Looking for suggestions- expressive language issues

[NYmomof4]

All, I need your collective wisdom to figure out what to do with DD this summer. Here is where we are:

 

·         DD has struggled in school since 1^st grade with pretty much everything

·         We’ve done ton of therapies at home with some noticeable results

·         DD was tested by PS in Jan 2015 and overall scores were within average ranges. School psyc concluded visual spatial, visual organizational, planning, and writing deficits/LDs

·         I personally don’t agree with the above diagnoses. I believe her writing struggles stem from her language processing glitches. She does equally poorly when she writes the information down herself vs. relaying the same information orally. It’s painful to see how she struggles to pull her thoughts together into a meaningful sentence. She frequently uses wrong prepositions, skips subjects, uses sentence fragments, and makes basic grammar mistakes. She also has a very hard time acquiring new vocabulary. For what it’s worth, her receptive language score was 2 standard deviations above her expressive language score, but somehow the school did not use that as part of her diagnoses.

 

Despite all this, she had a good year at our local PS.

·         DD finished 7^th grade with 90% average. Core subjects were all mid 80s, with electives in mid 90s

·         DD started the year in all gen. ed classroom, but was moved to English Fundamentals class at the end of 1^st quarter because she was struggling

 

School is finally finished, and I want to spend the next 10 weeks doing some remediation, except I am not sure what resources to use or what to do. In the past 2 years, we’ve done Linguisystems auditory processing books, their language processing HELP series, and parts of their grammar book. We did REWARDS Social Studies last summer. DD works on Wordly Wise series for vocabulary. I feel like DD does well on individual exercises in all these workbooks, but struggles to literally make sentences when she needs to express herself.  WWYD? I would appreciate any resource suggestions or ideas on how to help DD.  

[PeterPan]

Get a private SLP eval immediately to update her CELF/CASL scores and diagnoses.  You're probably also going to need to get a private psych eval.  Clearly stuff is going on.  So private psych, private SLP.

 

PS grades are bogus.  We have kids come through all the time who were getting "good grades" who had underlying problems.  How are her achievement test scores?  Any discrepancies there?

 

A neuropsych can usually run the more detailed language testing like the CELF, btw.  I would want both the SLP and psych evals anyway.  One will probably be faster than the other to get into, and they'll be complementary.

Edited June 23, 2016 by OhElizabeth

[PeterPan]

If you intervene before you get private evals, you're undercutting the data you need to get interventions.  I know you want to help her, but I wouldn't do it.  Probably what happened is her peers are pulling ahead for language. It will be more obvious now.  And, if they didn't qualify her with those serious discrepancies, you may need an advocate.  

 

If you want to do it all yourself and don't want to fight through the IEP process, you can.  At that point, I'd be asking about homeschooling, just because it would give you more time to focus on the issues.  A dc at that age isn't going to tolerate therapy a long time.  She's a rising 8th grader?  You've got one year here to make a big difference.  You could pull her out for a year, do private therapy, do academics that weave in the goals, get it to come togheter, then put her back in somewhere for high school.

 

It's just different scenarios.  You're right though that at this age they stop giving a rip about intervention and just go to pushing them through.

[PeterPan]

Have you been to:

 

Super Duper Inc

 

ProEd /Linguisystems

 

Great Ideas for Teaching

 

Those are the three places I look for paid materials.  There's actually some really good stuff on TPT (Teachers Pay Teachers) sometimes.  You'll find SLPs, etc. using materials from there.  But to me, when it's like you want to buy it, you want to know it's good quality and thorough, those are three places to look.  And if you find things you're considering, you can ask about them here or do a google site search to see if someone has used them.

[PeterPan]

My ds doesn't have a vocabulary issue.  I still think you need updated testing BEFORE you do any of this.  You really want that.  You don't know how much she has dropped relative to her peers, nothing.  And as long as you do that baseline, you can take those to the school any time this coming year and fight in the IEP process if you want.  But without that baseline, you're screwed.  

 

Anyways, vocabulary, from what I gather, can be kind of complicated.  Someone else can speak to it.  I think there are various aspects.  (semantics, lexicon, blah blah)  So word retrieval issues can be speed, lexicon (how the words are organized in the brain), etc.  Did they do any ADHD testing?  My dd has some word retrieval issues with her ADHD, and she has low processing speed.  Meds can bump processing speed, yes?  I'm saying you need to know what things are working together to cause the retrieval issues, the vocab issues, etc.  

 

Did she have any speech problems as a dc?  It's funny, because my dd, when tested by the OT, had the retrieval problems you'd expect with apraxia.  Like the OT would have her do exercises making lists, and dd had troubles with it.  Dd has some mild overall praxis, but not enough to get her a DCD label.  My ds came along, and he goes all the way, diagnosed with verbal apraxia.  But I think the word retrieval issues are most commonly linked to praxis and dyslexia.

 

And the reason that gets interesting, is because then you go ok, maybe we have some overall body stuff (praxis) going on, and maybe we conclude some OT for midline issues would actually help our language!  Our SLP *swears* by OT.  She said her kids often get expressive language bumps when they start OT.  Like noticeable, dramatic bumps.  And it's midline stuff.  The OT she brought in used S'cool Moves/Focus Moves.  I just linked it in another thread.  It's super easy to implement at home, only $10 for the ebook.  If you buy it, pm me and I'll give you some stuff I made to make it easy to implement.  

 

The OT I used with dd (this was before my ds' SLP and OTs) had dd do things like skip counting to a beat while walking backward on a treadmill.  Wild.  We did some metronome work with her.  Really, for the $10, I really like the Focus Moves ebook.  

 

I have some of the DeGaetano books for word retrieval that Great Ideas for Teaching sells.  I like them.  I like all DeGaetano's stuff, actually, and so do numerous therapists I've taken my ds to.  They're just good, practical, easy to implement.  Remember, you can use materials multiple ways too.  I have this Grammar Processing Program I got from Super Duper.  It's ostensibly for receptive, but I use it both ways.  The grammar spirals and builds slowly.  I read the sentences and he points, then he makes up sentences for which I point.  So it's building that expressive language and catching those holes too.  

[NYmomof4]

OhElizabeth,

DD had CELF-5 done in Jan 2015 as part of overall testing. Her scores were:

world classes - 15

formulated sentences - 9

recalling sentences -9

semantic relationships-9

core language -102

 

Achievement scores were all in low to mid average range according to WIAT III and consistent with what I see at home. Listening, decoding, comprehension, are around 50%, oral expression, spelling, essay composition closer to 30%. 

 

Does this change your recommendations at all?

 

I've looked at linguisystestes and pro-ed site. There were a couple of books similar to what we've done in the past. However, I don't feel confident that more of the same is going to help. I am sort of at a loss. I don't know exactly what I am looking for, but I feel like I was see is not it. Not sure if it makes sense....

Edited June 23, 2016 by NYmomof4

[PeterPan]

Has she had a full psych eval, including IQ?  That word classes is high, but those other scores are right at mean.  For standard scores, the mean is 10, standard deviation 3.  You know this, but then you also know that they don't really consider IQ.  To me, as a mom, it makes sense to, but the school doesn't have to, not for speech.

 

Did they run all the subtests on the CELF5, or just those?  And what other evals has she had?  Processing speed and ADHD?

 

Are the areas that are really high things that were worked on?

 

Lots of people are going to have a relative weakness and not get a label.  They'll chalk it up to ADHD and you compensate.  I don't think they'll consider IQ to diagnose by discrepancy, the way they do an SLD.  

 

I'm wondering how much of that is splinter skills.  If they ran the rest of the CELF, it would be good to see those scores.  Where was that vocab that you said was low?

Edited June 23, 2016 by OhElizabeth

[PeterPan]

Sorry, I'm scanning pictures and losing track of things.  They did the WIAT, so that's good.  Did they do a WISC?  If those achievement test scores are low for IQ, did they diagnose SLDs?  Or they didn't get there?  If her IQ is average (let's just say) and her language scores in general are at the median, that's really good!  That's like ok, she has the language to comprehend what she's reading. 

 

My ds has this mismatch, where I got his language scores up to median but they're not enough to comprehend the material to match IQ for reading.  That's a problem and at his age it's really glaring.  So that's sort of gathering all that information and looking at the whole, which is why I ask if they ran the IQ and how that's comparing to what you're getting.

 

Any history of speech problems?

 

I tend to think/guess/assume that 15 on the word classes is a splinter skill, something you worked on.  Yes? 

Edited June 23, 2016 by OhElizabeth

[NYmomof4]

She had quite a bit done last Jan. 

 

2015 WISC-V

 

VCI - 100 - 50%

 

            Similarities - 37%

 

Vocabulary - 63%

 

VSI - 92 - 30%

 

            Block Design - 50%

 

Visual Puzzles - 16%

 

FRI - 94 - 34%

 

Matrix Reasoning - 50%

 

Figure Weights - 25%

 

WMI - 107 - 68%

 

            Digit Span - 84

 

Picture Span - 37

 

PSI - 98 - 45%

 

            Coding - 25

 

Symbol Search - 63

 

FSIQ - 99 - 47%

 

 

TAPS 3 - test of auditory processing skills:

word discrimination - 50%

 

phonological segmentation - 63%

 

phonological blending - 95%

 

number memory forward - 50%

 

number memory reversed - 37%

 

word memory - 63%

 

sentence memory - 5%

 

auditory comprehension - 25%

 

auditory reasoning - 25%

 

 

 

Expressive one word picture vocabulary test - 18%

 

Receptive one word picture vocabulary test - 53%

 

 

Bender-Gestalt II

Copy subtest - 12th %

 

Recall subtest - 58th %

 

 

She did not have any specific to ADHD testing, but that never came up as a concern. 

 

Also to answer your earlier questions, she had expressive language delays early on, and started EI when she was 2.5. She's pretty much been in some sort of Speech therapy since then. She's had OT for several years as a pre-schooler to early elementary and graduated at around age 8. Same for PT - had it for a couple of years around age 7 and graduated. 

 

Homeschooling next year is unfortunately not an option. I do what I can with her after school, but I am not around all day to take on homeschooling. 

[PeterPan]

Her coding is low.  Her language scores on the CELF are all matching the IQ.  

 

Did you take her to the audiologist?  I'm not super crazy for the TAPS3, but it is flagging a bunch of areas.  You should get an audiologist to do the SCAN3 and get that sorted out.  Your super low vocab scores (18 an 53%) were from... ?

 

 

[PeterPan]

I'm having a moment.  Where's the processing speed score from the WISC?

[NYmomof4]

Expressive and Receptive tests were called EOWPVT-4 and ROWPVT-4. 

 

Processing speed on WISC was 45% (PSI)

 

She was evaluated by the audiologist twice, in 1st and 2nd grades. 1st grade scores were all in single digits. With much therapy and work, 2nd grade scores were all in the average range. I haven't had her re-evaluated since then, but we continued working on Linguisystems auditory processing books for quite a few years after that. At this point, I assume it's as good as it will ever get.... 

[PeterPan]

Did they actually test her for APD?  There are some more things they can do with hearing aids... She can also get accommodations (seating, note takers, etc.).

[PeterPan]

You've done so much work!  I think you're right that there might not be magic bullets.  However there *might* be things that you target and go ok, this is pivotal, working on this will make some other areas easier.  So that working memory and sentence recall is something you could work on, and then that might make some other things better.  My ds struggled to repeat ANYTHING, and that has improved radically with the GPP book and that slowly built up work.  

 

That's what I'm thinking, that these things start to merge.

[PeterPan]

Look at that 5% sentence memory.  How is she going to get out a sentence of any length if she can't remember what she's hearing and imitate?  What SLPs will do sometimes is record everything the dc says for a period of time and then analyze it for sentence length, grammar, etc. She's old for that, but I'm just thinking maybe you've noticed that showing up?  

[NYmomof4]

I was actually truly surprised by that score. A few years ago we worked on auditory memory using Casimano book and DD had no trouble repeating the sentences. When I tell her a sentence, she easily repeats it... 

 

Can you post a link to GPP book?

 

Do you think there is anything else we can use to work on her expressive language?

[PeterPan]

The Grammar Processing Program

 

I'm not saying that's what she needs, just that I'm using it.

 

Check, but I think the TAPS is done with no visual.  The therapist puts up a barrier so the dc can't see her face.  She may be reading your lips.

Edited June 23, 2016 by OhElizabeth

[PeterPan]

Fwiw, my ds does GPP entirely with auditory memory.  He couldn't make those sentences up himself.  He remembers what I say and then repeats them back.  So if you decide to do something like GPP or a sequel book (there are 2), you want to put up a barrier so she's not using any visual hints from you or reading lips.