Consideration in service delivery to special populations

Question 1

INTRODUCTION

Answer 1

Internationally adopted children

Question 2

Decreasing numbers of IAC in the U.S

Answer 2

# adopted is about ¼ of 
what it was

Question 3

https://travel.state.gov/content/adoptionsabroad/en/about-us/statistics.html 2017

Answer 3

Majority of adoptees in 2015 were 1-12 years old

Question 4

Some top countries children adopted from:

Answer 4

1. China
2. Ethiopia
3. Haiti
4. South Korea

Question 5

Hwa-Froelich :

Answer 5

US families adopt ch from abroad 4-16x more than other countries.
Most studies: South Korea & Romania
South Korea: Positive Outcomes
Romania: Negative outcomes

Question 6

BECOMING AN “ORPHAN

Answer 6

In home countries of IAC, usually found in orphanages

Some have parents who are dead

In many cases, however, parents put their children into orphanages  cannot afford to feed them

Also, in some cases, parents are NOT MARRIED; great DISGRACE in some countries, so the child is placed in an orphanage

Question 7

Kathleen Morris (Practical strategies for therapists working with SI/SPD Disorders)

Answer 7

Volunteered: Russian, Romanian, Bulgarian orphanages

She has also worked for 17 years as the founder and director of two SI clinics

I went to her workshop

Question 8

According to Kathleen Morris:

Answer 8

Russian cities-mother abandon ch on street
Walking along holding hands; mother says, “look there!” drops ch hand, runs away.
Orphange workers go out in the PM to look inside manholes-ch hiding from cold.

Question 9

(Morris)

Answer 9

Smell in orphanage is so bad that some visitors throw up when they enter.
In some Bulgarian orphanages, schedule:
1.Breakfast
2.Sit on bench
3.Lunch
4.Sit on bench
5.Dinner
6.Go to bed-stay there

Question 10

Former student Marilyn Stansfield, (worked in Romanian orphanage)

Answer 10

Orphanage workers stole supplies-diapers, wheelchair parts, bottles, soap, combs, toilet paper
Sometimes told not to change a wet diaper or use shampoo during bath.
Workers took orphans’ food.

Question 11

Marilyn also volunteered at a Romanian hospital for abandoned babies…

Answer 11

8 beds-room
Only human contact=diaper change
Not held or cuddled
All meals; blanket/pillow propped next to heads, bottle placed on blankets

Question 12

Marilyn tried to feed a newbie from a bottle…

Answer 12

Wouldn’t eat-stared at Marilyn
Nurse: baby unfamiliar w/ being held while feeding
Too much sensory input-be held and eat simultaneously

Question 13

ACCULTURATION ISSUES

Answer 13

Frequently, IAC are ABRUPTLY TAKEN OUT of their familiar surroundings and placed into totally new environments

This is especially hard on OLDER IAC

They may miss the FAMILIARITY of surroundings they have known all their lives

Used to INTERACTING with other CHILDREN, not adults

Question 14

GENERAL CONSIDERATIONS

Answer 14

Possible post-traumatic stress syndrome

Consequent need for psychological services, emotional support

Adoptive PARENTS may need these services also–feel OVERWHELMED

Question 15

Other potential areas of concern include

Answer 15

Malnourishment-decrease brain development general health
Decrease dental care
Decrease gross, fine motor skills
Behavioral issues
Physical abuse-neglect
Decrease emotional bonding opportunities
Potential alcoholism in birth mothers (esp. Eastern European)

Question 16

Hwa-Froelich—major parent concerns

Answer 16

HIV infection # one
Latent TB
Immunization status
Short stature

Question 17

SPEECH AND LANGUAGE CONSIDERATIONS**

Answer 17

Articulatory-phonological skills may be negatively impacted by LOW ORAL MUSCLE TONE

Some IAC refuse to even chew, let alone speak

Again, dental/orthodontic needs may have been neglected

Question 18

We will remember the definition of “language

Answer 18

A system of symbols that represents concepts formed by exposure and experience

With very limited exposure and experience, some IAC may have very LIMITED CONCEPTUAL FOUNDATIONS

Question 19

A challenge for many IAC

Answer 19

Decrease cognitive-linguistic stimulation in L1
Rapid L1 LOSS.
WEAK conceptual FOUNDATION upon which to build L2

Question 20

IAC may have

Answer 20

Post-institutional Autistic Syndrome

—experienced such abuse and neglect that they exhibit autistic-like behaviors—e.g., rocking, hair-pulling

Question 21

Ellesef (Adoption and pragmatic problems. ADVANCE for SLPs, December issue)

Answer 21

5-10 years post-adoption, some c tested high on standardized tests of lang.
But signif. Pragmatic deficits
Pragmatic deficits interfered w/ academic performance and social interactions inside and outside school.

Question 22

So we know from research that

Answer 22

The YOUNGER IAC are at the age of adoption, the better their chances for developing language normally

Those who show initial delays may still have them later; we always need to TEST when the children are NEWLY ADOPTED and follow up

Question 23

CONCLUSION

Answer 23

SLPs are becoming increasingly involved in providing services to IAC, especially on multidisciplinary teams

Remember, parents need support too!

Anecdotal evidence: pediatricians may tell adoptive parents “wait and see”

Increasingly, this is being viewed as UNACCEPTABLE; currently, most experts recommend that adoptive parents just ASSUME that children will need ADDITIONAL services and stimulation in ALL AREAS of development

Question 24

When children are evaluated:

Answer 24

• Parent report is usually highly reliable and valid
• Macarthur Communicative Development Inventory is popular
• Use PRELINGUISTIC measures of joint attention, symbolic play, object permanence, PRESPEECH vocalization

Question 25

When children are evaluated:

Answer 25

• Parent report is usually highly reliable and valid
• Macarthur Communicative Development Inventory is popular
• Use prelinguistic measures of joint attention, symbolic play, object permanence, prespeech vocalization

Question 26

In terms of service delivery:

Answer 26

• May be CILF-FALF gap- hard for parents-CILF usually develops fast
• Good for parents to read, play games, provide sensory stimulation
• Environment-well structured with daily routines-avoid over stimulation
• Ideal to videotape parent-ch. Interaction, give feedback

Question 27

Again, remember that social-emotional-pragmatics problems needing tx may include:

Answer 27

• Decreased theory of mind
• Difficulty regulating emotion
• Poor comprehension of abstract and inferential information
• Difficulty interpreting body lang, facial expressions, gestures

Question 28

Glennen, S. (2015). Internationally adopted children in the early school years: Relative strengths and weaknesses in language abilities. Language, Speech, and Hearing Services in Schools, 46, 1-13.**

Answer 28

IAC adopted between 1-4 years of age were assessed at 5 and 6-7 years

Children were from Russia, Kazakhstan, Hungary, and Romania (mostly Russia)

Question 29

Glennen (2015) found:

Answer 29

• Most IAC are adopted by college-educated parents with incomes that are 300% above poverty level
• IAC’s lang skills doing well at ages 5-7 years
• Good vocab skills, average in other lang areas

Question 30

Glennen, 2015—areas of weakness were:

Answer 30

• Expressive syntax
• Verbal short term memory
• Probably due to early environmental deprivation and learning a new lang after the initial critical period has passed

Question 31

STUDENTS WITH AUGMENTATIVE/ALTERNATIVE COMMUNICATION (AAC) NEEDS

Answer 31

How comfortable are families with high-tech devices?

If they are not, we might need to introduce LOW-TECH devices or even boards with pictures

Researchers recommend: picture communication systems printed BOTH in L1 and ENGLISH

Question 32

STUDENTS WITH DEVELOPMENTAL DELAYS

Answer 32

We have to be careful, because ELL students tend to be OVERIDENTIFIED

Students with DD CAN STILL BE BILINGUAL

Be careful about early intervention recommendations, because parents may not believe that early independence is important

Question 33

Dixon & Zhao, 2017:

Answer 33

• Being bilingual does not “overstress” the DD child’s system
• Research is conclusive: ch with developmental delays, autism, etc. can and do successfully become bilingual

Question 34

SERVICE DELIVERY TO CLD DEAF STUDENTS

Answer 34

• Culturally linguistically diverse(CLD) Ch with HI more likely to be in special ed restrictive environments than mainstream.
• Different countries have different forms of sign lang. may or may not be similar to ASL
• Some deaf CLD Ch-little- no exposure to sign lang
• Encourage development and use of sign lang, don’t force ch to be oral only

Question 35

Research has found great success

Answer 35

With classroom amplification

Studies: if a teacher uses an FM SYSTEM and students hear her voice more loudly, they may

pay better ATTENTION
participate more in DISCUSSIONS
learn new vocab words faster

Question 36

STUDENTS WITH AUTISM SPECTRUM DISORDER

Answer 36

Stoll, Tolentino, and Roseberry-McKibbin (CSHA) studied CLD families with ASD children

These families believed in mainstream causes of ASD and also in mainstream treatment (e.g., early intervention, dietary modifications, etc.)

Question 37

Challenges impacting service delivery include

Answer 37

• If ch not speaking, pediatricians say “bilingualism at home” and tell parents ch will “grow out of it”
• Many countries: little-no recognition of phenomenon of ASD. Stigma.
• Some families not comfortable with play-based tx, may prefer highly structured tx