Information about speech, language, and executive function challenges

Black, Brown & Female Children Less Likely to Receive Intervention for Communication Disorders

Communication disorders detected between 0-3 years of age, are eligible for free early intervention services. Many communication challenges can be addressed at that time, and do not become a disorder. However, some children even after early intervention, continue to struggle with language development because they are not developing speech and language skills quickly enough to keep up with academic demands. For many children, especially black and brown children, they are less likely to receive the intervention for which they are eligible than their black counterparts due to many factors.

Prevalence of Communication Disorders

Nearly 1 in 12 (7.7 percent) U.S. children ages 3-17 has had a disorder related to voice, speech, language, or swallowing in the past 12 months.¹
Among children who have a voice, speech, language, or swallowing disorder, 34 percent of those ages 3-10 have multiple communication or swallowing disorders, while 25.4 percent of those ages 11-17 have multiple disorders.¹
Boys ages 3-17 are more likely than girls to have a voice, speech, language, or swallowing disorder (9.6 percent compared to 5.7 percent).¹
The prevalence of voice, speech, language, or swallowing disorders is highest among children ages 3-6 (11.0 percent), compared to children ages 7-10 (9.3 percent), and children ages 11-17 (4.9 percent).¹
More than half (55.2 percent) of U.S. children ages 3-17 with a voice, speech, language, or swallowing disorder received intervention services in the past year.¹ White children (ages 3-17) with a voice, speech, language, or swallowing disorder are more likely to have received intervention services in the past 12 months, compared to Hispanic and black children, at 60.1 percent, 47.3 percent, and 45.8 percent respectively.¹
Boys (ages 3-17) with a voice, speech, language, or swallowing disorder are more likely than girls to receive intervention services, at 59.4 percent and 47.8 percent, respectively.¹
Among children ages 3-17 who have a voice, speech, language, or swallowing disorder, those with speech or language problems, 67.6 percent and 66.8 percent respectively, are more likely to receive intervention services, compared to those who have a voice disorder (22.8 percent) or swallowing problems (12.7 percent).¹
More than half (55.2 percent) of U.S. children ages 3-17 with a voice, speech, language, or swallowing disorder received intervention services in the past year.¹ White children (ages 3-17) with a voice, speech, language, or swallowing disorder are more likely to have received intervention services in the past 12 months, compared to Hispanic and black children, at 60.1 percent, 47.3 percent, and 45.8 percent respectively.¹
Boys (ages 3-17) with a voice, speech, language, or swallowing disorder are more likely than girls to receive intervention services, at 59.4 percent and 47.8 percent, respectively.¹
Among children ages 3-17 who have a voice, speech, language, or swallowing disorder, those with speech or language problems, 67.6 percent and 66.8 percent respectively, are more likely to receive intervention services, compared to those who have a voice disorder (22.8 percent) or swallowing problems (12.7 percent).¹

_{NIDCD. 2022. Quick Statistics About Voice, Speech, Language. [online] Available at: <https://www.nidcd.nih.gov/health/statistics/quick-statistics-voice-speech-language> [Accessed 28 February 2022].}

When a communication weakness is diagnosed at 0-3 years of age and a child receives early intervention. Many communication challenges can be addressed at that time, and do not become a disorder. However, some children after early intervention, continue to struggle with communication because they are not developing speech and language skills at a typical rate needed to meet academic demands. This communication weakness is further exacerbated by the mismatch between language development and academic demands.

Differences between Girl and Boys

Both girls and boys, more boys than girls, take part in speech-language therapy in elementary school. As they get older, boys will continue in treatment while girls become less willing to participate. This may be partly because girls are more concerned with being part of their peer group, want to work in their own way, and may be more able to convince their mother that they do not need or want additional help. Some girls that do not receive treatment for communication disorders feel they can not learn and become unmotivated in school. In addition, they may have poor self -esteem and self worth, which results in underperformance in school. Boys on the other hand can also be resistant for some of the same reasons, but are identified as needing help more frequently than girls. Early intervention is especially critical for both girls and boys, but boys are often identified earlier than girls.

Diversity and Speech and Language Services

Black and brown students do not receive services at the same rate as white children. For black and brown students with co-existing developmental disorders and moderate to severe communication disorders, more substantial services may be accessed through early intervention process or primary care doctors. However, for BIPOC youth with average intelligence or above and mild to moderate communication disorders, services may be difficult to qualify for through the IEP process, even though the communication deficit is impacting their educational attainment. This is because the IEP process requires a diagnosis which uses standardized testing and observation. There is unrecognized bias in the standardized testing and often in the evaluator that can impact POC children’s ability to receive appropriate services. Children can be overdiagnosed or underdiagnosed and each of these occurence have a significant impact on the child’s development. Not only are these children often dealing with unacknowledged biases, they are more likely to be labeled with behavior problems that are often the result of the communication challenges. This co-0ccurance of behavioral problem and communication problems often are not taken into consideration. Black and brown youth are more likely to be treated harshly and labeled inaccurately in the current IEP process which makes it difficult for parents to know what to do.

Children for whom English is a second language can also have difficulty getting an accurate diagnosis through the school system. First speech-language testing, although improving, does not allow children to speak in the dialect or language they are most comfortable unless they are tested by a SLP who speaks their language. Unfortunately the field of speech pathology is predominantly white and female. According to ASHA, American Speech Language and Hearing Association, there are 4% black SLP’s, 3% Asian SLP’s, 6% Hispanic, and 1% multiracial, so speech pathology is not a very diversified field and that is reflected in both testing used and testing bias found in current evaluation. (1 “A Demographic Snapshot of SLPs.” The ASHA Leader, vol. 24, no. 7, American Speech–Language–Hearing Association, July 2019, p. 32. https://doi.org/10.1044/leader.aag.24072019.32) The assessments assume common knowledge which is often culturally bias and current tests do a poor job of defining more high-level communication problems found when assessing the whole communication system as a whole. For instance, children may be able to do tasks at the word or phrase level which most standardized test, evaluate adequately, but they can not tell a narrative or comprehend more complex information. In these cases, a narrative sample is needed. Most speech language pathologist in schools have heavy caseloads do not have the time to do this additional work intensive step, so they rely heavily on standardized tests and observations. Another factor is that most 86% of SLP’s are white and 96% female which demonstrates a lack of diversity in language and culture and may be less aware of their unknowledge biases which is based on their own life experiences that often lack any interactions with people of color. For these reasons, black and brown children may not receive an accurate diagnosis and therapy goals may be mismatched.

In addition, kids of color have an additional burden when assigned to “special ed” that further alienates them from their peers and may result in teasing. Receiving special education services in public school is a stigma that many children have difficulty overcoming. Special education is often synonymous in children’s minds with not being smart, even though communication disorders and intelligence are not linked. Intellectual disorders and communication disorders co-occur, but for many children communication disorders are not related to intelligence For many reasons black and brown children do not receive the speech-language services they need which can cause continued struggles in language that last a lifetime and impact academic goals.

What to do? There are no simple answers. Here are a few general ideas.

1.) After receiving the evaluation through your public school, if you don’t agree, request in writing an outside evaluation. Do not sign the IEP.

2.) Be persistent and document everything by keeping a log of all calls, meetings, and emails

3.) Find a self-advocacy group in your area that can help you learn to advocate effectively for your child. In the Boston metro area that group is Federation for Children with Special Needs

4.) For kids of color and girls if you can either afford outside testing or outside services you think will help, use the school testing and seek outside services especially if your child is struggling with self esteem issues in elementary school.

1 “A Demographic Snapshot of SLPs.” The ASHA Leader, vol. 24, no. 7, American Speech–Language–Hearing Association, July 2019, p. 32. https://doi.org/10.1044/leader.aag.24072019.32.

Fostering Growth Mindset in Students with Speech & Language Challenges

neurons developing in the brain — Growth mindset results in strengthening neurons in the brain.

Carol Dweck’s research on “growth mindset” supported my work with adults and children struggling with speech and language challenges. Early in my career working with elementary, middle and high school students, the biggest challenge was getting students to produce. No grades were given, the work being done was in the most difficult areas and many had developed negative attitudes about what they could learn. One student said, “I don’t talk because I’m just quiet and come from a quiet family.” I recently met up with him and now he can’t stop talking. Another student said,” I just don’t get it. I can’t understand how to do this!” (talking about how to use strategies to help with word finding and comprehension problems.) Recently, he said, “Now, I know what to do. I hear you in my head telling me to look for the I can use strategy.” He is doing his high school work on his own. None of these changes happened overnight. The work was repetitive, frequent and required many small achievable steps. What helped those kids to hang in there? Developing a growth mindset. Those students learned that working on challenging tasks, “growth mindset” made their brains grow stronger.

As a student, imagine your embarrassment and shame when you realize that the same work everyone else is completing, you are struggling to finish. This does not happen just once, but frequently at all stages of their academic career. Because of the frequency of these experiences, many students develop negative attitudes toward school, an unwillingness to take academic risks, and poor self-esteem. In addition, different developmental stages can exacerbate these feelings. For example, it is especially difficult for middle schoolers struggling with communication problems, who desperately want to fit in with peers to receive support. They do not want to be different. However, receiving the right support at that time means not developing bad habits that will impact their learning for a lifetime.

In speech-language therapy sessions, clients are asked to work on painful areas of weakness. Many recognize they have a problem, but as children do, many blame themselves. It has been surprising to me to see children as young as 3 avoiding areas of language weakness with interesting strategies. One little guy had these amazing poses and phrases he used that made people think he understood when he did. Overtime, he learned that sometimes his words “flew out the window.” He knew what he wanted to say, but couldn’t find the word. (We call that a word finding problem.) With remediation and strategies, he learned to deal with his challenges.

Having private speech and language sessions offers adults and children the opportunity to talk honestly about their struggles. It is only in the privacy of that room that many allow themselves to show their true feelings of frustration and anger. Not understanding what people are saying, worrying if you will produce a certain sound, or fearing no one will understand your message, is painful. Most of us never think about any of this, we just do it. Ignoring even mild speech and language problems can cause adults and children to suffer from anxiety, depression, and self-esteem problems. To address these feelings, clients must acknowledge their struggles, learn to evaluate their needs accurately, use strategies, self advocate, and accept their differences.

Changing speech and language problems is hard work. Clients must be motivated to tackle difficult tasks and practice regularly. We have ways to make the tasks easier, but instruction in “growth mindset,” helps clients understand that by working on their weaknesses and reflecting on their struggles they are changing and strengthening their brain. This knowledge has been a game changer.

Resources:

With elementary students I use a series of videos based on the growth mindset that I love called the ClassDojo. They never fail to help children understand this important concept. The fact that the setting in the video in a classroom doesn’t matter because the same information can easily be applied to home situations. One viewing however is usually not enough. Clients usually need to see all the videos often followed by a discussion. The Mysterious World of Neurons is one of my favorites.

Can corporate America accommodate people with social skills deficit?

Adult speech-language therapy can improve work performance

Can corporate America accommodate people with social skills deficit?

Well, yes, but how? Companies have cultures. Some may be easier for people with social skills deficits than others. As the employee what is your role? What is the managers role? There are no easy answers ,and it depends on the job. It’s a lot easier to be in corporate America if you are an IT, accounting, managing inventory, or have a skilled based jobs as opposed to sales or management. Let’s face it there are no apparently stated rules regarding social skills in corporations, but there are many unstated rules along with the understanding that you will get along with others and do your job. We all know when it comes to working, the company culture can make or break the job.

A social skills deficit means you have difficulty interpreting and using social language, diagnoses that include social skills deficit include autism, social skills deficit, and ADHD. Historically social skills have been taught through family and social interactions, but for many, these informal modes of learning are not enough. In addition, it is becoming increasingly clear in our society that learning to cooperate and work together takes more than informal training. Look at the state of our politics! Social skills does not just involve being agreeable in a group, but requires understanding others perspective and having the ability to tolerate differences. We are seeing in real time increasingly that the rules regarding social skills are often dominated by one primary group while all other groups must conform to that group’s expectation. These unstated rules make it difficult to navigate corporate culture.

All jobs require that you get along and communicate effectively with co-workers and the boss(es), be responsible and respectful, but if you have major weaknesses in social skills, figuring out the unwritten rules of the company culture can feel impossible. Even for those with no disability in social skills this task is daunting. Do you have lunch alone everyday to recover from the days interaction or have lunch with the group? If you regularly have lunch alone you are missing out on the company gossip which can tell you about upcoming layoffs and other potential arising problems. How do you find a mentor to help you navigate the social arena? Looking for someone with better social skills, and asking directly for help can be one a useful strategy. Although companies have some accommodations, due to ADA( Americans with Disability Act), the burden continues to mostly fall on the individual to adjust to the corporate culture. Unfortunately navigating the social landscape at many corporate jobs continues to fall heavily on the worker.

Acceptance in a corporation has a lot to do with the companies tolerance for differences, the skills brought to the company by the employee, the ability to adjust to request for change and the effectiveness in self advocating. Not all companies are the same. Remember that corporate America is interested in the bottom line, money; not in taking care of it’s employees. Self care is up to each employee, so you have to be willing to try and learn even if you will never meet the expectations of others.

What company you work for will also make a huge difference. Before you apply for a job, look at the company’s culture: do they have other employees with disabilities? What is the level of diversity at the company? Does the company have any flexibility in how you work, example do you have the option of working from home or a hybrid model. If you apply to a company that values diversity, is flexible around where you are allowed to work, has generous, policies around requesting time off for illness or vacation you will find they are more likely to accept and value all types of people including those with social skills deficits.

“Your Fantastic Elastic Brain”: Motivating Children and Teens with Speech and Language Disorders

Growth mindset helps people with speech and language disorders go far

Struggling to motivate children and teens with speech and language disorders is an on going concern. Many learn to navigate around their deficit using strategies, but others avoid learning risks at all cost. In therapy using interesting games is a popular motivator, but using these tools does not teach students how and why they should take learning risks. Carol Dweck’s research on growth mindset has demonstrated that children with a growth mindset do better in school. They develop a positive attitude toward learning and enjoy working on difficult tasks. These children believe their intelligence can be developed. Many children with speech and language disorders believe their abilities are fixed. This is called a fix mindset. Tools that help children develop a growth mindset are a valuable tool.

My new favorite therapy tool is the book, Your Fantastic Elastic Brain: Stretch It, Shape It by JoAnn Deak, Ph.D. The book provides a general description of the function of the major parts of the brain. It discusses ways we train our brains from practicing difficult tasks to making mistakes and facing our fears. Geared to children under 10, I find that young adults also appreciate the books simplicity. This book has been an important addition to my growth mindset tools.

Please, stop screaming!: ADHD and Aggressive Behavior

I read an article on Understood.org by Kate Kelly ADHD and Aggression: What You Need to Know. I wish I had read this article on ADD and aggressive behavior earlier in my parenting career because it would have been nice to confirm my personal experiences. Hitting, throwing objects, screaming, falling on the floor, or refusing to do what’s asked are all behaviors that kids with problems regulating their emotions can demonstrate. It’s confusing. What did I do wrong? Why is this happening to me? Am I a good mom? So often as parents we think our child’s aggression is directed at us, but when you have a child that has difficulty managing their emotions and who is also impulsive it’s not always about you. What I learned through research, my professional education and what this article confirms is that lagging executive function skills in emotional regulation, poor communication skills, and impulse control can have a major impact on family life. Knowing how to deal with ADHD and aggressive behavior is not in many of the parenting books.

But it’s not enough to know that lagging skills are the cause. What do you do? What I learned over time is as follows:

In the moments when your child is out of control:
Take care of yourself
Breath -( take a minute)
Don’t create a negative story about their motivation- They aren’t doing this to make your difficult. (even though it may feel like it at)
Stay open- Know in your heart that, “If they could do better they would”
Remember they may be behaving this way because they can not manage their emotions.
Remind yourself that this will pass

Take care of your child
Stay calm and speak quietly.
Stay with them
Acknowledge their feelings if it does not escalate the behavior
Assure them they will be okay ( They are probably scared too)

Take a break
For single parents, it’s not easy to take a break, but if you have family members, let them help. If not find a safe way to separate from your child to allow them to have the chance to calm down. Maybe leave them in a room with soft music, a book, or just go into another nearby room. They need you, but it’s better to leave then to stay and do something you regret. Society does not give single parents support, so we have to do figure how to do that for ourselves.

Some or all of these steps may not work for you it’s okay. You are still a good parent even if you don’t manage the episode well, but you will need help. Schools have social workers, speech pathologist and psychologist that can evaluate and teach your child executive function skills and give them tools to help them manage. Managing ADHD and aggressive behavior can be quite a challenge. They will get better at managing their emotions as they get older, but it takes work. Don’t expect the problem to fix itself. Try to figure out whether your reaction is improving the problem or making it worse. If your reaction is making the situation worse think of alternative ways to respond. Can you be less demanding? Give more choices? When the conversation becomes increasingly heated can you just be quiet? Are you giving too many choices? Talking too much? Not talking enough? Can you recognize when you will get the big reaction? What can you do to change your communication style?

There are books on executive function skills that will help you understand the underlying problem your child is having with ADHD and aggressive behavior. If you prefer and can afford a professional that is great, but if you can’t let your primary care physician know what is happening and ask for a neuropsychological evaluation and therapy sessions. If needed get therapy for yourself. It’s not just your child’s problem. Work on your own communication style and learn to understand your own reaction. If your child is out of control and you are worried about ADHD and aggressive behavior try changing eliminating sugar and processed foods from their diet, make sure they get enough rest and cut down on screen time, in addition to seeking help to manage ADHD and aggressive behavior.

Even if your child does not have an official diagnosis of ADHD, they can still have characteristics of ADHD. Because of our society obsession with productive, lots of kids are having difficulty with regulating their behavior. No gym time in school, too much screen time, too much sugary and processed foods…. Truly when so many children have a diagnosis then it becomes a normal state, and that is almost the point we have come to with ADHD. If your child has some of the characteristics of ADHD and they are aggressive try some of the strategies and tools I’ve used.

Finally my last piece of weird advice. I love the “Dog Whisperer” Cesar Milan. It’s on Saturday mornings in my area, but how he changes the behavior of dogs is through teaching their owners how to interact with them. Kids aren’t dogs, but they are not adults. What is the energy you bring to the situation? Teaching them often means having to teach ourselves how to interact. I am fascinated by “The Dog Whisperer” because he often talks about the energy you bring to the room. Don’t let your fears cause your child’s behavior to escalate. Lead by showing them how to deal with their feelings and if you haven’t learned yet, now is a good time. Don’t feel bad if you don’t have your feelings under control. Just think this time as a great opportunity to learn. Children feed off our energy. So dealing with ADHD and aggressive behavior means figuring out how to remain calm while being with your child in a way that helps them learn to calm themselves. It won’t be an easy road, but you don’t have to learn it all in one day. Remember you are not alone, and one day you will look at your beautiful child and forget these difficult times.

Resources

Here are a few books I have read that helped me understand lagging executive function skills

Smart but Scattered by Peg Dawson and Richard Guare
The Explosive Child by Dr. Ross Greene
Executive Skills in Children and Adolescents, Second Edition by Peg Dawson and Richard Guare

Tools you may want to try to help with calming:

Pressure vest PresSureVest gives hugs to those needing a little extra sensory input. Ideal for deep pressure therapy. Some children need extra sensory information to calm down this is a great tool for that.

Weighted blanket – These are beautiful blankets. but of course you can find cheaper ones on Amazon

Please if you have other ideas or things that have helped your family please share them. We all have information that can help each of us.

Speech-Language Therapy vs Tutoring (Updated)

Speech-language therapy vs tutoring: What’s the difference?

In order to choose the right services for yourself or your child, it’s important to understand the difference between speech-language therapy vs tutoring. How is speech-language therapy different from tutoring? Why choose one service over the other?

Tutors re-teach information taught in the curriculum. Students acquire information at different rates. A tutor helps students acquire academic material by teaching the strategies and specific material. Tutors reinforce information taught in the classroom, help students use specific strategies for specific tasks and help students finish academic tasks. The goal of tutoring is to help children and adults access material they have learned in school.

Speech-Language Therapy

Speech-language therapy focuses on mastering communication skills. We acquire language by closely watching and listening to our mother’s and other family and friends. Eventually, we go to school to receive more formalized instruction. As we progress, communication skills become more complex. At first we learn each skill separately, but then we use multiple skills together. This means that it’s not just possible to have language problems when we are young, but as we progress to middle, high school and college, we can face new communication challenges. Without solid communication skills, achieving academic and professional goals is hard. Therefore, the goal of speech-language therapy is to remediate and improve fundamental communication skills throughout the lifespan.

A speech-language therapist helps clients learn academic subjects, but the focus of therapy is to improve a specific area of speech, language, or executive function skills. For example, Johnny might struggle in math because of his poor reading comprehension skill. The therapist works with Johnny using his math work, but the goal of his speech-language therapy is improving his reading comprehension, which will improve his math performance. Math becomes the vehicle for teaching reading comprehension. With so many support services to choose from, it’s important to understand the differences between speech-language therapy vs tutoring.

Which is the right choice for you?

Speech-language therapy vs tutoring, which is the right type of support? How do you determine what direction to take? First ask the following questions:

Communication problems for school age children to adults to look for:

Is the challenge in one subject area that is not reading, vocabulary, or writing?
Are similar challenges seen across many subjects?
Can people understand you when speaking or telling a story?

Here are a few examples speech and language challenges.

inability to follow multi-step directions,
limited ability to tell a story,
problems comprehending a conversation or information orally or in writing
poor communication with friends and peers
voice to soft, too loud, raspy, or interest/ need to change the pitch
limited vocabulary due to word finding problems ( words don’t come when needed)
disfluent speech stuttering,
problems with language formulation
articulation problems

The most effective way to identify underlying speech and language problems is to have an evaluation. For children this is available through your local public school, even if your child attends a private school. For adults some health insurances will pay for speech-language services. An experienced speech-language therapist can identify speech, voice, and language problems. Even subtle problems can impact communication throughout a person lifetime, and prevent them from reaching their academic, social and/or professional goals.

Not eligible for speech-language services

No longer eligible for speech and language services

Not eligible for speech-language services

“Not eligible for speech and language services!” What’s going on? Your child has been receiving speech and language services for several years or needs services. After a recent team meeting, you were informed that your child is not eligible for speech-language services. How can this be? Is this the right time to end services? What can you do?

Are they ready for discharge?

If your child has received speech and language services for a while they may indeed be ready to move from an individual or small group therapy to the regular classroom. You will know if they are ready because they are demonstrating their new skills not just on standardized tests, but in everyday life. Sometimes, however, students can do well on standardized test but still, struggle with using language in daily living. Students on the autism spectrum and students who are trying to use complex language beyond their abilities can have problems with language use that is not detected by a certain standardized tests. Another issue that arises is that some students catch up in language because of the individualized instruction, but they are not able to keep up in a regular class as the language demands become more complex. All of these problems may not be revealed using standardized testing alone. So if you are not sure your child is ready for discharge from services you may be right, but you will need to ask for additional testing or an independent evaluation.

Not eligible for speech-language services, but the struggle continues…

….with reading, writing, comprehension or verbal expression, and test results aren’t reflecting that reality, then further exploration is warranted. In order to uncover underlying language problems, there are a few things that you can ask a speech-language pathologist. First, make sure that current testing by subtest are comparable to previous testing. Those skills should be consistent in the level of performance, so for instance if in 3rd grade they were in the 9o percentile in vocabulary then in 5th grade they should not be in the 27 percentile that is a discrepancy. Large differences in numbers from year to year can be an indication of a difficulty, but can not be taken alone A discrepancy between subtest scores can also indicate problems, if it is 15 or more points different it is considered significant. Ask the examiner to account for those discrepancies. For example, if on the vocabulary subtest your child scores a standard score of 100, but on a sentence repetition task they score standard score of 65. What does the SLP think is the cause of that difference? We all do have strengths and weaknesses, but differences in skill level can result in frustration for your child.

Still trying to understand …another look

Next ask for a written or verbal narrative or language sample Some children with average intelligence easily perform structured tasks, including those on the autism spectrum, but given real-life tasks, in spite of, demonstrating average or even above average scores they do poorly. They may have an incredible difficulty time writing or telling a story or reading and writing a paragraph summary. Make sure if its a written sample that it is not from a classroom assignment but actually what they are able to do on their own in a 15-30 minute time span. In other words, it should be spontaneous and not scripted or edited by teachers. It can be edited by the child of course. A language sample gives a true example of how your child uses language. It is a valuable tool.

If you are concerned because you were told your child is, “not eligible for speech-language services,” here are a few tips to help you and school professionals uncover underlying speech and language problems. Looking at these areas ensures that your child’s language foundation will support the academic challenges ahead.

Are Females Less likely To Be Diagnosed With Autism?

The Myth of Males vs Female Differences in Autism

Why are females less likely to be diagnosed with autism? In spite of the fact, that both males and females with autism have similar characteristics, males are routinely diagnosed more frequently. In the article posted on the “The Employers Network for Neurodiversity Action website, ENNA, titled Autism in Women: What’s Different and What to Look Out For they suggest the difference in diagnosis rate is due to the fact that females on the autism spectrum are more likely to camouflage and/or mask their symptoms. It states that females use social strategies to adapt to their social limitations and therefore examiners don’t recognize their symptoms. For example a girl might make more eye contact even if it’s difficult because they recognize the social importance of eye contact. Is this really true?

In fact there are a segment of people on the autism spectrum, both male and female with the ability to camouflage and mask some of their symptoms, but males with this ability still often receive the correct diagnosis. What does the misdiagnosis of women say about the criteria examiners are using to make the diagnosis? Blaming the use of a strategy, such as “camouflaging” is a shortsighted excuse that blames the individual, not the system. Does the fact that some females “camouflage” their symptoms really address the fact that young girls are less likely to be diagnosed with autism?

Systematic Problems not Individual Ones

Could the diagnostic process, including testing and examiner bias, be more likely the reason for the difference in rates of diagnosis? Doesn’t the difference between male and females diagnostic rates suggest that testing protocols and symptom criteria demonstrate a preference for a particular type of client? It has become increasingly clear that many test and procedures are standardized primarily on white males, and therefore are not inclusive of the wide variations of characteristics presented by other genders and races. If the fact that girls with autism are under diagnosed is not enough to prove the limitation of the diagnostic process, then the additional fact that people of color are also under diagnosed should. In the end systematic sexism and racism built in to the diagnostic process does offer a better reason for the disparity. Furthermore we see the same gender trend with the ADHD diagnosis.

Let’s stop blaming the victim and look at the system. When there is a variation in one person, you look at the person, but when you see issues in groups, look at the process.

Finally, why does a diagnosis matter? Services, services, services with the diagnosis comes access to many types of services.

References

Ennaglobal. (2021, October 5). Autism in women: What’s different and what to look out for. Enna. Retrieved April 28, 2022, from https://enna.org/autism-in-women/

College Academic-Social Skills Coach

Services for college students — College students spend 70% of their time working independently

John, not his real name, a freshman was having difficulty managing his life on campus. He spent most of his time in his room playing video games or watching Netflix, went to bed a 2-3 am missed classes and was turning in late assignments. By midterm, not only had John gained weight, he had no friends and many past due assignments. John’s parents were very worried that he was depressed and was going to fail. This is a good example of a situation where a student would benefit from additional support.

College students need a variety of skills to succeed. Not just academic skills, but life, time management, and social skills as well. A college academic-social skills coach helps students learn to manage their lives by providing coaching in life, social, and executive function skills.

How it works

A college academic-social skills coach provides direct services by phone or online. For example John (not his real name) coach helped him to create a plan that scheduled homework, monitored eating, sleeping social and screen time. Working closely with his coach, he reported his progress regularly identifying problems and brainstorming solutions along the way. John learned to identify assignments he found difficult, advocate with professors and schedule appointments with learning support and tutors. In addition with his coach John created a rubric that he used to evaluate his sleep, social and eating patterns. Soon John was up to date on most of his assignments, was participating in a few clubs, and was managing his personal life.

Simultaneously, the coach helped John’s identify interests and explore deterrents. First John acknowledged that his television and video game habits were impacting his success. He also identified that he ate more because he ate alone in his room. He tried numerous strategies to manage this aspect of his life, but he also had to improve his social skills. He began participating in new groups and taking more social risks like eating his meals in the dining hall. Eventually he recognized students from his classes and began developing relationships. With the help of a college academic-social skills coach John was able to achieve his goal of remaining in school, and eventually graduated from college.

What does a College Academic-Social Skills Coach do?

A college academic-social skills coach helps college students acquire critical skills needed to navigate higher education. Colleges expect students to be independent, self-advocates who are able to manage their school work, social connections, and self-care. Some students need help in this transition. A coach provides services to help bridge the gap between college and high school.

College Academic-Social Skills Coach offers online support in the following areas:

Instruction in using tools, including technology, to manage classes, social engagements and academic work
Help in thinking, planning, and communicating in order to access social clubs and special interests.
Tailored social skills training as needed
Time management support as needed for daily activities
Training in project management
Training in self-advocacy that empowers students to use their strengths to mitigate their challenges
Help identify necessary accommodations

Reading Comprehension > Decoding Words

photo of girl reading book — Learning to read

Reading comprehension is one of the most complex cognitive activities in which humans engage, making it difficult to teach, measure, and research. (2)

Reading is not equal to just decoding words. In order to have excellent reading skills, children must have strong decoding skills, a strong language foundation, in addition to other cognitive skills. Reading involves coding sounds into words in order to create a mental picture that has meaning. Reading comprehension heavily relies on language knowledge in grammar, vocabulary semantics and syntax. For example, students must understand that words have multiple meanings, and word endings matter. Therefore, reading comprehension problems can result from a variety of difficulties.

“Extracting meaning from text and forming a coherent mental model relies on the coordination of multiple cognitive processes (Kintsch, 1998 RAND Reading Study Group, 2002).It is, therefore, not surprising that researchers have not been able to isolate one causal factor to explain children’s weaknesses in reading comprehension, but have instead found multiple sources that contribute to such difficulties, including weaknesses in decoding, working memory, linguistic reasoning, executive functioning, vocabulary, and prior knowledge (e.g., Cutting & Scarborough, 2006; Perfetti, Marron, & Foltz, 1996).(1)

Each person is different and their comprehension problems are caused by a unique set of weaknesses. However identifying the specific areas of weakness and targeting those areas in a comprehensive reading approach that teaches general reading strategies maybe a more time consuming, but effective approach. There is no program that teaches reading comprehension because reading comprehension is a complex problem that takes time to effectively remediate.

Reading Comprehension Problems

For example, one client had difficulty understanding the following sentence. “MR. McGREGOR was on his hands and knees planting young cabbages, when he jumped up and ran after Peter, waving a rake and calling out, “Stop thief!” Problems with comprehension could be the result of limited background knowledge, difficulty with vocabulary, or an inability to visualize. They might have never planted a garden, so they simply read the words and have no accompanying mental image. They might have difficulty with vocabulary or grammar. This example was taken from an actual case and the child had difficulty understanding the pronoun reference. Once he understood the rules around pronoun references, he easily understood the sentence and the rest of the story. Only by recognizing the error pattern could the appropriate rule be taught to address the problem.

Another child with reading comprehension challenges wasn’t able to visualize because they had weakness in word memory. That child read a sentence and if there were 2-3 keywords they did not know, they were lost. Since reading is a dynamic process, there are several ways that we define vocabulary in text. In the case of unfamiliar vocabulary, one way is to figure out the word meaning from context. Young readers are often inefficient at this skill. The second approach young children rely on is asking nearby adults. This child asked an adult for definitions, but by the time they went back to read the sentence, they’d forgotten the definition. The end product was an inability to create a visual image, but the inability to visualize did not cause the problem. For that child, writing the meaning down or drawing a picture of the meaning helped her retain the information until she could incorporate it into the sentence, but again, that was only addressing one problem. The other skill that needed to be addressed was defining words from context.

Targeted Intervention in an Integrated Approach

Reading comprehension is a skill that demands the integration of many cognitive skills. Identifying and targeting specific problems and integrating them into the entire reading process which focuses on vocabulary, inference, and background process is one way to help struggling readers. There are also elements that would improve overall reading comprehension instruction in the classroom for all students. Some ideas are addressed in the article below including more reading with discussion in class and assigning reading that builds on background knowledge in addition to requiring students to use reading strategies in all academic classes. If all academic subjects taught in schools focused on using reading strategies when reading text students would be required to practice their skills. In order to solve reading comprehension difficulties, one must encompass a broad range of skills, target areas of weakness in a broad holistic reading approach, and consciously and consistently teach strategies that improve reading comprehension in all subject areas starting in elementary school.

An early and sustained focus on developing background knowledge, vocabulary, inference, and comprehension monitoring skills is necessary to improve reading comprehension across grade levels. (2)

Reading Comprehension Focused Strategies

Vocabulary/Word memory – Play word memory games Going on a picnic etc things that encourage memorizing words

Background knowledge – How does what I am reading relate to what I know?

Reread and Summarize – After each sentence summarize and reread as needed

Visualize – Create your own movie – mental image ( What image do the words create? What does the character look like? etc)

Monitor and repair ( while reading) STOP if something doesn’t make sense and reread

Additional strategies

References for reading strategies

1 Elleman, A. M., & Compton, D. L. (2017). Beyond Comprehension Strategy Instruction: Whats Next? Language Speech and Hearing Services in Schools,48(2), 84. doi:10.1044/2017_lshss-16-0036

2 Elleman, A. M., & Oslund, E. L. (2019, March). Reading comprehension research: Implications for … – sage journals. https://journals.sagepub.com/doi/full/10.1177/2372732218816339. Retrieved October 31, 2022