A question for you

5 Mar

Okay so I’m having this trouble in my life and I need some SLP input. Actually it’s not just me with this particular trouble, it’s all the EI SLPs I know.

Imagine you get a referral for a late-talker. 18-24 months, little to no verbal output. And you and the family work and work and play and play and teach and teach and tada! – the child is almost three, and they’re jib jabbing up a storm. Oh man, they have a ton of great, functional one-three word utterances. Maybe they have 100, even 200 functional phrases. Wow! What great progress!

Now it’s time for a transition evaluation to see if they qualify for school services. Obviously you administer whatever assessment your state recommends for qualifying children for skilled SLP services. And they come out WNL right? Somewhere between 85-100 standard score. And their receptive language is strong – they can identify all sorts of good stuff, and they might even be a bit advanced with the colors, shapes, numbers, letters.

However, you feel something is just not right. Because you know that between 30-36 months a child should have between 450-1,000 words, and your kiddo is not quite there yet. ( Linguisystems Communication MilestonesΒ – page 18).

You would maybe even describe this child’s language as “rote.” Practiced. Routine. Reliant. Known. Structured. It’s functional, and they use the vocabulary they have very appropriately, because you are an excellent SLP and you’ve taught the child and the family all about modeling functional and useful words. But what does their spontaneous language look like? Can they answer basic Wh- questions? Are they asking basic questions? Are they using pronouns, possessives, present progressive -ing, plurals? Can they participate in “conversational” dialogue?

Chances are they are probably not doing these things unless these grammatical structures are part of a word or phrases that has been taught to them to use within a specific structure or routine. Their spontaneous output consists of those 100-200 words and phrases, over and over and over and over. Very limited novel output.

You guys know these kids right? You have a picture in your mind of a child or ten children on your caseload who fits this description?

I want to know, how are you expressing your concerns to the schools? Are you just hoping clinical judgment and qualitative explanation will help you make your point? Are you using an assessment? A language sample with type-token ratio? I was recently told about the Language Use Inventory, but I’m wondering if there are any other assessments you are using for this age group. My concern with the LUI is that it’s a parent questionnaire, so it may not really help our case despite the fact that it is standardized.

I hate to see my little guys who I know need the support lose services until they’re re-identified in Kindergarten at age 5. How can we prevent these kids from slipping through the early intervention cracks?

NP: Lana Del Rey – American

7 Responses to “A question for you”

  1. Lisa S (@sylinca) March 6, 2015 at 6:58 am #

    Very interesting topic. I’m not sure how it works in the US world, it does not even work the same in all Canadian provinces. I’m on the other side, in the school. I have two schools (including 16 kindergarten classes). At the beginning of kindergarten, parents (who want to disclose the information) bring their evaluation and progress report to the school. If they have a severe language impairment, a committee will decide if they go in a special class. But if they feel they can manage kindergarten of if the disorder is still not confirmed, they come to me. As well as everybody else who is milder than severe.
    The readaptation center can offer services to the child until he is five, so we overlap in kindergarten. However, if I provide service, they stop providing on their side.

    Sometimes I feel the girls at the readaptation center will push the severity of the disorder so he get services (since we have so little time, we restrict our criteria for services).

    If a child comes to me with a 85-100 score everywhere, he is not going to get services, at least not in the first year. We see how he adapt and communicates in Kindergarten. However, you may question your evaluation tools: Don’t forget that even a disorder can progress with the child. He WILL get better in certain areas, that doesn’t mean is isn’t impaired regarding to communication.

    What tests have you done? PLS? MacArthur? Reynell?
    If you want functional communication, I like to use the Communication Matrix, which is free (:-D) and gives a good idea about the intent of the child.

    Also, don’t rely too much on the amount of words used: late talkers will have a similar pattern. And finally, keep in mind that you are the professional, don’t hesitate to make a judgment call, talk to the school SLP to make the case transfer and put everything you can in the report, it is often the only piece of information we have. And make sure the parents give it to the school and see if the child will need IEP or not.

    I hope I’m not too much beside the point, I know that we don’t work in the same context 😦

    • weathersby March 6, 2015 at 3:14 pm #

      Thank you for your input Lisa!

      The state-wide protocol we give is the PLS-5, which I feel is a soft test, and not sensitive to children demonstrating the reliance on rote phrases I described above.

      I hadn’t considered using the Communication Matrix, I may give that a try! Also the LUI I believe you can buy like 5 copies for $15 or something so I may just give that a shot too.

      I agree with you that if I gave a child the a language eval and they were within that WNL range I likely wouldn’t recommend without more information indicating they need the services. I know most of these kids are not receiving services upon their third birthday because of that WNL score. In early intervention 0-3 there’s a LOT more leeway with clinical judgment, so if I know a child and I know how rote they are I usually recommend they continue to receive services. But once the school gets that transition eval that says “Standard score 88 expressive language” I know they aren’t going to get the services from 3-5. Then they go two years without, and show up in Kindergarten needing services. That’s why I’m hoping that I’m missing some kind of supplemental eval tool that could help back me up as far as these kiddos go, who are 30-36 mos and their pragmatic use of language is limited.

      You’re not off point at all! I super appreciate ideas and feedback πŸ™‚

      • Lisa S (@sylinca) March 6, 2015 at 4:20 pm #

        Ok, kids are in the school system starting at 3! For us, it’s 5, 4 for some children going to pre-K. But most kids stay in daycare. Though we do have more affordable daycare (7$ a day) than in the US.

        You are right: I find the PLS a bit soft, especially for younger child.
        And the expressive part is mostly vocab + “can he make short sentences”, so not as precise.

        Keep us posted on what you decide ! I’ve found your blog a great source of information and confort while I was in school and since we both graduate, I don’t see you posting as much. I know we have to be careful with preserving the identities of our patients, but I truly appreciate your view on things.

        From “Just another speechie”, a similar concern: https://justanotherspeechie.wordpress.com/2015/03/03/when-almost-normal-is-not-very-normal-at-all/

      • weathersby March 8, 2015 at 11:18 am #

        Thanks Lisa!

        You’re right, it can be hard when I have a question but don’t want to share any personal info, and I don’t want a parent to read something and assume I’m talking about their child specifically! Luckily in this instance I have A LOT of children who fit this description.

        I wish I had more time to blog, I have missed it and it keeps me connected with the SLPEEPS πŸ™‚ I’m kind of getting into a groove with have multiple jobs so I’m discovering where I have free time, so hopefully I’ll pick it back up soon! It’s funny, according to wordpress you’re my number one commenter! Go you!

      • weathersby March 8, 2015 at 11:19 am #

        Also…SEVEN DOLLARS FOR DAYCARE? Holy guacamole!

        And yes, we do Part C 0-3 years, then at three they can become part of the school district, and then at 5 they HAVE to become part of the school district

  2. tnslp29 March 7, 2015 at 7:50 am #

    Being on the “receiving” end, I would appreciate a language sample, and a phone call. In my state, the score has to be 1.5 SD below the Mean, which, in most instances, is a “77” or below. So…if I saw the score on this child, my initial reaction would be, “Wow! This kid is no where near certifying!” However, we all know that clinical judgement comes into play with a child like this. I currently have a 2nd grade student who I tested when she was 3. The school SLP may want to have a look at this child for her impressions/ a 2nd opinion. That being said, we both know there is a difference between medical/educational model, and the child may be performing WNL for the educational setting. In that case, the parent may choose to continue therapy within a medical model. Bottom line: if you can get in touch with the school SLP, call and voice your concerns. Also give her the results of a language sample. Just because the standard score is too high for certification doesn’t mean he can’t receive services. Again, in my state, the IEP team can over-ride the test scores for certification…with the appropriate documentation!

    • weathersby March 8, 2015 at 11:15 am #

      Awesome, thank you! It’s weird but I very rarely get any contact info for the school SLP, and I rarely get any questions from the school SLP (they have my contact info). I try to give as MUCH as and description as possible, but I’ll start using a language sample approach with these kids too (sometimes can be hard because we do group therapy so trying to record a language sample might be weird for me but I can figure it out πŸ™‚ ) But I think the language sample will be a good supplement to the PLS which I personally find doesn’t ID kids who may need services very well. And for the parents of these kids I really encourage them to pursue a follow up eval so they don’t go until they’re five without services.

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