Language Development & Disorders in. Internationally Adopted Children. Today s Topics 9/11/2015. Age of Adoption for. Changing Demographics

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1 Sharon Glennen, Ph.D., CCC-SLP Director, The Institute for Well-Being Professor, Audiology, Speech Pathology & Deaf Studies Towson University Development & Disorders in Internationally Children ISHA Fall Conference Indianapolis, IN September 19, 2015 Changing Demographics Today s Topics Children at ages 1-2 and 3-4 years Assessment Guidelines Typical Outcomes Children at 5+ years of age Dynamic Assessment Summary & Questions Age of Adoption for Internationally Children Yrs 8% 5+ Yrs 15% 1-2 Yrs 36% Under 1 Yr 41% 5+ Yrs 38% 3-4 Yrs 16% Under 1 Yr 8% 1-2 Yrs 38% U.S. State Department 1

2 Longitudinal Study of Development & Disorders in Internationally Children 14 Year Project 56 Children 392 Annual Evaluations Receptive Expressive Articulation Literacy Hearing Screen Goal: To Develop Local Norms Newly Assessment Results Communication & Symbolic Behavior Scales-DP CSBS Norm Social Interaction Speech Symbolic Total Score (Glennen, 2007) Putting it Together: New Arrivals Social Interaction What to Assess What to Expect When to Refer Eye Contact Normal eye contact Poor eye contact Frequency of Communication Communicative Intent Requests Attention Protests Comments Joint Attention Frequent communication attempts Variety of communicative intents Mild Delays Infrequent communication Lack of age appropriate intent No attention to pointing attempt 2

3 Putting it Together: New Arrivals Gestures What to Assess What to Expect When to Refer Use of Gestures Gestures + Variety of Gestures Age Appropriate Less than age appropriate use of gestures Vocalizations Gestures + Eyegaze Shifts Gesture Combinations Person to Object Eyegaze Shifts Age appropriate Lack of eyegaze while gesturing Putting it Together: New Arrivals Vocalizations & Speech What to Assess What to Expect When to Refer Frequency of Vocalizations Communicative Use of Vocalizations Complexity of Sounds Imitation of First Words History of Using Birth Words Fewer Vocalizations No vocalizations Infrequent use of vocalizations to communicate Mild Delay in Complexity Word Attempts by 15+ Months Word Attempts for Children 18+ Months Vocalizations not used communicatively More than mild delays in sound complexity No word imitations after 15+ months Putting it Together: New Arrivals Symbolic Play & Comprehension What to Assess What to Expect When to Refer Developmental Level of Play Variety of Objects Used in Play 2-3 step Play Sequences Early Word Comprehension Typical Developmental Play Age appropriate use of objects Age appropriate play sequences. Comprehension of some age appropriate words Mild Delays in Play Mild Delays Mild Delays Unable to comprehend any words or simple commands. 3

4 Table 2 Expressive Sentence Length (MLU Average for the 3 Longest Utterances) For Internationally Children by Age of Adoption (Glennen & Masters, 2002) Current Age 0 to 12 Months 13 to 18 Months 19 to 24 Months 25 to 30 Months Average Words Referral Criteria Average Words Referral Criteria Average Words Referral Criteria Average Words Referral Criteria 18 Months Months 2.6 > > Months 5.9 > > > > Months 9.5 > > > > Months 9.5 > > >3.9 Children Who Fall Below the Referral Criteria Should be Referred for Speech & Services MCDI Expressive Vocabulary Development 700 Number of Words Maximum = MCDI 50%ile MCDI 10%ile Intl Adoption 50%ile Internationally Children Chronological Age in Months Putting it Together: First Years Assessment Guidelines Children 0 12 Months of Age At Arrival Assess in English without accommodations Children Months of Age One Year Home Assess in English without accommodations MLU will be low average Child will not be at full potential 4

5 Standard Scores Standard Scores 9/11/2015 Children After Age 3 = Complex Issues Orphanage & Pre-adoption Environment Bilingualism and Development Limited English Exposure before starting School 110 Changes in Receptive Over Time Adoption Age mos mos yrs yrs yrs Mos 9 Mos 1.3 Yrs 2.3 Yrs 3.4 Yrs Time Home: Length of English Exposure Glennen, S. (2014). A Longitudinal study of language and speech in children who were internationally adopted at different ages. Speech & Hearing Services in Schools, 45, Changes in Expressive Over Time Adoption Age mos mos yrs yrs yrs Mos 9 Mos 1.3 Yrs 2.3 Yrs 3.4 Yrs Time Home: Length of English Exposure Glennen, S. (2014). A Longitudinal study of language and speech in children who were internationally adopted at different ages. Speech & Hearing Services in Schools, 45,

6 Standard Scores Standard Scores 9/11/ Changes in MLU SSE Over Time Adoption Age mos mos yrs yrs yrs MLU SSE = [( [Child s MLU-Predicted MLU]/Predicted MLU Standard Deviation) * 15] Mos 9 Mos 1.3 Yrs 2.3 Yrs 3.4 Yrs Time Home: Length of English Exposure Glennen, S. (2014). A Longitudinal study of language and speech in children who were internationally adopted at different ages. Speech & Hearing Services in Schools, 45, Changes in Articulation Over Time Adoption Age mos mos yrs yrs yrs Mos 9 Mos 1.3 Yrs 2.3 Yrs 3.4 Yrs Time Home: Length of English Exposure Glennen, S. (2014). A Longitudinal study of language and speech in children who were internationally adopted at different ages. Speech & Hearing Services in Schools, 45, Age of Adoption Glennen (2014) Length of Exposure to English Receptive Standardized Test Scores Expressive Standardized Test Scores MLU SSE Standardized Score Equivalent Articulation Standardized Test Scores Between Months of Age N = 17 Between Months of Age N = 8 Between Years of Age N = 13 Between Years of Age N = 12 Between Years of Age N = 6 M SD M SD M SD M SD (7.76) (6.49) (23.47) 2.5 mos Home 9 mos Home (14.27) (10.61) (8.63) 1.3 yrs Home (14.02) (16.53) (17.53) (12.34) 2.3 yrs Home (13.73).20 (10.40) (8.70) (8.25) 3.4 yrs Home (12.37).27 (10.82) (10.97) (10.87) 2.5 mos Home (21.23) (13.49) (18.27) 9 mos Home (15.13) (5.90) (11.69) 1.3 yrs Home (12.02) (9.78).26 (26.28) (7.15) 2.3 yrs Home (9.18) (10.71) (10.65) (7.87) 3.4 yrs Home (9.89) (9.32) (5.91) (12.65) 2.5 mos Home (14.17) (8.05) (7.74) 9 mos Home (14.96) (11.74) (23.44) (9.61) 1.3 yrs Home.75 (13.85) (16.77) (24.43) (11.75) 2.3 yrs Home (10.22) (12.55) (17.58) (13.38) 3.4 yrs Home (6.38) (15.20) (9.69) 2.5 mos Home (6.72) (3.09) (5.86) 9 mos Home (10.95) (10.47) (12.36) (12.49) 1.3 yrs Home (9.35) (11.29) (14.37) (14.53) 2.3 yrs Home (16.46) (13.73) (13.87) (12.42) 3.4 yrs Home.02 (14.82) (16.58) (9.69) 2.5 mos Home (15.87) (16.94) (9.10) 9 mos Home (9.96) (15.09) (16.65) (11.19) 1.3 yrs Home (2.31) (9.21) (15.83) (8.67) 2.3 yrs Home.13 (14.07) (16.36) (5.34) (3.16) 3.4 yrs Home (6.08) (7.48) (6.17) 6

7 L2 Second Proficiency Basic Interpersonal Communication Skills (BICS) Acquired Rapidly Masks True Proficiency Cognitive Academic Proficiency (CALP) Acquired Slowly Learning Implications when the Child has no Proficient L1 Internationally Children with or Speech Delays (-1SD Below Mean) Ages 3 & 4 Years 2 Yrs Post Adoption Age 3 n = 11 Age 4 n = 6 3 Yrs Post Adoption Age 3 n = 10 Age 4 n = 6 Receptive 18% 16% 0% 0% Expressive 18% 33% 20% 0% MLU SSE 27% 16% 20% 0% Articulation 18% 0% 10% 0% One Delay Area 45% 50% 30% 0% Two or More Delay Areas 27% 0% 10% 0% Conclusion Ages 3-4 years <2 Years Exposure Assess in English but use local norms >3 Years Exposure Assess in English and use standard norms Strength = Receptive language, Articulation Weakness = Expressive Syntax & Morphology Incidence of Delays 7

8 Reason 1: The Lens IA Children SES Matched Children 3-yr olds (Cohen et al., 2010) 8-yr olds (Desmarais et al., 2012) PLS Receptive PLS Expressive CASL Paragraph Comprehension 7-yr olds (Delcenserie et al., 2011) CELF CFD CELF-R Sentence Recall EOWPVT Written Age 7 8 (Scott, Roberts, & Krakow, 2008) Written Test Scores Test of Word Reading WDRB Passage Comp WDRB Word Attack WRAT3 Reading WRAT3 Spelling Reason 2: Weaknesses Ages 6 & 8 (Glennen, 2015) Area Vocabulary (Age 6) Syntax & Morphology (Age 6) Memory for (Age 6) Auditory & Working Memory (Age 8) CELF-IV, CTOPP, Subtests Standard Score (Mean = 10) Percentage Of Children 1SD < Mean Expressive Vocabulary % Word Classes Receptive % Sentence Structure (Rec) % Formulated Sentences (Exp) % Word Structure (Exp) % Concepts & Following % Directions Recalling Sentences % Number Repetition % Familiar Sequences % CTOPP Nonword Repetition % Rapid Naming CTOPP Rapid Naming % 8

9 Pre-Adoption History BICS - Develops Rapidly CALP Progresses over Time Articulation L1-L2 Errors Grammar/Syntax L1-L2 Errors Non-linguistic Assessment Verbal Memory Rate of Learning Dynamic Assessment: Multiple Data Sources Context at Home and School Pre-Adoption History Birth/Orphanage Medical Developmental & Speech Living environments, parent/caregiver to child ratios Estimates on quality of care and language stimulation Relevant developmental or medical history What were the parents told about the child s language and speech development? Did others in the birth country have a difficult time understanding the child? Did the child appear to understand and follow instructions? Did the child enjoy socially interacting with known adults and peers? Did those interactions appear normal? Academics Did the child attend school in the birth country? Was the school in the community or isolated in the orphanage? Are there any records of how the child was progressing in school? Was the child learning to read and if so, were there any concerns? Goal: Was there a language or speech disorder in the Birth L1? Post-Adoption History Exposure How Long has the Child Been Exposed to English? Is the child still exposed to the birth language? Is English the only language spoken in the home? Medical Significant medical concerns discovered post-adoption BICS Development How quickly did the child start using English words? How quickly did English become the primary language? Does the child comprehend simple instructions, basic conversations about routine events, conversations about shared past events? Does the child s English appear fluent, or are there differences in pronunciation, grammar, or vocabulary? Academics Is the child attending school? Are they placed in the age-appropriate grade? If not, why? Are they receiving ESL or special services? Are they doing well academically when compared to class peers? Goal: Is there a language or speech disorder in the new adopted L1? 9

10 Glennen, S., & Bright, B., (2005). Five years later: in school age internationally adopted children. Seminars in Speech and, 26, Glennen, S. (2014). A Longitudinal Study of and Speech in Children who were Internationally at Different Ages: Outcomes and Assessment Guidelines., Speech and Hearing Services in Schools, 45, References Delcenserie, A., Genesee, F., & Gauthier, K. (2011). abilities of internationally adopted children from China during the early school years: Evidence for early age effects? Applied Psycholinguistics, 34, Desmarais, C., Roeber, B., Smith, M., & Pollak, S. (2012). Sentence comprehension in postinstitutionalized school-age children. Journal of Speech,, and Hearing Research, 55, Glennen, S. (2009). Speech and language guidelines for children adopted from abroad at older ages. Topics in Disorders, 29(1) Glennen, S. (2015). Internationally adopted children in the early school years: Relative strengths and weaknesses in language abilities., Speech and Hearing Services in Schools, 46. Glennen, S., & Masters, G. (2002). Typical and atypical language development in infants and toddlers adopted from Eastern Europe. American Journal of Speech- Pathology, 11, Scott, K., Roberts, & Krakow, R. (2008). Oral and written language development of children adopted from China. American Journal of Speech Pathology, 17, Scott, K., Roberts. J., & Glennen, S. (2011). How well do children who are internationally adopted acquire language? A meta-analysis. Journal of Speech,, and Hearing Research, 54, Sheridan, M., Fox, N., Zeanah, C., McLaughlin, K., & Nelson, C. (2012). Variation in neural development as a result of exposure to institutionalization early in childhood. PNAS: Proceedings of the National Academy of Sciences, 109,