As a speech language pathologist working in  psychiatric setting I see children act out all the time displaying a number of maladaptive behaviors ranging from aggression and avoidance to withdrawal and elopement.  However, working with this population have taught me over the years not to jump to the obvious conclusions  but to dig a little deeper.

One question I often find myself asking these days is: ”Is it behavior or is it sensory?”

Many times after doing a bit of detective work,  the answer does surprise me.

For those parents and professionals who are currently dealing with a first time onslaught of difficult behaviors and are not so certain how to recognize which one is which,  I recommend the following screening  instrument:

The Listening Inventory (2005) Academic Therapy Publications developed by Donna Geffner, PhD and Deborah Ross-Swain, EdD

1. Presentation Title:     Behavior Management Strategies for School Based Speech Language Pathologists

Time:                         Thursday, April 19                8:15 AM - 10:15 AM

Summary: In recent years more and more school based speech-language pathologists have to work with children who present with behavioral deficits in conjunction to speech-language delays/impairments. A significant portion of work with these children in therapy sessions involves successful management of inappropriate behaviors such as excessive inattention, hyperactivity, aggression, opposition/non-compliance and/or apathy, which interferes with successful objective completion and goal attainment. This workshop will explain what type of common challenging behaviors can manifest in children with select communication, psychiatric, and neurological disorders.  It will outline behavior management strategy hierarchy from most to least intrusive methods for students with differing levels of cognitive functioning (high-average IQ to varying levels of MR). It will list positive proactive behavior management strategies to: prevent inappropriate behaviors from occurring, increase students’ session participation as well as improve compliance and cooperation during therapy sessions.

2. Presentation Title:     Social Pragmatic Assessment of Children Diagnosed with Emotional/Psychiatric Disturbances in the Schools

Time:                         Thursday, April 19              10:45 AM - 12:45 PM

Summary:  The number of children who present with autism spectrum and non-spectrum emotional, behavioral, and psychiatric disturbances (oppositional defiant disorder, reactive attachment disorder, mood disorder, etc) has been steadily increasing in recent years. Many of these children attend district schools and due to high incidence of communication issues associated with these conditions, speech language pathologists are frequently included on the team of professionals who treat them.   This workshop is aimed at increasing the participants knowledge regarding aspects of social pragmatic language. It will describe the role of speech language pathologist in assessment of pragmatic language and social cognitive abilities of school-age children. Participants will learn about common pediatric psychiatric diagnoses and the impact of psychiatric disturbances on language development of school age children.  Participants will be able to utilize the latest formal and informal assessment instruments to assess pragmatic language and social cognitive abilities of school age children in order to qualify them for appropriate services.

Summary:  The article introduces the concept of multisensory stimulation and explains its benefits for internationally adopted children of all ages.  It also provides suggestions for parents and professionals on how to implement multisensory strategies in a variety of educational activities in order to stimulate interest, increase task participation as well as facilitate concept retention.

References:

Doman, G & Wilkinson, R (1993) The effects of intense multi-sensory stimulation on coma arousal and recovery. Neuropsychological Rehabilitation. 3 (2): 203-212.

Johnson, D. E et al (1992) The health of children adopted from Romania. Journal of the American Medical Association. 268(24): 3446-3450

Ti, K, Shin YH, & White-Traut, RC (2003), Multisensory intervention improves physical growth and illness rates in Korean orphaned newborn infants. Research in Nursing Health.  26 (6): 424-33.

Milev et al (2008) Multisensory Stimulation for Elderly With Dementia: A 24-Week Single-Blind Randomized Controlled Pilot Study. American Journal of Alzheimer’s Disease and Other Dementias. 23 (4): 372-376.

Tarullo, A & Gunnar, M (2006). Child Maltreatment and Developing HPA Axis. Hormones and Behavior 50, 632-639.

White Traut (1999) Developmental Intervention for Preterm Infants Diagnosed with Periventricular Leukomalacia. Research in Nursing Health.  22: 131-143.

White Traut et al (2009) Salivary Cortisol and Behavioral State Responses of Healthy Newborn Infants to Tactile-Only and Multisensory Interventions. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 38(1): 22–34

 Resources:

• American Occupational Therapy Association (AOTA) http://www.aota.org/
• American Speech-Language-Hearing Association (ASHA) http://www.asha.org/
• Anatomy Arcade: http://www.anatomyarcade.com/
• Cannon, Janell (2000) Crickwing. Harcourt Children’s Press.
• DLTK Printable Crafts for Kids www.dltk-kids.com
• Enchanted Learning: http://www.enchantedlearning.com/crafts/halloween/pastaskeleton/ How to make a pasta skeleton;
• Enchanted Learning:  http://www.enchantedlearning.com/crafts/edible/ Edible Crafts
• Percival Touch ‘n’ Feel Book (2005). Bendon Publishing International
• Sensory Processing Disorders Foundation Website http://www.sinetwork.org/index.html
• Sensory Processing Disorder Blog http://www.sensory-processing-disorder.com/index.html
• Wendy Z Learning Resources. 5 recycled multisensory learning games. Retrieved October 30^th 2011.  (http://wendyzshandsonlearning.blogspot.com/2009/06/5-recycled-multisensory-learning-games.html)

Date; January 25th 2012

By the end of the workshop participants will be able to:

•Identify skills and knowledge necessary to qualify a practitioner to be called a bilingual SLP

•Identify and describe cultural and linguistic variables that may impact speech-language pathology services to bilingual/bicultural children

•Explain typical language development for monolingual and bilingual  speakers

•Explain the process of second language acquisition in children.

•Contrast communication differences and communication disorders in bilingual children

•Discuss research driven evidence based practice (EBP) assessment strategies for bilingual clients with communication disorders.

•Illustrate potential limitations of standardized tests

•Explain how to use alternative, non standardized methods to reduce assessment bias

•Describe research driven evidence based practice (EBP) treatment techniques for bilingual children with speech-language disorders.

Date: January 25th 2012

Time: 9:00 AM – 3:00 PM Special Considerations and Challenges in Assessment and Treatment of Bilingual Children with Developmental Disabilities

Eligible Hours: Six (6) Professional Development Hours

Learning Community: Speech/Language Specialists/Therapists, Special Education Teachers, Administrators, Child Study Team Members, Guidance Counselors, Psychologists, Social Workers.

Registration: $120 Full Tuition, $100 PDA Subscription Members

Location:  Professional Development Academy, 1690 Stelton Road, Piscataway, NJ 08854, (732) 777-9848 Ext. 3560

Description:  While many children who learn several languages during childhood exhibit appropriate language milestones in both languages, there are some children who present with evident dual language acquisition difficulties, often without a clear reason for the delay. These children are frequently referred for diagnostic assessments due to their dual language based learning deficits (which typically begin to manifest in their primary language first). This workshop will focus on how to provide effective evidence based practice diagnostic and treatment services to bilingual children with suspected and confirmed language deficits.  It will discuss normal developmental progression of dual language learning, describe how language impairment signs manifest in bilingual children, list assessment challenges, explain unequal linguistic skills distribution (how communicative and cognitive language mastery differ from home/community vs. school environment) as well as go over latest clinical approaches to assessment and intervention of bilingual children. 

Please see attached flyer for more information

Article Title: Orofacial Observations of Internationally Adopted Children: Recommendations for Parents and Non-Medical Adoption Professionals

Article Summary:  This article explains what parents should initially do if they note anything unusual regarding their internationally adopted child’s orofacial appearance. It explains how orofacial observations may be relevant to diagnosis of medical, genetic or neurological disorders via clinical case examples. It offers parents general guidelines for noting atypical orofacial features and explains why in some select circumstances, parents may be the first individuals to note unusual facial characteristics in their adopted children.  

 Several months ago, I’ve administered speech-language testing to a 3-8 year old boy, adopted from Russia at the age of 3.  During the course of my assessment I noticed his atypical facial features.  He had a very small head, inward set eyes, and widely set ears.  At that time, even though this boy had already seen a number of other adoption professionals (including a neurologist, an occupational therapist and another speech language pathologist), I felt that it was very important to record my findings and refer the parent for a second opinion with a pediatrician specializing in working with internationally adopted children.  My rationale for seeking a second opinion for this child was further reinforced by a number of additional red flags, which included his significantly decreased play skills, severely impaired language ability, as well as significant social emotional and behavioral manifestations characterized by excessive impulsivity, distractibility, hyperactivity, decreased self-regulation, rapid over-stimulation, as well as anger outbursts and tantrums when others refused to follow his agenda and attempted to set limits on his behavior.

Subsequent, second opinion consultations for this child resulted in a diagnosis of Fetal Alcohol Spectrum Disorder, a term which describes the range of physical, mental, behavioral, and learning disabilities that can occur in children whose prenatal history is remarkable for excessive maternal alcohol consumption.

I use this case to illustrate a point.  At the time of adoption this child presented with significant unrecognized deficits, which continued to persist unrecognized and unaddressed post adoption.  While I acknowledge that oftentimes little could be done done before a child is adopted, I also want to emphasize that this child could have been receiving relevant and necessary services for 8 months post adoption, but didn’t because his deficits were missed!

The above case is not an isolated occurrence by any means. As a speech language pathologist who works exclusively with various at-risk pediatric populations (including internationally adopted children), I have numerous clinical examples I can share with you. In the past I have encountered undiagnosed feeding and swallowing issues, submucous clefts, vocal webs, Cerebral Palsy, Wilson’s Syndrome, a number of undiagnosed Fetal Alcohol Spectrum Disorder cases, and even several cases of severe infections due to excessive tooth decay and poor oral hygiene.   I can go on for a while but I do believe that I have sufficiently demonstrated my point.

Fact is that oftentimes internationally adopted children arrive to US with a host of undetected disorders and deficits.  Lack of detection is further increased in children adopted from economically developing countries or from hard to access insular regional orphanages, where they may fail to receive consistent and appropriate medical care, or where overcrowded conditions coupled with staff shortages may cause for deficits to be missed or unrecognized.

Consequently, oftentimes it is the parent(s) who are the first individuals to observe something different or unusual regarding their child’s facial features, oral structures, or any other appearance anomalies.

While many parents, of course, are not professionally trained in recognizing physical signs and symptoms of serious disorders, it is important to note that detection of unusual features is not as difficult as it sounds.

Here are some basic guidelines:

Does your child’s face look symmetrical or do you see any obvious signs of weakness (paralysis) on either side of the face (particularly evident when the child smiles and one side of the face droops or doesn’t move).

Do you find that your child’s features look odd or unusual in any way? Examples may include, but are not limited to: unusually wide or narrow set eyes, unusually set ears, virtual absence of a nose bridge, excessively thin upper lip, flatness of a groove above the lip, and so on (although with respect to facial appearance one needs to be very careful and account for differences in normal facial variation among various ethnic groups).

Do you notice any unusual spots, nodules, or openings on your child’s face or body or in his/her mouth?

In what condition is your child’s mouth? Is there excessive tooth decay? Do you see an unusual absence of teeth (in older children), or unusual bite (open bite, cross bite, etc)?  Is there excessive drooling?

Does your child have a usual voice or unusual cough in the absence of a documented illness?

If you do, then it would be a good reason to consult with a pediatrician specializing in international adoptions, to see whether your observations merit a referral to a specialist (e.g., neurologist, orthodontist, etc).

I realize of course that parents are not trained professionals, but they are observant individuals!  Moreover, there is a great likelihood that they are actually the first people to spend a prolonged period of time with the child.  There’s an even greater likelihood that they are the first people to actually “see” the child vs. the orphanage staff who may have fulfilled the child’s basic needs (feeding, diapering, etc) but who in reality may have actually spent very little face to face time with the child.

Furthermore, parents should not worry whether something that may see may not be a cause of concern.  What if it is and is not addressed?   That is why it is so important to share your concerns with relevant medical professionals.  It is up to them to investigate further whether your observations merit additional follow ups. If you are concerned, bring it up! You never know! You may paving the way to timely diagnosis and relevant intervention provision for your adopted child.

References:

• Golper, L (2009) Medical Speech Language Pathology: A Desk Reference. Clifton Park, NY: Delmar Cengage Learning
• Shipley, K, & McAfee, J (2008) Assessment in Speech Language Pathology: A Resource Manual. 4^th Ed. Clifton Park, NY: Delmar Cengage Learning