Verbal Skills Research Articles

Assessment of verbal and nonverbal cognitive abilities in children with stuttering using 5th edition Stanford Binet

Stuttering is a speech disorder disrupting fluency with implications that could affect psychological, educational, social, and occupational aspects of life. Cognitive functions include mental processes that allows for execution of goal-directed responses in different situations. They are usually referred to as executive functions (EF) which consists of three main components, working memory, cognitive flexibility, and inhibitory control. The Stanford Binet 5th edition (SB5) is an intelligence scale designed to assess various cognitive skills by measuring five main domains that require the administration of these executive skills. Recent research has focused on executive functions skills among children with stuttering (CWS), and how it might affect stuttering development and severity. Aim of the Study The aim of this study was to compare the cognitive verbal and nonverbal skills using the Stanford Binet intelligence quotient test 5th edition (SB5) between children with stuttering (CWS) and children with no stuttering (CWNS) and to assess which of these skills affected stuttering severity among CWS. Methods A total of 70 children, 40 CWS and 30 CWNS, were assessed using the SB5 test. Further assessment of the CWS was done using the stuttering severity index (SSI) to determine the degree of stuttering. Statistical analysis and comparison were used to determine results and differences in cognitive skills, and regressive analysis was used to determine the most predicative factor in stuttering development and severity. Results Showed that CWS performed lower scores than CWNS in all SB5 domains except in non-verbal domain, where the two groups did not differ significantly in their performance. Working memory was the weakest skill among CWS and stood out as the only significant predicative factor in stuttering. Children with severe stuttering performed higher in their total IQ, nonverbal IQ, knowledge, and fluid reasoning than moderate stutterers, having the strongest performance in non-verbal IQ, still none of these domains turned out to be of a predicative significance in severity. Conclusion Findings suggest that working memory is the weakest executive skill in CWS as well as other executive functions related to cognitive flexibility compared to fluent controls. Working memory skills are significantly lower in CWS but does not correlate with its severity; whereas the strongest skills, among CWS compared to fluent controls, are in the nonverbal domains.

Validation of the Second Version of the LittlEARS® Early Speech Production Questionnaire (LEESPQ) in Romanian-Speaking Children with Normal Hearing

Objectives: The objectives of the current study were to validate the LittlEARS® Early Speech Production Questionnaire (LEESPQ) in Romanian and to evaluate the psychometric properties of the Romanian version of the questionnaire for Romanian children with normal hearing. The LEESPQ was created and tested for the assessment of preverbal and early verbal skills (0–18 months) in children with normal hearing. Methods: The English version of the LittlEARS® Early Speech Production Questionnaire (LEESPQ) was adapted into Romanian language using a translation/back-translation procedure and validation of the content before applying the questionnaire. The Romanian version was applied to the parents of 232 children with normal hearing, aged between 0 and 18 months. The questionnaire was statistically analyzed to assess its reliability, internal consistency, predictive accuracy, and the influence of gender on children’s scores. Results: Statistical analyses confirmed the LEESPQ’s reliability (α = 0.876) and high predictive accuracy (λ = 0.951). Age correlated strongly with total scores (ρ = 0.67; p < 0.001), supporting the age-dependent progression of speech production milestones. Gender did not significantly affect the scores. Normative curves and minimum expected scores were established for each age group. Conclusions: This study confirmed that the Romanian version of the LEESPQ is a reliable, valid, language-independent instrument, useful in the assessment of language development in children with normal hearing, aged up to 18 months.

An Overview of Dentist-Patient Communication in Quality Dental Care.

Dentist-patient communication is at the core of providing quality dental care. This study aims to review the importance, challenges, strategies, and training of dentist-patient communication. The World Dental Federation (FDI) emphasizes the importance of effective communication between oral healthcare providers and patients as a critical component of high-quality care. Effective dentist-patient communication allows dentists to accurately and effectively pass on essential medical information to patients. It improves the dentist's efficiency, boosts self-confidence, reduces occupational stress, and minimizes the risks of complaint or litigation. Moreover, it alleviates dental anxiety and fear, helps build trust between dentists and patients, addresses patients' needs and preferences, increases patients' adherence to improved treatment outcomes, and ultimately leads to enhanced patient satisfaction. Nonetheless, it has been widely acknowledged that dentists universally encounter the repercussions arising from suboptimal communication strategies. Time constraints, difficulties in establishing rapport, the oral-health illiteracy of the patients, the poor communication skills of the dentists, dentists' perceptions, and language barriers often hinder dentist-patient communication. Dentists should take the patient-centered approach as a premise and acquire verbal and non-verbal communication skills to overcome these communication barriers. The patient-centered approach comprises the understanding of patients' illness, shared decision-making, and intervention with mindfulness of the patient's own pace. Simple, succinct, and jargon-free language should be used in verbal communication. Proper body postures and gestures are fundamental for showing positive attitudes towards patients. Communication training for dental students should involve a structured pedagogical approach that includes didactic instruction, role-playing exercises, patient interviewing, and ongoing assessments. Key components of effective communication skills training in dental education include motivational interviewing, open-ended questioning, affirmations, reflective listening, and summaries to enhance patient engagement and adherence to treatment plans.

IQ and non-verbal intelligence: an integrative review of the literature

This bibliographic review article has the objective of carrying out an integrative review of the literature in English and Spanish on IQ and non-verbal intelligence as references for the consolidation of a holistic state of the art. The scope of the study is retrospective from 2013 to 2023, jointly, the use of the Integrative Review of Literature and its stages as guidelines for information filtering, highlighting the criteria for analysis of bibliographic information in the second stage, jointly, the RedENSO instrument to collate the data. The results denote that the literature related to IQ and non-verbal intelligence is incipient, most of the analyzed studies focus their development on praxis, and the qualitative scientific works are minimal. The relationship between IQ and nonverbal intelligence is complex. While IQ focuses on verbal and logical cognitive skills, nonverbal intelligence encompasses visual and spatial skills, as well as understanding emotions through nonverbal means. Both aspects are important for a full understanding of a person's intelligence, and it is essential to recognize and assess both verbal and nonverbal abilities when assessing intellectual ability.

"I Aim to Fulfill My Promise": Dementia Caregiving from the Perspective of Spouses and Partners.

In the United States, spouses provide 17% of in-home care for people living with dementia. Negative impacts of dementia care on spouses/partners are well-documented, but we lack information about the holistic experience for spouses/partners. We conducted a secondary thematic analysis of data from two observational studies about everyday music engagement and dementia care at home. In this paper, we report on experiences of dementia care from the perspectives of spouses/partners. Participants included 15 people living with dementia (20% women, 20% people of color); 15 spouses/partners (73% women, 27% people of color). Individual experiences varied, but underlying patterns emerged: 1) Caregiving approaches were grounded in loyalty and commitment 2) Spouses/partners struggled to accept changes occurring with dementia progression, and 3) As verbal skills diminished, spouses/partners found meaning in small gestures. Spousal/partner dementia care poses unique challenges and rewards. Identifying underlying motivations and sources of strength can support the caregiving experience.

Comparing transformer and RNN models in BCIs for handwritten text decoding via neural signals

A Brain-Computer Interface (BCI) is a technology that enables the user to operate devices or manipulate objects solely through their brain activity, which is especially useful for paralyzed individuals in regaining communication. The purpose of this study is to explore the use of a custom transformer model in BCIs that translates the neural activity present when an individual with limited verbal and fine-motor skills attempts to handwrite. Previous studies have found that transformers performed better than recurrent neural networks (RNNs) in translation tasks similar to decoding neural signals into intended handwritten text. Due to this known benefit, we hypothesized that the transformer BCI would show promise through the recorded metrics. The neural signals of a tetraplegic individual attempting to handwrite were provided by existing research. We conducted four trials using training data with or without augmentation, as well as training the model to separately minimize training and validation loss. Compared with the original RNN BCI, the transformer model performed less favorably across all trials. Although the results do not indicate that the transformer currently outperforms an RNN BCI, it is important to note that further testing of the model’s capabilities is necessary before determining whether transformers can enhance BCI communication. Future testing could include training the model with a larger and more preferable dataset, training for a longer duration, comparing training times between the RNN and transformer, or assessing how the transformer improves with an offline autocorrect feature.

Turner syndrome and neuropsychological abnormalities: a review and case series.

The objective of this study was to establish the genotype-phenotype correlation between karyotype results and the neurological and psychiatric alterations presented in patients with Turner syndrome (TS). A retrospective study was conducted on the medical records of 10/140 patients with TS and neurophysiological abnormalities seen at a university hospital in southern Brazil. In addition, a literature review spanning the period from January 1, 2012 to January 1, 2023 was carried out using the PubMed and Virtual Health Library databases. Our study showed a potential correlation between neurological and psychiatric alterations in patients with TS. These findings are in accordance with those described in literature such as a high prevalence of learning or intellectual disabilities. However, our sample found more seizure episodes than those reported in other studies. The correlation established could be due to X chromosome dose-effect, as the review suggests that sex chromosome number and hormonal development can be associated with verbal, social, and cognitive skills or impairments.

Should We Be Resurrecting the Handshake?

The simple handshake has been around for more than 3,000 years as a sign of friendship and as an indication that neither party is carrying a weapon. The physician-patient relationship often begins with a traditional handshake. Hand hygiene is an integral part of patient encounters to reduce the spread of infectious diseases; however, many physicians and allied health providers believe taking a break for hand hygiene interrupts the natural flow of the initial introduction and nonverbal body trust-inducing language. The elimination of the handshake may allow providers to focus on more culturally acceptable universal verbal and nonverbal communication skills that help us build essential trust with our patients. Yet, research indicates that handwashing reduces hospital-acquired infections, so it stands to reason that it should be integral to every patient visit.

CREATIVE BRAINSTORMING TECHNIQUES IN GROUP GUIDANCE

Group guidance services are services provided to a group of individuals, where they together get information from sources, especially mentors or counselors, which help them in their daily lives and in making decisions. Group guidance helps students in planning a future that suits their talents, interests, and aspirations. The service aims to stimulate the development of feelings, thoughts, perceptions, insights, and attitudes that support more effective behavior change, including improving verbal and nonverbal communication skills for students. One way that can be used in group guidance is the brainstorming technique. The research method used is a qualitative description with a literature study. The results of the study explain (1) the definition of brainstorming technique, which is a technique used to create a long list of different answers without assessing individual ideas. (2) The rules and also the purpose of the brainstorming technique (3) The steps of performing the creative brainstorming technique by exchanging diverse thoughts between students. (4) Stages of using solve problems so that creative ideas will be found from various points of view that will overcome the difficulty of the problem through fun and relaxing activities.

Mathematical Representation Capability Reviewed From The Learning Style Of Students In The City Of Cirebon In Solving SPLDV And SPtLDV Problem

This study aims to analyze the characteristics of students with visual, auditory and kinesthetic learning styles in solving SPLDV and SPtLDV problems. The research method taken is a qualitative research method. Qualitative research is carried out by means of observation, interviews, or document review. The results of this study are the characteristics of thirty-six students obtained that students who have symbolic representation skills are twelve students (33.33%) with five students (13.89%) having a kinesthetic learning style, three students (8.33%) having an auditory learning style, and four students (11.11%) having a visual learning style. Then students who had verbal representation skills were ten students (27.78%) with four students (11.11%) having a kinesthetic learning style, five students (13.89%) having an auditory learning style, and one student (2.78%) having a visual learning style. The students who had visual representation skills were fourteen students (38.89%) with four students (11.11%) having a kinesthetic learning style, one student (2.78%) having an auditory learning style, and nine students (25%) having a visual learning style.

Empowering Communication in Medicine: A Workshop Approach to Improve Presentation Skills for Ear, Nose, and Throat Specialists.

Introduction Effective communication is crucial for healthcare professionals, impacting patient care and interdisciplinary collaboration. However, medical education often lacks structured training in communication and presentation techniques. Herein, we evaluate the efficacy of structured workshops aimed at enhancing presentation skills among ear, nose, and throat (ENT) doctors through training in visual material design and concise verbal communication, including elevator pitches. Methods Two two-hour workshops were conducted for 23 ENT doctors under 50 years old, each with over 10 years of experience. The first workshop focused on creating effective visual aids, whereas the second targeted verbal communication skills. The questionnaire was administered before and after the workshops. Pre- and post-workshop questionnaires, using a 10-point Likert scale, evaluated participants' self-perceived abilities. Results The first workshop led to significant improvement in creating visually appealing and informative slides, using appropriate color schemes, and incorporating concrete examples. Despite a positive correlation with prior experience, time management did not improve significantly. The second workshop revealed significant gains in verbal communication skills, including concise messaging, audience engagement, and the effective use of storytelling techniques. Participants improved their ability to streamline information, maintain a conversational tone, and use eye contact and gestures effectively. Conclusion This study demonstrated that structured workshops significantly improved the presentation skills of ENT doctors, particularly in visual material design and verbal communication. Integrating such training into medical education and professional development can enhance patient care and interdisciplinary collaboration by fostering clear, effective communication among healthcare providers.

Artificial Intelligence and Canva-assisted Modeling the Way Methods to Improve the Multi-Representation Ability of Islamic Education Students

This study investigates applying the 'Modeling the Way' method, enhanced by artificial intelligence (AI) and Canva, to improve the multi-representation skills of students in the Islamic Education Studies Program (PAI) at Maulana Malik Ibrahim Malang UIN. Generation Z has unique learning characteristics and requires a more visual and interactive approach to education. This method uses AI to personalize learning experiences and Canva to facilitate the visualization of complex concepts. The study used an experimental design with a quantitative approach through pre-tests and post-tests to measure the verbal, mathematical, graphical, and symbolic representation skills of 58 students. The results showed a significant improvement in student multi-representation skills after the intervention, with an average increase of 31 points, from 49.75 in pre-tests to 80.75 in post-tests. Inferential statistical analysis suggests that this method has a significant positive impact on student abilities, marking the effectiveness of this innovative approach in meeting the learning needs of Generation Z. This research contributes to the literature by showing that integrating AI and Canva in learning can create a more dynamic and adaptive learning environment, improving student motivation and academic outcomes. These findings significantly impact the development of curricula and more effective teaching methods in higher education. This research suggests the need for additional experiments to test the effectiveness of these methods in different educational contexts, as well as the potential integration of other technological tools to enhance the learning experience. The use of AI and Canva as learning aids underlines the importance of adopting modern technology in education, improving academic achievement, and preparing students to face the challenges of the ever-expanding digital world.

Nonverbal Skills Evolution in Children with Autism Spectrum Disorder One Year Post-Diagnosis

Background: Gestural production, a crucial aspect of nonverbal communication, plays a key role in the development of verbal and socio-communicative skills. Delays in gestural development often impede verbal acquisition and social interaction in children with Autism Spectrum Disorder (ASD). Although various interventions for ASD focus on improving socio-communicative abilities, they consistently highlight the importance of integrating gestures to support overall communication development. This study aimed to investigate the progression of gestural production in preschoolers with ASD one year post-diagnosis, taking into account whether they had received interventions for ASD. Method: This study followed 76 Italian preschoolers with ASD, aged 2 to 4 years, who underwent three different types of interventions or no intervention at all. Data on gestural production were collected using the MCDI, a standardized parent-proxy report. Results: The results indicate that all groups, regardless of intervention type, experienced increased gesture production, suggesting that interventions, combined with factors like time, symptom severity, and learning differences unique to ASD, positively influence nonverbal communication. This improvement may be due to various factors. On one hand, joint attention and socio-communicative interactions drive progress, while on the other, children with ASD may benefit from learning through non-socially mediated linguistic material. Conclusions: These findings highlight the need to understand individual learning preferences and strategies for developing nonverbal communication skills in children with ASD. Identifying effective strategies early on can enhance both diagnosis and intervention planning, ensuring they are tailored to the specific developmental needs of each child.

The influence of perspective on VR job interview training

Third-person perspectives in virtual reality (VR) based public speaking training enable trainees to objectively observe themselves through self-avatars, potentially enhancing their public speaking skills. Taking a job interview as a case study, this study investigates the influence of perspective on the training effects in VR public speaking training and explores the relationship between training effects and the sense of embodiment (SoE) and presence, as these concepts are central to virtual experiences. In the experiment, VR job interview training was conducted under three conditions: a first-person perspective (1PP), a typical third-person perspective from behind the avatar (Back), and a third-person perspective from the front of the avatar (Front). The results indicate that participants trained in the Front condition received higher evaluations from others in terms of verbal communication skills and the overall impression of the interview compared to those trained in the other conditions, highlighting the advantages of training while observing a self-avatar. Furthermore, it was confirmed that training effects correlated with the subcomponents of SoE and presence, suggesting that these trends may vary depending on perspective.

Model Pembelajaran The Learning Cell untuk Kepercayaan Diri dan Kemampuan Komunikasi Siswa di MIS Darul Ihsan

Learning is essentially to develop students' abilities both academically and non-academicly. Apart from achieving learning objectives based on basic competencies and indicators, the learning process also needs to develop aspects of students' personalities. Teachers must become facilitators for students to become more skilled in various fields. Self-development that teachers can improve and internalize through learning activities is self-confidence and communication skills. Students will need these two things as preparation to be ready and brave enough to express their aspirations in society. The learning cell learning model is a learning method that provides opportunities for students to actively interact with fellow students and encourages students to get used to appearing in front of other friends. Through this activity, student activity is increased, indirectly, students who have a turn to ask questions and answer are trained to be confident in conveying, and their verbal communication skills are also trained.

Pediatric Emergency Medicine Physicians' Perspectives of Concussion in Young Children.

Traumatic brain injury (TBI) during early childhood (before 6 years) is prevalent, accounting for rising rates of emergency department visits. These injuries may lead to postconcussive symptoms, which may be subtle and difficult to diagnose in young children. Inadequate discharge counseling may lead to prolonged duration of symptoms and possible developmental delays. We aimed to explore pediatric emergency medicine (PEM) physicians' perspectives on "concussion" terminology, diagnosis, and management, specifically in a young child with mild TBI. We conducted semistructured interviews using open-ended questions involving a hypothetical scenario. We recruited currently practicing PEM physicians by a snowball sampling method. A research team recorded, transcribed, and analyzed the interviews. Using social constructionism as the philosophical framework, we developed and refined codes and derived themes until reaching thematic saturation. Peer debriefing with an expert collaborator aided with revisions of themes. A single PEM researcher interviewed 13 participants. Three primary themes emerged. Our first theme identified the role of guidelines and tools in the diagnostic workup. Most participants utilized a clinical prediction tool for neuroimaging but no clinical symptom scales. Our second theme described the difficulties and inconsistencies in the approach to diagnosis of concussion, largely due to young age, lack of verbal skills and unreliable examinations. Our last theme focused on the difficulty in providing clear discharge instructions to parents. Many participants described difficulty providing activity restrictions, instead allowing self-modulation, and lack of counseling for educational tasks. Variability exists among PEM physicians in diagnosis and management of concussions in young children. Discomfort with lack of reliability of symptoms and underappreciation of typical early childhood characteristics may account for findings. Educational initiatives, age-appropriate clinical tools and treatment-guided outcomes research are needed to guide PEM physicians in the care of young children with head injuries.

Conflict Resolution in Intercultural Business Contexts: An Interdisciplinary and Reflective Framework

This paper adopts an interdisciplinary and reflective framework and aims to analyze the parameters and factors involved in conflicts arising in intercultural business settings, such as those of firms employing a diverse workforce, involving people of different cultural backgrounds. First, it presents the main concerns that need to be examined in a negotiation or mediation process (outcome vs. relationship) and proposes approaches and strategies for the resolution of major or minor disputes, to minimize costs and “side effects”. Secondly, based on conflict case scenarios involving intercultural interaction, the paper aims to illustrate the link between the negotiation approaches adopted, the participants’ emotional state, and their verbal and non-verbal communication skills. Finally, it aims to bring to the surface the importance of maintaining a communication climate promoting collaboration and establishing “rapport” to pursue an interests-based, integrative negotiation (win-win). Thus, it becomes evident that in the context of today’s globalized enterprises, it is essential, on the one hand, to take into account the increased need for effective intercultural communication (and, sometimes, mediation) and, on the other, to adopt appropriate approaches and strategies to ensure positive and mutually acceptable outcomes by adhering to a reflective model of thinking. Based on the findings and suggestions of the paper, it is proposed that training in conflict resolution strategies aiming for “integrative” outcomes (by applying the proposed CIIS framework as a pilot) should become a component of corporate policies and business communication, given also that migration flows are constantly changing workforce composition.

Neurocognitive disruption in pediatric kidney transplant candidates: Medical and sociodemographic factors

We evaluated the effects of kidney failure etiology, dialysis, and area deprivation index on the subdomains of neurocognitive functioning in pediatric kidney transplant candidates. The study included 78 pediatric kidney transplant candidates (47.4% male, 70.5% White, M.age = 11.77 years, and 51.3% patients have public insurance) who completed a pre-transplant neuropsychological evaluation between 1/1/2010 and 10/31/2022. Linear regression models were employed to complete data analyses. The mean scores of various neurocognitive functioning domains in pediatric kidney transplant candidates were significantly lower than in the general population (ps < .001). After adjusting for covariates, patients with congenital anomalies of the kidney and urinary tract (M = 87; 95% CI: 80–94) and other etiologies (M = 82; 95% CI: 76–89) had significantly lower processing speed compared to patients with nephrotic syndrome (M = 98; 95% CI: 89–107) (p = .02). Patients living in high-level deprivation neighborhoods showed significantly lower verbal skills (p = .01), working memory performance (p = .02), and full-scale IQ (p = .03) than patients living in median-level and low-level deprivation neighborhoods. Additionally, dialysis did not show significant association with neurocognitive domains ((ps ranged from .07 to .52).

Perceived Effectiveness of a Positive Thinking Training Course on Professional Identity: Reconciliation of Bipolar English as a Foreign Language Teachers with Positive Thinking

Objectives: About 5% of the world’s population suffer from bipolar disorder. These people, in general, and teachers in particular, have many personal, social, and working problems. Different approaches, such as positive thinking, have been suggested to cope with such issues. Moreover, professional identity, similar to general identity, has been applied in various ways in teacher and instructor training. Using a basic interpretive design, we explored perceptions of English foreign language (EFL) teachers with bipolar disorder and the effectiveness of a training course on positive thinking on their professional identity. Methods: The participants consisted of 25 (16 males and 9 females) bipolar EFL teachers who were purposefully selected from EFL teachers teaching in private language institutes in Kerman City, Iran. A bipolar spectrum diagnostic scale and a semi-structured interview were used to collect the study data. Also, a positive thinking training course was developed to be administered in ten 60-minute sessions. Results: Regarding the effectiveness of the positive thinking training course on professional identity, the output of a thematic analysis of the interviews conducted with bipolar EFL teachers were as follows: Improvement in communicative and motivational skills, enhancement of willingness to reach professional development and classroom management skills, working on English language proficiency, seeking the best teaching methods, attention to students’ needs, enhancement of verbal skills, and reducing teaching fear. Discussion: The research results help people participate in bipolar tests and psychological studies and strive for their mental health. It will also create a spirit of hope in patients. The findings have some implications for EFL teacher education administrators and bipolar EFL teachers. Training on positive thinking skills can contribute to positive changes and orientations in EFL bipolar teachers, reconstructing their professional identity.

Selective Mutism in the Context of Autism and Bilingualism.

Juan is a 5-year-old boy who has been followed by a developmental-behavioral pediatrician and pediatric neuropsychologist since being diagnosed with language delay and autism spectrum disorder at age 2 years. He is otherwise healthy and was born at term after a healthy pregnancy. His primary language is Spanish, and he has minimal interactions in English. His first words were at 20 months; they were not functional but rather words related to his interests such as "train." He began using 2 to 3-word phrases shortly after but only to request needs. He began speaking in complete sentences at age 4 years.A neuropsychological evaluation was conducted at age 2 years during which Juan demonstrated repetitive behaviors such as hand-flapping, toe-walking, body rocking, and head banging. He displayed sensory seeking behaviors such as rubbing items on his face and close visual inspection. He did not respond to his name and his use of eye contact was inconsistent. He demonstrated rigidity and difficulty transitioning between activities. He did not engage in social reciprocity, and his facial expressions were limited. Minimal spontaneous language was observed, and expressive language largely consisted of echolalia in both languages. Juan was diagnosed with autism spectrum disorder and applied behavior analysis, speech and language therapy, and occupational therapy were recommended.Developmental-behavioral follow-up over the next 2 years noted improvements in behavior, transitions, and social interactions. He participated in early childhood intervention and early childhood special education with significant advances for speech and language in English and Spanish, demonstrating a large vocabulary. At 4 years, parents noted Juan to have reluctance to speak in English. He stopped speaking in English entirely for 3 weeks, though he continued to speak in Spanish. When he resumed speaking in English, it was only with people he knew well (e.g., parents, teachers, babysitter). In clinic, he did not speak to the English-speaking developmental-behavioral pediatrician but spoke in short sentences to the Spanish-speaking neuropsychologist.A repeat neuropsychological evaluation completed at age 5 years revealed that Juan had stopped speaking in English completely, even among those previously deemed "safe." Results were consistent with average cognitive abilities with a strength in verbal skills. Juan's single-word vocabulary in Spanish was exceptionally high. He did not provide expressive responses in English, but his receptive English vocabulary was high average. He responded to English language with nonverbal gestures or spoken language in Spanish. Parents reported Juan to display increased anxiety accompanied by extreme school refusal, behavioral difficulties, and reluctance to leave the home.Given this information, what are your diagnostic considerations and treatment recommendations?