Insights Into Effective Language Treatment for Internationally Adopted Children

Indian boy
I was recently asked to consult on a speech-language evaluation for a 12-year-old child who has lived with her adoptive parents in the United States for the last three years. English is the fourth language she has been exposed to since birth, but there is no trace of the child’s first three languages ever since her immersion in an English-speaking environment.

Though her adoptive parents knew which languages she was exposed to, they did not know the extent or quality of that exposure, and they were given very little information about her receptive and expressive language skills in those languages. The referring speech-language pathologist was very cautious in how she approached the assessment. She was careful to look at the length of time the child has been exposed to English, the quantity and quality of language input she has received up to this point, and so on. She recognized that the child had experienced significant native language loss.

The most important piece of information she needed, however, was missing. No one could affirm whether or not the child ever had appropriate language skills in any of the previous languages of exposure. No information was available on her comprehension, her vocabulary use, her ability to form sentences, and so forth, in her previous languages.

So how does one arrive at an appropriate diagnosis for children whose language backgrounds are virtually unknown? First, look for patterns of language development. Second, urge prospective parents to obtain extensive information on their child’s current native language functioning prior to leaving the birth country. For more on this topic, I recommend reading the articles of language-development researcher Sharon Glennen, including her ASHA Leader piece “Speech and Language ‘Mythbusters’ for Internationally Adopted Children.”

I would like to highlight a few things that set internationally adopted children apart:

  • They are not the typical English Language Learner in the sense that most adoptive parents do not speak the native language of the child. Thus, the likelihood of preserving the native language is very slim. We see that expressive and receptive language loss occurs rapidly with these children because their need for the native language is virtually nonexistent due to complete immersion in the adoptive language. In contrast, most ELLs whose contact with the native language continues (such as immigrant families) do experience varying levels of language loss but at a much slower and gradual pace. They retain some measure of bilingualism, whereas IA children do not and in essence become monolingual English speakers. This means the majority of IA children, particularly ones adopted at younger ages, won’t require bilingual testing (again, Glennen explains this thoroughly).
  • For children adopted at older ages, distinguishing true language disorders can be somewhat trickier, so it is imperative that parents gather and share with SLPs extensive information on their child’s communication skills in the native language. If accurate information is not obtained from the start, by the time concerns arise significant language loss will have already occurred. Knowledge of native language proficiency is only beneficial in the evaluation process if that knowledge is based on what was happening before the complete language immersion experience.  I have developed a simple screening measure specifically for parents to use in the birth country prior to bringing their child home.  My hope is that this will assist parents in asking the right questions of orphanage workers, caseworkers, or any adult familiar with the child.  Parents can then store the answers if more information is needed, whether immediately or in the future. The bottom line is, because of the inevitability of instant language loss, if the IA child’s native language skills are shown to be delayed on adoption, there is no need to postpone speech and language testing and to implement appropriate and direct intervention.
  • IA children gain conversational language skills more rapidly than most ELLs due to their full immersion experience, but some may struggle with cognitive language development as other ELLs do. Cognitive language or academic language encompasses specialized or content-specific vocabulary, complex grammatical structures, abstract concepts, discourse patterns or text structures, and reasoning. This means that parents can be proactive in how they assist their IA children to succeed in the school environment, especially children adopted at older ages. Resources available for adoptive parents include the SmartStart program by psychologists Carol Lidz and Boris Gindis, which is designed to help parents facilitate thinking and learning in their adoptive children through fun, meaningful family activities, games and experiences.

Though the number of international adoptions has declined in the United States in recent years, largely due to more stringent rules and regulations, thousands of children are adopted yearly into U.S. families from abroad. Given this, we must continue to provide guidance and resources for families walking this journey, as these children’s language development, school readiness and adjustment are often at the forefront of their parents’ minds.

Ana Paula G. Mumy, MS, CCC-SLP,  is a trilingual speech-language pathologist and the author of various continuing education eCourses, leveled storybooks, and instructional therapy materials for speech/language intervention.  She has provided school-based and pediatric home health care services for nearly 12 years and offers resources for SLPs, educators and parents on her website The Speech Stop.

On the Other Side of the Table: Receiving the Diagnosis

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As a professional working with communication disorders for 13 years, I find it second nature to complete evaluations and report results and recommendations to families. Due to my graduate training and a couple of wonderful professors—in addition to an understanding of assessment and treatment of speech/language impairments—I feel I came away with effective skills in counseling and empathizing with families in the face of an unexpected diagnosis.

It was not until recently, however, that I found myself on the other side of the table, watching my father go through neurological and cognitive testing and hearing the impending diagnosis: moderate Alzheimer’s.  Though I was confident he was showing clear signs of dementia prior to the evaluation, as I sat with him during the exam, it was difficult, yet eye opening, to watch him struggle through simple language and memory tasks that previously would have been so easy for him.

Even more eye opening was his own unawareness of the problem, his inability to understand the reason he was seeing a neurologist in the first place, and the fact that most of his responses were incorrect, though he thought he nailed them!

At home with my mother, more eye openers came very quickly.  Though I primarily work with children, I have always been a big advocate for family and parent training, and I have sought to educate and include parents and family members as much as I can in the treatment of my clients. I have learned that my skills—what comes naturally to me, how I engage with children, how I intuitively attempt to promote speech and language at every turn—are not skills I can assume that parents and caregivers possess, and this understanding has helped me shape my family/parent education model.

With adults, however, I haven’t always thought in those terms.  I have come to realize that I tend to assume that adults, especially educated adults without impairment, should know how to engage with other adults who have cognitive-communication impairments.

It took me by surprise that my mom did not possess the understanding or the skills to handle my father’s memory lapses, lack of retention, confusion, reduced reasoning skills, and disorientation to time, place, and people.  The changes that are needed in their current home environment and in my mom’s interactive style with him appear obvious to me, and I can immediately “frame-switch” with him, changing the way I respond, react, reassure and redirect due to his current deficits. My mom, however, doesn’t know where to begin. Though she is an intelligent and very caring person, she appears stuck in the relational style she has always had with him, demonstrating by her words and actions that she expects from him the same sharpness and clarity of mind.

There is no overt denial of his condition, but there appears to be what I’m calling a “relational denial.”  She knows his cognitive function is progressively deteriorating, but she does not know how to modify her way of interacting with him. She cannot even identify that her expectations have not changed. The take-home point that has been solidified for me is this: One of the most important and effective roles I have as a speech-language pathologist serving adult populations is caregiver education and training.  I realize this is not a breakthrough discovery in the field of speech-language pathology, but I believe many of us do not spend enough time giving caregivers the tools and strategies to help themselves and their loved ones.

Even though my mom and I talked openly, honestly and lovingly about the needed changes, she could not readily implement them. Switching her frame of mind and subsequent actions and reactions has required much intentional modeling and repetition on my part. It has required identifying how she automatically responds and reacts, then identifying what a more effective way to respond and react would be to reduce her own frustration and his.

One discussion session would not have been enough.  A set of handouts or a brochure would not have been enough. Recommending a good book on Alzheimer’s would not have been enough.

This experience has caused me to evaluate not only my views on caregiver education and training for adult populations but also my investment in a hands-on family education model that is thorough, caring, and thoughtful. Families and caregivers desperately need our expertise in practical ways to effectively cope and help their loved ones!

 

Ana Paula G. Mumy, MS, CCC-SLP,  is a trilingual speech-language pathologist who provides school-based and pediatric home health care services in Colorado Springs, Colo. The author of various continuing education eCourses, leveled storybooks and instructional therapy materials for speech/language intervention, she also offers resources for SLPs, educators and parents on her website The Speech Stop.

My Baby Can Play: How Productive Play Promotes Literacy

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(photo credit)

My Baby Can Read…Play: How Productive Play Promotes Literacy

If you pay attention to the current toys, television shows, and materials for children like Your Baby Can Read! you should notice a cultural shift to the promotion of literacy, especially early literacy skills.  From older shows such as Sesame Street and Between the Lions to newer shows such as WordGirl, WordWorld, and Super Why! we see the push for phonological awareness skills and reading skills, which encompass rhyming, letter/sound naming and identification, sound segmenting and blending, and so on.

The available research clearly shows the importance of promoting literacy skills early, and the overall consensus is that oral language provides the building blocks for literacy.  So if oral language is the foundation, and if we achieve language through quality language input, how is that input provided for infants and toddlers?  Through play!

Besides daily care-taking routines that parents and children engage in (feeding, grooming, sleeping), the next most important activity they engage in (where crucial language input is provided) is play.

So, if appropriate play skills predict appropriate language skills, and if strong language skills predict literacy skills, then I see a clear link between play and reading.

I’m not suggesting reading to infants and toddlers is not valid and necessary; I am suggesting that perhaps there should be a greater, or at least equal, push for promoting quality play.  My meaning of play, however, is where the play partner of the child is engaging the child and providing quality language input naturally but purposefully.

In a nutshell, let’s not bypass the building block of play because we’re so concerned that children be able to read.

As a personal example, both of my toddlers love books.  From the time my four-year-old daughter was one, she would quietly sit on the floor going through baskets I had set around the house full of little books, and she would flip through the pages “reading” one book after another.  I often find my two-year-old son sitting in a rocking chair in his room surrounded by books “reading.”  He spontaneously points out characters and talks about the pictures.  His big sister also helps him out, making up stories for him based on the pictures as though she is reading…and he believes every word!

As parents, my husband and I have read to them consistently, have made sure books are readily available and accessible to them, and have encouraged them to talk about the pictures and relate what they’re seeing to experiences they’ve had, but I firmly believe their enjoyment of books would not have been fostered without purposeful play in our home.

Purposeful play is crucial in order to develop what I call the 4 C’s: Concentration (attention), Curiosity, Creativity (imagination), and family Connection (through a shared activity).  These four components are extremely important for promoting reading ability.

So as professionals, educators, and parents, let’s evaluate where we’re investing our time and resources and make sure the push for early literacy doesn’t overshadow or do away with the need for consistent and quality play, not through the latest electronics or gadgets, but using good ol’ blocks, dolls, cars, toy farms, puzzles, toy kitchens, playdough…and the list goes on and on.

For purposeful play suggestions, check out free tip sheets (known as P.O.P. sheets) entitled Purposeful Ongoing Play: Enhancing Language Skills Through Play.

(This post originally appeared on The Speech Stop)

Ana Paula G. Mumy, MS, CCC-SLP, is a multilingual speech-language pathologist and the author of various continuing education courses, leveled storybooks, and instructional therapy materials for speech/language intervention.  She has provided school-based services, home health care, and private services for more than 12 years and thoroughly enjoys providing resources for SLPs, educators, and parents on her website The Speech Stop.

What Do Impact Craters Have to Do with Speech-Language Pathology?

As a speech-language pathologist, one of the questions I am asked most often by concerned parents of late talkers is, “How do I know if my child will be okay?” or “Will they catch up?” Though we don’t have crystal balls that foretell the future, we do possess the knowledge of potential red flags or areas to consider when determining whether parents have legitimate concerns that should be investigated further or if more time and quality language exposure may be sufficient remedy.

As I’ve sought ways to effectively communicate to parents what to look for, I’ve coined a term or acronym that helps parents think through five different areas of language development that give us valuable clues. The acronym is W.I.P.U.L., pronounced “whipple” as the name of a lunar impact crater. I utilize the mental picture of an impact crater (a depression on the surface of a solid body formed by impact of a smaller body with the surface) when thinking of a “depression” in language skills that may not be indicative of a true language delay or disorder. If you’re looking for a simple way to walk parents through these five areas, feel free to utilize my visual for WIPUL. Below is a summary of how I present this to parents.

Words - Use of Words More Than Gestures

Here I discuss how gestures and body language are effective communication tools early on, but eventually words become more effective for communication, and therefore, normally-developing children tend to rely on words more than gestures as they mature and develop.

IntentCommunicative Intent or Desire to Communicate is Present

Here I explain that even when all the words are not there for expression, seeing a child’s desire and attempts to engage in communicative interactions, including eye contact for example, is a good sign. Red flags go up when children remain isolated or disinterested in communicative interactions with those in their environment.

PlayAppropriate Play Skills

Here I walk parents through normal stages of play, from solitary play to parallel play, from associative play to cooperative play, where children go from playing alone as they explore their environments to playing side by side without much social interaction to playing together with structure, cooperation and shared goals. I also speak of the important skills of pretending and symbolic play, as children demonstrate a clear understanding of objects, their use, as well as appropriate associations and representations during play interactions.

Understanding - Good Understanding of Vocabulary and Language

Here I discuss how some children may have smaller vocabularies, may not be combining words, or may have disorganized language structure, which all create communication barriers. If these children, however, show a good understanding of the vocabulary and language around them, being able to follow commands, to respond appropriately, and to clearly show understanding of the vocabulary/language in relation to objects, toys, foods and people in their environment, then less concern is warranted.

Learning - Readily Learning New Words and Concepts on a Daily/Weekly Basis

Lastly, I assure parents that if their children show they are learning new words and concepts on a regular basis, even if not at the same pace as their peers, that steady growth is a positive sign. I also explain we look not only for concrete words for persons, places, and things (nouns) but also for action words (verbs) and more descriptive words such as in/on/off (location), hot/cold (feature), big/small (size), one/all (quantity), fruit (class) and so on.

I must note that for multicultural families, this conversation may be somewhat different since some cultural norms dictate different behaviors and expectations of children as well as different interaction styles between adults and children.

As parents utilize this acronym to analyze their children’s communicative development, it facilitates their understanding of their child’s current status and assists them in the decision-making process in terms of if and when to seek a professional for a comprehensive speech-language evaluation.

 

Ana Paula G. Mumy, MS, CCC-SLP,  is a trilingual speech-language pathologist and the author of various continuing education eCourses, leveled storybooks, and instructional therapy materials for speech/language intervention, as well as the co-author of her latest eSongbook which features songs for speech, language and hearing goals.  She has provided school-based and pediatric home health care services for nearly 12 years and thoroughly enjoys providing resources for SLPs, educators and parents on her website The Speech Stop.

Tips for Parents Raising Bilingual Children: When the Home Language Differs From the Community Language

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Photo by agreste3000

Be Intentional

  • Realize that everyday activities such as mealtimes, getting dressed, bath time, and playtime are all opportunities for talking, teaching, and providing quality language exposure. Be intentional about ongoing verbal interactions about things, routines and events in your child’s life.
  • Arrange for varied opportunities for your child to have diverse contexts for engaging in the minority language such as book sharing and reading experiences, singing, educational videos, children’s shows, play groups, family visits and trips. It is important for your child to have access to other speakers of the minority language as much as possible.
  • When your child uses incorrect words or grammar, simply model the correct vocabulary and/or sentence structure in response to the child’s utterance.
  • When appropriate, expand your child’s utterances by first affirming what he/she said and then by adding to what was said if the vocabulary or grammar usage was lacking.
  • Even if your child is tending to speak more in the majority language, continue speaking to him/her in the minority language. When appropriate, recast the utterance, or present it in a different or changed structure while maintaining its meaning. For example, if your child utters a phrase or sentence partly or entirely in the majority language, recast the utterance in the minority language, modeling correct usage where any vocabulary or grammatical gaps were noted.
  • Instill in your child a sense of pride and “need” for the minority language by keeping it relevant and constant in his/her everyday life. Children will inevitably discard a language they do not feel they need.
  • Consider teaching your child to read and write in the minority language. The more competencies your child develops in the minority language, the more internally relevant and important that language will become.

Be Consistent

  • If you are the primary source of language input for your child in the minority language, consistently speak to your child in that language whether at home or out in the community.
  • Though code mixing, or alternating between two languages while speaking, is completely normal and appropriate for bilinguals, in order to clearly draw a line between the two languages in your child’s linguistic environment, limit code mixing as much as possible at least at the beginning stages.

Be Persistent

  • Don’t lose heart or give up even if your child’s language proficiency or skills seem to fluctuate over time in his/her two languages. Some fluctuation is normal as children learn to navigate between both languages.
  • Don’t allow for interruptions or long periods of little or no exposure to the minority language. • When it seems hard and laborious, remember the long-term benefits and rewards you are bestowing upon your child by raising him/her to be bilingual.
  • Relatives, friends, and community members may misunderstand or even disagree with your decision to raise your child bilingually for various reasons. If you can, kindly educate them about your decision, but if not, politely stand your ground based on what’s best for your child. Your dedication, consistency and persistence will pay off in the end!

“The bilingualism of children should be a source of joy, both for parents and children, even if there are occasional moments of difficulties.” François Grosjean

(This post originally appeared on The Speech Stop)

 

Ana Paula G. Mumy, MS, CCC-SLP,  is a trilingual speech-language pathologist and the author of various continuing education eCourses, leveled storybooks, and instructional therapy materials for speech/language intervention, as well as the co-author of her latest eSongbook which features songs for speech, language and hearing goals.  She has provided school-based and pediatric home health care services for nearly 12 years and thoroughly enjoys providing resources for SLPs, educators and parents on her website The Speech Stop.

One-Dimensional Speech-Language Therapy: Is the iPad Alone Enough?

Dimensional Doors

Photo by the_tahoe_guy

Smart phones, iPods, e-readers, webcams, iPads and more…my humble listing does not even touch the surface of the plethora of hard-to-pass-up gadgets introduced by technology.

We undoubtedly live in a digital era. I just co-authored a digital songbook for speech, language and hearing goals. I am in the process of developing an app for the iPad for language intervention. My 3-year-old daughter could easily become an iPad junkie if allowed unlimited access. I’ve also been guilty of texting my husband from the upper level of our home because I was too lazy to walk downstairs. I understand emails and text messages have become primary modes of communication, and I am not opposed to the reality in which we live.

My concern today is that I have heard of SLPs who are abandoning all traditional or old-school therapy materials and methods and beginning to strictly incorporate the iPad in most if not all of their therapy sessions.

I cannot deny the iPad is a powerful motivator, a versatile and effective therapy tool if used appropriately, and a great time-saver in multiple ways, but can I deny the effectiveness of other tried and true therapy tools? Have flashcards, markers and paint, manipulatives and hard copy storybooks become obsolete? My personal and professional opinion is a resounding NO!

When recently perusing a long list of available apps geared for speech/language pathologists, I was amazed to find that there truly seems to be an app for everything—articulation, phonology, minimal pairs, wh– questions, following directions, predicting, inferring, pragmatics, categorization skills, verb usage, homophones, comparing/contrasting, story starters, goal-writing, and on and on and on. While these resources are great and I commend the innovative SLPs creating these wonderful apps, my only caution is that we not become one-dimensional in our provision of services.

Allow me to clarify that I love my iPad and use it regularly with various children I work with, however, I don’t believe any one tool will ever be sufficient or appropriate for every child or for every intervention goal regardless of how technologically advanced it is.

The crux of the matter is, in addition to our digital reality, the other reality I see is that children still must learn to interact with people in addition to machines. There is still much to be said for the meeting of the eyes, for the exchanging of words between humans, for appropriate physical contact, for the manipulation of objects in one’s hands, and so forth, so we must not write-off valuable non-techie resources and materials that are still available to us.

This is not a call to put away our iPads, it is merely a call to evaluate and utilize all of the effective tools we possess in order to provide excellent speech and language services to the individuals we serve.

Let’s not sacrifice all traditional therapy materials and methods on the altar of technology!

(This post originally appeared on The Speech Stop)

 

Ana Paula G. Mumy, MS, CCC-SLP,  is a trilingual speech-language pathologist and the author of various continuing education eCourses, leveled storybooks, and instructional therapy materials for speech/language intervention, as well as the co-author of her latest eSongbook which features songs for speech, language and hearing goals.  She has provided school-based and pediatric home health care services for nearly 12 years and thoroughly enjoys providing resources for SLPs, educators and parents on her website The Speech Stop.

Tips for Clinical Fellows: More Than Surviving Your First Year

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Photo by bluishorange

Get Organized

  • Weed through all of the papers, manuals, and orientation/training materials you received and make a list of all important deadlines in progressive order. This will ensure you stay on top of them!
  • Make a spreadsheet schedule of when you see clients/students, laminate it, and follow it!
  • Print a list of your clients/students in order of when annual reviews and reevaluations are due.
  • If you’re overloaded with initial evaluations to complete, pick a feasible number of evaluations to be completed weekly. Schedule those and pat yourself on the back when you accomplish the number you set, even if it’s just one or two weekly.
  • When first getting to know your clients/students, place simple abbreviations of their goals on the data sheets you’re utilizing to quickly jog your memory about their challenge areas. Even if your main target for the therapy session is X, you can be indirectly addressing Y or Z as well.
  • Be prepared for meetings. If you know certain topics, disorders, or clients/students will be discussed, if you are unfamiliar with that subject, do your homework. You don’t have to know it all, but aim to gain the trust of those around you by adding to the discussion.
  • Maintain open and frequent communications with your CFY supervisor.

Get Creative

  • As you build your “tool box” of therapy materials, think functional, relevant, and motivational. Invest in materials that will motivate your clients/students to invest themselves in their own progress.
  • Don’t merely make plans for great therapy sessions…carry them out!

Get Involved

  • Make yourself readily available to family members, parents, teachers, administrators, and coworkers. Be an approachable point of contact for questions or concerns. If you don’t know the answer, there’s always opportunity to look it up!
  • Know your clients’/students’ birthdays and other important information. We all like to know that we’re more than just a name (or number on a caseload).
  •  Take part in your clients’/students’ special activities or life events when possible.

Get Noticed

  • Develop a simple monthly or quarterly newsletter for family members, parents, teachers, administrators and/or coworkers. Let the first one be an introduction to yourself and market yourself as a resource on speech and language issues. Because we’re all inundated with things to read and little time to read them, make each newsletter short, concise, and interesting.
  • Prepare a bulletin board accentuating your services or an area of interest or benefit to your clients/students. Don’t wait until May when Better Speech and Hearing Month comes around!

 (This post originally appeared on The Speech Stop)

 

Ana Paula G. Mumy, MS, CCC-SLP,  is a trilingual speech-language pathologist and the author of various continuing education eCourses, leveled storybooks, and instructional therapy materials for speech/language intervention, as well as the co-author of her latest eSongbook which features songs for speech, language and hearing goals.  She has provided school-based and pediatric home health care services for nearly 12 years and thoroughly enjoys providing resources for SLPs, educators and parents on her website The Speech Stop.