Could there be a child in your life with a 'hidden' language difficulty that is a significant reason behind his/her attention, learning, or even social challenges?

It is not always easy to spot. For example, would it surprise you if a 5-year-old boy who had different things to say to every person who opened the door for trick or treating (including "Can I see your kitchen?") actually had expressive language delay?

Expert treatment of language-based challenges can have a significant impact. In fact, another little boy no longer qualified for his original autism spectrum diagnosis after working with a speech and language pathologist (SLP) (and an OT).

So the mistake is that speech and language evaluations don't seem to be suggested often enough.  

Issues can go undetected for years, with the child's self-image suffering during that time. Studies show that 30 - 60% of kids with ADHD have speech or language difficulty. Speech and language is an essential evaluation to consider when a child has ADHD.

In this video you'll find out more about:

• the long-term effects of not treating speech and language difficulties
• how virtual learning is showing more underlying challenges
• how a little boy 'lost' his autism spectrum diagnosis

LINKS

Ilene's practice

FULL TRANSCRIPT

Veronica: Hello to all of our parents out there. We're so glad to have you here today. And today we are going to be looking into speech and language pathology and what that can do for your child.

I have personally found it to be an amazing part of our experience, so very helpful. So today I'm going to start with a little bit of sharing my own experience, and then Mrs. Ilene Refkin is going to talk a little bit about the profession of speech and language pathology and where you can find her and her practice. And I'm so looking forward to this conversation, welcome Ilene.

Ilene: Thank you.

Veronica: So going into a little bit about what working with you has meant for our family, I first called you about a year and a half ago because I was experiencing with my child - he was seven years old at the time - and what we were seeing at home is that he would grab something from his siblings' hand. So then immediately the siblings were then screaming because they just had something ripped out of their hands and they have no idea why.

Given that I have four kids at home in four years. So there were ages seven down to three, this presented numerous problems for our family life.

And I called Ilene, and I asked her at seven years old, is this what should be going on? And she explained to me a little bit about expressive receptive language, and I had no idea what that term even meant at that time.

And I think I had another question for another child too, because this the seven year old has a twin sister who is also seven-year-olds old obviously. And she would be saying "wead" instead of "read". So I was always trying to hold in my patience when there was this expression of "I'm going to go and wead right now". And I'm thinking, are you reading a book or weeding a garden?

So I was also asking this, I mean about those questions as well. And after just a few months of working with my daughter, Ilene was able to eliminate that speech pronunciation issue, which was something that we had been looking forward to for a few years, because I had been asking questions about it for a long time.

And my son with the expressive language, after just a short time of working with Ilene, he started to be able to speak something out before interacting with the other kids, so that this conflict that was always happening within our family, where the, you know, someone who was having something taken from there, so immediately they would get upset that was starting to reduce and eliminate. So obviously it was a big stress reducer within our home.

So I was so thankful for Ilene and the services that she has done with my children and interacting with her and her teaching me too what to do with my kids, because there were a lot of parts that I was missing and I just had no idea. So thank you very much for everything that you've done for our family.

Ilene: My pleasure.

Veronica: For today, what I was hoping that you would focus on is you are a pediatric speech and language pathologist, and when I started this journey, I had no idea what that meant, or I didn't even know who to call, right, with all of these questions.

And so the goal for today is really to help our listeners to understand what you do and be comfortable to pick up the phone and talk to someone in their own area, or being now that everything is virtual, they can always call you as well.

So can you start off by just telling us a little bit about what is the scope of things that you treat or deal with when it comes to children and speech?

Ilene: Sure, absolutely I can. So in my practice, I see children that start from about two years, maybe 18 months, all the way up to children that are in high school. And I see children who have language problems, who are spectrum children, who are stutterers, who have all different kinds of communication difficulties, who have oral motor difficulties,

I'm prompt trained, so I see all kinds of muscle difficulties, sound production difficulties, all kinds of communication difficulties. I do not see voice children, anybody who has nodules gets referred to a voice specialist. So really I run the scope of children who have receptive and expressive communication difficulties and articulation, even muscle based articulation difficulties.

Veronica: Thank you. Can you explain a little bit, what is receptive language and what is expressive language? What's the difference between those two?

Ilene: So receptive language would be the understanding of language and expressive language would be the ability to express oneself. Language difficulties are all the language areas that are involved with learning. So we talk about language based learning disabilities, and those are all the areas that are involved with understanding.

And they come in with pre-reading skills, and we see the pre-reading skills which are problematic when a child has attention based problems or executive functioning problems. And those are the children who have language-based learning disabilities. And I would be the person that would attack the language areas that are causing the language-based learning disabilities.

Veronica: Okay. So we might be alerted by the school, for example?

Ilene: You might be alerted by the school that the child has some acting out because they are not following directions or they're having word-finding difficulties, or they're talking around and around rather than targeting the word they need, or they're having organizational difficulties; they can't talk in sequence, they can't tell you what happens first, second, third, or it's very difficult for them to tell you a story and you can't follow what happened when you asked them what happened during their day.

Veronica: Okay. So I might just think if I'm hearing those types of things that perhaps my child just isn't good at writing, or you know, that that's just not their strong suit. What would be your response to that?

Ilene: So my response would be, well, let's take a look at why they're writing is problematic. Is their writing problematic because they can't organize their writing? They can't find the words, they don't have the ability to use adjectives in their writing. Just what is the problem with their writing skills?

And we have to really take a look. So we would do some diagnostics, we'd evaluate what's happening and see just what the problems are. And we would also look at their level of frustration.

Very often, children who have language difficulties are also very, very frustrated. Maybe there's some memory difficulties, maybe they are not remembering directions. Maybe they're only following the third direction the teacher's given because they are not remembering the first and the second direction. And they're looking around to every other child to get some cues, as far as what was told to them before the third direction and the first and second direction left, it completely is gone. They don't remember it and they're left behind.

So if they can't remember it, they can't do it. And then the teacher might be either disciplining them or calling them out for it. And it becomes embarrassing. And the child is left feeling very poorly and the self-image starts to suffer. And it's a self-fulfilling negative prophecy. So you have to wonder what's happening to this poor child every day in their school.

Veronica: Yeah, I can imagine that it's a common story actually, right?

Ilene: It's too common. And now with virtual, what we're seeing is that they're just very turned off completely because they can't follow what's going on virtually. So they're just not willing to attend at all.

Veronica: And then they shut down? That's been my observation, when my kids get into that kind of zone, they just kind of shut down. And then of course, me as a parent, my natural inclination is to push forward.

Ilene: Right. And so you end up at odds with them. Exactly. And they just do not want to be on there and you want them to be on there and it's not good, but you haven't really answered the problem, which is why. And we need to look at the why.

But in particular I can think of one little boy and one family that has really, really, really had a mark in my life. And this was a little boy with a big, big set of eyes. And the mom called me. And in those days we weren't seeing children virtually because there wasn't a virus at that point. And the mom called me and she was very, very frustrated.

The little boy was three years old. And she said that he was acting out and very, very difficult and that he used his words, but that she didn't feel that he was communicating effectively. He was very, very frustrated. And because he was so frustrated, she felt that he was completely physical. And when she brought him in, he was very, very, very physical.

And when he sat down and we took out a big play house and he really calmly sat down and I didn't find him to be frustrated at all. And we've used the people in the play house and we set up beds and we set up a table and chairs and little by little, with the little communication that he displayed, he was able to use my modeling situation and communicate.

And he showed me that he had so much difficulty following directions and organizing his language and just showing me that he could organize any kind of language there. And when his mom would have given him directions, I'm sure that he couldn't have understood very much of the language. And that's why he was so, so frustrated. And that's why he was acting out.

And we just broke down his language little by little. And because this was a diagnostic situation, his mom was sitting there and watching every bit of this. And I could see out of the corner of this eye, that his mom's jaw was dropping because he was so cooperative and so calm. And we started an incredible relationship.

And this little boy just began to flourish. And years, years later, this little boy came to see me. I no longer had a relationship, but still have a relationship with the family. This little boy did beautifully. The language came in. The sound production came in. He no longer showed any frustration because he needed to deal with his language and to be understood.

And you know what? He just needed the patience and the diagnosis that was going to benefit him. And you know what? We held his hand and we did everything we needed to do, and his mom needed the direction. And he did incredibly well. Today, he's in high school, he's happy, he's social. He has siblings and he is a great, great child, the child that he should be.

And that's the kind of story that I hear over and see over and over again, because speech and language is something that children need to be effective in life. And that's what makes my profession incredibly, incredibly wonderful.

Veronica: So then these types of skills can actually be improved?

Ilene: Oh, for sure. But they have to be correctly diagnosed first.

So that would be the first question, what is really happening? And so when you would make that phone call to me, I would ask that question and you and I would be chatting about just what you think the difficulty is. Do they follow your directions at home? Do they have difficulty? Do they turn off? Are they acting out? What is the problem exactly? And if you give them one direction, do they follow it without difficulty? When you put noise in the background, does that direction become more difficult? When you give them two directions, is it more still? When you turn the noise off, does it become easier? What's happening in all those different scenarios?

Veronica: Got it. So then it sounds like based upon the conversation that you have with a parent, you go forward and then you'd make a selection of diagnostics to run? Is that correct? Or do you do like a base line all of the time?

Ilene: I'm actually probably asking you to try a few things at home and then tell me what happens. And then I probably would start by just chatting with the person, with your child, and see what I get, and then start with the very first diagnostic and see what I get in the very first diagnostic and go from there.

Veronica: Okay. Can you explain in a little bit of detail what the purposes of these diagnostics are? Just a person just coming into this whole world, what does that mean?

Ilene: Well, just depending on the child's age and depending on what you've told me is the problem, I'm trying to really limit down which one of these difficulties it could be. Because is a child acting out, or are they turned off because they're having difficulty with, A. expressive language, B. auditory comprehension, C. is there central processing difficulty?

Which one of these problems are we seeing? And if we are seeing one of these problems, what we need to do, the diagnostics put me in the direction of what goals I need to be working on and what I need you to do at home to improve their attitude and outlook at home and how I can help them in a therapeutic situation.

Veronica: Got it. What's the difference, either the similarity or the difference between the tests that you would run and what they might have received at school through a child study team?

Ilene: Probably the child study team hasn't done anything that has looked specifically at central auditory processing. They do not do central auditory processing in a school environment.

In fact, very often they are completely unaware of what central auditory processing is. I had a little boy, not a little boy, a junior high school boy whose mom called me this week. And she told me that he has been diagnosed with a central auditory processing disorder, it's called CPT. And it's written in his IEP that he should be receiving therapy for central auditory processing. And he was handed over to the English teacher for central auditory processing. But the English teacher does not have a clue what central auditory processing is.

So there you go. So yeah, that is something that I've seen happen an awful lot. Central auditory processing testing cannot happen until they're seven years old. And central auditory processing is crucial in terms of the signal getting mixed up in children's ability to process the signal coming in.

Veronica: Got it. So do you think a lot of kids fly under the weather, so to speak, or under the radar?

Ilene: Enough. And you know, I think that children, there are two things that happened with children, either they are very well-behaved, so they are not a problem in a classroom, and if they have attentional difficulties, they're sitting very nicely and they're not noticed, so intellectually they're not functioning at their levels. They're just not noticed. And sometimes they're not noticed for years.

Third grade is a big year for comprehension. And usually by third grade, they do get noticed because by that point they are doing things much more independently and then the skills aren't there. So they do get noticed around third grade or they do start to act out. And when they start to act out, it might be that they're noticed for their discipline problems. And it might be misdiagnosed as a discipline problem rather than a processing problem or an attentional problem.

Veronica: Got it. So what are the parents seeing or what did they describe as a problem that they're seeing that causes them to call you?

Ilene: That they can't attend at all in a virtual situation. And some parents are asking if they need to put their child in a small pod for learning, why aren't they able to learn in a virtual situation?

Or I'm seeing a lot of executive functioning; that they're not able to have any organization at all, that they just cannot hold it together and they need much more help in the executive functioning areas.

Veronica: Interesting. So when you get that kind of call, what do you do? Or do you have an idea of a treatment? How do you know you're going to be a able to help a child like that?

Ilene: Well, usually I do some diagnostics and then I almost always see that the language based learning this disabled child has some executive functioning difficulties that go along with that.

And so I start to set them up on some organizational approaches and I usually see that goes along with it, but not always because every child is an individual. But sometimes I see some expressive language difficulties that are hurting them socially, that are hurting them in their writing skills, and are hurting them and their expressive skills with their parents and with their siblings.

So I set them up with goals in all those areas. In terms of the executive functioning, we just start with a calendar. And so the calendar is a way of setting them up with what needs to happen when, and it's visual for them because they need to use all their sense modalities to organize themselves. And that helps them so much.

Veronica: So I know for myself and my experience, it took me a while to pick up the phone and call you because I guess I just didn't know who to call or there were so many questions that I had in my head, but I was glad that I did, ultimately.

It sounds like if people are experiencing any of these things, just pick up the phone and make a phone call to a practitioner such as yourself and ask questions. Is that in your professional community have you found that to be a problem? Like do you mind when parents call and ask these types of questions to you?

Ilene: I don't mind in the least, I welcome it. I love to explain these things to parents. I find when people go to somebody such as myself or not, it has to be a good match. You're working very closely with the family and you're working with their children. And so my comment is always come and meet me or meet the person that you have in mind and find out if you're comfortable with them at a good match before you set anything up, pick their brain and see if you're comfortable. I think that part is so important. You have a lot of questions, I think they should be answered. So I think that's the first step.

Veronica: And then another barrier that I had had was being concerned about the cost. So in your experience, does insurance cover speech and language?

Ilene: You know, insurance today is so, so confusing and so different depending on your individual policy.

So I would say, make that phone call to your insurance plan and ask a lot of questions. Very often, it is. And sometimes it isn't. So you have to call and you have to ask and you have to discuss exactly what the problem is.

You may have to call the speech and language person first. You may have to get some idea of what the diagnosis code might be, and then call the insurance plan and have specifics ready to discuss with the insurance plan and find out.

Veronica: So going to my, my personal experience, again, I just it's been some paperwork for me, but I've been able to just take on the responsibility for that paperwork, but it's meant that my children get access to, you know, you who have been able to help them improve not only our home life and interacting with people, but their academics as well. So definitely it's worth, it never hurts to make a phone call and get more information, right? 

Ilene: That's what we hope for. That's the ideal way to go. That's for sure.

Veronica: Excellent. Now, before we sign off, I know I'm throwing you this question, like off the cuff about sharing a story, can you share maybe one success story? Perhaps there's a kid that quickly comes to mind or about someone who had attentional difficulties inside of the school and where they are now?

Ilene: Yes, I can. I can share millions of stories actually, but I can think of a little boy who I'm still seeing. He's not quite finished yet, but he's almost finished.

And he came when he was first diagnosed to have a spectrum disorder. And when he came, he was referred by his occupational therapist who is actually I work very closely with an occupational therapist. And he came and I certainly saw why he was diagnosed with a spectrum disorder, but his mom brought him because he had very poor expressive language skills. And as a spectrum child, he also could not use his expressive language in a social manner.

So we worked a lot on his word finding skills and on his ability to express himself. And he was little, he was in kindergarten and the social skills were very poor. So that was one of the goals. And we worked for a long time on these skills. And whenever he didn't like what was going on in the session, he had this habit of turning his head away from me as if to say I'm not doing that. And whenever he did that to me, I would simply take out of the bag - it wasn't virtual at that point - I would take out of the bag, another character in the play house, and immediately he would turn back around because he wanted to play with that character.

Well, he worked for another six months or so, and little by little, became much, much, much more expressive. And he's finishing up his therapy at this point. And actually he has been discharged from occupational therapy. He'll be discharged from me in the next couple of months.

And the nicest part is that they have decided that he has a little bit of a social anxiety diagnosis, but that his expressive skills and relational skills have come so far, that they don't feel that this spectrum disorder diagnosis is even so appropriate anymore. And so they're changing his diagnosis to a social anxiety diagnosis.

So he's truly a success story and he doesn't turn his head from me anymore. He just kind of looks at me if he doesn't want to do something or tells me using his expressive language, which is wonderful. So he is truly a success story. So that's wonderful. And I think about him a lot. 

Veronica: It must be very rewarding because of course you can project the difference that it's made in his life being that he's so young, right? That this intervention was made versus waiting years and years and all of the social anxiety and other, the much grander scale that all that could have presented for him, an emotional impact.

Ilene: Well, the rewarding part is that his parents have said to me often, "he doesn't stop talking". I always laugh when they say that. I want to say to them, did you ever think you'd say that? And they probably don't, but I love when they say that. 

Veronica: That's awesome. It's so great. So we're going to end on that story. For our listeners, I want to share where are you can find Ilene. She is the - your practice is called IM speech and you operate out of Tenafly, New Jersey, and we will link to her contact information on the show notes or the webpage. And in the meantime, Ilene, we thank you so much for pleasure.

Ilene: Absolutely. Have a good day.