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Part IV: Components of Comprehensive Dyslexia Testing – Writing and Spelling

Recently I began writing a series of posts on the topic of comprehensive assessment of dyslexia.

In part I of my post (HERE), I discussed common dyslexia myths as well as general language testing as a starting point in the dyslexia testing battery.

In part II (HEREI detailed the next two steps in dyslexia assessment: phonological awareness and word fluency testing.

In part III  (HEREI discussed reading fluency and reading comprehension testing.

Today I would like to discuss part IV of comprehensive dyslexia assessment, which involves spelling and writing testing.

Spelling errors can tell us a lot about the child’s difficulties, which is why they are an integral component of dyslexia assessment battery.   There is a significant number of linguistic skills involved in spelling.   Good spellers  have well-developed abilities in the following areas (Apel 2006, Masterson 2014, Wasowicz, 2015):

  1. Phonological Awareness – segmenting, sequencing, identifying and discriminating sounds in words.
  2. Orthographic Knowledge – knowledge of alphabetic principle, sound-letter relationships; letter patterns and conventional spelling rules
  3. Vocabulary Knowledge -knowledge of word meanings and how they can affect spelling
  4. Morphological Knowledge- knowledge of “word parts”: suffixes, prefixes, base words, word roots, etc.; understanding the semantic relationships between base word and related words; knowing how to make appropriate modifications when adding prefixes and suffixes
  5. Mental Orthographic Images of Words- clear and complete mental representations of words or word parts

By administering and analyzing spelling test results  or  spelling samples and quizzes,  we can determine where students’  deficits lie,  and design appropriate interventions  to improve knowledge and skills in the affected areas.

twsWhile there are a number of spelling assessments currently available on the market  I personally prefer that the  Test of Written Spelling – 5 (TWS-5) (Larsen, Hammill & Moats, 2013). The  TWS-5  can be administered to students 6-18 years of age in about 20 minutes in either individual or group settings. It has two forms, each containing 50 spelling words drawn from eight basal spelling series and graded word lists. You can use the results in several ways: to identify students with significant spelling deficits or to determine progress in spelling as a result of RTI interventions.

Now,  lets  move on to assessments of writing.   Here, we’re looking to assess a number of abilities,  which include:

  • Mechanics – is there appropriate use of punctuation, capitalization, abbreviations, etc.?
  • Grammatical and syntactic complexity – are there word/sentence level errors/omissions? How is the student’s sentence structure?
  • Semantic sophistication-use of appropriate vs. immature vocabulary
  • Productivity – can the student generate  enough paragraphs, sentences, etc. or?
  • Cohesion and coherence-  Is the writing sample organized? Does it flow smoothly? Does it make sense? Are the topic shifts marked by appropriate transitional words?
  •  Analysis – can the student edit and revise his writing appropriately?

Again it’s important to note that much like the assessments of reading comprehension  there are no specific tests which can assess this area adequately and comprehensively.  Here, a combination of standardized tests, informal assessment tasks as well as analysis of the students’ written classroom output is recommended.

TEWL-3_EM-159

For standardized assessment purposes clinicians can select Test of Early Written Language–Third Edition (TEWL–3) or Test of Written Language — Fourth Edition  (TOWL-4)

The TEWL-3 for children 4-12 years of age, takes on average 40 minutes to administer (between 30-50 mins.) and examines the following skill areas:

Basic Writing. This subtest consists of 70 items ordered by difficulty, which are scored as 0, 1, or 2. It measures a child’s understanding of language including their metalinguistic knowledge, directionality, organizational structure, awareness of letter features, spelling, capitalization, punctuation, proofing, sentence combining, and logical sentences. It can be administered independently or in conjunction with the Contextual Writing subtest.

Contextual Writing. This subtest consists of 20 items that are scored 0 to 3. Two sets of pictures are provided, one for younger children (ages 5-0 through 6-11) and one for older children (ages 7-0 through 11-11). This subtest measures a child’s ability to construct a story given a picture prompt. It measures story format, cohesion, thematic maturity, ideation, and story structure. It can be administered independently or in conjunction with the Basic Writing subtest.

Overall Writing. This index combines the scores from the Basic Writing and Contextual Writing subtests. It is a measure of the child’s overall writing ability; students who score high on this quotient demonstrate strengths in composition, syntax, mechanics, fluency, cohesion, and the text structure of written language. This score can only be computed if the child completes both subtests and is at least 5 years of age.

TOWL-4_EM-147The TOWL-4 for students 9-18 years of age, takes between 60-90 minutes to administer (often longer) and examines the following skill areas:

  1. Vocabulary – The student writes a sentence that incorporates a stimulus word. E.g.: For ran, a student writes, “I ran up the hill.”
  2. Spelling – The student writes sentences from dictation, making proper use of spelling rules.
  3. Punctuation – The student writes sentences from dictation, making proper use of punctuation and capitalization rules.
  4. Logical Sentences – The student edits an illogical sentence so that it makes better sense. E.g.:  “John blinked his nose” is changed to “John blinked his eye.”
  5. Sentence Combining – The student integrates the meaning of several short sentences into one grammatically correct written sentence. E.g.:  “John drives fast” is combined with “John has a red car,” making “John drives his red car fast.”
  6. Contextual Conventions – The student writes a story in response to a stimulus picture. Points are earned for satisfying specific arbitrary requirements relative to orthographic (E.g.: punctuation, spelling) and grammatic conventions (E.g.: sentence construction, noun-verb agreement).
  7. Story Composition – The student’s story is evaluated relative to the quality of its composition (E.g.: vocabulary, plot, prose, development of characters, and interest to the reader).

It has 3 composites:

  1. Overall Writing- results of all seven subtests
  2. Contrived Writing- results of 5 contrived subtests
  3. Spontaneous Writing-results of 2 spontaneous writing subtests

However, for the purposes of the comprehensive assessment only select portions of the above tests may need be administered  since other overlapping areas (e.g., spelling, punctuation, etc.) may have already been assessed by other tests, a analyzed via the review of student’s written classroom assignments or were encompassed by educational testing.

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Part III: Components of Comprehensive Dyslexia Testing – Reading Fluency and Reading Comprehension

Image result for child reading

Recently I began writing a series of posts on the topic of comprehensive assessment of dyslexia.

In part I of my post (HERE), I discussed common dyslexia myths as well as general language testing as a starting point in the dyslexia testing battery.

In part II I detailed the next two steps in dyslexia assessment: phonological awareness and word fluency testing (HERE).

Today I would like to discuss part III of comprehensive dyslexia assessment, which discusses reading fluency and reading comprehension testing.

Let’s begin with reading fluency testing, which assesses the students’ ability to read word lists or short paragraphs with appropriate speed and accuracy. Here we are looking for how many words the student can accurately read per minute orally and/or silently (see several examples  of fluency rates below).


Research indicates that oral reading fluency (ORF) on passages is more strongly related to reading comprehension than ORF on word lists. This is an important factor which needs to be considered when it comes to oral fluency test selection.

Oral reading fluency tests are significant for a number of reasons. Firstly, they allow us to identify students with impaired reading accuracy. Secondly, they allow us to identify students who can decode words with relative accuracy but who cannot comprehend what they read due to significantly decreased reading speed. When you ask such children: “What did you read about?” They will frequently respond: “I don’t remember because I was so focused on reading the words correctly.”

One example of a popular oral reading fluency test (employing reading passages) is the Gray Oral Reading Tests-5 (GORT-5). It yields the scores on the student’s:GORT-5: Gray Oral Reading Tests–Fifth Edition, Complete Kit

  • Rate
  • Accuracy
  • Fluency
  • Comprehension
  • Oral Reading Index (a composite score based on Fluency and Comprehension scaled scores)

Another types of reading fluency tests are tests of silent reading fluency. Assessments of silent reading fluency can at selectively useful for identifying older students with reading difficulties and monitoring their progress. One obvious advantage to silent reading tests is that they can be administered in group setting to multiple students at once and generally takes just few minutes to administer, which is significantly less then oral reading measures take to be administered to individual students.

Below are a several examples of silent reading tests/subtests.

TOSWRF-2: Test of Silent Word Reading Fluency–Second EditionThe Test of Silent Word Reading Fluency (TOSWRF-2) presents students with rows of words, ordered by reading difficulty without spaces (e.g., dimhowfigblue). Students are given 3 minutes to draw a line between the boundaries of as many words as possible (e.g., dim/how/fig/blue).

The Test of Silent Contextual Reading Fluency (TOSCRF-2) presents students with text passages with all words printed in uppercase letters with no separations between words and no punctuation or spaces between sentences and asks them to use dashes to separate words in a 3 minute period.

Similar to the TOSCRF-2, the Contextual Fluency subtest of the Test of Reading Comprehension – Fourth Edition (TORC-4) measures the student’s ability to recognize individual words in a series of passages (taken from the TORC-4′Text Comprehension subtest) in a period of 3 minutes. Each passage, printed in uppercase letters without punctuation or spaces between words, becomes progressively more difficult in content, vocabulary, and grammar. As students read the segments, they draw a line between as many words as they can in the time allotted.  (E.g., THE|LITTLE|DOG|JUMPED|HIGH)

However, it is important to note oral reading fluency is a better predictor of reading comprehension than is silent reading fluency for younger students (early elementary age). In contrast, silent reading measures are more strongly related to reading comprehension in middle school (e.g., grades 6-8) but only for skilled vs. average readers, which is why oral reading fluency measures are probably much better predictors of deficits in this area in children with suspected reading disabilities.

Now let’s move on to the reading comprehension testing, which is an integral component for any dyslexia testing battery. Unfortunately, it is also the most trickiest. Here’s why.

Many children with reading difficulties will be able to read and comprehend short paragraphs containing factual information of decreased complexity. However, this will change dramatically when it comes to the comprehension of longer, more complex, and increasingly abstract age-level text. While a number of tests do assess reading comprehension, none of them truly adequately assess the students ability to comprehend abstract information.

For example, on the Reading Comprehension subtest of the CELF-5, students are allowed to keep the text and refer to it when answering questions. Such option will inflate the students scores and not provide an accurate idea of their comprehension abilities.

To continue, the GORT-5 contains reading comprehension passages, which the students need to answer after the stimuli booklet has been removed from them. However, the passages are far more simplistic then the academic texts the students need to comprehend on daily basis, so the students may do well on this test yet still continue to present with significant comprehension deficits.

Similar could be said for the text comprehension components of major educational testing batteries such as the Woodcock Johnson IV: Passage Comprehension subtest, which gives the student sentences with a missing word, and the student is asked to orally provide the word. However, filling-in a missing word does not text comprehension make.

WIAT-III Examination KitLikewise, the Wechsler Individual Achievement Test®-Third Edition (WIAT-III), Reading Comprehension subtest is very similar to the CELF-5. Student is asked to read a passage and answer questions by referring back to the text. However, just because a student can look up the answers in text does not mean that they actually understand the text.

So what could be done to accurately assess the student’s ability to comprehend abstract grade level text? My recommendation is to go informal. Select grade-level passages from the student’s curriculum pertaining to science, social studies, geography, etc. vs. language arts (which tends to be more simplistic) and ask the student to read them and answer factual questions regarding supporting details as well as non factual questions relevant to main ideas and implied messages.

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Part II: Components of Comprehensive Dyslexia Testing – Phonological Awareness and Word Fluency Assessment

Lettere01gorgoA few days ago I posted my first installment in the comprehensive assessment of dyslexia series, discussing common dyslexia myths as well as general language testing as a starting point in the dyslexia testing battery. (You can find this post HERE).

Today I would like to discuss the next two steps in dyslexia assessment, which are phonological awareness and word fluency testing.

Let’s begin with phonological awareness (PA). Phonological awareness is a precursor to emergent reading. It allows children to understand and manipulate sounds in order to form or breakdown words. It’s one of those interesting types of knowledge, which is a prerequisite to everything and is definitive of nothing. I like to compare it to taking a statistics course in college. You need it as a prerequisite to entering a graduate speech pathology program but just because you successfully complete it does not mean that you will graduate the program.  Similarly, the children need to have phonological awareness mastery in order to move on and build upon existing skills to become emergent readers, however, simply having this mastery does not a good reader make (hence this is only one of the tests in dyslexia battery).

When a child has poor phonological awareness for his/her age it is a red flag for reading disabilities. Thus it is very important to assess the child’s ability to successfully manipulate sounds (e.g., by isolating, segmenting, blending, etc.,)  in order to produce real or nonsense words.

Why are nonsense words important?

According to Shaywitz (2003), “The ability to read nonsense words is the best measure of phonological decoding skill in children.” (p. 133-134) Being able to decode and manipulate (blend, segment, etc.) nonsense words is a good indication that the child is acquiring comprehension of the alphabetic principle (understands sound letter correspondence or what common sounds are made by specific letters). It is a very important part of a dyslexia battery since nonsense words cannot be memorized or guessed but need to be “truly decoded.”

While a number of standardized tests assess phonological awareness skills, my personal preference is the Comprehensive Test of Phonological Processing-2 (CTOPP-2), which assesses the following areas:

  • Phonological Segmentation
  • Blending Words
  • Sound Matching
  • Initial, Medial and Final Phoneme Isolation
  • Blending Nonwords 
  • Segmenting Nonwords 
  • Memory for Digits
  • Nonword Repetition 
  • Rapid Digit Naming 
  • Rapid Letter Naming 
  • Rapid Color Naming 
  • Rapid Object Naming 

 As you can see from above description, it not only assesses the children’s ability to manipulate real words but also their ability to manipulate nonsense words. It also assesses word fluency skills via a host of rapid naming tasks, so it’s a very convenient tool to have as part of your dyslexia testing battery.

This brings us to another integral part of the dyslexia testing battery which is word fluency testing (WF).  During word fluency tasks a child is asked to rapidly generate words on a particular topic given timed constraints (e.g., name as many animals as you can in 1 minute, etc.). We test this rapid naming ability because we want to see how quickly and accurately the child can process information. This ability is very much needed to become a fluent reader.

Poor readers can name a number of items but they may not be able to efficiently categorize these words. Furthermore, they will produce the items with a significantly decreased processing speed as compared to good readers. Decreased word fluency is a significant indicator of reading deficits. It is  frequently observable in children with reading disabilities when they encounter a text with which they lack familiarity. That is why this ability is very important to test.

Several tests can be used for this purpose including  CTOPP-2 and Rapid Automatized Naming and Rapid Alternating Stimulus Test (RAN/RAS) just to name a few. However, since CTOPP-2 already has a number of subtests which deal with testing this skill, I prefer to use it to test both phonological awareness and word fluency.

Read part III of this series which discusses components of Reading Fluency and Reading Comprehension testing HERE.

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Components of Comprehensive Dyslexia Testing: Part I- Introduction and Language Testing

Image result for dyslexia lawsWith the passing of dyslexia laws in the state of New Jersey in 2014, there has been an increased focus on reading disabilities and dyslexia particularly in the area of effective assessment and remediation. More and more parents and health related professionals are looking to understand the components of effective dyslexia testing and who is qualified to perform it. So I decided to write a multi-part series regarding the components of comprehensive dyslexia testing in order to assist parents and professionals to better understand the steps of the testing process.

In this particular post I would like to accomplish two things: dispel several common myths regarding dyslexia testing as well as discuss the first step of SLP based testing which is a language assessment.

Myth 1: Dyslexia can be diagnosed based on a single test!

DYSLEXIA CANNOT BE CONFIRMED BY THE ADMINISTRATION OF ONE SPECIFIC TEST. A comprehensive battery of tests from multiple professionals including neuropsychologists, psychologists, learning specialists, speech-language pathologists and even occupational therapists needs to actually be administered in order to confirm the presence of reading based disabilities.

Myth 2: A doctor can diagnose dyslexia!

A doctor does not have adequate training to diagnose learning disabilities, the same way as a doctor cannot diagnose speech and language problems. Both lie squarely outside of their scope of practice! A doctor can listen to parental concerns and suggest an appropriate plan of action (recommend relevant assessments)  but they couldn’t possibly diagnose dyslexia which is made on the basis of team assessments.

Myth 3: Speech Pathologists cannot perform dyslexia testing!

SPEECH-LANGUAGE PATHOLOGISTS TRAINED IN IDENTIFICATION OF READING AND WRITING DISORDERS ARE FULLY QUALIFIED TO PERFORM SIGNIFICANT PORTIONS OF DYSLEXIA BATTERY.

So what are the dyslexia battery components?

Prior to initiating an actual face to face assessment with the child, we need to take down a thorough case history (example HERE) in order to determine any pre-existing risk factors. Dyslexia risk factors may include (but are not limited to):

  • History of language and learning difficulties in the family
  • History of language delay (impaired memory,  attention, grammar, syntax, sentence repetition ability, etc) as well as
  • History of impaired phonological awareness skills (difficulty remembering children’s songs, recognizing and making rhymes, confusing words that sound alike,  etc).

After that, we need to perform language testing to determine whether the child presents with any deficits in that area. Please note that while children with language impairments are at significant risk for dyslexia not all children with dyslexia present with language impairments. In other words, the child may be cleared by language testing but still present with significant reading disability, which is why comprehensive language testing is only the first step in the dyslexia assessment battery.

Image result for language testingLANGUAGE TESTING

Here we are looking to assess the child’s listening comprehension. processing skills, and verbal expression in the form of conversational and narrative competencies. Oral language is the prerequisite to reading and writing.   So a single vocabulary test, a grammar completion task, or even a sentence formulation activity is simply not going to count as a part of a comprehensive assessment.

In children without obvious linguistic deficits such as limited vocabulary, difficulty following directions, or grammatical/syntactic errors (which of course you’ll need to test) I like to use the following tasks, which are sensitive to language impairment:

Listening Comprehension (with a verbal response component)

  • Here it is important to assess the student’s ability to listen to short passages and answer a variety of story related questions vs. passively point at 1 of 4 pictures depicting a particular sentence structure (e.g., Point to the picture which shows: “The duck was following the girl”). I personally like to use the Listening Comprehension Tests for this task but any number of subtests from other tests have similar components.

Semantic Flexibility

  • Here it is important to assess the student’s vocabulary ability via manipulation of words to create synonyms, antonyms, multiple meaning words, definitions, etc. For this task I like to use the WORD Tests (3-Elementary and 2-Adolescent).

Narrative Production:

  • A hugely important part of a language assessment is an informal spontaneously produced narrative sample, which summarizes a book or a movie.  Just one few minute narrative sample can yield information on the following:
  • Sequencing Ability
  • Working MemoryRelated image
  • Grammar
  • Vocabulary
  • Pragmatics and perspective taking
  • Story grammar (Stein & Glenn, 1979)

Usually I don’t like to use any standardized testing for assessment of this skill but use the parameters from the materials I created myself based on existing narrative research (click HERE).

Social Pragmatic Language

  • Given my line of work (school in an outpatient psychiatric setting), no testing is complete without some for of social pragmatic language assessment in order to determine whether the student presents with hidden social skill deficits. It is important to note that I’ve seen time and time again students acing the general language testing only to bomb on the social pragmatic tasks which is why this should be a mandatory part of every language test in my eyes. Here, a variety of choices exists. For quick results I typically tends to use the Social Language Development Tests as well as portions of the Social Thinking Dynamic Assessment Protocol®.

Not sure what type of linguistic deficits your student is displaying? Grab a relevant checklist and ask the student’s teacher and parent fill it out (click HERE to see types of available checklists)

So there you have it! The first installment on comprehensive dyslexia testing is complete.

READ part II which discusses components of Phonological Awareness and Word Fluency testing HERE

Read part III of this series which discusses components of Reading Fluency and Reading Comprehension testing HERE.

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How Early can “Dyslexia” be Diagnosed in Children?

Image result for dyslexiaIn recent years there has been a substantial rise in awareness pertaining to reading disorders in young school-aged children. Consequently, more and more parents and professionals are asking questions regarding how early can “dyslexia” be diagnosed in children.

In order to adequately answer this question, it is important to understand the trajectory of development of literacy disorders in children. Continue reading How Early can “Dyslexia” be Diagnosed in Children?

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Help, My Child is Receiving All These Therapies But It’s NOT Helping

On a daily basis I receive emails and messages from concerned parents and professionals, which read along these lines: “My child/student has been diagnosed with: dyslexia, ADHD, APD etc., s/he has been receiving speech, OT, vision, biofeedback, music therapies, etc. but nothing seems to be working.”

Up until now, I have been providing individualized responses to such queries, however, given the unnerving similarity of all the received messages, today I decided to write this post, so other individuals with similar concerns can see my response. Continue reading Help, My Child is Receiving All These Therapies But It’s NOT Helping

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Why “good grades” do not automatically rule out “adverse educational impact”

Image result for good grades?As a speech-language pathologist (SLP) working with school-age children, I frequently assess students whose language and literacy abilities adversely impact their academic functioning.   For the parents of school-aged children with suspected language and literacy deficits as well as for the SLPs tasked with screening and evaluating them, the concept of ‘academic impact’ comes up on daily basis. In fact, not a day goes by when I do not see a variation of the following question: “Is there evidence of academic impact?”, being discussed in a variety of Facebook groups dedicated to speech pathology issues. Continue reading Why “good grades” do not automatically rule out “adverse educational impact”

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Dear Reading Specialist, May I Ask You a Few Questions?

Because the children I assess, often require supplementary reading instruction services, many parents frequently ask me how they can best determine if a reading specialist has the right experience to help their child learn how to read. So today’s blog post describes what type of knowledge reading specialists ought to possess and what type of questions parents (and other professionals) can ask them in order to determine their approaches to treating literacy-related difficulties of struggling learners. Continue reading Dear Reading Specialist, May I Ask You a Few Questions?

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Treatment of Children with “APD”: What SLPs Need to Know

Free stock photo of people, woman, cute, playingIn recent years there has been an increase in research on the subject of diagnosis and treatment of Auditory Processing Disorders (APD), formerly known as Central Auditory Processing Disorders or CAPD.

More and more studies in the fields of audiology and speech-language pathology began confirming the lack of validity of APD as a standalone (or useful) diagnosis. To illustrate, in June 2015, the American Journal of Audiology published an article by David DeBonis entitled: “It Is Time to Rethink Central Auditory Processing Disorder Protocols for School-Aged Children.” In this article, DeBonis pointed out numerous inconsistencies involved in APD testing and concluded that “routine use of APD test protocols cannot be supported” and that [APD] “intervention needs to be contextualized and functional” (DeBonis, 2015, p. 124)

Image result for time to rethink quotesFurthermore, in April 2017, an article entitled: “AAA (2010) CAPD clinical practice guidelines: need for an update” (also written by DeBonnis) concluded that the “AAA CAPD guidance document will need to be updated and re-conceptualised in order to provide meaningful guidance for clinicians” due to the fact that the “AAA document … does not reflect the current literature, fails to help clinicians understand for whom auditory processing testing and intervention would be most useful, includes contradictory suggestions which reduce clarity and appears to avoid conclusions that might cast the CAPD construct in a negative light. It also does not include input from diverse affected groups. All of these reduce the document’s credibility.” 

Image result for systematic reviewIn April 2016, de Wit and colleagues published a systematic review in the Journal of Speech, Language, and Hearing ResearchThey reviewed research studies which described the characteristics of APD in children to determine whether these characteristics merited a label of a distinct clinical disorder vs. being representative of other disorders.  After a search of 6 databases, they chose 48 studies which satisfied appropriate inclusion criteria. Unfortunately, they unearthed only one study with strong methodological quality. Even more disappointing was that the children in these studies presented with incredibly diverse symptomology. The authors concluded that “The listening difficulties of children with APD may be a consequence of cognitive, language, and attention issues rather than bottom-up auditory processing” (de Wit et al., 2016, p. 384).  In other words, none of the reviewed studies had conclusively proven that APD was a distinct clinical disorder.  Instead, these studies showed that the children diagnosed with APD exhibited language-based deficits. In other words, the diagnosis of APD did not reveal any new information regarding the child beyond the fact that s/he is in great need of a comprehensive language assessment in order to determine which language-based interventions s/he would optimally benefit from.

Now, it is important to reiterate that students diagnosed with “APD” present with legitimate symptomology (e.g., difficulty processing language, difficulty organizing narratives, difficulty decoding text, etc.). However, all the research to date indicates that these symptoms are indicative of broader language-based deficits, which require targeted language/literacy-based interventions rather than recommendations for specific prescriptive programs (e.g., CAPDOTS, Fast ForWord, etc.) or mere in-school accommodations.

Image result for dig deeper quotesUnfortunately, on numerous occasions when the students do receive the diagnosis of APDthe testing does not “dig further,” which leads to many of them not receiving appropriate comprehensive language-literacy assessments.  Furthermore, APD then becomes the “primary” diagnosis for the student, which places SLPs in situations in which they must address inappropriate therapeutic targets based on an audiologist’s recommendations.  Even worse, in many of these situations, the diagnosis of APD limits the provision of appropriate language-based services to the student.

Since the APD controversy has been going on for years with no end in sight despite the mounting evidence pointing to the lack of its validity, we know that SLPs will continue to have students on their caseloads diagnosed with APD. Thus, the aim of today’s post is to offer some constructive suggestions for SLPs who are asked to assess and treat students with “confirmed” or suspected APD.

The first suggestion comes directly from Dr. Alan Kamhi, who states: “Do not assume that a child who has been diagnosed with APD needs to be treated any differently than children who have been diagnosed with language and learning disabilities” (Kamhi, 2011, p. 270).  In other words, if one carefully analyzes the child’s so-called processing issues, one will quickly realize that those issues are not related to the processing of auditory input  (auditory domain) since the child is not processing tones, hoots, or clicks, etc. but rather has difficulty processing speech and language (language domain).

If a student with confirmed or suspected APD is referred to an SLP, it is important, to begin with formal and informal assessments of language and literacy knowledge and skills. (details HERE)   SLPs need to “consider non-auditory reasons for listening and comprehension difficulties, such as limitations in working memory, language knowledge, conceptual abilities, attention, and motivation (Kamhi & Wallach, 2012).

Image result for language goalsAfter performing a comprehensive assessment, SLPs need to formulate language goals based on determined areas of weaknesses. Please note that a systematic review by Fey and colleagues (2011) found no compelling evidence that auditory interventions provided any unique benefit to auditory, language, or academic outcomes for children with diagnoses of (C)APD or language disorder. As such it’s important to avoid formulating goals focused on targeting isolated processing abilities like auditory discrimination, auditory sequencing, recognizing speech in noise, etc., because these processing abilities have not been shown to improve language and literacy skills (Fey et al., 2011; Kamhi, 2011).

Instead, SLPs need to target we need to focus on the language underpinnings of the above skills and turn them into language and literacy goals. For example, if the child has difficulty recognizing speech in noise, improve the child’s knowledge and access to specific vocabulary words.  This will help the child detect the word when the auditory information is degraded.  Child presents with phonemic awareness deficits? Figure out where in the hierarchy of phonemic awareness their strengths and weaknesses lie and formulate goals based on the remaining areas in need of mastery.  Received a description of the child’s deficits from the audiologist in an accompanying report? Turn them into language goals as well!  Turn “prosodic deficits” or difficulty understanding the intent of verbal messages into “listening for details and main ideas in stories” goals.   In other words, figure out the language correlate to the ‘auditory processing’ deficit and replace it.

Image result for quackeryIt is easy to understand the appeal of using dubious practices which promise a quick fix for our student’s “APD deficits” instead of labor-intensive language therapy sessions. But one must also keep something else in mind as well:   Acquiring higher order language abilities takes a significant period of time, especially for those students whose skills and abilities are significantly below age-matched peers.

APD Summary 

  1. There is still no compelling evidence that APD is a stand-alone diagnosis with clear diagnostic criteria.
  2. There is still no compelling evidence that auditory deficits are a “significant risk factor for  language or academic performance.”
  3. There is still no compelling evidence that “auditory interventions provide any unique benefit to auditory, language, or academic outcomes” (Hazan, Messaoud-Galusi, Rosan, Nouwens, & Shakespeare, 2009; Watson & Kidd, 2009).
  4. APD deficits are language based deficits which accompany a host of developmental conditions ranging from developmental language disorders to learning disabilities, etc.
  5. SLPs should perform comprehensive language and literacy assessments of children diagnosed with APD.
  6. SLPs should target   literacy goals.
  7. SLPS should be wary of any goals or recommendations which focus on remediation of isolated skills such as: “auditory discrimination, auditory sequencing, phonological memory, working memory, or rapid serial naming” since studies have definitively confirmed their lack of effectiveness (Fey et al., 2011).
  8. SLPs should be wary of any prescriptive programs offering APD “interventions” and instead focus on improving children’s abilities for functional communication including listening, speaking, reading, and writing (see Wallach, 2014: Improving Clinical Practice: A School-Age and School-Based Perspective).  This article  “presents a conceptual framework for intervention at school-age levels” and discusses “advanced levels of language that move beyond preschool and early elementary grade goals and objectives with a focus on comprehension and meta-abilities.”

There you have it!  Students diagnosed with APD are best served by targeting the language and literacy problems that are affecting their performance in school. 

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