Month: October 2021

As a part of LD Awareness Month, we are spotlighting important aspects of the journey for neurodivergent learners and caregivers. In a previous blog, The Learner Support Ecosystem and Why it’s Important to Have One, we detailed the common roles within the learner’s support ecosystem. In this blog, let’s take a look at the role of the speech therapist. For this, we interviewed Heather Hamilton, a Licensed Speech Language Pathologist.

About Heather Hamilton

Heather Hamilton, M.S., CCC-SLP is the founder of TALK Speech & Language Therapy, LLC in Atlanta, Ga. She received both her undergraduate and graduate degrees from Syracuse University in the field of Speech-Language Pathology. Heather has over 25 years of experience from her time working in Educational, Medical, and Private settings across the United States. With a focus on continuing education and the most current, research-based practices, TALK is an international clinic that sees clients of all ages to focus on communication needs related to speech and language disorders, literacy, and corporate speech challenges. 

What is Speech and Language Therapy? 

Speech-Language Therapy is so multifaceted! In our clinic, our clients range in age from 1-year to 67-years of age and no two client profiles are exactly the same. At its core, Speech-Language Therapy is individualized treatment that helps an individual meet their full communication potential in order to confidently share and receive information from others through spoken, written, gesture-based, or picture-based language forms. Some children learn language from the exposure they receive in their environments, and some children require direct Speech-Language Intervention to help them master new skills.

Can you help our community with some common terminology? 

Receptive Language is the ability to comprehend language at varying levels of complexity. To assess comprehension of language we look at an individual’s ability to show comprehension. For example, we might show a child three toys, hold out our hands, and say CAR. If they point to or grab the car, we know they understood. However, language complexity increases quickly. If you ask a child to, “Point to the car that is not blue,” it requires that they understand the noun CAR, the adjective BLUE, the verb POINT, the negative NOT, and understand the order of the words presented.

Expressive Language involves the ability to utilize specific words (vocabulary/semantics) in the correct combination and form (syntax and morphology). Children are using single words by 1-year and then by 3 to 4 years a child is expected to have a vocabulary of 800 to 1700 words, and be 90% to 100% intelligible during long conversations that utilize compound and complex sentences of 4 to 5 ½ words in length. 

Some children and adults are nonverbal and do not communicate with spoken language. When this is the case, Assistive Technology (Augmentative and Alternative Communication or AAC) is utilized to help individuals communicate their thoughts. Low-tech forms of AAC are things like picture symbols, communication boards or writing with a pen and paper. Examples of high-tech forms of AAC include the use of iPads, computers, or devices that generate speech for a user.

Pragmatic Language is the ability to use language in socially appropriate ways across various settings.

Articulation refers to the ability to spontaneously say speech sounds correctly. Some children struggle with the production of only one or two sounds and would be diagnosed with an articulation disorder. Others have difficulty being understood (intelligibility) because they are not able to say many sounds correctly. This might be diagnosed as a Phonological Disorder as they have consistent error patterns. Childhood Apraxia of Speech (CAS) is a motor coordination problem that prevents an individual’s oral structures (i.e., lips, tongue, teeth, jaw) from executing the motor planning steps that the brain tells them to. This results in inconsistent error patterns that can change each time a word is produced. It is important for parents to know that Childhood Apraxia of Speech is different from adult apraxia that results from a stroke or a traumatic brain injury. 

Other elements of spoken communication that might be addressed in therapy include Voice Disorders and Stuttering.

Our caregivers would appreciate an understanding of a list of symptoms that may otherwise go unnoticed. What should they look out for in their learners? 

Parents and caregivers need to trust their instincts! So often families know that something is not right, but they listen to a pediatrician, family member, or friend and do not seek a professional’s opinion. If you sense that something is not developing as it should, reach out to a professional to get their recommendations. Getting intervention early can make a difference in long-term outcomes.

A few questions parents and caregivers can ask themselves to see if consultation with an SLP might be of benefit:

• Do I feel like something is not quite right with how my child is engaging, speaking, or using language? If so, call a Speech-Language Pathologist (SLP) and ask for a phone consultation. Reputable practices will offer a complimentary call.
• Have I been told by a friend or teacher that my child should see an SLP? If so, there is no harm in seeking out additional information about your child’s communication skill development. 
• Is my child struggling to follow directions independently without gestures or help? 
• If your child is 2 years of age, can they name some pictures, use simple pronouns (I, me, you) and verbs, and say some routine phrases?
• If your child is 2 ½ years of age can they use 150-350 words, ask simple questions and add some simple modifiers to nouns (e.g. big truck)?
• If your child is 3 years old can they carry on a meaningful conversation, describe actions seen in books and repeat some rhymes?
• Are you noticing that your child says several words incorrectly not because of a speech sound error pattern, but because they seem to have learned the word incorrectly (for example, they say Pucause of Because)? Perceptual errors can be a sign of an underlying phonological processing deficit that suggests a child would benefit from structured phonological awareness training. 
• Does my child seem frustrated when trying to communicate? Frustration at any age can be a sign of an underlying communication problem. 

What services do you and your therapists provide? 

TALK Speech & Language Therapy, LLC provides both in-person and Teletherapy intervention in the areas of speech sound disorders, expressive language, receptive language, pragmatic language & social communication,  literacy, written language, voice therapy, and fluency (stuttering). We have the pleasure of seeing an international population and specialize in working with bilingual and multilingual families. Additionally, TALK provides Corporate Speech Therapy services to help clients target accent reduction, cultural communication differences, pragmatic language, and effective communication strategies in the workplace. 

Are there any final thoughts you wish to share? 

Parents and caregivers should know that speech sound disorders are not just about saying speech sounds correctly. From the time they are toddlers, children are developing the Phonological Awareness skills that will allow them to be successful readers and spellers. Remediation of speech sound production errors, along with structured phonological awareness intervention, can prevent literacy issues down the road. 

Finally, everyone should know that Speech-Language Therapy is not just for children. Our practice works with clients of all ages. In recent years more and more adults have sought intervention after gaining a greater understanding of their child’s challenges and recognizing the same struggles have always been an issue for them as well. It is never too late to reach out to a Speech-Language Pathologist for a consultation. 

As a part of LD Awareness Month, we are spotlighting important aspects of the journey for neurodivergent learners and caregivers.  In a previous blog, The Learner Support Ecosystem and Why it’s Important to Have One, we detailed the common roles within the learner’s support ecosystem.  In this blog, we’re digging into psychological assessments. For this, we interviewed Dr. Ilana Jurkowitz, a Licensed Clinical Psychologist, who often administers these assessments and can offer insights into the overall goals and importance of this process.

About Dr Ilana Jurkowitz

I am a Licensed Clinical Psychologist with a specialty in pediatric psychodiagnostic assessment.  In my private practice, I focus on providing comprehensive psychodiagnostic evaluations for children and adolescents to better identify their cognitive and academic profiles and create a plan to help them reach their potential.  I am also an adjunct professor at Alliant International University in the Ph.D. Clinical Psychology graduate program where I teach psychodiagnostic assessment to doctoral candidates and train them in specific test instruments and data interpretation.  I completed my postdoctoral training at the Reiss-Davis Child Study Center in their Psychoeducational and Diagnostic Testing Program and received extensive training in cognitive, academic, attentional, and psychological testing.  I work closely with families, schools, and other professionals in supporting children and improving their learning experiences.  

What does a Comprehensive Psychodiagnostic Evaluation entail? 

A comprehensive psychodiagnostic evaluation typically includes a parent interview, administration of several tests that measure various areas of cognitive, academic, and psychological functioning, a classroom observation (if possible), and feedback sessions with the family.  The tests administered evaluate various areas of functioning, including cognition, verbal processing, non-verbal processing, memory, processing speed, attention and concentration, executive functioning, academics, and emotional experience.  Tasks include things like puzzles, word games, drawings, and storytelling.  Test administration lasts anywhere from 7-10 hours total, typically divided into shorter 1-3 hours sessions.  Parents walk away from the assessment process with a final report and specific recommendations for how to best support their child. 

Are psycho-educational assessment referrals cause for concern? 

Absolutely not!  A referral for an evaluation just means that a student may not be learning in the way expected.  The information gathered from an assessment will help teachers instruct the child and help the child apply specific strategies to the learning process.  Completing an evaluation should never be about finding out what is “wrong,” but rather about finding out what is “right.”  Evaluations will identify specific strengths, which will empower the child and help them approach tasks and learning in a way that works for their brain.  An assessment could benefit every child!

Can you help our community with some common terminology?

Specific Learning Disability: This is a diagnostic category in the DSM-5 (Diagnostic and Statistical Manual) that describes specific weaknesses in the areas of reading, writing, or mathematics.  Diagnoses are issued if the child is performing below the expected level, as determined by formal testing.  The expected level is determined by IQ testing.

IQ: Intelligence Quotient.  This is a numerical representation of a person’s cognitive ability.  IQ is comprised of several areas of functioning including, verbal ability, visual-spatial ability, fluid reasoning (i.e. problem-solving ability), working memory, and processing speed.  These combined areas make up a person’s IQ.

Comprehensive Testing: Comprehensive Testing means that the tests administered would measure many areas of functioning.  This is different from just a psycho-educational assessment, which would look at basic cognitive abilities (i.e. IQ) and academic performance only.  A comprehensive evaluation takes a deeper look at the way a child thinks and processes information, which helps to formulate specific recommendations and tailor classroom instruction.

Our caregivers would appreciate an understanding of sneaky symptoms of learning differences that may otherwise go unnoticed. What should they look out for in their learners? 

Anytime a child seems to be avoiding a specific academic task, teachers and caregivers should wonder whether the difficulty of the task is what is getting in the way.  A hasty and careless approach to tasks may also indicate difficulty with that subject area.  The length of time it takes to complete homework may also be indicative of a learning difficulty.  Students should not be spending hours completing their homework every night!

How do caregivers learn their child needs an assessment?

Typically, a teacher or school administrator will recommend an assessment based on their in-class observations.  This conversation may begin with an initial conversation about areas of concern or weakness observed in the classroom.  Caregivers may also notice that certain academic tasks are more difficult for their child to complete and wonder whether it is a function of a learning weakness.  Referrals may also come from a child’s individual therapist, should they be in therapy.  There may be questions that the therapist can’t answer and test data can help clarify how a child processes the world.  An evaluation can also help guide therapists in their treatment and provide a type of manual for how the child sees the world.  

What services are typically recommended if a learner qualifies for an official diagnosis? 

Services may include educational therapy, psychotherapy, occupational therapy, speech, and language therapy.  

What are a few key tips for caregivers to keep in mind while their learner undergoes psychological evaluations? 

It is important not to think about the evaluation process as a test, but rather as a journey of understanding how a child’s brain works and their strengths.  Kids shouldn’t feel like they need to “score high” or get the answers right because many of the tasks are intended to be difficult or beyond the child’s capacity.  The goal is to encourage the child to do the best they can and not feel like they are getting a grade.  

Any final thoughts you wish to offer to our shared audience? 

The evaluation process should be empowering for both the child and parents and seen as a positive experience.  Weaknesses can be reframed as areas of growth and the evaluation process can give kids the tools to understand how they learn and know how to approach specific tasks.  Diagnoses can also be discussed in terms of a common language and not as a way to identify what is wrong.  A diagnosis by itself does not tell the child’s story and should only be used as a way to classify some of the areas of difficulty.  It will never answer all the questions, and the same diagnosis could look very different in two different kids.