for Educational Service Unit #3, Omaha, NE.
Elleseff, T (2012, Oct 28) Behavior Management Strategies for Related Professionals. Session presented for the New Jersey Occupational Therapy Association, 38th Annual Convention. Seton Hall University, South Orange, NJ.
Elleseff, T (2012, Oct 24) Narrative Assessments of Preschool and School Aged Children. Session presented for the Morris County Speech and Hearing Association, Whippany, NJ.
Elleseff, T (2012, Oct 18) Psychiatric Impairments and Language Disorders in School Aged Children:
Why Psychiatrists and Speech Pathologists Should Collaborate More Together. Development Through the Life Cycle Lecture Series for the Child and Adolescent Psychiatry Fellows University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School, Piscataway, NJ
Elleseff, T (2012, Oct 11) From First Words through Preschool: Recognizing the Warning Signs of Language Delay. Development Through the Life Cycle Lecture Series for the Child and Adolescent Psychiatry Fellows University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School, Piscataway, NJ
Gordina, A, Elleseff, T, & Shifrin, L (2012, Jul 27) Inattention, Hyperactivity and Impulsivity in Adopted and Foster Children. Workshop presented at the 38^th North American Council on Adoptable Children, Crystal City, VA.
Elleseff, T (2012, July) Improving Social Skills of Children with Psychiatric Disturbances. Webinar presented for speechpathology.com, San Antonio, TX
Elleseff, T (2012, May) Assessing Social Skills of Children with Psychiatric Disturbances. Webinar presented for speechpathology.com, San Antonio, TX
Elleseff, T (2012, April) Behavior Management Strategies for School Based Speech Language Pathologists Workshop presented at New Jersey Speech Language Hearing Association Convention, Long Branch, NJ
Elleseff, T (2012, April) Social Pragmatic Assessment of Children Diagnosed with Emotional/Psychiatric Disturbances in the Schools. Workshop presented at New Jersey Speech Language Hearing Association Convention, Long Branch, NJ
Elleseff, T (2012, Jan) Special Considerations and Challenges in Assessment and Treatment of Bilingual Children with Developmental Disabilities. Workshop presented for Middlesex Regional Educational Services Commission, Metuchen NJ.
Gordina, A & Elleseff, T (2011, Oct) A Case of Isolated Social Pragmatic Language Deficits and Sensory Integration Dysfunction in an Internationally Adopted Child: Implications for Medical Referral Workshop presented at the American Academy of Pediatrics: Council on Foster Care, Adoption and Kinship Care, Boston, MA.
Gordina, A, Elleseff, T, & Shifrin, L (2011, Oct) Inattention, Hyperactivity and Impulsivity in At-Risk Children Workshop presented at the Opening Doors: Partnerships for Prevention and Healing, New Jersey Taskforce on Child Abuse and Neglect, East Brunswick, NJ.
Elleseff, T (2011, June) The Role of Frontal Lobe in Speech and Language Functions. Lecture presented at the University of Medicine and Dentistry of New Jersey: Child Therapeutic Day Program. Piscataway, NJ.

Article Publications

Elleseff, T (2016) Embracing ‘Translanguaging’ Practices: A Tutorial for SLPs New Jersey Speech Language Hearing Association. VOICES, Summer, 9.
Elleseff, T (2015, Aug). Assessing social communication of school-aged children Perspectives on School-Based Issues 16 (3): 79-86
Caruso, C, Concepcion-Escano, Y & Elleseff, T (2015, Jan). Technical Manual: A guide for the appropriate assessment of culturally & linguistically diverse and internationally adopted individuals. New Jersey Speech Language Hearing Association.
Elleseff, T (2014). Creating Successful Team Collaboration: Behavior Management in the Schools. Perspectives on School-Based Issues, 15(1): 37-43.
Elleseff, T (2014). ELL Spotlight on Russian: Considerations for Assessment and Treatment. New Jersey Speech Language Hearing Association: VOICES, Winter: 9-11.
Elleseff, T (2013, Dec) Recognizing FASD-Related Speech and Language Deficits in Internationally Adopted Children. National Adoption Advocate. No. 66, pp 1-8.
Elleseff, T(2013) Changing Trends in International Adoption: Implications for Speech-Language Pathologists. Perspectives on Global Issues in Communication Sciences and Related Disorders, 3: 45-53
Elleseff, T (2013, Aug) FASD and Background History Collection: Asking the Right Questions Adoption Today, pp 32-35.
Elleseff, T (2012, Dec 24) Understanding the risks of social pragmatic deficits in post institutionalized internationally adopted children. Published in Advance for Speech Language Pathologists and Audiologists. Pp 6-9.
Elleseff, T (Jan 2, 2012) Speech-Language Strategies for Multisensory Stimulation of Internationally Adopted Children: Activity Suggestions for Parents and Professionals. Adoption Today Magazine. pp 40-43.
Elleseff, T (Nov 16, 2011) The importance of pediatric orofacial assessments in speech pathology. Advance for Speech Language Pathologists and Audiologists
Elleseff, T (Oct 1, 2011) Understanding the extent of speech and language delays in older internationally adopted children: Implications for School Based Speech and Language Intervention Adoption Today Magazine, pp 32-35
Elleseff, T (June 6, 2011) Differential diagnosis of AD/HD and Auditory Processing Disorders in Internationally Adopted School Age Children Post Adoption Learning Center, International Adoptions Articles Directory
Elleseff, T (Mar 14, 2011) What are social pragmatic language deficits and how do they impact international adoptees years post adoption? Post Adoption Learning Center, International Adoptions Articles Directory
Elleseff, T (Feb 23, 2011) A case for early speech-language assessments of adopted children in the child’s birth language Post Adoption Learning Center, International Adoptions Articles Directory
Elleseff, T (June 30, 2009) How to improve the feeding abilities of young adopted picky eaters Post Adoption Learning Center, International Adoptions Articles Directory
Elleseff, T (May 27, 2009) Speech Language Services and Insurance Coverage: What Parents Need to Know Post Adoption Learning Center, International Adoptions Articles Directory
Elleseff, T (May 11, 2009) How to select the right speech language pathologist for your adopted child? Post Adoption Learning Center, International Adoptions Articles Directory
Elleseff, T (Feb 20, 2009) Functional Strategies for Improving the Language Abilities of Your Adopted School-Age Child Post Adoption Learning Center, International Adoptions Articles Directory
Elleseff, T (Feb 15, 2009) Creating a learning rich environment to facilitate language development in adopted preschoolers. Post Adoption Learning Center, International Adoptions Articles Directory

ASHA Leader Blog Contributions:

Elleseff, T (Jul 19, 2016) Assessing Students: Why Background History Matters
Elleseff, T (Oct 15, 2015) Why the Phrase ‘It’s Not So Bad’ Causes Treatment Problems
Elleseff, T (Feb 19, 2015) How to Evaluate Misbehavior
Elleseff, T (Oct 1, 2013) A Tool to Help Children Ask for Help
Elleseff, T (Sept 17, 2013) Why Suspected Childhood Apraxia of Speech Requires Careful Assessment
Elleseff, T (Nov 28, 2012) “Appdapting” Flashcard Apps to Address Social Skills.
Elleseff, T (Oct 29, 2012) Therapy Fun with Ready Made Fall and Halloween Bingo.
Elleseff, T (Aug 14, 2012) Adventures in Word Finding or is Their Language Comprehension Really THAT Bad?
Elleseff, T (Jul 3, 2012) Dinner with Friends or the Value of interdisciplinary Collaboration and Follow-Up
Elleseff, T (Mar 6, 2012) Multicultural Considerations in Assessment of Play.
Elleseff, T (Nov 3, 2011) Speech-Language Activity Suggestions for Multisensory Stimulation of At-Risk Children.
Elleseff, T (Aug 4, 2011) Improving Pragmatic and Social Cognitive Abilities of Children with Psychiatric Disturbances.

Language Difference vs. Language Disorder: Assessment & Intervention Strategies for SLPs Working with Bilingual Children

Posted on March 14, 2011January 5, 2022 by Tatyana Elleseff — 3 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

When to seek private pragmatic language evaluation and therapy services?

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

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

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

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

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

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

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

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

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

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

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

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

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

References

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

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

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

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

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

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

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

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

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

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

Overview of Select Standardized Tests Limitations for Monolingual and Bilingual Children

Posted on January 23, 2017January 5, 2022 by Tatyana Elleseff — Leave a comment

Dear SLPs, Here’s What You Need to Know About Internationally Adopted Children

In the past several years there has been a sharp decline in international adoptions. Whereas in 2004, Americans adopted a record high of 22,989 children from overseas, in 2015, only 5,647 children (a record low in 30 years) were adopted from abroad by American citizens.

Primary Data Source: Data Source: U.S. State Department Intercountry Adoption Statistics

Secondary Data Source: Why Did International Adoption Suddenly End?

Despite a sharp decline in adoptions many SLPs still frequently continue to receive internationally adopted (IA) children for assessment as well as treatment – immediately post adoption as well as a number of years post-institutionalization.

In the age of social media, it may be very easy to pose questions and receive instantaneous responses on platforms such as Facebook and Twitter with respect to assessment and treatment recommendations. However, it is very important to understand that many SLPs, who lack direct clinical experience in international adoptions may chime in with inappropriate recommendations with respect to the assessment or treatment of these children.

Consequently, it is important to identify reputable sources of information when it comes to speech-language assessment of internationally adopted children.

There are a number of researchers in both US and abroad who specialize in speech-language abilities of Internationally Adopted children. This list includes (but is by far not limited to) the following authors:

The works of these researchers can be readily accessed in the ASHA Journals or via ResearchGate.

Meanwhile, here are some basic facts regarding internationally adopted children that all SLPs and parents need to know.

Demographics:

A greater number of older, preschool and school-aged children and fewer number of infants and toddlers are placed for adoption (Selman, 2012).

Significant increase in special needs adoptions from Eastern European countries (e.g., Ukraine, Kazhakstan, etc.) as well as China. The vast majority of Internationally Adopted children arrive to the United States with significant physical, linguistic, and cognitive disabilities as well as mental health problems. Consequently, it is important for schools to immediately provide the children with a host of services including speech-language therapy, immediately post-arrival.

It is also important to know that in the vast majority of cases the child’s linguistic, cognitive, or mental health deficits may not be documented in the adoption records due to poor record keeping, lack of access to adequate healthcare or often to ensure their “adoptability”. As such, parental interviews and anecdotal evidence become the primary source of information regarding these children’s social and academic functioning in their respective birth countries.

The question of bilingualism:

Internationally Adopted children are NOT bilingual children! In fact, the vast majority of internationally adopted children will very rapidly lose their birth language, in a period of 2-3 months post arrival (Gindis, 2005), since they are most often adopted by parents who do not speak the child’s birth language and as such are unable/unwilling to maintain it.

IA children do not need to be placed in ESL classes since they are not bilingual children. Not only are IA children not bilingual, they are also not ‘truly’ monolingual since their first language is lost rather rapidly, while their second language has been gained minimally at the time of loss.

IA children need to acquire Cognitive Language Mastery (CLM) which is language needed for formal academic learning. This includes listening, speaking, reading, and writing about subject area content material including analyzing, synthesizing, judging and evaluating presented information. This level of language learning is essential for a child to succeed in school. CLM takes years and years to master, especially because, IA children did not have the same foundation of knowledge and stimulation as bilingual children in their birth countries.

Assessment Parameters:

IA children’s language abilities should be retested and monitored at regular intervals during the first several years post arrival.

Glennen (2007) recommends 3 evaluations during the first year post arrival, with annual reevaluations thereafter.

Hough & Kaczmarek (2011) recommend a reevaluation schedule of 3-4 times a year for a period of two years, post arrival because some IA children continue to present with language-based deficits many years (5+) post-adoption.

If an SLP speaking the child’s first language is available the window of opportunity to assess in the first language is very limited (~2-3 months at most).

Similarly, an assessment with an interpreter is recommended immediately post arrival from the birth country for a period of approximately the same time.

If an SLP speaking the child’s first language is not available English-speaking SLP should consider assessing the child in English between 3-6 months post arrival (depending on the child and the situational constraints) in order to determine the speed with which s/he are acquiring English language abilities
- Children should be demonstrating rapid language gains in the areas of receptive language, vocabulary as well as articulation (Glennen 2007, 2009)
- Dynamic assessment is highly recommended

It is important to remember that language and literacy deficits are not always very apparent and can manifest during any given period post arrival

To treat or NOT to Treat?

“Any child with a known history of speech and language delays in the sending country should be considered to have true delays or disorders and should receive speech and language services after adoption.” (Glennen, 2009, p.52)

IA children with medical diagnoses, which impact their speech language abilities should be assessed and considered for S-L therapy services as well (Ladage, 2009).

Helpful Links:

References:

Gindis, B. (2005). Cognitive, language, and educational issues of children adopted from overseas orphanages. Journal of Cognitive Education and Psychology, 4 (3): 290-315.
Glennen, S (2009) Speech and language guidelines for children adopted from abroad at older ages. Topics in language Disorders 29, 50-64.
Ladage, J. S. (2009). Medical Issues in International Adoption and Their Influence on Language Development. Topics in Language Disorders , 29 (1), 6-17.
Selman P. (2012) Global trends in Intercountry Adoption 2000-2010. New York: National Council for Adoption, 2012.
Selman P. T he global decline of intercountry adoption: What lies ahead?. Social Policy and Society 2012, 11(3), 381-397.

Additional Helpful References:

Abrines, N., Barcons, N., Brun, C., Marre, D., Sartini, C., & Fumadó, V. (2012). Comparing ADHD symptom levels in children adopted from Eastern Europe and from other regions: discussing possible factors involved. Children and Youth Services Review, 34 (9) 1903-1908.
Balachova, T et al (2010). Changing physicians’ knowledge, skills and attitudes to prevent FASD in Russia: 800. Alcoholism: Clinical & Experimental Research. 34(6) Sup 2:210A.
Barcons-Castel, N, Fornieles-Deu,A, & Costas-Moragas, C (2011). International adoption: assessment of adaptive and maladaptive behavior of adopted minors in Spain. The Spanish Journal of Psychology, 14 (1): 123-132.
Beverly, B., McGuinness, T., & Blanton, D. (2008). Communication challenges for children adopted from the former Soviet Union. Language, Speech, and Hearing Services in Schools, 39, 1-11.
Cohen, N. & Barwick, M. (1996). Comorbidity of language and social-emotional disorders: comparison of psychiatric outpatients and their siblings. Journal of Clinical Child Psychology, 25(2), 192-200.
Croft, C et al, (2007). Early adolescent outcomes of institutionally-deprived and nondeprived adoptees: II. Language as a protective factor and a vulnerable outcome. The Journal of Child Psychology and Psychiatry, 48, 31–44.
Dalen, M. (2001). School performances among internationally adopted children in Norway. Adoption Quarterly, 5(2), 39-57.
Dalen, M. (1995). Learning difficulties among inter-country adopted children. Nordisk pedagogikk, 15 (No. 4), 195-208
Davies, J., & Bledsoe, J. (2005). Prenatal alcohol and drug exposures in adoption. Pediatric Clinics of North America, 52, 1369–1393.
Desmarais, C., Roeber, B. J., Smith, M. E., & Pollak, S. D. (2012). Sentence comprehension in post-institutionalized school-age children. Journal of Speech, Language, and Hearing Research, 55, 45-54
Eigsti, I. M., Weitzman, C., Schuh, J. M., de Marchena, A., & Casey, B. J. (2011). Language and cognitive outcomes in internationally adopted children. Development and Psychopathology, 23, 629-646.
Geren, J., Snedeker, J., & Ax, L. (2005). Starting over: a preliminary study of early lexical and syntactic development in internationally-adopted preschoolers. Seminars in Speech & Language, 26:44-54.
Gindis (2008) Abrupt native language loss in international adoptees. Advance for Speech/Language Pathologists and Audiologists. 18(51): 5.
Gindis, B. (2005). Cognitive, language, and educational issues of children adopted from overseas orphanages. Journal of Cognitive Education and Psychology, 4 (3): 290-315. Gindis, B. (1999) Language-related issues for international adoptees and adoptive families. In: T. Tepper, L. Hannon, D. Sandstrom, Eds. “International Adoption: Challenges and Opportunities.” PNPIC, Meadow Lands , PA. , pp. 98-108
Glennen, S (2009) Speech and language guidelines for children adopted from abroad at older ages. Topics in language Disorders 29, 50-64.
Glennen, S. (2007) Speech and language in children adopted internationally at older ages. Perspectives on Communication Disorders in Culturally and Linguistically Diverse Populations, 14, 17–20.
Glennen, S., & Bright, B. J. (2005). Five years later: language in school-age internally adopted children. Seminars in Speech and Language, 26, 86-101.
Glennen, S. & Masters, G. (2002). Typical and atypical language development in infants and toddlers adopted from Eastern Europe. American Journal of Speech-Language Pathology, 44, 417-433
Gordina, A (2009) Parent Handout: The Dream Referral, Unpublished Manuscript.
Hough, S., & Kaczmarek, L. (2011). Language and reading outcomes in young children adopted from Eastern European orphanages. Journal of Early Intervention, 33, 51-57.
Hwa-Froelich, D (2012) Childhood maltreatment and communication development. Perspectives on School-Based Issues, 13: 43-53;
Jacobs, E., Miller, L. C., & Tirella, G. (2010). Developmental and behavioral performance of internationally adopted preschoolers: a pilot study. Child Psychiatry and Human Development, 41, 15–29.
Jenista, J., & Chapman, D. (1987). Medical problems of foreign-born adopted children. American Journal of Diseases of Children, 141, 298–302.
Johnson, D. (2000). Long-term medical issues in international adoptees. Pediatric Annals, 29, 234–241.
Judge, S. (2003). Developmental recovery and deficit in children adopted from Eastern European orphanages. Child Psychiatry and Human Development, 34, 49–62.
Krakow, R. A., & Roberts, J. (2003). Acquisitions of English vocabulary by young Chinese adoptees. Journal of Multilingual Communication Disorders, 1, 169-176
Ladage, J. S. (2009). Medical issues in international adoption and their influence on language development. Topics in Language Disorders , 29 (1), 6-17.
Loman, M. M., Wiik, K. L., Frenn, K. A., Pollak, S. D., & Gunnar, M. R. (2009). Post-institutionalized children’s development: growth, cognitive, and language outcomes. Journal of Developmental Behavioral Pediatrics, 30, 426–434.
McLaughlin, B., Gesi Blanchard, A., & Osanai, Y. (1995). Assessing language development in bilingual preschool children. Washington, D.C.: National Clearinghouse for Bilingual Education.
Miller, L., Chan, W., Litvinova, A., Rubin, A., Tirella, L., & Cermak, S. (2007). Medical diagnoses and growth of children residing in Russian orphanages. Acta Paediatrica, 96, 1765–1769.
Miller, L., Chan, W., Litvinova, A., Rubin, A., Comfort, K., Tirella, L., et al. (2006). Fetal alcohol spectrum disorders in children residing in Russian orphanages: A phenotypic survey. Alcoholism: Clinical and Experimental Research, 30, 531–538.
Miller, L. (2005). Preadoption counseling and evaluation of the referral. In L. Miller (Ed.), The Handbook of International Adoption Medicine (pp. 67-86). NewYork: Oxford.
Pollock, K. E. (2005) Early language growth in children adopted from China: preliminary normative data. Seminars in Speech and Language, 26, 22-32.
Roberts, J., Pollock, K., Krakow, R., Price, J., Fulmer, K., & Wang, P. (2005). Language development in preschool-aged children adopted from China. Journal of Speech, Language, and Hearing Research, 48, 93–107.
Scott, K.A., Roberts, J.A., & Glennen, S. (2011). How well children who are internationally do adopted acquire language? A meta-analysis. Journal of Speech, Language and Hearing Research, 54. 1153-69.
Scott, K.A., & Roberts, J. (2011). Making evidence-based decisions for children who are internationally adopted. Evidence-Based Practice Briefs. 6(3), 1-16.
Scott, K.A., & Roberts, J. (2007) language development of internationally adopted children: the school-age years. Perspectives on Communication Disorders in Culturally and Linguistically Diverse Populations, 14: 12-17.
Selman P. (2012a) Global trends in intercountry adoption 2000-2010. New York: National Council for Adoption.
Selman P (2012b). The rise and fall of intercountry adoption in the 21st century. In: Gibbons, J.L., Rotabi, K.S, ed. Intercountry Adoption: Policies, Practices and Outcomes. London: Ashgate Press.
Selman, P. (2010) “Intercountry adoption in Europe 1998–2009: patterns, trends and issues,” Adoption & Fostering, 34 (1): 4-19.
Silliman, E. R., & Scott, C. M. (2009). Research-based oral language intervention routes to the academic language of literacy: Finding the right road. In S. A. Rosenfield & V. Wise Berninger (Eds.), Implementing evidence-based academic interventions in school (pp. 107–145). New York: Oxford University Press.
Tarullo, A. R., Bruce, J., & Gunnar, M. (2007). False belief and emotion understanding in post-institutionalized children. Social Development, 16, 57-78
Tarullo, A. & Gunnar, M. R. (2005). Institutional rearing and deficits in social relatedness: Possible mechanisms and processes. Cognitie, Creier, Comportament [Cognition, Brain, Behavior], 9, 329-342.
Varavikova, E. A. & Balachova, T. N. (2010). Strategies to implement physician training in FAS prevention as a part of preventive care in primary health settings: P120.Alcoholism: Clinical & Experimental Research. 34(8) Sup 3:119A.
Welsh, J. A., & Viana, A. G. (2012). Developmental outcomes of children adopted internationally. Adoption Quarterly, 15, 241-264.

Posted on March 11, 2015January 5, 2022 by Tatyana Elleseff — 4 Comments

Recommendations for Assessing Language Abilities of Verbal Children with Down Syndrome (DS)

Assessment of children with DS syndrome is often complicated due to the wide spectrum of presenting deficits (e.g., significant health issues in conjunction with communication impairment, lack of expressive language, etc) making accurate assessment of their communication a difficult task. In order to provide these children with appropriate therapy services via the design of targeted goals and objectives, we need to create comprehensive assessment procedures that focus on highlighting their communicative strengths and not just their deficits.

Today I’d like to discuss assessment procedures for verbal monolingual and bilingual children with DS 4-9 years of age, since testing instruments as well as assessment procedures for younger as well as older verbal and nonverbal children with DS do differ.

When it comes to dual language use and genetic disorders and developmental disabilities many educational and health care professionals are still under the erroneous assumption that it is better to use one language (English) to communicate with these children at home and at school. However, studies have shown that not only can children with DS become functionally bilingual they can even become functionally trilingual (Vallar & Papagno, 1993; Woll & Grove, 1996). It is important to understand that “bilingualism does not change the general profile of language strengths and weaknesses characteristic of DS—most children with DS will have receptive vocabulary strengths and expressive language weaknesses, regardless of whether they are monolingual or bilingual.” (Kay-Raining Bird, 2009, p. 194)

Furthermore, advising a bilingual family to only speak English with a child will cause a number of negative linguistic and psychosocial implications, such as create social isolation from family members who may not speak English well as well as adversely affect parent-child relationships (Portes & Hao, 1998).

Consequently, when preparing to assess linguistic abilities of children with DS we need to first determine whether these children have single or dual language exposure and design assessment procedures accordingly.

Pre-assessment Considerations

It is very important to conduct a parental interview no matter the setting you are performing the assessment in. One of your goals during the interview will be to establish the functional goals the parents’ desire for the child which may not always coincide with the academic expectations of the program in question.

Begin with a detailed case history and review of current records and obtain information about the child’s prenatal, perinatal and postnatal development, medical history as well as the nature of previous assessments and provided related services. Next, obtain a detailed history of the child’s language use by inquiring what languages are spoken by household members and how much time do these people spend with the child?

Choosing Testing Instruments

A balanced assessment will include a variety of methods, including observations of the child as well as direct interactions in the form of standardized, informal and dynamic assessments. If you will be using standardized assessments (e.g., ROWPVT-4) YOU MUST use descriptive measures vs. standardized scores to describe the child’s functioning. The latter is especially applicable to bilingual children with DS. Consider using the following disclaimer: “The following test/s __________were normed on typically developing English speaking children. Testing materials are not available in standardized form for child’s unique developmental and bilingual/bicultural backgrounds. In accordance with IDEA 2004 (The Individuals with Disabilities Education Act) [20 U.S.C.¤1414(3)],official use of standard scores for this child would be inaccurate and misleading so the results reported are presented in descriptive form. Raw scores are provided here only for comparison with future performance.”

Selecting Standardized Assessments

Depending on the child’s age and level of abilities a variety of assessment measures may be applicable to test the child in the areas of Content (vocabulary), Form (grammar/syntax), and Use(pragmatic language).

For children over 3 years of age whose linguistic abilities are just emerging you may wish to use a vocabulary inventory such as the MacArthur-Bates (also available in other languages) as well as provide parents with the Developmental Scale for Children with Down Syndrome to fill out. This will allow you to compare where child with DS features in their development as compared to typically developing peers. For older, more verbal children who are using words, phrases, and/or sentences to express themselves, you may want to use or adapt (see above) one of the following standardized language tests:

Informal Assessment Procedures

Depending on your setting (hospital vs. school), you may not perform a detailed assessment of the child’s feeding and swallowing skills. However, it is still important to understand that due to low muscle tone, respiratory problems, gastrointestinal disorders and cardiac issues, children with DSoften present with feeding dysfunction which is further exacerbated by concomitant issues such as obesity, GERD, constipation, malnutrition (restricted food group intake lacking in vitamins and minerals), and fatigue. With respect to swallowing, they may experience abnormalities in both the oral and pharyngeal phases of swallow, as well as present with silent aspiration, due to which instrumental assessment (MBS) may be necessary (Frazer & Friedman, 2006).

In contrast to feeding and swallowing the oral-peripheral assessment can be performed in all settings. When performing oral-peripheral exam, you need to carefully describe all structural (anatomical) and functional (physiological) abnormalities (e.g., macroglossia, micrognathia, prognathism, etc). Note any issues with:

Dentition (e.g., dental overcrowding, occlusion, etc)
Tongue/jaw disassociation (ability to separate tongue from jaw when speaking)
Mouth Posture (open/closed) and tongue positioning at rest (protruding/retracted)
Control of oral secretions
Lingual and buccal strength, movement (e.g., lingual protrusion, elevation, lateralization, and depression for volitional tasks) and control
Mandibular (jaw) strength, stability and grading

Take a careful look at the child’s speech. Perform dual speech sampling (if applicable) by considering the child’s phonetic inventory, syllable lengths and shapes as well as articulatory/phonological error patterns. Make sure to factor in the combined effect of the child’s craniofacial anomalies as well as system wide impairment (disturbances in respiration, voice, articulation, resonance, fluency, and prosody) on conversational intelligibility. Impaired intelligibility is a serious concern for individuals with DS, as it tends to persist throughout life for many of them and significantly interferes with social and vocational pursuits (Kent & Vorperian, 2013)

Don’t forget to assess the child’s voice, fluency, prosody, and resonance. Children with DS may have difficulty maintaining constant airstream for vocal production due to which they may occasionally speak with low vocal volume and breathiness (caused by air loss due to vocal fold hypotonicity). This may be directly targeted in treatment sessions and taught how to compensate for. When assessing resonance make sure to screen the child for hypernasality which may be due to velopharyngeal insufficiency secondary to hypotonicity as well as rule out hyponasality which may be due to enlarged adenoids (Kent & Vorperian, 2013). Furthermore, since stuttering and cluttering occur in children with DS at rates of 10 to 45%, compared to about 1% in the general population, a detailed analysis of disfluencies may be necessary(Kent & Vorperian, 2013). Finally, due to limitations with perception, imitation, and spontaneous production of prosodic features secondary to motor difficulties, motor coordination issues, and segmental errors that impede effective speech production across multisyllabic sequences, the prosody of individuals with DS will be impaired and might require a separate intervention. (Kent & Vorperian, 2013)

When it comes to auditory function, formal hearing testing and retesting is mandatory due to the fact that many children with DS have high prevalence of conductive and sensorineural hearing loss (Park et al, 2012). So if the child in question is not receiving regular follow-ups from the audiologist, it is very important to make the appropriate referral. Similarly, it is also very important that the child’s visual perception is assessed as well since children with DS frequently experience difficulties with vision acuity as well as visual processing, consequentially a consultation with developmental optometrist may be recommended/needed.

Describe in detail the child’s adaptive behavior and learning style, including their social strengths and weaknesses. Observe the child’s eye contact, affect, attention to task, level of distractibility, and socialization patterns. Document the number of redirections and negotiations the child needed to participate as well as types and level of reinforcement used during testing.

Perform dual language sampling and look at functional vocabulary knowledge and use, grammar measures, sentence length, as well as the child’s pragmatic functions (what is the child using his/her language for: request, reject, comment, etc.) Perform a dynamic assessment to determine the child’s learnability (e.g., how quickly does the child learns and adapts to being taught new concepts?) since “even a minimal mediation in the form of ‘focusing’ improves the receptive language performance of children with DS” (Alony & Kozulin, 2007, p 323)

After all the above sections are completed, it is time to move on to the impressions section of the report. While it is important to document the weaknesses exposed by the assessment, it is even more important to document the child’s strengths or all the things the child did well, since this will help you to determine the starting treatment point and allow you to formulate relevant treatment goals.

When making recommendations for treatment, especially for bilingual children with DS, make sure to provide a strong rationale for the provision of services in both languages (if applicable) as well as specify the importance of continued support of the first language in the home.

Finally, make sure to provide targeted and measurable [suggested] treatment goals by breaking the targets into measurable parts:

Given ___time period (1 year, 1 progress reporting period, etc), the student will be able to (insert specific goal) with ___accuracy/trials, given ___ level of, given _____type of prompts.

Assessing communication abilities of children with developmental disabilities may not be easy; however, having the appropriate preparation and training will ensure that you will be well prepared to do the job right! Use multiple tasks and activities to create a balanced assessment, use descriptive measures instead of standard scores to report findings, and most importantly make your assessment functional by making sure that your testing yields relevant diagnostic information which could then be effectively used to provide effective quality treatments for clients with DS!

For comprehensive information on “Comprehensive Assessment of Monolingual and Bilingual Children with Down Syndrome” which discusses how to assess young (birth-early elementary age) verbal and nonverbal monolingual and bilingual children with Down Syndrome (DS) and offers comprehensive examples of write-ups based on real-life clients click HERE.

Other Helpful Resources

Posted on October 1, 2011January 5, 2022 by Tatyana Elleseff — 4 Comments

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

Tatyana Elleseff MA CCC-SLP

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

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

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

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

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

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

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

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

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

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

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

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

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

Contrastingly, a speech and language report in the child’s birth language will outline the nature and severity of disorder, and state that given the extent of the child’s deficits in his/her birth language, similar pattern will be experienced in English unless intervention is provided. According to one of the leading speech-language researchers, Sharon Glennen, “Any child with a known history of speech and language delays in the sending country should be considered to have true delays or disorders and should receive speech and language services after adoption.” (Glennen, 2009, p.52)

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

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

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

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

Cognitive Language Mastery (CLM) refers to language needed for formal academic learning. This includes listening, speaking, reading, and writing about subject area content material including analyzing, synthesizing, judging and evaluating presented information. This level of language learning is essential for a child to succeed in school. Language impaired children adopted at older ages need time and support to become develop cognitive language and become proficient in academic areas, an ability which usually takes a number of years to refine. Before discharging the child from therapy services it is very important that their cognitive/academic language abilities are assessed and are found within average limits.

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

References:

• Gindis, B. (1999) Language-Related Issues for International Adoptees and Adoptive Families. In: T. Tepper, L. Hannon, D. Sandstrom, Eds. “International Adoption: Challenges and Opportunities.” PNPIC, Meadow Lands , PA. , pp. 98-108

• Gindis, B. (2005). Cognitive, language, and educational issues of children adopted from overseas orphanages. Journal of Cognitive Education and Psychology, 4 (3): 290-315.

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

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

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

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

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

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

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

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

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

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

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

Dear School Professionals Please Be Aware of This

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

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

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

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

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

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

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

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

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

If the child’s pre-adoption records specifically state that s/he has birth language delay then it should be taken seriously (Gindis, 1999) since language delays in the birth language transfer and affect the new language (McLaughlin, Gesi, & Osani, 1995). These delays will not “go away” without appropriate interventions. “Any child with a known history of speech and language delays in the sending country should be considered to have true delays or disorders and should receive speech and language services after adoption.” (Glennen, 2009, p.52)

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

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

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

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

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

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

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

Tatyana Elleseff MA CCC-SLP

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