SELECTED ARTICLE
Article Title

Understanding the extent of speech and language delays in older internationally adopted children

Author

Tatyana Elleseff MA CCC-SLP

Posted Date

10/25/2011

 

This article was first published in October 2011 Issue of Adoption Today Magazine (pp. 32-35)

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. (Gindis, 1999, 2005) 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.

References

Tatyana Elleseff MA CCC-SLP is a bilingual speech language pathologist with a full-time hospital affiliation and a private practice in Central, NJ. She received her MA from NYU and her Bilingual Extension Certification from Columbia University. Currently she is licensed by the states of NJ and NY and holds a Certificate of Clinical Competence from ASHA. She specializes in working with bilingual, multicultural, internationally and domestically adopted as well as at-risk children with complex medical, psychiatric, developmental, neurogenic, and acquired communication disorders. Tatyana maintains a blog: www.smartspeechtherapy.com/blog/ pertaining to her areas of specialty in speech pathology. For more information call her at 917-916-7487

Article Downloads

3949

Article Title

Differential diagnosis of AD/HD and Auditory Processing Disorders in Internationally Adopted School Age Children

Author

Tatyana Elleseff MA CCC-SLP

Posted Date

6/16/2011

 

Scenario

Corinne is an adorable 8 year old girl with an infectious smile, who has been adopted from Russia at the age of 15 months. She sits quietly by the bookshelf; completely absorbed by the book in her lap, while her distraught mother is quietly telling me in the hallway why Corinne has come to visit me today. Corinne has numerous listening difficulties. She is very inattentive and frequently mishears verbal messages. She is very distractible and tends to act impulsively at home and in school. She has trouble organizing her verbal output when speaking and is constantly forgetting what has been told to her, even if it was only moments ago. Corinne has never had a speech and language assessment before, but she does have a documented diagnosis of ADHD, for which she is currently taking medication. The trouble is that this medication does not seem to be helping Corinne one bit. She is just as distractible, impulsive and inattentive as she was before. Not only that, but this is not the first medication or the lowest dosage that Corinne has been taking for her ADHD. According to Corinne’s mother, Corinne’s medications and dosages have been adjusted multiple times by several doctors, but so far it hasn’t really affected anything. Corinne’s parents’ are at their wit’s end! Corinne is desperately struggling with her studies despite working very hard and getting a lot of help at home, but she is doing so poorly - that her school has been hinting very strongly that Corinne ought to be held back in 3rd grade. Fast forwarding several assessment sessions later, I am not so convinced that ADHD is Corinne’s primary deficit, or even if it’s an appropriate diagnosis for Corinne at all. Testing has revealed that Corinne has a severe language processing difficulty and requires a referral to an audiologist for a comprehensive auditory processing testing battery. Corinne’s mom is bewildered at the news: “But no one has suggested anything like this at all before!” Sadly, Corinne’s case is far from unique. The incidence and prevalence of AD/HD (the slash is used to denote both subtypes with and without the hyperactivity component) in internationally adopted children is very high and continues to be on the rise. What further complicates the situation is lack of valid statistical data. At this time there are no reliable statistics to cite! However, parents of internationally adopted children and those professionals who work with this unique population know just how frequently this label is used. AD/HD prevalence in internationally adopted children is so highly alarming that it begs a number of important questions:

  • “What criteria are currently used for diagnosing AD/HD in internationally adopted children?”
  • “Are other disorders with similar symptoms being ruled out before the diagnosis of AD/HD is made?”
Attention Deficit/Hyperactivity Disorder is one of the most commonly diagnosed disorders of childhood. As a speech language pathologist, who works in a pediatric psychiatric hospital setting, I see many children, including a large number of internationally adopted children, who have the diagnosis of AD/HD in conjunction with other comorbidities including psychiatric disorders as well as speech-language and learning deficits. However, after the initial screening and assessment period when these children are seen by our multidisciplinary team (psychiatrist, psychologist, nurse, occupational and speech therapists, as well as a learning specialist) in a number of cases, the AD/HD diagnosis is ruled out. It is very important to understand that the core symptoms of AD/HD: inattention, hyperactivity, and impulsivity are also the core symptoms in a variety of other disorders, which need to be ruled out in order for the diagnosis of AD/HD to be confirmed with reasonable accuracy. The above “core symptoms” are observed in a number of disorders:
  • Sensory Processing Dysfunction
  • Auditory Processing Disorder
  • Mental Retardation
  • Hearing Deficits
  • Mood Disorders
  • Sleep Disorders
  • Seizure Disorders
  • Acquired Traumatic Brain Injury
  • Autistic Spectrum Disorders
  • Language Disorders
  • Nonverbal Learning Disorder
  • Yeast Overgrowth

And this list is by no means exhaustive. Since I am a speech language pathologist, in this article I would like to focus on a diagnosis that is most frequently mistaken or may co-occur with AD/HD, which is auditory processing disorder (APD), also referred to as Central Auditory Processing Disorder (C/APD). Auditory Processing Disorder (APD) is technically not one disorder but a number of disorders, which affect the processing and use of auditory information at the level of the Central Nervous System (CNS). A child with APD has normal hearing but has trouble recognizing, processing and/or interpreting auditory information. The reason why it’s not just a name for one disorder is because according to the 2005 ASHA’s CAPD Technical Report, auditory processing difficulties may affect a number of abilities such as “sound localization and lateralization; auditory discrimination; [and/or] auditory pattern recognition.” Additionally, the difficulties could be with the “temporal aspects of audition, including temporal integration, temporal discrimination (e.g., temporal gap detection), temporal ordering, and temporal masking; auditory performance in competing acoustic signals (including dichotic listening); and auditory performance with degraded acoustic signals” (ASHA, 2005, CAPD Technical Report). These technical terms translate into some of the following auditory processing difficulties for the child:

1. Difficulty processing auditory information efficiently

  • Child may require increased processing time to respond to questions
  • Child may present like they are ignoring the speaker
  • Child may request the speaker to repeat presented information several times
  • Child may not be able to follow long sentences
  • Child will have difficulty keeping up with class discussions in group settings
  • Child’s poor listening abilities under noisy conditions may be interpreted as “distractibility”
2. Difficulty maintaining attention on presented tasks
    a. Frequent loss of focus b. Difficulty completing assignments on their own

3. Poor Short Term Memory - difficulty remembering instructions and directions or verbally presented information

4. Difficulty with phonemic awareness, reading and spelling

    a. Poor ability to recognize and produce rhyming words
    b. Poor segmentation abilities (separation of sentences, syllables and sounds)
    c. Poor sound manipulation abilities (isolation, deletion, substitution, blending, etc)
    d. Poor sound letter identification abilities
    e. Poor vowel recognition abilities
The combination of above factors may result in generalized deficits across the board, affecting the child’s social and academic performance:
  • Poor reading comprehension;
  • Poor oral and written expression
  • Disorganized thinking (e.g., disjointed narrative production)
  • Sequencing errors (recalling/retelling information in order, following recipes, etc)
  • Poor message interpretation
  • Difficulty making inferences
  • Misinterpreting the meaning of abstract information

Auditory processing difficulties frequently coexist along with AD/HD. So a child may have both diagnoses AD/HD and APD. However, the child may also be accidentally misdiagnosed with one, instead of the other, or may even have a different diagnosis entirely, which is why a differential diagnosis is absolutely crucial!

How to initiate an appropriate referral process if you suspect that your school age child has auditory processing difficulties?

If your child is exhibiting any of the above mentioned symptoms, it is very important to address the cause of the problem. Even though AD/HD and APD may have similar core symptoms, the management of both disorders is quite different. Management of AD/HD may require a number of interventions including behavioral management, medication, and language therapy vs. APD which may require language intervention only, since behavior therapy and stimulant medications used to control AD/HD do not improve the symptoms of APD! (Tillary et al 2000) The differential diagnosis of auditory processing disorder falls under the auspices of an audiologist. However, because many of AD/HD and APD symptoms overlap and manifest as language difficulties, before a referral to an audiologist is made, a speech language pathologist is often consulted first to determine the presence and/or extent of language difficulties that affect the child’s listening comprehension, short term memory, attention to verbal messages, and so on. A speech language pathologist may also be consulted before the audiologist, if the symptoms in question pertain to a younger child (e.g., 4-5 years of age). Most auditory processing batteries can only be administered partially when a child is minimally 5 years of age (e.g., SCAN-3C; Pearson Publications) and comprehensively when a child reaches about 7 years of age, due to the differences in speed of brain maturation in children. In contrast, a speech language pathologist can determine much earlier if a child presents with difficulties which may later be diagnosed as APD. In fact one recent test that came out in 2010, the Auditory Skills Assessment (ASA), available from Pearson Publications, screens children as young as 3;6 years of age for early auditory and phonological skills. As the result of the above guidelines, some parents have asked me in the past: “If an auditory processing disorder is suspected but only fully diagnosed at 7, does it mean that we have to wait until that age to confirm the diagnosis and only then initiate language therapy?” Absolutely not! If the assessment indicates that intervention is merited, the speech pathologist can begin addressing specific deficits (e.g., understanding verbal messages, following complex directives, etc), long before the diagnosis of auditory processing disorder can be made, since our aim is to treat the presenting symptoms and not a specific label! Furthermore, even after an audiologist confirms the presence of an auditory processing disorder, in the vast majority of cases, the child will be sent back to the speech language pathologist for treatment since treatment of auditory processing deficits falls under the auspices of a speech language pathologist. Thus, early detection (e.g., ages 4-5) frequently facilitates successful treatment, remediation, and/or mitigation of symptoms. Early treatment may also decrease symptom severity (e.g., mild-moderate auditory processing disorder vs. severe auditory processing disorder) by the time the child is tested by an audiologist at an older age (e.g., age 8). After the initial referral is made, and depending on the nature of deficits (e.g., attention, processing, phonological awareness, memory, etc) a speech pathologist may chose to use a number of language testing instruments, sensitive to various auditory processing components. Below are just several of the popular screening and testing instruments which may be used by a speech language pathologist in order to determine whether a referral for a comprehensive auditory processing assessment battery with an audiologist is merited.

  • The Listening Inventory (TLI) (2005) available from Academic Therapy Publications
  • Differential Screening Test for Processing (DSTP) (2006)*
  • Dynamic Screening for Phonological Awareness (DSPA) (2010)*
  • Test of Auditory Processing Skills-3 (2005)**
  • The Listening Comprehension Test-2 (LCT-2) (2006)*
  • The Listening Comprehension Test Adolescent (LCT-A) (2009)*
  • Phonological Awareness Test -2 (PAT-2) (2007)*
  • Comprehensive Test of Phonological Processing (CTOPP) (1999)**
  • Lindamood Auditory Conceptualization Test-3 (LAC-3) (2004)**

*Denotes instruments available from Linguisystems ** Denotes instruments available from multiple publishers such as Linguisystems, Pearson Publications, and/or Super Duper Publications Please note that a speech language pathologist does not have to use the above tests in order to refer the child for an auditory processing assessment battery. He/she can select the testing subtests from a number of commonly used language testing instruments such as Clinical Evaluation of Language Fundamentals-4 or Test for Auditory Comprehension of Language-3 (Pearson Publications) in order to test the affected areas of difficulty (e.g., listening comprehension, following directions, etc). So, the SLP will test the child’s language abilities in order to determine if their testing results are indicative of deeper auditory processing deficits. If they are, and the child’s age is appropriate, then the child will need to see an audiologist who will first perform a routine hearing test to rule out hearing impairment and then, if the hearing is normal, the audiologist will administer the auditory processing testing battery.

What is the role of audiologist in the assessment of auditory processing disorders?

  • An audiologist is the ONLY professional who diagnoses auditory processing disorders.
  • An audiologist is the ONLY professional who is responsible for describing auditory processing deficits diagnosed during the above assessment.
  • The audiologist is EXPECTED to suggest treatment and management strategies for school and home accommodations, which are specific to the child’s unique deficits.
  • An audiologist MAY provide auditory processing remediation to the child but TYPICALLY he/she will refer the child to a speech language pathologist for further treatment.
  • Subsequent to receiving auditory processing intervention, the child will go back to the audiologist (usually after 1 year) in order to receive an auditory processing reassessment battery.
  • The child may continue to receive yearly reassessments until the audiologist determines that further assessments/treatments are no longer necessary.

Audiological testing battery differs from speech language testing battery. Most audiological tests are administered in sound-proof booths and involve the attention and response to signals/tones in addition to attention and response to recorded words, word pairs, and sentences (in contrast to live voice) in the absence and presence of background noise. Based on presenting symptoms an audiologist will determine what combinations of tests need to be administered. After testing is completed it is very important that parent request that the audiologist outline confirmed deficits, suggest treatment hierarchy with goals and objectives as well as make recommendations for school and home accommodations which will be specific to the child’s unique deficits. This is especially important because much of the terminology used by audiologists may not be familiar to many school based speech language therapists much less parents who are attempting to interpret the report. Therefore, it is important that an audiologist clearly explain what the deficits are and what needs to be done. This is necessary in order to avoid confusion regarding the meaning of terms as well as to avoid generalized and unnecessary interventions. For example, the deficits pertaining to term “tolerance fading memory” should be explained as difficulties with speech interpretation in the presence of background noise as well as difficulty with short term memory. Moreover, it is also important to caution parents that the generic recommendation of an FM system (frequency modulation system) is not applicable to all children with auditory processing deficits but only to those who have been accurately diagnosed with auditory sensitivity and/or auditory distractibility. Similarly, not all parents of children with auditory processing disorders need to rush out to purchase “Earobics” (www.earobics.com) or “Lindamood-Bell” (www.lindamoodbell.com) software programs especially because these phonological awareness programs and their levels of difficulty may not be necessarily applicable to many children with APD symptoms. Parents should also be wary of recommendations heavily emphasizing specific costly software or remediation programs (to the exclusion of all other interventions), since not all recommendations are based on scientific research and evidence. Therefore it’s very important to research the efficacy and effectiveness of these products and programs on the ASHA (American Association of Speech Language and Hearing Science) website. I also want to reemphasize again that even after the diagnosis of C/APD has been confirmed, it may be necessary to revisit the child’s remaining symptoms once more in order to reassess the continued applicability of AD/HD diagnosis and use of medications as well as to rule out the presence of additional comorbidities. On such occasions, I have found that The Listening Inventory (TLI) screening instrument is a very helpful tool for making additional referrals. This questionnaire, which can be filled out by parents AND teachers in as little as 15 minutes, has the users rating the child’s difficulties in 6 areas: linguistic organization, decoding/language mechanics, attention/organization, sensory/motor, social/behavioral, and auditory processes. After all the statements are rated and the index scores are calculated, many parents are often surprised by the results. Oftentimes the difficulties they interpret as being social behavioral may actually be the result of sensory/motor impairments, which require an assessment by an occupational therapist. This is why the multidisciplinary approach to identification, differential diagnosis, and management of disorders like AD/HD and/or C/APD is so important. Just one individual assessment, be it psychological, occupational, or audiological, CANNOT reliably determine accurate diagnosis to the exclusion of all others, especially when the diagnostic criteria is based on generalized symptomology (symptoms fit several diagnoses). To learn more about auditory processing disorders 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 professionals specializing in assessment (audiologist) and treatment (speech language pathologist) of auditory processing disorders in your area please visit: http://asha.org/proserv/.

References

  • American Speech-Language-Hearing Association. (2005). (Central) Auditory Processing Disorders [Technical Report]. Available from www.asha.org/policy.
  • Lucker, J.R. (2007). History of Auditory Processing Disorders in Children. In D. Geffner and D. Ross-Swain, Auditory Processing Disorders for Speech-Language Pathologists San Diego: Plural Publishers.
  • Tillery et al. (2000) Effects of Methylphenidate (Ritalin) on Auditory Performance in Children With Attention and Auditory Processing Disorders. Journal of Speech Language and Hearing Research 43, 893-901

References

Tatyana Elleseff MA CCC-SLP is a bilingual speech language pathologist with a private practice in Somerset, NJ as well as multiple hospital affiliations in Central New Jersey. She is a New York University graduate with Bilingual Certification from Columbia University. Additionally she holds dual licensure from the states of New York and New Jersey as well as a Certificate of Clinical Competence from ASHA (American Speech Language and Hearing Association). She specializes in providing a variety of comprehensive speech and language services to bilingual pediatric clients as well as to internationally adopted children from Eastern Europe. For more information about her services or to schedule a consultation, call 917-916-7487. You can also visit her website: www.smartspeechtherapy.com

Article Downloads

4567

Article Title

Stuttering Therapy: Is a Speech Therapist Needed?

Author

Sophie Wagner

Posted Date

3/20/2010

 

Whether you're searching for help for your self or to your child, chances are you'll be pondering of requesting help from a speech therapist. You may wonder if this is the precise option. There are a number of points to think about when deciding for those who or your child ought to go to a speech therapist.

One instance wherein consulting a speech therapist is a valid strategy is that if stuttering is so severe that it impacts your functioning. If it is so extreme that it is disruptive to your everyday life, help from knowledgeable could also be in order. Whether or not the stuttering has been a long-term downside, or whether or not its onset has been sudden, a speech therapist might be helpful.

A second scenario is if all techniques and strategies for controlling your stutter have failed. Though the methods are easy to learn and successful for many people, they might not be as effective for you. In case you have put your best effort into these methods, and have discovered no reduction from your stuttering, a visit to a speech therapist could also be in your best interest.

Another situation which makes consulting a speech therapist a wise choice is if your stuttering is related to any medical or psychological cause. In these cases, controlling your stutter on your own could also be impossible. If a preexisting medical or psychological situation is discovered to be at the root of your stutter, a speech therapist can direct you to the professional help that's appropriate for you. While consulting a speech therapist will not be obligatory for most cases of childhood or adolescent stuttering, there are conditions in which it's the best course of action. The child whose stutter is so severe that no strategies provide any reduction is one of these situations. The kid whose stutter places an undue burden on his everyday life is another. Normally, children reply to natural techniques in addition to adults. However, if they don't work for you or your youngster, visiting a speech therapist could be your best interest. The child who refuses to cooperate in learning to control his stutter is one other situation which requires a speech therapist. This does not mean hurrying to make an appointment as soon as your child refuses to comply. You must expect some degree of boredom or disinterest when teaching him these new ideas. The child who flatly refuses to cooperate at all, shows anger or resentment at your attempts to help, or firmly believes that nothing will work, can benefit from seeing a speech therapist. The youngster who reveals psychological problems related along with his stutter may benefit from seeing a professional. In these instances, his pediatrician or your family physician can recommend a therapist who will help him. In case you or your child will be seeing a speech therapist, these visits should not be any more disruptive to everyday life than necessary.

The child who sees a therapist might resent putting his time into it, and will feel that this course of action is a negative reflection on himself. The most effective method for dealing with effectively with these issues is to present the visits in a constructive light. If he views his speech therapist as a pal, and as a nice person who really wants to help him, he can sit up for the visits and benefit from them even more. Speech therapists might be costly. If this is an issue to you, it's good to have the entire details before you make a commitment. You can check to see in case your insurance will cover a speech therapist, or ask if he or she will accept an inexpensive payment plan. Cost should not be the deciding factor in whether to seek help from a professional. Your pediatrician or family doctor is the best resource for finding a speech therapist. He is conscious of your explicit situation, and might recommend the therapist who is correct for you. Do not hesitate in asking for his advice. Usually, stuttering could be controlled solely by learning easy methods and making use of them to your everyday speech. Nonetheless, when you or your child are in considered one of these particular situation, an expert speech therapist can be greatly beneficial. The earlier you ask for help, the earlier you will get the stutter under control.

References

Read more about Stuttering Therapy. Stop by Chris Robinnson's site where you could find all about Stuttering Help and what it may possibly do for you.

Article Downloads

1693

Article Title

Music Mediated Baby Sign Language Instruction Enhances Motivation And Learning Development

Author

Toan Dinh

Posted Date

8/19/2009

 

Music mediated sign language instruction has several central purposes. The first is to guide each child, deaf or hearing, in developing fluent language skills while promoting effective communication between the children and their family and peers. The second is to support the development of language as a tool for literacy attainment. Third, it will create an effective and rewarding vehicle for self-expression and self-esteem, allowing participants to explore new means of expression while they enhance existing ones. The fourth purpose of the objective is to facilitate social interaction and age appropriate play. Additional benefits include more rhythmic speech; growth in balance, spatial reasoning and motor skills; increased IQ, auditory and perceptual awareness, attention span, memory recall, and vocabulary; reinforcement of cultural identity if Deaf; and improvements in family relationships as communication is clarified.

The first three years are the most critical years for a child’s language development, though sign language may be used to encourage communication among children of varying ages, abilities and interests. Signing not only offers a method of communication to nonverbal children, but it also facilitates the onset and development of spoken language for pre-linguistic children. Studies have proven that once a set of conceptual, cognitive, and linguistic skills are developed in a first language, they can be transferred or are applicable to the subsequent development of a second language.

As children naturally gesture in self-expression, there is a growing consensus that a sign language such as American Sign Language (ASL) should be presented as the first language in infancy and childhood. By exposing babies to sign language classes, parents will facilitate the development of thought patterns and enable full communication of intelligence to their child. With the use of signing, unexpected benefits may occur for children who hear normally. Hearing children learn to think in words; when they are told it is raining and simultaneously shown the signed word for rain, they are provided the opportunity to visualize rain through sign. Otherwise, words are quite abstract. Baby sign language classes (for parents) will provide a means of communication more closely aligned with pre-linguistic thinking.

The development of language should be accomplished by making use of experiences, interests, and needs of children. Music is one medium to achieve this goal. Teaching sign language to children (through baby sign language classes for parents for example) using music, enhances motivation, enjoyment, social skills, self-concept, and development of language. Benefits of music mediated sign language instruction are endless. Families can do endless activities at home to reinforce language development, reading skills, motor skills and other benefits mentioned above. First and foremost, have fun! Talk and sing to your baby as you are out taking a walk or inside making dinner. Carry your baby in the front carrier or sling so you can sing and dance together. Quietly listen to and feel each other’s breathing and heartbeats, two of the most significant aspects of both life and music. Include in his or bedtime routine singing a lullaby or reading a story, get a sign language dictionary, put a photo album together of your baby’s favorite people, places and things. Invest in a baby sign language class or two… For more information, visit MyBabyFingers.

References

Baby Fingers LLC, founded by Lora Heller, Board Certified and Licensed Music Therapist with a M.Sc. in Special Education/Deaf Education, specializing in music mediated sign language instruction. For more information, visit www.MyBabyFingers.com.

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Article Title

Using Sign Language And Music To Communicate With Your Newborn

Author

SEO Consulting

Posted Date

7/31/2009

 

Playing in his crib at 10 months old, Ezekiel calmly got his mother’s attention and signed "more music." Realizing only then that the mobile had stopped, his mom wound it up again and Ezekiel continued playing happily. A hearing child in a hearing family, he has been exposed to sign language since birth. Not only was he able to express his needs clearly without tears of frustration, he also used a two "word" phrase. This level of language is rarely present until 18 months, or more typically at two years. Music mediated sign language instruction has several central purposes. The first is to guide a child, deaf or hearing, in developing fluent language skills while promoting effective communication.

The second is to support the development of language as a tool for literacy attainment. Third, it will create an effective and rewarding vehicle for self-expression and self-esteem. The fourth purpose or objective is to facilitate social interaction and age appropriate play. Additional benefits include more rhythmic speech; growth in balance, spatial reasoning and motor skills; increased IQ, auditory and perceptual awareness, attention span, memory recall, and vocabulary and improved family relationship. The first three years are the most critical years for a child's language development, though it may be introduced among children of any age.

Signing not only offers a method of communication to nonverbal children, but it also facilitates the onset and development of spoken language for pre-linguistic children. Studies have proven that once a set of conceptual, cognitive, and linguistic skills are developed, they can be transferred or are applicable to the subsequent development of a second language. As children naturally gesture in self-expression, there is a growing consensus that a sign language such as American Sign Language (ASL) should be presented as the first language in infancy and childhood.

Research in early childhood development has indicated a strong relationship between the ability to keep a steady beat and the ability to read. Further studies have found that the early experience of signing, results in the ability to keep a competent, steady beat, thus linking music and sign language to reading skills. A longitudinal study conducted in California ascertained that by second grade, a group of children who were exposed to sign language in infancy were advanced in vocabulary development, and had an average IQ 12 points higher than their peers. Researchers have discovered that music training can improve children's future abilities to solve complex math and geometry problems, navigate ships, design skyscrapers, and improve intelligence. In one particular study, spatial reasoning skills of preschool children given eight months of music lessons far exceeded that of preschoolers without music training.

What can families do at home to reinforce language development? First and foremost, have fun! Talk and sing to your baby at all times. Carry your baby in the front carrier or sling so you can sing and dance together heart to heart-literally. Quietly listen to and feel each other's breathing and heartbeats, two of the most significant aspects of both life and music. Respond to your baby's cooing and babbling. Make eye contact. Listen to music together; children should be exposed to all genres from birth. Watch an opera. Make Sesame Street a family event; count and sing along. Dance together; demonstrate and watch how our body rhythms can change along with musical changes. Sing out loud; all our voices are good enough for singing, at least in the privacy of our own homes! Have a basket of small hand held instruments available for spontaneous play-include drums, maracas, bells, kazoos/whistles, xylophones. Be the performer and the audience, allowing your child to play both roles as well...take a bow and applaud one another. Find picture books or storybooks with sign language diagrams, such as My First Sign Language ABC, Animal Signs, and the Where's Spot? series.

Purchase a sign language dictionary or find one on line. Dawn Sign Press has published a book called Signs for Me, full of children's vocabulary--it also makes a great coloring book. Put in a video tape of signed songs and watch as a family; even make your own music and/or sign language video together. Learn signs for your child's favorite animals, toys, foods...incorporate them into your day as you play, walk through the park, eat, and shop. Put a photo album together of your baby's favorite people, places, and things; s/he can start to communicate by smiling or cooing, then pointing to the photo, later using the sign, and eventually saying the name or word. Encourage other significant people in your child's life like baby sitter, grandparents, siblings, etc. to learn the signs as well. Look for age appropriate playgroups so you and your baby both have an opportunity to socialize. Invest in a class or two to take together.

References

Baby Fingers LLC - Based on considerable research, Baby Fingers is designed to promote family communication while enhancing motivation to speak, increasing IQ, improving vocabulary and literacy skills, decreasing frustration, refining motor coordination and spatial reasoning skills. For more information, please visit - mybabyfingers.com

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