Intervention for voice disorders will include a full assessment (subjective and objective data collection), indirect and/or direct treatment (depending on the age of the child), and teaching of strategies for improved voice use, elimination of vocal abuse, and management of voice related medical conditions (reflux). Parent education and training is a crucial part of voice therapy, as parents will be responsible for implementing behavioral programs in the home for best voice recovery.

Lisa Rubin M.S. CCC-SLP is a licensed speech-language pathologist specializing in voice disorders. She provides assessment and treatment services for children from birth through adolescence who exhibit various forms of communication disorders (voice, speech, language, and fluency (stuttering). She received her Bachelors of Science in Communication Disorders at Boston University and then earned her Masters of Science in Communication Science from Hunter College (CUNY). Lisa holds a Certificate of Clinical Competence from the American Speech-Language Hearing Association and is licensed to practice in the state of New York. Currently employed by The Brooklyn Hospital Center, Lisa brings a medical focus to behavioral intervention. In addition, Lisa has held the position of Adjunct Professor of Communication Sciences at Hunter College since 2006, where she has taught courses in the anatomy and physiology of speech production, speech science, phonetics, and voice disorders. Currently, Lisa works with children ages birth to three years for speech and language stimulation therapy, the pre-school aged population (3-5 years) for speech, language, voice, and fluency intervention, and the school-aged and adolescent population for fluency and voice intervention.

Lisa Rubin M.S. CCC-SLP travels to your Manhattan home (Upper East Side, Midtown East, Murray Hill, Gramercy, Union Square, East Village, Soho, Upper West Side, Midtown, Chelsea, and West Village) and she makes Brooklyn home visits (Fort Greene, Brooklyn Heights). She involves the family in the treatment process as much as possible and she works with babies, preschoolers, and school age children and adolescents.

For more information, please contact Lisa Rubin M.S. CCC-SLP at lisa@brooklynlearning.com

Who are Late Talkers?
The late talkers reflect 15% of the toddler population and are identified around two years of age when children produce fewer than 50 words and do not combine words. The late talker also has normal hearing, cognitive, sensory and motor development. A typical child at two years of age would be using over 300 words and putting together 2-4 word sentences.

Why Late Talkers are Not a Variation of Normal Language Development
Language characteristics of the late talkers are not reflective of typical language development in the areas of:

1. Word learning
• Receptive language (understanding): Late talkers do not learn (point to) new words as accurately as their peers. (Ellis Weismer & Evans, 2002; MacRoy-Higgins, Schwartz, Shafer & Marton, 2009)
• Productive language (expressive vocabulary): Once late talkers say words, they are slow to add more words to their vocabularies; they do not systematically add words to their vocabularies as observed in typically developing toddlers (MacRoy-Higgins et al., 2009).

2. Phonology (sounds)
The sounds in the words that they do say show delays and disordered patterns. For instance, late talkers produce atypical sound errors, atypical sound patterns and show little change in development over time as compared to language-matched peers (Williams & Elbert, 2003)

3. Morphology/syntax (grammar and word combinations)
Once late talkers begin to combine words they show delayed and disordered patterns. For instance, late talkers produce more errors than their language-matched peers (Thal et al., 2004)

4. Social skills
At risk for social/behavioral disorders. Late talkers are less social than their peers; quality of parent-child relationships in late talkers is judged to be more stressful than parent-child relationships in typically developing toddlers (Irwin, Carter & Briggs-Gowan, 2002)

Are there Long-Term Implications for Late Talkers?
The research has indicated that late bloomers show improvement in language skills but that they perform significantly poorer than their peers in reading/literacy, syntax and morphology (word combinations/sentences and grammar) and vocabulary deficits are observed through 17 years of age.
Toddlers with Specific Language Impairment (SLI) demonstrate significant difficulties with all aspect of language (understanding, expression and literacy/reading).

Why is it Important to Provide Speech and Language Services to Late Talkers?
Approximately one-half of toddlers who are late talkers will be labeled as having Specific Language Impairment in preschool/elementary school. Those that show improvement (late bloomers) continue to perform poorer than their peers in language and literacy skills throughout elementary and secondary school.

Late talkers are not a variation of normal development because at age two they show disordered patterns of
• Vocabulary acquisition (understanding and naming)
• Phonology (sound system)
• Grammar
• Social skills

Why is Early Intervention so Important for Late Talkers?
An early foundation in oral language skills is paramount for the development of literacy and reading skills. Late talking toddlers are at significant risk for academic difficulties and therefore would benefit from language intervention as early as their language disorder is identified.

Is Language Intervention for Late Talkers Effective?
Language intervention for late talkers is effective. Late talkers receiving intervention by a Speech-Language Pathologist over a short period of time showed improved language skills (vocabulary, production of sentences, speech sound production) as compared with late talkers who did not receive intervention (Robertson & Weismer, 1999), and these results suggest that if untreated, late talkers will not improve their language at the same rate as their typically developing peers, with the significant risk of lifelong language difficulties impacting academic achievement, reading and literacy.

References
Ellis Weismer S., & Evans, J.L. (2002). The Role of Processing Limitations in Early Identification of Specific Language Impairment. Topics in Language Disorders, 22(3), 15-29.

Irwin, J.R., Carter, A.S., & Briggs-Gowan, M.J. (2002). The Social-Emotional Development of ‘Late-Talking’ Toddlers.Journal of the American Academy of Child & Adolescent Psychiatry. 41(11), 1324-1233.

Leonard, L.B. (2000). Children with Specific Language Impairment. Cambridge, MA: MIT Press.

MacRoy-Higgins, M. Schwartz R.G., Shafer, V.L., & Marton, K. (2009). Word learning and phonological representations in children who are late talkers. (Doctoral Dissertation), Graduate Center, CUNY, New York, NY.

Rescorla, L. (1989). The Language Development Survey: A screening tool for delayed language in toddlers. Journal of Speech and Hearing Disorders, 54, 587-599. 22.

Rescorla, L. (2009). Age 17 Language and Reading Outcomes in Late-Talking Toddlers: Support for a Dimensional Perspective on Language Delay. Journal of Speech, Language, and Hearing Research. 52, 16–30.

Robertson S.B. & Ellis Weismer, S. (1999). Effects of Treatment on Linguistic and Social Skills in Toddlers With Delayed Language Development. Journal of Speech, Language, Hearing Research. 42, 1234-1248.

Thal, D.J., Reilly, J., Seibert, L., Jeffries, R., & Fenson, J. (2004). Language Development in children at risk for language impairment: Cross-population comparisons. Brain and Language, 88, 167-179.

Williams, A.L., & Elbert, M. (2003). A Prospective Longitudinal Study of Phonological Development in Late Talkers. Language, Speech and Hearing Services in Schools, 34, 138-153.

The Study:
We are using a medication called BuSpar, that acts like serotonin. It is a medicine that has been around for many years given to treat anxiety in children and adults. Children are randomly assigned to receive placebo, low-dose BuSpar, or higher dose BuSpar.

Schedule:
Children are followed for six months. They are seen once a month and there is phone contact once a month. At the beginning of the study, we do a full evaluation for autism and IQ, and interview parents. Parents are given the results of that evaluation for their records. At the end of the six-month study, the autism diagnostic observation schedule is repeated to see if improvement has occurred.

Cost:
The study is free, including initial evaluations, and transportation is covered.

If BuSpar proves to be effective, it will likely become a standard therapy for children diagnosed with autism. If you are interested in finding out more about the study, contact Dr. Ruth Nass, Pediatric Neurology at NYU, (212) 263-7753, ruth.nass@nyu.edu

Dr. Ruth Nass, M.D., Professor of Child Neurology, Child & Adolescent Psychiatry, and Pediatrics at NYU Langone Medical Center, has over 30 years of medical experience and practices in Pediatrics and Neurology. Her research interests include pediatric neurology, learning and developmental disabilities, hemiplegic CP, and autism.

When: Wed. February 29th, 6:45pm to 8:15pm.

Where: 435 15th St. #1 between 8th Ave and Prospect Park West in Park Slope, Brooklyn. One block from the F and G subway- 15th St. stop. *Please note the Brooklyn bound F subway does not stop at 15th St. Please exit at the 7th Ave stop (when exiting the subway station, walk up the stairs to 8th Ave).

Cost: $15 per person. No refund, unless event is canceled. Spots limited to 12 people.

Interested?
Email Craig at craig@brooklynlearning.com to RSVP.

Once confirmed, please mail a check for $15, written out to Craig Selinger, and mail it to:

Craig Selinger
435 15th St. #1,
Brooklyn, NY 11215

Language/Communication Characteristics:

A person with ASD typically has an early history of language delay. Some children even have a regression in language skills, meaning that they start to develop language, but then stop speaking. This regression can be gradual or sudden. The good news, however, is that most people with autism spectrum disorders develop language, particularly with the help of intervention.

Individuals with ASDs also tend to use language in an idiosyncratic manner. These idiosyncrasies include using language in a repetitive manner (echolalia), speaking with an unusual tone of voice, using formal language, and speaking in an invented language/using invented words. Some children speak much like an adult would. Conversation is also difficult for people with ASD. Someone with ASD may talk a lot, but it is hard for them to engage in a reciprocal conversation, meaning that they might talk on and on about one topic or try to bring conversations about varying topics back to a topic of particular interest. Others might not respond at all to the social use of language. In children with ASD, there is also sometimes a difficulty with pretend, imaginary play. This is sometimes an area of play that children with ASD do not enjoy.

Social Characteristics:

Individuals with ASD vary in terms of their interest in engaging socially with others. Some people with ASD really want to have friends and interact with others, while some people with ASD prefer to spend time alone, not interacting with others. In both groups, peer relationships are difficult. Those who want to engage with friends often have difficulty with the reciprocal nature of social relationships, so skills such as turn-taking, sharing, and allowing for everyone to influence the progression of play can be a struggle.

Another often problematic area of social development for individuals with ASD is the use of nonverbal behaviors to regulate social interactions. This means that a person with ASD may have trouble using eye contact, so they may avoid making eye contact, or they may make too much eye contact such that it appears they are staring. Facial expression and gesture also may be implicated here, so that the person with ASD may have a limited range of facial expressions (e.g. always smiling) or do not use or inconsistently use gestures such as waving goodbye and pointing.

Individuals with ASD may also have trouble with a concept known as “socioemotional reciprocity.” This means that social skills such as comforting others who are hurt or sad, responding appropriately when someone approaches them, and initiating social contact in an appropriate manner may be difficult for them.

Finally, individuals with ASD have trouble in many cases with “shared enjoyment.” Shared enjoyment refers to behaviors such as smiling, making eye contact, and saying enthusiastic comments, such as, “This is great!” when happy and excited about something.

Interests and Behaviors:

People with ASD often have strong interests that captivate them. These interests can pervade play, conversation, leisure time, and academics, and in many cases, the individual is incredibly knowledgeable about their topic of interest. A person may have one interest that they maintain for years and years, or they may have an intense interest for a month or two, and then shift to a new intense interest.

Individuals with autism also are often interested in the parts of objects. For example, instead of playing with matchbox cars by setting up a racing scenario, they may prefer to turn the car over and watch the wheels spin. Individuals with ASD also may engage in repetitive motor behaviors, such as hand flapping or finger flicking. These mannerisms may be brief and subtle, or they may be very obvious.

Finally, people with ASD often adhere to routinized behavior. For instance, they may insist on taking the same route to school everyday, or keeping the same strict schedule day after day. Many parents don’t recognize these routines until an unexpected disruption occurs and their child becomes very upset.

ASDs can be diagnosed at a range of ages, from early childhood through adulthood. No matter what age, diagnosis can be a valuable way to secure the supports and services an individual might need to meet their potential.

Carolyn Kessler, Ph.D., is a child psychologist with more than 10 years of experience working with children, adolescents, and their families on issues related to behavior management and parenting, anxiety disorders, mood disorders, developmental disabilities, and ADHD. Family training is a key component of her therapy. Dr. Kessler specializes in the diagnosis and treatment of autism spectrum disorders. She is a Codirector of Psychology Services at the New York University Child Study Center’s Institute for Pediatric Neuroscience and is in private practice in Park Slope, Brooklyn, where she provides assessment, treatment, and consultation to families and schools. In addition to standardized testing of IQ, achievement, memory, and behavior, her assessment skills include the use of the Autism Diagnostic Observation Schedule (ADOS), an instrument on which Dr. Kessler trains other professionals, as well as the Autism Diagnostic Interview- Revised (ADI-R).