Tag

language

Aug 07
6

Pediatric-onset Multiple Sclerosis

By | Nesca Notes 2023

By: Ferne Pinard, Ph.D.
NESCA Pediatric Neuropsychologist

Although typically thought of as an “adult illness,” children and adolescents can get diagnosed with multiple sclerosis (MS). Pediatric-onset multiple sclerosis (POMS) occurs when MS is diagnosed before age 18.

Approximately 30% of POMS patients show evidence of cognitive impairment. Problems with attention, working memory, processing speed, and language (including word retrieval) are commonly reported. Poorer verbal expression/vocabulary acquisition have also been reported among patients who were diagnosed at younger ages. Overall IQ, memory, complex attention (i.e., shifting attention between competing stimuli) and visual-motor integration skills may also be impacted. These cognitive deficits as well as absences due to illness and fatigue can undermine the student’s academic performance (i.e., grades), leading to feelings of inadequacy and a sense of not being able to “keep up with” their peers academically.

However, POMS can also affect the child’s/adolescent’s social and emotional functioning. Fatigue, depression, bowel/bladder problems and physical limitations can decrease a child’s/adolescent’s interest in socializing. Heat sensitivity can limit participation in physical activities while in a warm environment, which can make them feel even more isolated. They may also feel embarrassed and have lowered self-esteem because they feel different from peers. Children/adolescents with chronic illnesses are also at an increased risk for teasing and bullying from peers. It is no surprise then that children/adolescents with MS are vulnerable to psychiatric disorders. Depression, anxiety, and bipolar disorder occur more often in the MS population than the general population.

Multiple sclerosis is an unpredictable disease. Symptoms can come and go without apparent reason or warning, and no two people experience MS symptoms in exactly the same way. Some symptoms are clearly visible (like weakness, causing walking problems) or less visible (like fatigue or cognitive concerns). It is not possible to predict when symptoms will occur or what parts of the body will be affected. MS symptoms can change from week to week.

It is important that school officials understand that because symptoms come and go without warning, accommodations need to be in place, even when symptoms seem to diminish for a time. Accommodations can include:

    • Home tutoring when students are not able to attend school
    • Excused absences and a reasonable plan to make up missed work
    • Extended time for tests/exams/projects
    • Second set of books at home
    • Preferential seating for visual, attention, or bladder/bowel issues
    • Bathroom pass/extended bathroom time
    • Portable air conditioner/fan
    • Elevator access
    • Psychotherapeutic support
    • Plan to manage fatigue:
      • Frequent/scheduled breaks
      • Modification of class schedule
      • Workload modifications

A detailed neuropsychological evaluation is essential for objectively measuring any neurocognitive deficits, tracking them over time, and informing treatment recommendations. Speech/language, audiology, occupational therapy, and physical therapy evaluations may also be warranted depending on the severity of symptoms to determine whether these services are needed. Psychologists, psychiatrists, school guidance counselors, teachers, and school administrators as well as support groups with other patients and families facing this disease should also be part of the child’s/adolescent’s care team.

 

About Pediatric Neuropsychologist Ferne Pinard, Ph.D.

Dr. Pinard provides comprehensive evaluation services for children, adolescents, and young adults with learning disabilities, attention deficit/hyperactivity disorders (ADHD), and psychiatric disorders as well as complex medical histories and neurological conditions. She has expertise in assessing children and adolescents with childhood cancer as well as neuro-immunological disorders, including opsoclonus-myoclonus-ataxia syndrome (“dancing eyes syndrome”), central nervous system vasculitis, Hashimoto’s encephalopathy, lupus, auto-immune encephalitis, multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), and acute transverse myelitis (ATM), and optic neuritis.

 

To book a neuropsychological evaluation with Dr. Pinard or another expert neuropsychologist at NESCA, complete NESCA’s online intake form. 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts; Londonderry, New Hampshire; and Coaching and Transition staff in greater Burlington, Vermont, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Nov 07
6

The SLP’s Role in Written Language Disorders

By | NESCA Notes 2022

By Olivia Rogers, MA., CCC- SLP
Speech-Language Pathologist, NESCA

A written language disorder is an impairment in fluent word reading (i.e., reading decoding and sight word recognition), reading comprehension, written spelling, and/or written expression (Ehri, 2000; Gough & Tunmer, 1986; Kamhi & Catts, 2012; Tunmer & Chapman, 2007, 2012). As written language disorders are quite complex, appropriate assessment and treatment often incorporates many members. Members of the interprofessional practice team may include, but are not limited to, reading specialists, occupational therapists, special educators, learning specialists, and more.

When you think of a speech-language pathologist (SLP), a few words probably come to mind; terms like articulation, language, or fluency. Often, SLPs are associated with spoken language only. Most people don’t think of reading or writing when they think of SLPs. However, in addition to the diagnosis and treatment of spoken language disorders, it is well within the scope of practice of a SLP to diagnose and treat written language disorders. In fact, spoken and written language have a reciprocal relationship; each builds on the other to result in general language competence. Children with spoken language problems frequently have difficulty learning to read and write, and children with reading and writing problems frequently have difficulty with spoken language. Children with speech and language deficits are at a higher risk for reading and writing difficulties. Higher rates of all forms of written language disorders have been documented in children with speech and/or language impairments. Take a look at these findings:

  1. Comorbidity between literacy difficulties and speech and language deficits occurred in as high as 50% of cases (Stoeckel et al. (2013).
  2. By the end of kindergarten, more than 25% of children with language impairment were reported to also be poor readers (Murphy et al., 2016).
  3. Approximately 20%-28% of children with speech sound disorders (SSD) have literacy difficulties (Overby, Trainin, Smit, Bernthal, and Nelson, 2012).

No matter the age, SLPs can assess and treat spoken and written language difficulties. SLPs bring knowledge of communication processes and disorders, and language acquisition to the literacy table. Additionally, SLPs are skilled in dynamic assessment and have clinical experience in developing individualized programs for children and adolescents. Here are just a few written language skills that SLPs work on:

Reading: Pre-reading Skills

Before a child can decode, or read, they must have an understanding that words are composed of smaller units and how these units operate separately and together. SLPs incorporate the following skills into sessions:

  • Rhyming (e.g., “flag and stag”)
  • Syllable segmenting (e.g., “student: stu/dent”)
  • Blending sounds into words (e.g., “sh/i/p says ‘ship’”)
  • Segmenting words into their sounds (e.g., “leg: l/e/g”)
  • Deleting sounds in words (e.g., “cup without the c is up”)
  • Substituting sounds in words (e.g., “change the ‘B’ in bat to an ‘M’”)

Reading: Language Comprehension

This is the biggest one for SLPs. To target language comprehension, we work on smaller goals, such as:

  • Grammar
  • Story Grammar Elements
  • Visualizing and Verbalizing
  • Vocabulary
  • Active Reading Strategies
  • Themes

Writing: Organization/Planning

Before writing, it is important to plan out what you will write. Many children with language disorders have trouble with these skills. Here are just a few ways that SLPs help children plan and develop their writing by:

  • Using visuals for story grammar components
  • Make and practice using graphic organizers
  • Teaching sentence, paragraph, and essay construction

Spelling

Yes, spelling! SLPs are equipped to work on spelling. After all, it is just another language skill. Some ways to target spelling include:

  • Working on phonological awareness and phonemic awareness
  • Teach students about morphology (the study of words and their parts)
  • Incorporation of working memory strategies, such as chunking, visualization, or mnemonics

If you have concerns about your child’s pre-literacy or literacy skills, or would like to support your child’s written language skills, please contact NESCA’s Olivia Rogers at orogers@nesca-newton.com or fill out our Intake Form, noting an interest in speech language pathology.

 

Sources:

Overby, Trainin, Smit, Bernthal, and Nelson, 2012) Preliteracy Speech Sound Production Skill and Later Literacy Outcomes: A Study Using the Templin Archive.

American Speech-Language-Hearing Association. (2001). Roles and responsibilities of speech-language pathologists with respect to reading and writing in children and adolescents [Position Statement]. Available from www.asha.org/policy.

Catts, H.W. & Weismer, S.E. (2006). Language Deficits in Poor Comprehenders: A Case for the Simple View of Reading. Journal of Speech, Language, and Hearing Research, 49, 278-293.

 

About the Author

Olivia Rogers received her Master of Arts in Speech-Language Pathology from the University of Maine, after graduating with a Bachelor of Arts in Communication Sciences and Disorders and concentrations in Childhood Development and Disability Studies.

Ms. Rogers has experience working both in the pediatric clinic setting as well as in public schools, evaluating and treating children 2-18 years of age presenting with a wide range of diagnoses (e.g., language delays and disorders, speech sound disorders, childhood apraxia of speech, autism spectrum disorder, social communication disorder, and Down syndrome). Ms. Rogers enjoys making sure therapy is fun and tailored to each client’s interests.

In her free time, she enjoys listening to podcasts and spending times with friends and families.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

To book an appointment with Olivia Rogers, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

Jun 27
7

Learning with Executive Dysfunction—How Graphic Organizers Can Help

By | NESCA Notes 2022

By Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

When it comes to executive dysfunction, we often see students struggle with the organization of language. This presents differently in each student, but may be seen as difficulty comprehending information, and getting ideas out of their heads and organized into words or on paper. They might recognize the words when listening or reading, but they hit a wall when it comes to making sense of the message or describing it. This often results in students feeling lost, confused, and overwhelmed.

When students struggle to organize language and grasp concepts independently in the classroom, we need to break it down and teach it differently. Graphic organizers help us to do so.

What is a graphic organizer?

Graphic organizers are tools that use visual symbols to express knowledge, concepts, thoughts, or ideas, and the relationships between them. The main purpose of a graphic organizer is to provide a visual aid to facilitate learning and instruction. They help students see visually what is expected of them, what they should focus on, and break complex tasks down for them.

What does the evidence show?

There is plenty of evidence demonstrating the benefits of using graphic organizers. The results of most studies have voiced the positive effects of graphic organizers in mainly comprehension and writing, in addition to remembering course content. One such study recommended the use of graphic organizers for teaching expository text structures with students to improve reading comprehension. A popular strategy to help students understand expository texts is to teach the various types of text structures: cause-and-effect, compare/contrast, problem/solution, etc. When students know the underlying organization of the information, it helps them create a working model of it in their minds, resulting in a better understanding and ability to recall. (Pyle et al., 2017). Another study sought to investigate how pre-writing activities based on graphic organizers, such as webs, and beginning, middle and end charts, affect the overall quality of student writing. The results of the study indicate that using appropriate pre-writing strategies based on graphic organizers and giving enough time for the students lead to better quality writing (Servati, 2012).

How are Graphic Organizers Used in Speech Language Therapy?

1. Graphic Organizers Help Students Focus

Many students exhibit disorganized thinking processes, poor initiation skills, word recall difficulties, poor attention, and decreased task endurance. These weaknesses can impact a student’s ability to get started on a project, organize a writing assignment, or even complete a math task. Graphic organizers help students access prior knowledge and get them actively engaged in learning.

2. Graphic Organizers Provide a Visual Map and Help Clarify Abstract Concepts

Have you ever had so much information that you couldn’t hold onto it all? Graphic organizers bring together large pieces of information and tie the relationships together. The concepts and linguistic relationships flow better and make sense to students.

3. Graphic Organizers Help Build Vocabulary

Students benefit from graphic organizers as they expand their word knowledge and make connections. Graphic organizers are great for teaching concepts like descriptive adjectives, antonyms/synonyms, items in a category, part/whole relationships, and definitions.

4. Graphic Organizers Improve Expressive Language

Graphic organizers support oral and written language in all areas of academic learning. Some students have difficulty creating pictures in their head, retrieving words to verbalize their ideas, and putting their thoughts in order. Utilizing a graphic organizer can help students when they need to present information orally or develop a draft for writing.

 

Resources:

Architects For Learning. (2022, May 18). Helping students manage what’s hard about school and thrive as life-long learners. Retrieved June 21, 2022, from https://www.architectsforlearning.com/students-parents/about-us/

Erwin, L. (2017, May 26). 5 reasons to use graphic organizers in speech therapy. My Speech Tools. Retrieved June 21, 2022, from https://myspeechtools.blogspot.com/2017/05/5-reasons-you-should-use-graphic-organizers-speech-therapy-sessions.html

Servati, Katrina, “Prewriting Strategies and their Effect on Student Writing” (2012). Education Masters. Paper 242. https://fisherpub.sjfc.edu/education_ETD_masters/242

Sherman, H. (2017, December 23). Using Graphic Organizers is Essential in Speech Therapy. Speech Time Fun Speech and Language Activities. Retrieved June 21, 2022, from https://speechtimefun.com/using-graphic-organizers-is-essential-in-speech-therapy/

Pyle, N., Vasquez, A. C., Lignugaris, K., & B., Gillam, S.L., Reutzel, D.R., Olszewski, A., Segura, H., Hartzheim, D., Laing, W., and Pyle, D. (2017). Effects of expository text structure interventions on comprehension: A meta-analysis. Reading Research Quarterly, 52(5), 1–33. https:// doi. org/ 10. 1002/ rrq. 179

 

About the Author

Olivia Rogers received her Master of Arts in Speech-Language Pathology from the University of Maine, after graduating with a Bachelor of Arts in Communication Sciences and Disorders and concentrations in Childhood Development and Disability Studies. She holds a Certificate of Clinical Competence in speech-language pathology from the American Speech-Language-Hearing Association, as well as a professional license in speech-language pathology from the Commonwealth of Massachusetts.

Ms. Rogers has experience working both in the pediatric clinic setting as well as in public schools, evaluating and treating children 2-18 years of age presenting with a wide range of diagnoses (e.g., language delays and disorders, speech sound disorders, childhood apraxia of speech, autism spectrum disorder, social communication disorder, and Down syndrome). Ms. Rogers enjoys making sure therapy is fun and tailored to each client’s interests.

In her free time, she enjoys listening to podcasts and spending times with friends and families.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

To book an appointment with Olivia Rogers, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

Feb 28
6

Changes to the Developmental Milestones Guidelines Cause Confusion and Conflict

By | NESCA Notes 2022

By Olivia Rogers, MA, CF-SLP
Speech-Language Pathologist, NESCA

Recently, the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) updated guidelines for developmental milestones in the Learn the Signs. Act Early program for the first time since its initial release in 2004. This program provides free checklists of developmental milestones and outlines warning signs of developmental delays in the following areas: social/emotional, language/communication, cognition, and movement/physical.

One of the biggest CDC developmental milestone changes involves language development. Since 2004, the CDC has stated a 24-month-old should have a vocabulary of 50 words. Now, that milestone of 50 words has been pushed back to 30-months-old. This new standard clashes with the American Speech-Language-Hearing Association (ASHA) guidance, which states that saying fewer than 50 words at 24 months is a potential red flag for a language delay or disorder.

Confusion regarding the recent changes may impact the (already) difficult decision that many parents are faced with in the first few years of their child’s life: whether or not to seek professional support for their child.

Despite the changes to the outlined milestones, the intentions behind this checklist remain consistent—early identification and intervention is key. When it comes to your child’s speech and language development, we suggest not taking the “wait and see” approach. The first three years of your child’s life—when the brain is developing and maturing—is the most intensive period for acquiring key speech and language skills.

Though children vary in their development of speech and language skills, they do follow a natural progression for mastering these skills of language. If you’re worried your child isn’t meeting milestones and wondering when the right time or the best age is for speech/language therapy, take action sooner than later. Contact a local speech-language pathologist. The earlier a child is identified with a delay, the better, as treatment and learning interventions can begin.

We urge parents to follow their instincts and seek guidance when there is a concern. You will either get much needed help for your child or peace of mind, and your local speech-language pathologists are happy to help.

If your pre-school-aged child is having difficulty with any of the following, concerns can be addressed through a speech/language assessment and/or therapy:

  • Saying first words or combining words into sentences
  • Using gestures
  • Naming and describing objects, ideas, and experiences
  • Pronouncing words or being understood by family or others
  • Interacting socially or playing with others
  • Understanding words, concepts, or gestures
  • Listening, following directions, or answering questions
  • Knowing how to take turns when talking or playing with others
  • Using correct grammar, such as pronouns and verb forms

Resources:

Centers for Disease Control and Prevention. (2022, January 31). CDC’s Developmental Milestones. Centers for Disease Control and Prevention. Retrieved February 24, 2022, from https://www.cdc.gov/ncbddd/actearly/milestones/index.html

The National Institute on Deafness and Other Communication Disorders. (2000). Speech and Language Developmental Milestones. NIH Publication No. 00-4781.

 

About the Author

Olivia Rogers received her Master of Arts in Speech-Language Pathology from the University of Maine, after graduating with a Bachelor of Arts in Communication Sciences and Disorders and concentrations in Childhood Development and Disability Studies.

Ms. Rogers has experience working both in the pediatric clinic setting as well as in public schools, evaluating and treating children 2-18 years of age presenting with a wide range of diagnoses (e.g., language delays and disorders, speech sound disorders, childhood apraxia of speech, autism spectrum disorder, social communication disorder, and Down syndrome). Ms. Rogers enjoys making sure therapy is fun and tailored to each client’s interests.

In her free time, she enjoys listening to podcasts and spending times with friends and families.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

To book an appointment with Olivia Rogers, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

Oct 18
4

Thematic Instruction in Speech-Language Therapy

By | NESCA Notes 2021

By Olivia Rogers, MA, CF-SLP
Speech-Language Pathologist, NESCA

What exactly is a theme and why would we use them in speech therapy? A theme can be defined as the creation of various meaningful activities planned around a central topic or idea. For example, using activities that are all about the ocean, sports, or winter. Themed activities can be great for working on speech and language skills.

Here are some benefits of using thematic instruction (Hadley et al., 2018; Wallach, 2014):

  • Thematic instruction is a meaningful and motivating method of learning concepts.
  • Knowledge on different themes and categories supports a child in making connections between various concepts. It also provides the opportunity to teach and practice new skills by building on a child’s existing knowledge of the topic.
  • Teaching words linked in thematic groups allows for a deeper understanding of functions, categories, and features. Thematic instruction can improve vocabulary and increases a child’s understanding and use of synonyms and antonyms.
  • Activating prior knowledge and engaging students in prior knowledge activities increases the comprehension and retention of information. This, in turn, supports story retelling skills, as well as ability to answer “WH” questions – who, what, where, when and why.
  • Themes are relevant to a child’s real-life experiences; therefore, thematic instruction improves a child’s ability to make inferences and predictions. Children can make better inferences and predictions about situations they may encounter on a daily basis with this knowledge of various themes and categories.
  • Thematic instruction promotes generalization outside the therapy room.

Thematic instruction can result in improvements in overall language skills. Additionally, using themes can keep speech-language therapy interesting and help increase engagement. This is key, as it’s been shown that when a child receives eight more minutes of engaging therapy, there is significantly greater improvement than with regular therapy (Schmitt, 2020).

What can you do at home?

Fortunately, thematic instruction can be easily incorporated into daily life or special occasions at home – and can be adapted for any age. October is one of my favorite months as it is packed with themes. I like to dedicate the first part of October to autumn and leaves, as well as fire safety and occupations. Then it’s time to dive into all things Halloween! Here are some Halloween-themed activities you can do at home to support your child’s language development:

  • Read different Halloween stories while increasing the understanding of Halloween-associated vocabulary (e.g., pumpkin, leaves, haunt, eerie, costume, cauldron, ghost, broomstick, etc.) and Halloween lingo (e.g., “trick or treat,” “boo,” “hair-raising,” “if you dare,” “pumpkin carving,” etc. Some great books to help you with these words and phrases are:
    1. Room on the Broom by Julia Donaldson
    2. There was an Old Lady Who Swallowed a Bat by Lucille Colandro
    3. Goodnight Goon by Michael Rex
  • Encourage your child to recall details and retell the stories you read. Have them:
    1. Describe the setting of the story.
    2. Tell you about one story character.
    3. Identify their favorite part of the story.
    4. Say what happened at the end of the book.
  • Encourage the use of Halloween-associated vocabulary by going on a neighborhood walk and playing I Spy with your child (e.g., “I spy something orange, that you can carve during Halloween,” or “I spy something that changes colors then falls from trees,” etc.).
  • Discuss the history of Halloween and where it originated.
    1. Make predictions regarding this upcoming Halloween and Halloweens to follow.
    2. Compare and contrast Halloween traditions over the years.
  • Create a hands-on activity (e.g., carving pumpkins, drawing a haunted house, collecting leaves for a craft, etc.) where your child/children follow directions to cooperatively complete the project. This encourages problem solving, reasoning and use of appropriate social skills.
  • Engage in a pretend play scenario about Halloween using all the information your child has learned throughout your thematic intervention.

Resources:

Hadley, E. B., Dickinson, D. K., Hirsch-Pasek, K., & Golinkoff, R. M. (2018). Building semantic networks: The impact of a vocabulary intervention on preschoolers’ depth of word knowledge. Reading Research Quarterly.

Schmitt, M. (2020). Children’s active engagement in public school language therapy relates to greater gains. American Journal of Speech-Language Pathology. https://doi.org/10.1044/2020_AJSLP-19-00157

 

About the Author

Olivia Rogers received her Master of Arts in Speech-Language Pathology from the University of Maine, after graduating with a Bachelor of Arts in Communication Sciences and Disorders and concentrations in Childhood Development and Disability Studies.

Ms. Rogers has experience working both in the pediatric clinic setting as well as in public schools, evaluating and treating children 2-18 years of age presenting with a wide range of diagnoses (e.g., language delays and disorders, speech sound disorders, childhood apraxia of speech, autism spectrum disorder, social communication disorder, and Down syndrome). Ms. Rogers enjoys making sure therapy is fun and tailored to each client’s interests.

In her free time, she enjoys listening to podcasts and spending times with friends and families.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

To book an appointment with Olivia Rogers, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

Aug 02
7

Does Scatter Matter? How to Understand Your Child Better

By | NESCA Notes 2021

By: Moira Creedon, Ph.D. 
Pediatric Neuropsychologist, NESCA

Families often come to testing with questions like these: My child is so smart, why is reading so hard for them? If she can remember the smallest conversation from three years ago, why can’t she remember the two things I sent her upstairs to get? If he can do all of the calculations, why can’t my son solve a word problem? The answer can show itself in the scatter.

Assessment measures are based on statistical conversions, where the number of points a child or teen earns is “translated” into a scaled or standard score. This helps us to understand how your child performs compared to other children their same age. Tests are largely based on the idea that scores should “hang together” – meaning that if your child is average for his or her age on one task (e.g., visual-spatial skills) then they should be average on another (e.g., verbal knowledge). And while this may be true for many people, it certainly it not true for all people. Many people have “scatter,” meaning that there is a statistical difference between their scores.

I will spare you the controversy about scatter in our field, about whether a certain degree of scatter or difference between scores means that you cannot calculate certain other scores. There is also specific knowledge of scatter needed to diagnose specific learning disabilities (e.g., if your child has high average verbal skills, how far apart do their reading scores need to be in order to fit the diagnostic criteria). While those topics are incredibly important to the field, my focus today is to build a little empathy for how scatter can matter.

There are times when this scatter can lead us to a diagnostic decision. For example, a relatively common pattern that I see is that of a very bright teenager whose cognitive and problem-solving are at least above average, while their basic focus and attention is below average. With other evidence that corroborates it, this can mean ADHD. A big difference between a child’s verbal knowledge/language skills and their ability to use their language for social purposes can suggest an Autism Spectrum Disorder. In these instances, the scatter absolutely matters. But, scatter can be meaningful to a child’s daily experience even if it’s not statistically “big enough” to warrant diagnosis.

Imagine being your child for a moment. Perhaps your child has a knack for building complex Lego sets and can spend hours assembling structures that are intricate, detailed, and involve more small pieces that my adult fingers could tolerate (let alone our feet as we step on them!). Perhaps your child’s visual-spatial skills are incredible, scoring in the high average range compared to their friends. Then you place a book in their hands and ask them to read a page aloud, where they struggle to sound out words, track their eyes smoothly across the page, or understand the meaning of anything they are saying. While you are left scratching your head as a parent, imagine the frustration and disappointment your child must feel wondering: why can I work with Legos better than anyone I know, but decoding words is torture?

In my mind, scatter can mean frustration. To feel exceptionally strong and confident in one skill domain and then barely hang on in another can leave your child disappointed, angry, and self-critical. Imagine having a vocabulary and encyclopedia of facts in your mind and your hand simply cannot keep up with your thoughts as you try to take notes or write down ideas for an essay. For an adult, it can be a bit like sitting in front of your computer with too many browser windows open and programs running at once, slowing down the entire operating system to the point that you growl in frustration (anyone else?).

While it can be easy to get lost in the controversy over the technical and statistical nature of scatter, it is important that we all have some empathy for what this must feel like for your child or teen. Empathy for this experience is a critical part of building the roadmap forward: where we can use those strong skills to build up the weaker ones, to grow new and stronger neural connections, and to give ourselves a little grace and patience when those weaker muscles get challenged.

 

About the Author

Dr. Creedon has expertise in evaluating children and teens with a variety of presenting issues. She is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. With experiences providing therapy and assessments, Dr. Creedon bridges the gap between testing data and therapeutic services to develop a clear roadmap for change and deeper of understanding of individual needs.

 

If you are interested in booking an evaluation with Dr. Creedon or another NESCA neuropsychologist, please fill out and submit our online intake form. 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Jul 26
4

Speech-Language Pathology at NESCA with Olivia Rogers, MA, CF-SLP

By | NESCA Notes 2021

Speech-Language Pathologist Olivia Rogers, MA, CF-SLP, joined NESCA in June, working with clients in the Newton, Massachusetts office, and is scheduling new clients now. We sat down with Olivia to learn more about her, what her passions in speech and language are and why she joined NESCA.

By Jane Hauser
Director of Marketing & Outreach

How did you initially get interested in Speech-Language Pathology (SLP)?

I started my undergraduate education as a bioengineering major. A project I was assigned to required me to research devices that related to the medical side of bioengineering. After some research, I came upon cochlear implants, which led me to learn more about Audiology and Speech-Language Pathology (SLP). Ultimately, I knew I desired to work with people and make an impact in the healthcare field, but I didn’t feel like bioengineering was where I belonged. After I switched my major to Communication Sciences and Disorders, I knew I had made the right decision.

Additionally, I am the oldest of five children, so was always around kids. Once I stumbled upon this major, I realized it was a great way to combine my desire to work with kids and a career that really fulfilled me.

In what settings have you worked previously?

I’ve done a few clinical rotations in different settings. I spent a semester in a K-8 public school, and a year in pediatric private practice.  Those opportunities allowed me to work with children with various speech and language challenges. I also spent some time in a hospital working with adults in the inpatient acute care unit. All of these experiences strengthened my passion for working with the pediatric population and implementing therapy that is both functional and personal to each individual.

What brought you to NESCA?

Last summer, I was a student intern with NESCA’s Speech-Language Pathologist Abbey Gray, MS, CCC-SLP, as part of my third clinical placement. When the opportunity to work with Abbey and also some of the kids we worked with together again came to my attention, I jumped at the opportunity to work with all of them again.

It’s exciting to work at NESCA in the clinic setting where the Speech-Language team is expanding, and collaboration is so important. Here, I get to be a part of a great team of therapists, clinicians and neuropsychologists. I also appreciate that NESCA is so open to and supportive of its clinicians continuing to learn. For example, I am hoping to gain feeding therapy experience alongside the other feeding therapists here at NESCA.

What part of being a SLP do you enjoy the most?

Being able to communicate is one of the most important life skills, and giving others the tools they need to do so effectively is amazing in itself. However, no two clients are the same and it is up to me to be creative in catering to each individual to make sure that therapy is motivating and beneficial. As a SLP, creativity and play are not only allowed but encouraged. I really enjoy that part of my job.

I really love all of the work I do with children, especially working with kids on receptive and expressive language therapy. With the older children I work with, I enjoy working on the social pragmatic aspects of communication. With the younger kids, I love play-based therapy and working with parents and families to ensure that the language we are targeting is practical.

How do you partner with families when you are working with a child at NESCA?

Integrating real life and therapy is one of the most important aspects of what I do as a SLP. It’s essential for parents or other family members/caregivers to be involved in a child’s therapy to make sure that there is carryover into the home setting. Building functional language skills is a full-time venture involving therapy sessions and practice at home. I strive to have family involved either in the weekly therapy sessions and/or taking notes on what we are working on to further support that child in reaching their goals.

And regarding goals, it’s so important to have parent/caregiver input on the goals we work toward. With the older kids I work with, they are often able to communicate what they’d like to or need to work on. With the younger children, it’s critical for parents and families to help communicate a child’s challenges in order for us to establish the goals we work toward together.

What is one of the most inspiring milestones you have experienced as a Speech-Language Pathologist?

While I was working in the K-8 school, most of the children I worked with were deaf or hard of hearing. There was one 10-year-old boy who was profoundly deaf and utilized cochlear implants. He was essentially nonverbal, and our goal was to help him to auditorily recognize and verbally produce a couple of functional words that could support him in the classroom and at home. In particular, we were trying to get him to interact verbally with his dog; this was a personal goal of his. After months of work, his mom let us know that at home he said, “Sit,” and his dog followed his command! He was so motivated to learn more words since he saw how language could help him to function more easily and successfully. It was such an inspiration and really solidified my strong desire to work with kids to help them in speech and language, and in life.

 

About Speech-Language Pathologist Olivia Rogers

Olivia Rogers received her Master of Arts in Speech-Language Pathology from the University of Maine, after graduating with a Bachelor of Arts in Communication Sciences and Disorders and concentrations in Childhood Development and Disability Studies.

Ms. Rogers has experience working both in the pediatric clinic setting as well as in public schools, evaluating and treating children 2-18 years of age presenting with a wide range of diagnoses (e.g., language delays and disorders, speech sound disorders, childhood apraxia of speech, autism spectrum disorder, social communication disorder, and Down syndrome). Ms. Rogers enjoys making sure therapy is fun and tailored to each client’s interests.

In her free time, she enjoys listening to podcasts and spending times with friends and families.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

To book an appointment with Olivia Rogers, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

May 31
154

The Importance of Play in Speech-Language Therapy

By | NESCA Notes 2021

By: Abigael Gray, MS, CCC-SLP
NESCA Speech-Language Pathologist

As a speech-language pathologist, I immediately think about toys and games when planning my therapy sessions. Parents may wonder why speech-language therapy often looks like “just playing.” Children learn about their world through play. It facilitates their cognitive, emotional, physical, and social development. As young children develop, they begin understanding, learning how to communicate, and socializing within the context of play.

As I discussed in my last blog post, Five Ways to Facilitate Language Growth at Home, motivation and interest are key in language development, and play is highly motivating and interesting for children. When children learn in the context of play, these new concepts, sounds, and words became relevant and meaningful to the child. This promotes retention and generalization, which both increase learning.

Symbolic play is especially important in the development of language. Symbolic play is the use of objects to represent other objects (e.g., using a block as a phone). Language itself is symbolic since signs, gestures, and words represent ideas, objects, or relationships. Early symbolic play helps children understand that objects can be used to represent another object. Development of symbolic play often correlates with development of language: children often start to use single words when they begin using one object to represent another, and they may begin combining words when they combine two symbolic play actions.

Speech-language pathologists may even use play within assessment. Play in evaluations “is a nonthreatening way to gather information about general symbolic skills, linguistic skills, behaviors skills (i.e., attention and organization), and task persistence in a child-friendly setting” (Fewell & Rich, 1987; Short et al., 2011). I also use play to take language samples, which allows me to look at language understanding and use in a naturalistic environment.

For my older elementary- or middle school-aged clients, play often looks like playing games in therapy. The turn taking of games mimics the social reciprocity that we see in conversation and social communication. This facilitates older children’s understanding of taking the lead when it is their turn and waiting, listening, and watching when it is the other person’s turn. I also find more willingness to participate in therapy when it is fun and centered around specific interests.

In my opinion, we are never too old to play! I’ve found that most people learn and retain information better within the context of fun and enjoyable activities, which is why play is such an important aspect of speech-language therapy.

References:

Jarrold C, Boucher J, Smith P. Symbolic play in autism: a review. J Autism Dev Disord. 1993 Jun;23(2):281-307. doi: 10.1007/BF01046221. PMID: 7687245.

Short EJ, Schindler RC, Obeid R, Noeder MM, Hlavaty LE, Gross SI, Lewis B, Russ S, Manos MM. Examining the Role of Language in Play Among Children With and Without Developmental Disabilities. Lang Speech Hear Serv Sch. 2020 Jul 15;51(3):795-806. doi: 10.1044/2020_LSHSS-19-00084. Epub 2020 May 13. PMID: 32402229.

Terrell, B. Y., Schwartz, R. G., Prelock, P. A., & Messick, C. K. (1984). Symbolic play in normal and language-impaired children. Journal of Speech & Hearing Research, 27(3), 424–429. https://doi.org/10.1044/jshr.2703.424

 

About the Author

Abigael Gray has over six years of experience in assessment and treatment of a variety of disorders, including dysphagia, childhood apraxia of speech, speech sound disorder, receptive and expressive language disorder, autism spectrum disorder and attention deficit hyperactivity disorder. She has a special interest and experience in working with children with feeding and swallowing disorders, including transitioning infants to solid foods, weaning from tube feeding, improving sensory tolerance, developing chewing skills, increasing variety and volume of nutritional intake and reducing avoidance behaviors during mealtimes.

 

To book an appointment with or to learn more about NESCA’s Speech & Language Therapy, please fill out our online Intake Form, email NESCA’s Director of Clinical Services Julie Robinson or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Mar 29
154

Facilitating Language Growth at Home

By | NESCA Notes 2021

By: Abigael Gray, MS, CCC-SLP
NESCA Speech-Language Pathologist

I recently got to spend time with my 18-month-old nephew, after not having seen him in a year and a half due to the pandemic. It got me thinking about practical ways to help facilitate language throughout the day without feeling like you’re doing anything extra. Play and routines are great times to build language, and you can often find opportunities that are motivating for your child. Motivation and interest are key, because children are much more likely to participate and communicate. Below, I discuss tips to incorporate into your daily routine at home.

Five ways to facilitate language growth at home:

  1. Play!
    • Play the way your child is playing and imitate what they’re doing.
    • Even if you had a plan, don’t be afraid to change it to focus on their interests (i.e., follow their lead, as explained below).
    • Use fun sounds, words and gestures to go with what you’re doing (e.g., “beep beep” when playing with cars, “pop” when popping bubbles, “yummy/mmm” and rubbing your stomach when pretending to eat play food).
  2. Follow your child’s lead
    • Observe what they’re interested in, wait until they initiate or continue interaction, and listen to their words and sounds.
    • Get on their level so they know you are joining in.
    • If they are doing something unsafe, explain why it’s unsafe in simple terms and redirect them to a safe activity.
  3. Get silly
    • Repeat actions they think are funny.
    • Switch up routines in a silly way (e.g., “forget” their favorite bath toy, give them a fork with their yogurt). This encourages language when your child notices and wants to tell you something is different or missing.
    • Change song lyrics or words in stories to be about your child, their interests and/or what is happening around you in the moment.
  4. Pause
    • Slowly sing familiar nursery rhymes and songs and then pause at key words to encourage them to fill in a word or gesture.
    • Pause a familiar activity, such as pushing the swing, and wait for them to ask you to continue using words or gestures (e.g., “more,” “again,” “go”).
    • When looking for a response, stop talking, lean forward and look at them expectantly. You can count slowly to 10 silently, which gives your child time to respond.
  5. Expand
    • When your child uses one to two words, turn it into a short sentence. For example, if they say “up” wanting you to pick them up, you could say, “Ok, I’ll pick you up.”
    • Be sure to use correct grammar when expanding their message, even if your child is still using immature grammar.
    • Use a variety of words (e.g., describing words, action words, words for feelings, location words, etc.). Start with words your child would want to say to talk about the things they are interested in.

Many of these ideas are things you may already be doing throughout the day, but it is good to think about how doing so helps your child learn to understand and use language. If you feel that your child may be behind in their language understanding or production, it is helpful to schedule an evaluation with a speech-language pathologist. If therapy is warranted, your speech-language pathologist can make recommendations specific to your child and family and show you how to best encourage language growth in the home environment.

References:
Weitzman, E. (2017). It takes two to talk: A practical guide for parents of children with language delays (5th ed.). Toronto: Hanen Centre.

 

About the Author

Abigael Gray has over six years of experience in assessment and treatment of a variety of disorders, including dysphagia, childhood apraxia of speech, speech sound disorder, receptive and expressive language disorder, autism spectrum disorder and attention deficit hyperactivity disorder. She has a special interest and experience in working with children with feeding and swallowing disorders, including transitioning infants to solid foods, weaning from tube feeding, improving sensory tolerance, developing chewing skills, increasing variety and volume of nutritional intake and reducing avoidance behaviors during mealtimes.

 

To book an appointment with or to learn more about NESCA’s Speech & Language Therapy, please fill out our online Intake Form, email NESCA’s Director of Clinical Services Julie Robinson or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.