Friday, March 29, 2013

FREEBIE Friday! Blue Car, Blue Car, What do you See?

 A few weeks ago a brilliant follower  on my FB page  (you know who you are) commented on a story about my son and she gave me a great idea!  Why not make a transportation themed book that imitates a much loved children's book that is repetitive and rhythmic in nature?  At that moment, Blue Car, Blue Car What Do You See? was formulating in my mind.  

Over the last few weeks, I've been able to purchase these very cute graphics from ReviDevi @ and make this book for my PK kiddos.

And of course you know the rules here at C-Station:  if I make, you get it!  So here it is! 

Note that this booklet is made so you can either print it front to back (and fold) OR single pages (and cut down center line and place in order).  My personal preference is single pages (so you can only see the preview picture, not the next page) but if you need to save trees, you can do so by printing front to back and just folding the book!  It's really up to you! :)

I LOVE this book because of all the language skills I can work on:

  • concepts of transportation
  • color concepts
  • transportation sorting (land, air, water, or construction vs. rescue, etc.)
  • answering "What" and "Where" questions (e.g. What does a plane do?  Where do you see a plane?) 
  • similarities and differences between various types of transportation
  • making predictions with visual cues

At the bottom of each page is a small picture preview of what object is on the next page.  I made this book an interactive book by printing 2 copies of pages 1 and 2 and using the extra set of pictures with velcro to "match up" with the preview pictures on each page!

Above you see the second set of pages 1 and 2 cut and ready for the child to match up while using his/her visual cues to "predict" what we are going to "see" next!

We match it up (I like to use velcro but you don't have to) and turn the page to see if our prediction was correct!

Check out all of the pages!!!  Want your own copy?  Grab it at the bottom of this blog!

Error on this page above has been corrected in the download!

Want your FREE copy?  Grab it here!

Happy Talking!!!

Tuesday, March 26, 2013

Tip Tuesday! Ways to target categories for PK kiddos!

Last week I talked about the steps I use to teach PK kiddos how to understand analogies by focusing on understanding relationships between objects.  Today I'd like to just write the several ideas I have done with PK kiddos that have worked to teach them how to understand categories of objects!

If you have other ideas, PLEASE share by commenting below.  I know I can always use more ideas!!!!

There are some "rules" (for lack of a better word) I like to follow when teaching categories:

  1. Always begin with 2 MAXIMALLY different categories:  meaning I choose two general categories that have NOTHING in common (animals vs. clothing, OR furniture vs. musical instruments, etc.)
  2. Make categories as CONCRETE as possible:  meaning I use real objects as much as possible, followed by toys, than photographs, pictures, and cartoons (Microsoft clip art has tons of "cartoon" pics you can use); 
    1. NOTE: children who have speech and language deficits with NO OTHER cognitive delays or other co-morbid disorders do NOT require such and elaborate scaffolding system and can move very quickly from objects to pictures.  
    2. Children with OTHER cognitive delays or co-morbid disorders DO BENEFIT from this scaffolding system and in my clinical experience have been able to mastery understanding and verbal identification of categories with less difficulty using this system.
  3. Teach general categories FIRST followed by subcategories:  this means a child will demonstrate understanding of animals before I expect them to master "jungle, farm, ocean" animals; or a child will demonstrate understanding of food first before "fruit, vegetable, meat" subcategories.  I teach it this way b/c we know semantic learning is hierarchical in nature (general then subcategories, than sub-subcategories and so on) and we want our students to understand and organize their semantic relationships in a way that supports word retrieval and vocabulary development.  (Excuse the very crude visual below but this is just a quick display of the hierarchy of just one general category.  Clearly these sub-subcategories could continue and the number of items within them would number more than 3 animals.) 

Ok so those are the rules I like to follow when teaching categories.  Here are some activities I have done in the past to teach categories: (this list includes ONLY concrete sorting games as I think we are all familiar with file folder type sorting games)

Sorting for maximally different categories:
  • Using a big bowl and my Fisher Price farm-sorted food vs. animals
  • Using a box and a large serving plate-sorted musical instruments vs. food
  • Using a clothes line (yarn and clothes pins) and a doll house-sorted clothing vs. furniture
  • Using a box (labeled "Toy Box") and a book shelf-sorted toys vs. books
  • Felt board with volcano and felt board with sky on it-sorted $ store dinosaurs and sky transportation
  • using peers holding boxes (with picture labels on them)-sorted inside vs. outside items (then took outside times-pine cones, grass, flowers, acorns, leaves, etc. BACK outside)
  • Play stroller and clothes line-sorted baby items (baby food jars, rattles, bottles, diapers, etc.) and clothing on opposite sides of the room (when using maximal differences I do NOT add in baby clothing to this sorting activity)
Sorting subcategories:
  • Using a fish bowl and my Fisher price farm-sorted farm vs. ocean animals
  • Using legos (as our fences for a zoo or our jungle) and my farm-sorted zoo/jungle vs. farm animals
  • Using a fruit bowl and play refrigerator-sorted fruit vs. meat/vegetables/beverages
  • Using butcher paper, drew road, lake and sky-sorted land vs. sky vs. water transportation
  • Using a race track and water in my sensory table-sorted water vs. land transportation
  • Using my office desk and doll house-sorted school vs. home items
  • Using fire station and race track, with road signs and cones-sorted rescue vs. construction vehicles
  • While pretending to own book store-sorted books about animals and vehicles into 2 different boxes on either side of the room
  • While pretending to own restaurant sorted food categories in various places in my therapy room (refrigerator, table, microwave, fruit bowl, freezer, etc.)
  • Refrigerator and sink-sorted empty vs. full containers (empty goes in sink to be washed!)
  • Sorting by color and shape-using colored mats, colored cups, colored paper, colored egg cartons, etc.
  • Beach bag and box-sorted summer vs. winter clothing
  • Desk and kitchen-sorted writing vs. eating utensils 
  • Tons of sensory table play where we sort various subcategories of objects in play!
Well I think that is a pretty good start.  I know I've done so many more different types of sorting games with real objects and toys and as I remember more and more of them I will add them here!

What concrete sorting activities do your students like to do?

Happy Talking!

Sunday, March 24, 2013

SLP Link Up!

Oh, How Pintearesting! is having an SLP link up and I just love how you get to see some insights into what the SLP bloggers are up to right now!  Check out the rules by clicking the link above.

State of Mind:   Right now I am feeling Joyfully Blessed with all the time I am getting to spend with my husband and son recently.  The weather has been so nice here in southern AZ that we have been getting outside, playing, taking walks, hiking, and just having some good ol' fashioned family fun.  I don't think anything beats feeling that beautiful sunshine on my skin!  I am really hoping that Spring comes quickly to the rest of the US (especially those states that have been getting and expecting snow recently)!!!!

Loving:  I don't know about you but I ALWAYS LOVE Lent and the Easter Season!!!  It is my favorite time of year.  Firstly, it happens during my favorite season...YEP if you can't tell by now...I'm a Spring lover...bright happy colors, sunshine, flowers and trees blooming adds more hop in my step. :)  Secondly, I very much love the story of forgiveness, redemption and salvation that Easter brings to us every year!!!!  It's pumps me UP and gives me more hope in myself and in the human race.  We can be better people and every morning we wake up is a NEW DAY!  Yes...I am definitely a Spring lover!!! (Sorry groundhog, but you are outta here!)

Prepping:  As you all know by reading our speech blogs...we do what we do for the LOVE of the profession!  I LOVE being an SLP and I LOVE learning about new things.  I LOVE sharing information and I LOVE educating others on what we do and why what we do is important.  So of course, I am getting myself prepared for May's BSHM (for you non speechies out there...BSHM is Better Speech and Hearing Month for the American Speech-Language and Hearing Association)!  By the way, if you have any fantastically different or interesting ideas out there for BSHM...PLEASE don't hesitate to share below!

So that's what I'm up to!  Want to know what your favorite SLP bloggers are up to?  Head on over to Oh, How Pintearesting!  and check out their link ups at the bottom of the blog!

And as always...Happy talking!!!!

Friday, March 22, 2013

FREEBIE Friday: Artic Hidden Objects Easter Egg Hunt!

I made this simple activity to practice some articulation sounds in a fun way using the "idea" of going on a Easter egg hunt.

This packet has practice sheets for:
initial and final /K, G, S/ as well as /S, L, R/ blends.

What do you do?  Cut and laminate the eggs and place on top of the hidden objects.  As your students "find" the objects they will produce the object labels in words, phrases or sentences (which ever complexity you are working on).  You can also have one student "find" an object and describe (using attributes) to another student in order to connect articulation and language tasks.

Want to send these sheets home for homework?  Well you don't even need to use your color printer.  Just email the link to your student's parents and voila'...already made homework practice.

You've seen these eggs before you say?  That's right!  I made the puzzle match up last week using the same clip art from Clips by Jenn.  Check out what else she has at this link.

Grab your FREE copy of this packet here!

Enjoy and happy talking!!!

Wednesday, March 20, 2013

Review: Behavioral Management Strategies for School-Based SLPs

Badge courtesy of:
I don't often provide product reviews however, when I come across materials or educational information that I truly believe EVERY SLP can benefit from, I MUST share it!

As an SLP in the schools I have been certified year after year in CPI (Crisis Prevention Intervention) and have been part of behavior management teams.  I've taken data for FBAs (Functional Behavior Analysis) and participated in several BIPs (Behavior Intervention Program/Procedure) over the years, that I KNOW how important it is for SLPs to understand what behavior management is and how to effectively choose and use strategies for various students.

Why us?  Why SLPs?  In my opinion we as SLPs are so good at modifying the complexity of activities, accommodating for children with all disabilities and manipulating our environment to assist our students in being successful, that we are much more successful at understanding and identifying antecedents to behaviors in a way that other professionals do not get a chance to do in large groups (classroom teacher) or in one on one situations (such as other related services-PT, OT-provide).

So when Smart Speech Therapy's, Tatyana Elleseff, asked me to review one of her educational packets, I jumped at the chance to review her Behavioral Management Strategies for School Based SLPs packet.  Because I believe that EVERY SLP MUST UNDERSTAND BEHAVIOR MANAGEMENT AND KNOW HOW TO EFFECTIVELY USE VARIOUS STRATEGIES FOR INDIVIDUAL STUDENTS!

Product Review:  In the principle of full disclosure I will tell you that I did see the first version of this packet and was able to compare it to this updated version.

I LIKE this new packet so much for so many reasons:

  • This packet is written from the perspective of an SLP FOR SLPs.
  • Behaviors addressed target genetic, psychiatric AND neurological disorders.
  • Clear and concise explanation of a team approach and what an FBA is along with written examples!
  • Address the need to deferentially diagnose Behavior vs. Sensory issues as they are treated differently.  I have to admit in my experience Behavior Specialists often times forget about Sensory issues and if we as SLPs can't ID the difference between the two a child may end up with a BIP that is ineffective.
  • List of explanations behind behaviors (great for helping us as SLPs understand the use of the behavior.  Nice little cheat sheet!)
  • List of guidelines on how data for FBAs should be taken.  I only learned this through experience so its nice to see this written down in a packet for SLPs.
  • GREAT explanation of prioritizing behaviors (what to work on 1, 2, 3rd)!!!
  • LOVE that the packet addresses that punishment is NOT efficient and replacement/prevention is the BEST form of behavior management.
  • LOVE the  Behavior Management Hierarchy is listed LEAST to MOST intrusive b/c that is how we are expected to implement behavior management.
  • Explanations of Positive behavior cues is great for us and even for teachers who don't get this training!
  • I LOVE the Positive Interventions list as we may be the ONLY professional in these meetings advocating for positive reinforcement rather than negative consequences.  This list gives us an arsenal of options we can present.
  • This packet includes FUNCTIONAL examples of how to teach replacement behavior!

My FAVORITE Things in this packet:
  • There are 6 appendix that can be carried around with you when going to BIP and IEP meetings.  The 6 appendix are (1 page each on the following):
    • Behavior Functions
    • Antecedents
    • Behavior Management Hierarchy
    • Modifications
    • Maintaining Factors
    • Written examples of FBA
  • There are case samples in this packet that describe a student, and give you questions to ponder.   The BEST part if the next page has the answers to those questions to you can self-test to see how much you are understanding of behavior management and strategies!
  • The research is already done for you!  
  • This 62 page packet is packed full of Behavioral Management information that is ONLY important to us as SLPs!!!

Negative Note:  There is only 1 negative aspect about this packet that I think some of you will think of when you first see it and that is...
  • The Price:  $16.99 (however it going on sale if you want your copy, click the link at the bottom of this blog!!!)
  • I think at first some may think this packet is not worth the price but I have to admit that 
    • 1) it took me YEARS and participation in several FBAs before I fully understood Behavior Management, 
    • 2) I do not have any Behavior Management information written by an SLP for SLPs so I find this packet unique in that aspect, 
    • 3) I can't buy a book on behavior management for less than $20 let alone a information written for SLPs!
  • So to answer your question, "Do I think the packet is worth $16.99?"  I wouldn't have reviewed it if I didn't!  I know I am going to use this information in the future!

Want a Preview? 
Check it out all the slide previews by scrolling down!

Want to get this packet for yourself?  Go to Smart Speech Therapy, LLC's online store!
Remember it will be on sale check  it out!!!

Enjoy and Happy Talking!

Tuesday, March 19, 2013

Tip Tuesday: Teaching Analogies to PK kiddos!

Boarder: From the Pond @ 
When I first started working with preschoolers I thought it was bit crazy to think of teaching analogies to 4 year olds.  But after thinking about it, I realized that analogies are just about understanding relationships between two objects.  So here are my tried and true steps to teaching analogies.  These steps can be modified for all ages as appropriate.

3 Steps to teaching analogies:

1.  Understand attributes of objects:  The first thing I do is teach my clients that every object has several attributes.  We discuss the concepts of size, color, shape, object function, location, etc.  So I ask my kids questions about objects "what color/size/shape is this?" or "what do you use (object) for?", etc.  A PK student may not be able to describe objects by multiple attributes but if they can answer the above ?s I know they UNDERSTAND the concept of attributes and we can move to Step 2.  If they don't, I know I need to back up and teach those concepts first before we can answer these questions.

2. Category Sorting:  I spend a lot of time having my PK kiddos sort small objects, photographs of real objects, and pictured objects into categories.  We spend time sorting them by the same attributes we trained above (size, color, shape, object function, location, etc.) and discuss why we sorted these objects this way.  I ALWAYS use visuals for sorting at this age.  Some examples of how I do this are listed below (but you should always do whatever works for you kiddos):
  • I may have a picture of the ocean and a barn while I have my clients sort ocean and farm animals, or maybe I use my Little People Farm and a fish bowl and we sort the same animals;
  • Or I'll have several different colored cups (colored egg crates, colored pieces of paper, etc.) and we sort objects by color;
  • Or I'll use picture of "road" and "sky" to sort vehicles by the means they travel (object function), etc.

3.  Discuss relationships, thus creating analogies:  The final step is actually just making the small leap from sorting and discussing categories to creating the analogies.  So I may give a child a lemon and an apple and they will sort them, the apple on the red piece of paper, the lemon on the yellow.  And I'll say something like "Great job, (child name).  The apple is red; the lemon is (pause)" and the child completes the analogy with "yellow".  And voila' the analogy is born!!!

And that's it!  These are my 3 simple steps to teaching analogies for PK kiddos.

How do you teach analogies?  What are your tried and true methods?

Happy Talking!

Friday, March 15, 2013

FREEBIE Friday: Easter Egg Puzzles Word Association Game!

It's FREEBIE Friday again and it's time we get ready to celebrate Easter in my therapy sessions.  My clients had so much fun with my Heart Word Association Puzzles a few weeks ago, that I decided to make some Easter Egg ones as well.  You will notice that some of these associations are quite obvious and some require a bit more thinking.  I tried to make a few a bit more complex for my older clients.

This packet includes: 

  • 24 Easter egg puzzles with picture associations
  • Answer key
Grab your FREE copy HERE!

You may notice that these cute egg templates are actually made by Jenn over at Crazy Speech World.  You can go to this link and check out her Clips by Jenn!

Enjoy and happy talking!

Tuesday, March 12, 2013

Tip Tuesday! Connecting SL services with CCS: a webinar recap!

I participated in a free webinar held via Advance for Speech Language Pathologists on 2/28/13. The topic: How SLPs Can Connect Their Services to Common Core Standards.
The speaker: Perry Flynn, MEd, CCC-SLP.  

I'm going to attempt to recap the things I felt were important from this webinar.  (If you want to listen to this webinar, I believe that Advance will be posting a recorded version on their website over the next few weeks.  So I recommend you checking out their website here for more information).  

What are CCSS (Common Core State Standards)?

CCSS are a means to "level the playing field" for all children.  They are nationwide standards for education that are based on research and evidence based practice; they are aligned with college and work expectations (to functionally prepare students to go head out to the workforce or college after graduation); are considered rigorous; and are internationally benchmarked (so students who study abroad will be educated with the same expectations as other countries).  CCSS are supposed to ensure that children across the country are learning the same skills in each grade.

How can I get a copy of the CCSS?

You can go to to read the CCSS or you can download the FREE common core standards app to your smart phone, iPad, or tablet.

ASHA's resources on CCSS:—Resources-and-References.htm

Where did the CCSS come from?

The CCSSO (Council of Chief State School Officers) and the NGA (National Governors Association) contracted out this task to experts in the field of education, most recent research and evidence based practice.  This group created the CCS (in June 2010).

Why were the CCSS created?

The CCSS were created in response to legislation:  No Child Left Behind (Bush), Race to the Top (Obama) and Individuals with Disabilities Educational Improvement Act (IDEIA).

States that have YET to adopt the CCSS:  Virginia, Minnesota, Nebraska, Texas, and Alaska.  According to Dr. Flynn, these states may jeopardize  their chances for federal funding if they do not adopt CCSS.

So what do CCSS have to do with speech-language pathology?
  • CCSS has expectations for reading, writing, speaking, listening and language.
  • These are the areas of our expertise as SLPs therefore it makes sense that we would become an integral part in helping children "access" these standards even if they are delayed.
  • These particular areas target several communication skills we as SLPs are the experts in teaching:
    • "comprehending and evaluating texts
    • constructing arguments and conveying complex information
    • strong content knowledge
    • adapt communication to varying demands of audience, task, purpose, discipline
    • use technology strategically and capably
    • understand others perspectives and cultures"

  • Another area in which we as SLPs may play an integral part is the Critical Thinking and Problem Solving area which are based on Bloom's Taxonomy:
    • Remembering: recall, repeat, reproduces, memorize, define, duplicate list
    • Understanding: explain ideas/concepts (classify, describe, discuss, explain, ID, locate, recognize, report, select, translate, paraphrase)
    • Applying: use info in new way (choose, demonstrate, dramatize, employ, illustrate, interpret, operate, schedule, sketch, solve, use, write)
    • Analyzing: distinguish between different parts (appraise, compare/contrast, criticize, differentiate, discriminate, distinguish, examine, experiment, question, test)
    •  Evaluating: justify a stand or decision (appraise, argue, defend, judge, select, support, value, evaluate)
    • Creating: create new produce or point of view (assemble, construct, create, design, develop, formulate, write)
    • TEA
        • What Should We Do when a teacher comes to us and tells us one of their students cannot
        • perform a particular CCSS?

        • It is our job to observe the child and analyze this standard from various points of view.  We need
        • to determine why the child is struggling.  What is the underlying problem that we can assist
        • with? Is the child struggling with:
    • Bloom's Taxonomy 
    • Syntax
    • Semantics
    • Morphonology
    • Pragmatics
    • Phonological Difficulties
  • We can also analyze which language areas are affected:
    • Listening
    • Speaking
    • Reading
    • Writing
    • These are strategies that we can use as SLPs when "pushing into" classroom, co-teaching, group teaching, whole-class lessons, etc. and the % with which they improve a students ability to perform academically:
      • "Identifying similarities and differences (45% gain)
      • Summarizing and note-taking (34% gain)
      • Reinforcing effort and providing recognition (29% gain)
      • Homework and practice (28% gain)
      • Nonlinguistic representation (27% gain)
      • Cooperative learning (27% gain)
      • Setting objectives and providing feedback (23% gain)
      • Generating and testing hypothesis (23% gain)
      • Questions, cues, and advance organizers (22% gain)"
    • Reference:  Marzano, R.J., Pickering, D.J., Pollack, J.E. (2001). Classroom instruction that works: Research-based strategies for increasing student achievement. Alexandria, VA: Association for Supervision and Curriculum Development.
  • When writing out IEP goals, do we write the CCSS?
    • NO.  IEPs by their very nature are for students who are functioning below grade level (and CCSS are based on the child's current grade) AND they should be individualized based on the child's strengths and weaknesses.
    • However, CCSS can be discussed at IEP meetings in that you can present how your goal(s) will assist the child is getting closer to performing particular standards.
    • IEP goals are really for EVERYONE; therefore the teacher should have a "shorthand" list of goals you are working on and parents should get a list of ways they can also target/accomplish goals at home according to Dr. Flynn.
  • Dr. Flynn has a 6 Step approach to incorporating CCSS into Speech and Language Intervention:
  • 1.  Review content of standards by grade
    • may even require you to analyze several previous grades to determine which standards the child has met and which he/she continues to struggle with.
  • 2.  Determine where the child is performing (present level of performance)
    • gather data
      • classroom observations, 
      • work samples, 
      • teacher/clinician problems, 
      • criterion referenced tests
    • analyze instructional strategies, accommodations and modifications and their effects on the child
    • look for patterns in the child's communication needs that may need to be addressed.
  • 3.  Review IEP goals, accommodations and modifications
  • 4.  Review classroom materials and analyze instructional style
    • encourage use of classroom materials in therapy-limit use of materials NOT academically relevant to child
    • observe classroom environment
    • faciliate optimal communication between teacher and student
  • 5.  Collaborate with teachers
    • need to integrate speech and language interventions in classroom making the strategies useful and practical in the child's real world
    • SLP and classroom teacher determine together the nature of the interventions:
      • direct instruction by SLP?
      • co-teaching?
      • small group instruction in classroom?
  • 6.  Design and Implement intervention
    • intervention may be appropriate in a pull-out situation
    • ideally intervention will incorporate collaboration between teacher and SLP and some type of service incorporated into the classroom setting
    • use other collaborators: secretaries, janitors, principal, music, PE teachers, etc.
    • can collaborate in various ways:
      • in person
      • email
      • skype/facetime
      • drop box/google docs
      • meetings
      • planner/homework folder
      • etc.

  • Q&A time:  Dr. Flynn spent time answering ?s at end of webinar!  Here are some of the ?s and answers:
  • Q: How do you work on grade level vocabulary when the child is not at grade level?
    • A:  work on academic vocabulary child did not master from previous years (use CCSS to guide you)
  • Q:  What are cooperative learning groups?
    • A:  when group of students work together to achieve the same goal.  Each student has a specific job which targets their specific goals.
  • Q:  How do you manage a large caseload and implement suggestions of collaboration above?
    • A:  Ask principal for support to cluster students in one or two classrooms per grade or take advantage of "visitor time" (when students move to different classrooms for reading, math or writing, maybe speech and language students can all go into one classroom and you can co-teach, small group instruction there).
  • Q:  How to take data when co-teaching or teaching large group lesson?
    • A:  You can have the students responsible for their own data (helps with self-monitoring) or train teacher/aide to take data while teaching.  Or use small 3x5 card with child's name and goals on it and keep data as you are instructing.
  • Q: How do you measure standards when the very definition of "functioning" in these standards are labeled by the grade the student is in (e.g. standard: "A K student will understand vocabulary as compared to K standard level")?
    • A:  We are still waiting for those that created the CCSS to develop the ways we will be assessing them; possibly written tests, rubrics, data forms from classroom observations, work samples?  We don't know.

On a side note:  I just found this blog post (3/25/13)...Miss Thrifty SLP has an awesome post with goals for speech and language therapy for K and 1st grade using the CCSS!  Check it out at the link above!  You won't be disappointed :)
Things I really liked in this webinar:

  1. Explanation of how to analyze a standard (various language elements and/or 4 areas of communication-listening, speaking, reading, writing)
  2. LOVE LOVE LOVE the explanation of Marzano's strategies...we as SLPs already naturally use so many of those and now we have the research to prove to parents and teachers how what we are doing will translate to improvements in academics
  3. I'm a big fan of getting out of the therapy room (as appropriate and functional of course)...and I LOVE the explanations and enthusiasm of getting into the classrooms, co-teaching and collaborating... BUT also realistic expectation that if we don't have administration on board to cluster these kids in 1 or 2 classrooms per grade we as SLPs cannot realistically do it.
  4. 6 step model is good.  We are naturally doing most of these steps now I believe, but I do like the idea of working with the classroom teacher to train the style of communication effective for various students (how great would that work for our auditory processing kiddos????).  Of course we would need receptive teachers willing to try anything and I have met many, so I know they are out there!!!!
  5. Also enjoyed the Q&A b/c many of the answers were functional (again) IF we have backing and support from administrators, teachers and other professionals.

Well that was the webinar in a nutshell!!!  A lot of information in one hour but it did clear a few things up for for me.  Now I can't wait to see what the Extensions of the standards will look like (because that is really what will guide the way we make sure our kiddos get access to these standards while continuing to perform our therapy based on EBP of course) and what types of assessments will be done to determine how the child is meeting the standards.  I'll keep you posted (no pun intended) as I continue to learn more!

What do you guys think about this info?  Comment below and let me know your thoughts, concerns, positives and negative affects you believe the CCSS is having/will have on your speech therapy!  I'd love to hear some feedback particularly from school SLPs who are currently connecting their therapy to CCSS and how you go about doing it!

Enjoy and happy talking!!!
  • All

Friday, March 8, 2013

FREEBIE Friday: Shamrock Articulation-Rhyming Match Up!

clip art courtesy of: Oodles of Doodles found at 
This is the last St. Patty's Day material I made for my kiddos this year.  I wanted to make a material that focused on the articulation difficulties my kiddos where having while also encouraging phonemic awareness and early literacy skills.  So...the St. Patrick's Day Shamrock Articulation-Rhyming Match Up was born.

This packet contains 8 sound mats (see 2 examples below) for initial and final /k, g/ as well as final /b, p, m, s/.  Can you tell that my kiddos are working on fronting and final consonant deletion? Hahaha!

And shamrocks with the rhyming words on them (see below).

 The child is to match the shamrocks correctly by their rhymes.  

Many of my kiddos are non-readers and I specifically used words without pictures this time so my kiddos can focus on "hearing" the rhymes rather than guessing at the pictures.  I used this activity this week and I cued my young clients by giving them a choice between two: "Johnny, what rhymes with tan, can or sock?" or maybe "Which two sound alike?  Tan, can?  Tan, sock?"  This way we can work on articulation and phonological awareness at the same time!  I am so glad I made this activity because I realized how some of my kiddos are really struggling with this skill.  So it was helpful information for me as well as a good articulation activity.

I also added a blank mat and blank shamrocks for you to make your own rhymes and focus on whatever sounds you are working on with your students.

Download this activity for FREE here!

Enjoy and happy talking!

Tuesday, March 5, 2013

Tip Tuesday! Guest Post: APD or ADHD!

Today I have a wonderful guest blog from Smart Speech Therapy, LLC's Tatyana Elleseff,  on differential diagnosis between Auditory Processing Disorder and Attention Deficit Hyperactivity Disorder (hyperactive, inattentive type, and/or combination).

This blog first appeared on June 6, 2011 on Smart Speech Therapy, LLC's blog.  Click on this link to go to original blog post.

Summary: This article explains the difference between attention deficit hyperactivity disorder and auditory processing disorders.  It also outlines the referral process for differential assessment of auditory processing disorders, explains the roles of both audiologist and the speech language pathologist in the assessment and remediation of auditory processing disorders.  Finally, this article cites select assessment instruments sensitive to detection of auditory processing deficit, explains the benefits of multidisciplinary approach to identification and differential diagnosis of processing disorders as well as provides general explanations for parents with respect to treatment approaches to auditory processing disorders.

Differential diagnosis of AD/HD and Auditory Processing Disorders in Internationally Adopted School Age Children.

This post originally appeared in the PAL Center International Articles Directory as well as Smart Speech Therapy Blog

Scenario: Corinne is an adorable 8 year old girl with an infectious smile, who has been adopted from Russia at the age of 15 months. She sits quietly by the bookshelf; completely absorbed by the book in her lap, while her distraught mother is quietly telling me in the hallway why Corinne has come to visit me today.   Corinne has numerous listening difficulties. She is very inattentive and frequently mishears verbal messages. She is very distractible and tends to act impulsively at home and in school.  She has trouble organizing her verbal output when speaking and is constantly forgetting what has been told to her, even if it was only moments ago. Corinne has never had a speech and language assessment before, but she does have a documented diagnosis of ADHD, for which she is currently taking medication.  The trouble is that this medication does not seem to be helping Corinne one bit.  She is just as distractible, impulsive and inattentive as she was before. Not only that, but this is not the first medication or the lowest dosage that Corinne has been taking for her ADHD.  According to Corinne’s mother, Corinne’s medications and dosages have been adjusted multiple times by several doctors, but so far it hasn’t really affected anything.  Corinne’s parents’ are at their wit’s end! Corinne is desperately struggling with her studies despite working very hard and getting a lot of help at home, but she is doing so poorly - that her school has been hinting very strongly that Corinne ought to be held back in 3rd grade.        

Fast forwarding several assessment sessions later, I am not so convinced that ADHD is Corinne’s primary deficit, or even if it’s an appropriate diagnosis for Corinne at all.  Testing has revealed that Corinne has a severe language processing difficulty and requires a referral to an audiologist for a comprehensive auditory processing testing battery.   Corinne’s mom is bewildered at the news: “But no one has suggested anything like this at all before!”

Sadly, Corinne’s case is far from unique.  The incidence and prevalence of AD/HD (the slash is used to denote both subtypes with and without the hyperactivity component) in internationally adopted children is very high and continues to be on the rise. 

What further complicates the situation is lack of valid statistical data. At this time there are no reliable statistics to cite! However, parents of internationally adopted children and those professionals who work with this unique population know just how frequently this label is used.   AD/HD prevalence in internationally adopted children is so highly alarming that it begs a number of important questions:

  • “What criteria are currently used for diagnosing AD/HD in internationally adopted children?”
  • “Are other disorders with similar symptoms being ruled out before the diagnosis of AD/HD is made?”

Attention Deficit/Hyperactivity Disorder is one of the most commonly diagnosed disorders of childhood.  As a speech language pathologist, who works in a pediatric psychiatric hospital setting, I see many children, including a large number of internationally adopted children, who have the diagnosis of AD/HD in conjunction with other comorbidities including psychiatric disorders as well as speech-language and learning deficits.

However, after the initial screening and assessment period when these children are seen by our multidisciplinary team (psychiatrist, psychologist, nurse, occupational and speech therapists, as well as a learning specialist) in a number of cases, the AD/HD diagnosis is ruled out. 

It is very important to understand that the core symptoms of AD/HD: inattention, hyperactivity, and impulsivity are also the core symptoms in a variety of other disorders, which need to be ruled out in order for the diagnosis of AD/HD to be confirmed with reasonable accuracy. 

The above “core symptoms” are observed in a number of disorders:
  • Sensory Processing Dysfunction
  • Auditory Processing Disorder
  • Mental Retardation
  • Hearing Deficits
  • Mood Disorders
  • Sleep Disorders
  • Seizure Disorders
  • Acquired Traumatic Brain Injury
  • Autistic Spectrum Disorders
  • Language Disorders
  • Nonverbal Learning Disorder
  • Yeast Overgrowth

And this list is by no means exhaustive. 

Since I am a speech language pathologist, in this article I would like to focus on a diagnosis that is most frequently mistaken (or may co-occur) with AD/HD, which is auditory processing disorder (APD), also referred to as Central Auditory Processing Disorder (C/APD).   

Auditory Processing Disorder (APD) is technically not one disorder but a number of disorders, which affect the processing and use of auditory information at the level of the Central Nervous System (CNS).  A child with APD has normal hearing but has trouble recognizing, processing and/or interpreting auditory information.  

The reason why it’s not just a name for one disorder is because according to the 2005 ASHA’s CAPD Technical Report, auditory processing difficulties may affect a number of abilities such as “sound localization and lateralization; auditory discrimination; [and/or] auditory pattern recognition.”  Additionally, the difficulties could be with the “temporal aspects of audition, including temporal integration, temporal discrimination (e.g., temporal gap detection), temporal ordering, and temporal masking; auditory performance in competing acoustic signals (including dichotic listening); and auditory performance with degraded acoustic signals” (ASHA, 2005, CAPD Technical Report).     

These technical terms translate into some of the following auditory processing difficulties for the child: 

  • Difficulty processing auditory information efficiently
  1. Child may require increased processing time to respond to questions
  2. Child may present like they are ignoring the speaker
  3. Child may request the speaker to repeat presented information several times
  4. Child may not be able to follow long sentences
  5. Child will have difficulty keeping up with class discussions in group settings
  6. Child’s poor listening abilities under noisy conditions may be interpreted as  “distractibility”

  • Difficulty maintaining attention on presented tasks
  1. Frequent loss of focus
  2. Difficulty completing assignments on their own

·         Poor Short Term Memory - difficulty remembering instructions and directions or verbally presented information 

  • Difficulty with phonemic awareness, reading and spelling  
  1. Poor ability to recognize and produce rhyming words
  2. Poor segmentation abilities (separation of sentences, syllables and sounds)
  3. Poor sound manipulation abilities (isolation, deletion, substitution, blending, etc)
  4. Poor sound letter identification  abilities
  5. Poor vowel recognition abilities

The combination of above factors may result in generalized deficits across the board, affecting the child’s social and academic performance:
·         Poor reading comprehension;
·         Poor oral and written expression
·         Disorganized thinking (e.g., disjointed narrative production)
·         Sequencing errors (recalling/retelling information in order, following recipes, etc)
·         Poor message interpretation
·         Difficulty making inferences
·         Misinterpreting  the meaning of abstract information

Auditory processing difficulties frequently coexist along with AD/HD.   So a child may have both diagnoses AD/HD and APD. However, the child may also be accidentally misdiagnosed with one, instead of the other, or may even have a different diagnosis entirely (e.g., sensory processing dysfunction), which is why a differential diagnosis is absolutely crucial! 

How to initiate an appropriate referral process if you suspect that your school age child has auditory processing difficulties?

If your child is exhibiting any of the above mentioned symptoms, it is very important to address the cause of the problem.  Even though AD/HD and APD may have similar core symptoms, the management of both disorders is quite different. Management of AD/HD may require a number of interventions including behavioral management, medication, and language therapy vs. APD which may require language intervention only, since behavior therapy and stimulant medications used to control AD/HD do not improve the symptoms of APD! (Tillary et al 2000)

To begin, the differential diagnosis of auditory processing disorder falls under the auspices of an audiologist.  However, because many of AD/HD and APD symptoms overlap and manifest as language difficulties, before a referral to an audiologist is made, a speech language pathologist is often consulted first to determine the presence and or extent of language difficulties that affect the child’s listening comprehension, short term memory, attention to verbal messages, and so on.   

A speech language pathologist may also be consulted before the audiologist, if the symptoms in question pertain to a younger child (e.g., 4-5 years of age).  Most auditory processing batteries can only be administered partially when a child is minimally 5 years of age (e.g., SCAN-3C; Pearson Publications) and comprehensively when a child reaches about 7 years of age, due the differences in speed of brain maturation in children.  In contrast, a speech language pathologist can determine much earlier if a child presents with difficulties which may later be diagnosed as APD. In fact one recent test that came out in 2010, the Auditory Skills Assessment (ASA), available from Pearson Publications, screens children as young as 3;6 years of age for early auditory and phonological skills. 

As the result of the above guidelines, some parents have asked me in the past: “If an auditory processing disorder is suspected but only fully diagnosed at 7, does it mean that we have to wait until that age to confirm the diagnosis and only then initiate language therapy?” Absolutely not!

If the assessment indicates that intervention is merited, the speech pathologist can begin addressing specific deficits (e.g., understanding verbal messages, following complex directives, etc), long before the diagnosis of auditory processing disorder can be made, since our aim is to treat the presenting symptoms and not a specific label! 

Furthermore, even after an audiologist confirms the presence of an auditory processing disorder, in the vast majority of cases, the child will be sent back to the speech language pathologist for treatment since treatment of auditory processing deficits falls under the auspices of a speech language pathologist.   

Thus, early detection (e.g., ages 4-5) frequently facilitates successful treatment, remediation, and or mitigation of symptoms.  Early treatment may also decrease symptom severity (e.g., mild-moderate auditory processing disorder vs. severe auditory processing disorder) by the time the child is tested by an audiologist at an older age (e.g., age 8). 

After the initial referral is made, and depending on the nature of deficits (e.g., attention, processing, phonological awareness, memory, etc) a speech pathologist may chose to use a number of language testing instruments, sensitive to various auditory processing components.

Below are just several of the popular screening and testing instruments which may be used by a speech language pathologist in order to determine whether a referral for a comprehensive auditory processing assessment battery with an audiologist is merited. 

·         The Listening Inventory (TLI) (2005) available from Academic Therapy Publications
·         Differential Screening Test for Processing (DSTP) (2006)*
·         Dynamic Screening for Phonological Awareness (DSPA) (2010)*
·         Test of Auditory Processing Skills-3 (2005)**
·         The Listening Comprehension Test-2 (LCT-2) (2006)*
·         The Listening Comprehension Test Adolescent (LCT-A) (2009)*
·         Phonological Awareness Test -2 (PAT-2) (2007)*
·         Comprehensive Test of Phonological Processing (CTOPP) (1999)**
·         Lindamood Auditory Conceptualization Test-3 (LAC-3) (2004)**

*Denotes instruments available from Linguisystems
** Denotes instruments available from multiple publishers such as Linguisystems, Pearson Publications, and/or Super Duper Publications

Please note that a speech language pathologist does not have to use the above tests in order to refer the child for an auditory processing assessment battery.  He/she can select the testing subtests from a number of commonly used language testing instruments such as Clinical Evaluation of Language Fundamentals-4 or Test for Auditory Comprehension of Language-3 (Pearson Publications) in order to test the affected areas of difficulty (e.g., listening comprehension, following directions, etc). 

It is also important to know that speech language pathologists are testing language processing deficits only!  The terms auditory processing and language processing are frequently used interchangeably but - they are NOT synonymous!  As mentioned before auditory processing refers to neural processing of auditory stimuli at the level of the central nervous system, only.  In contrast, language processing deficits may have a variety of causes including global disorders such as mental retardation or autism spectrum disorders. 

So, the SLP will test the child’s language abilities in order to determine if their testing results are indicative of deeper auditory processing deficits.  If they are, and the child’s age is appropriate, then the child will need to see an audiologist who will first perform a routine hearing test to rule out hearing impairment and then if the hearing is normal, the audiologist will administer the auditory processing testing battery.

What is the role of audiologist in the assessment of auditory processing disorders?

  • An audiologist is the ONLY professional who diagnoses auditory processing disorders.
  • An audiologist is the ONLY professional who is responsible for describing auditory processing deficits diagnosed during the above assessment.
  • The audiologist is EXPECTED to suggest treatment and management strategies for school and home accommodations, which are specific to the child’s unique deficits.
  • An audiologist MAY provide auditory processing remediation to the child but TYPICALLY he/she will refer the child to a speech language pathologist for further treatment.
  • Subsequent to receiving auditory processing intervention, the child will go back to the audiologist (usually after 1 year) in order to receive an auditory processing reassessment battery.
  • The child may continue to receive yearly reassessments until the audiologist determines that further assessments/treatments are no longer necessary.  

Audiological testing battery differs from speech language testing battery. Most audiological tests are administered in sound-proof booths and involve the attention and response to signals/tones in addition to attention and response to recorded words, word pairs, and sentences (in contrast to live voice) in the absence and presence of background noise.   Based on presenting symptoms an audiologist will determine what combinations of tests need to be administered. 

After testing is completed it is very important that parent request that the audiologist outline confirmed deficits, suggest treatment hierarchy with goals and objectives as well as make recommendations for school and home accommodations which will be specific to the child’s unique deficits.

This is especially important because much of the terminology used by audiologists may not be familiar to many school based speech language therapists much less parents who are attempting to interpret the report. Therefore, it is important that an audiologist clearly explain what the deficits are and what needs to be done. 

This is necessary in order to avoid confusion regarding the meaning of terms as well as to avoid generalized and unnecessary interventions. For example, the deficits pertaining to term “tolerance fading memory” should be explained as difficulties with speech interpretation in the presence of background noise as well as difficulty with short term memory.  Moreover, it is also important to caution parents that the generic recommendation of an FM system (frequency modulation system) is not applicable to all children with auditory processing deficits but only to those who have been accurately diagnosed with auditory sensitivity and/or auditory distractibility. Similarly, not all parents of children with auditory processing disorders need to rush out to purchase “Earobics” ( or “Lindamood-Bell” ( software programs especially because these phonological awareness programs and their levels of difficulty may not be necessarily applicable to many children with APD symptoms. 

Parents should also be wary of recommendations heavily emphasizing specific costly software or remediation programs (to the exclusion of all other interventions), since not all recommendations are based on scientific research and evidence. Therefore it’s very important to research the efficacy and effectiveness of these products and programs on the ASHA (American Association of Speech Language and Hearing Science) website.

I also want to reemphasize again that even after the diagnosis of C/APD has been confirmed, it may be necessary to revisit the child’s remaining symptoms once more in order to reassess the continued applicability of AD/HD diagnosis and use of medications as well as to rule out the presence of additional comorbidities.   

On such occasions, I have found that The Listening Inventory (TLI) screening instrument is a very helpful tool for making additional referrals.  This questionnaire, which can be filled out by parents AND teachers in as little as 15 minutes, has the users rating the child’s difficulties in 6 areas: linguistic organization, decoding/language mechanics, attention/organization, sensory/motor, social/behavioral, and auditory processes.  After all the statements are rated and the index scores are calculated, many parents are often surprised by the results.  Oftentimes the difficulties they interpret as being social behavioral may actually be the result of sensory/motor impairments, which require an assessment by an occupational therapist. 

This is why the multidisciplinary approach to identification, differential diagnosis, and management of disorders like AD/HD and/or C/APD is so important.  Just one individual assessment, be it psychological, occupational, or audiological, CANNOT reliably determine accurate diagnosis to the exclusion of all others, especially when the diagnostic criteria is based on generalized symptomology (symptoms fit several diagnoses).

To learn more about auditory processing disorders please visit the ASHA website at and type in your query in the search window located in the upper right corner of the website. To find professionals specializing in assessment (audiologist) and treatment (speech language pathologist) of auditory processing disorders in your area please visit: 

·         American Speech-Language-Hearing Association. (2005). (Central) Auditory Processing Disorders [Technical Report]. Available from

·         Lucker, J.R. (2007). History of Auditory Processing Disorders in Children. In D. Geffner and D. Ross-Swain, Auditory Processing Disorders for Speech-Language Pathologists San Diego: Plural Publishers.

·         Tillery et al. (2000) Effects of Methylphenidate (Ritalin) on Auditory Performance in Children With Attention and Auditory Processing Disorders. Journal of Speech Language and Hearing Research 43, 893-901

Bio:  Tatyana Elleseff MA CCC-SLP is a bilingual SLP with a full time hospital affiliation as well as private practice in Central, NJ. She specializes in working with multicultural, internationally and domestically adopted as well as at-risk children with complex communication disorders. She presents workshops for a number of medical, academic, and non-profit organizations and writes articles for various specialized publications.  For more information visit her website and blog @

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