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Speech, Language, and Literacy Fun with Helen Lester’s Picture Books

Picture books are absolutely wonderful for both assessment and treatment purposes! They are terrific as narrative elicitation aids for children of various ages, ranging from pre-K through fourth grade.  They are amazing treatment aids for addressing a variety of speech, language, and literacy goals that extend far beyond narrative production.

There are numerous children books authors whom I absolutely adore (e.g., Karma Wilson, Keiko Kasza, Jez Alborough, M. Christina Butler, etc.). Today I wanted to describe how I implement books by Helen Lester into my treatment sessions with elementary aged children. (For information on how I use her books: “Pookins Gets Her Way” and “A Porcupine Named Fluffy” for narrative elicitation purposes click HERE.)

It is important to note that while Ms. Lester’s books are intended for younger children (4-7 years; pre-K-3rd grade), older children (~10 years of age) with significant language and learning difficulties and/or intellectual disabilities have enjoyed working with them and have significantly benefited from reading/listening to them.

Two reasons why I love using Ms. Lester’s books are versatility and wealth of social themes. To illustrate, “Hooway for Wodney Wat” and “Wodney Wat’s Wobot” are two books about a shy rat who cannot pronounce his ‘r’ sounds. Wodney is hugely embarrassed by that fact, and since there are no speech-language pathologists in Rodentia-land, Wodney spends his recess, hiding inside his jacket, trying to be as inconspicuous as possible. The arrival of a bullying, Miss-know-it-all, Camilla Capybara, brings some unexpected changes into the school’s dynamic, as well as provides Wodney with a very welcome opportunity to shine socially.

Image result for wodney wobotSpeech Production: Not only is there a phenomenal opportunity to use this book with children struggling with /r/ sound production, but it’s also heavily laden with a plethora of /r/ words in a variety of word positions (e.g., rodeo, robot, contraption, barrel, terrific, fur, prickled, bigger, fear, classroom, smarter, sure, etc.).

Language: There are numerous language goals that could be formulated based on Helen Lester’s books including answering concrete and abstract listening comprehension questions, defining story-embedded vocabulary words, producing word associations, synonyms, antonyms, and multiple meaning words (semantic awareness), formulating compound and complex sentences (syntax), answering predicting and inferencing questions (critical thinking), gauging moods and identifying emotional reactions of characters (social communication), assuming characters’ perspectives and frame of reference (social cognition, theory of mind, etc.), identifying main ideas in text (Gestalt processing) and much, much more.

  • Select Highlights:
    • VocabularyFor the ages/grades that there’ve written for (4-7 years; pre-K-3rd grade), Ms. Lester’s books are laden with a wealth of sophisticated vocabulary words such a: curtsy, contraption, trembled, dreary, shudder, varmint, fashionable, rodent, rattled, shenanigans, chanting, surgical, plunked, occasion, exception, etc.
    • Word Play:  Ms. Lester infuses a great deal of humor and wit in her books. Just look at the names of her characters in “A Sheep in Wolf’s Clothing”, which are: Ewetopia, Ewecalyptus, Ewetensil, Heyewe, Rambunctious, Ramshackle, and Ramplestiltskin.  Her ovine characters live in Pastureland and attend Woolyones’ Costume Balls while her porcine characters eat in a trough-a-teria.  
    • Social Communication: Many of Ms. Lester’s book themes focus on the celebration of neurodiversity (e.g., “Tacky the Penguin”), learning valuable life lessons (e.g., “Me First”), addressing one’s fears (e.g., “Something Might Happen”) and feeling uncomfortable in own skin (e.g., “A Sheep in Wolf’s Clothing”), etc.

Literacy: Similar to the above, numerous literacy goals can be formulated based on these books. These include but are not limited to, goals targeting phonological (e.g., rhyming words, counting syllables in words, etc.) and phonemic awareness, phonics, reading fluency and comprehension, spelling, as well as the composition of written responses to story questions.

  • Image result for princess penelope's parrotSelect Highlights:
    • Phonics: Students can practice reading words containing a variety of syllable shapes as well as decode low-frequency words containing a variety of consonantal clusters (Examples from “Princess Penelope’s Parrot” are:  hissed, parrot, buzzard, horribly, flicked, plucked, field,  flapped, silence, Percival, velvet, cloak, caviar, clippy-clopped, poofiest, impressed, expensive, galloping, gulped, bouquet, squawked, etc.)
    • Morphology: There’s a terrific opportunity to introduce a discussion on roots and affixes when using Ms. Lester’s books to discuss how select prefixes and suffixes (e.g., ante-, -able, -ive, -ion, etc.) can significantly increase word sophistication of numerous root words (e.g., impressive, exception, etc.)
    • Spelling: There is a terrific opportunity for children to practice spelling numerous spelling patterns to solidify their spelling abilities, including -ee-, -ea-, -ou-,-oo-, -oa-, -ui-, -ck, -tt-, -rr-, -ss-, -cc-, etc.

When working with picture books, I typically spend numerous sessions working with the same book. That is because research indicates that language disordered children require 36 exposures  (as compared with 12 exposures for typically developing children) to learn new words via interactive book reading (Storkel et al, 2016). As such, I discuss vocabulary words before, during, and after the book reading, by asking the children to both repeatedly define and then use selected words in sentences so the students can solidify their knowledge of these words.

I also spent quite a bit of time on macrostructure, particularly on the identification and definitions of story grammar elements as well as having the student match the story grammar picture cards to various portions of the book.

When working with picture books, here are some verbal prompts that I provide to the students with a focus on story Characters and Setting

  • Who are the characters in this story?
  • Where is the setting in this story?
  • Are there multiple settings in this story?
  • What are some emotions the characters experience throughout this story?
  • When did they experience these emotions in the story?
  • How do you think this character is feeling when ____?
    • Why?
    • How do you know?
  • What do you think this character is thinking?
    • Why?
    • How do you know?
  • What are some actions the characters performed throughout the story?
  • What were the results of some of those actions?

Here is a sampling of verbal prompts I provide to the students with a focus on story Sequencing 

  • What happened at the beginning of the story?
    • What words can we use to start a story?
  • What happened next?
  • What happened after that?
  • What happened last?
  • How do we end a story?
  • What was the problem in the story?
  • Was there more than one problem?
    • What happened?
    • Who solved it?
    • How did s/he solve it?
  • Was there adventure in the story?
    • If yes, how did it start and end?

Here is a sampling of verbal prompts I provide to the students with a focus on Critical Thinking 

  • How are these two characters alike/different? (compare/contrast)
  • What do you think will happen next? (predicting)
  •  Why/How do you think ___ happened (inferencing)
  • Why shouldn’t you, couldn’t s/he ____ ? (answering negative questions)
  • What do you thing s/he must do to ______? (problem-solving)
  • How would you solve his problem? (determining solutions)
  • Why is your solution ______ a good solution? (providing justifications)

Image result for tacky penguinHere is a small sampling of verbal prompts I provide to the students with a focus on Social Communication and Social Cognition 

  • How would you feel if ____?
  • What is his/her mood at ____ point in the story?
    • How do you know?
  • What is his/her reaction to the ____?
    • How do you know?
  • How does it make you feel that s/he are _____?
  • Can you tell me two completely different results of this character’s actions?
  • What could you say to this character to make him/her feel better?
    • Why?
  • What would you think if?

At times, I also use Ms. Lester’s guide for the following books: ‘It Wasn’t My Fault’, ‘Listen, Buddy’, ‘Me First’, and ‘A Porcupine Named Fluffy‘ to supplement my therapy sessions goals. It provides additional helpful ideas and suggestions on how her books can be further used in both therapy room as well as the classroom.

Finally, one of the major reasons why I really like Ms. Lester’s books is because some of them are ‘art imitating life’ and do not necessarily end up in a ‘traditional’ happily ever after. To, illustrate, “Princess Penelope’s Parrot” is a book about a spoiled princess who cannot get her new parrot to talk, even after threatening it and calling it insulting names. When Prince Percival comes courting, the parrot takes his hilarious revenge on Princess Penelope, and the parrot and Prince Percival do end up living happily ever after. However, Princess Penelope quickly gets over her embarrassment and goes back to her unrepentantly spoiled way of acting.

There you have it! Just a few of my many reasons why I adore using Helen Lester’s books for language and literacy treatment purposes. How about you? Do you use any of her books for assessment and treatment purposes? If yes, comment below which ones you use and why do you use them?

References:

Helpful Related Smart Speech Therapy Resources: 

 

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Tips on Reducing ‘Summer Learning Loss’ in Children with Language/Literacy Disorders

Related imageThe end of the school year is almost near. Soon many of our clients with language and literacy difficulties will be going on summer vacation and enjoying their time outside of school. However, summer is not all fun and games.  For children with learning needs, this is also a time of “learning loss”, or the loss of academic skills and knowledge over the course of the summer break.  Students diagnosed with language and learning disabilities are at a particularly significant risk of greater learning loss than typically developing students.

 However, there are a number of things that parents can do in an attempt to address this problem. Firstly, consistency is important, so is that there is an opportunity for the students to attend an extended school year it should definitely be taken. Similarly, while all students deserve a hard-earned break, taking an extended break (e.g., two months) from private therapies is not recommended. In the absence of an opportunity to attend an extended school year program, attendance at a summer camp with a good educational component may be the next best option (if financially viable for the parents).

However, in the absence of these options, parents can still do a great deal with the children at home in order to promote learning as well as mitigate the effects of summer learning loss. Consider creating a learning schedule for the week.  Sit down with your child and determine how many minutes a day s/he would be willing to engage in learning.  Rather than doing everything in one day, create a schedule of dates and times when reading, math, as well as science and social studies may be tackled in manageable quantities.

There are a number of fun educational outings for families to embark on in the summer.  While attendance of museums, zoos, or fairs, is often paid, there are still many free events accessible to parents out of which one could potentially create wonderful learning opportunities.

Image result for free admissionDenizens of major cities such as Washington DC or New York have a plethora of free educational events accessible to them. The Washington Mall offers free admission while numerous New York museums offer free admission on selected days of the week. However, a quick search also reveals that many US states, offer wonderful free educational attractions. Here’s a list of major free educational attractions in the state of NJ, which includes an art museum, a living farm, a center for contemporary art, a naval museum, and a 9/11 memorial, just to name a few.  All of these locations could be turned into wonderful learning opportunities replete with novel vocabulary words with science and social study themes.

In addition to these outings is strongly recommended that parents encourage their children to read for pleasure.   There are numerous lists of books available by grade level for the purpose of summer reading.  Furthermore, it is strongly recommended that parents read aloud to their kids, (link to read aloud book recommendations HERE) especially those who are still emergent readers to facilitate vocabulary growth and “introduce young ears to complex and nuanced syntax“.

But it’s not all books and direct learning. A lot of learning can actually be accomplished indirectly via educational summer games as well.   Games such as A to Z Jr, Tribond Jr, Fib or Not, etc., are terrific for working on word finding, verbal reasoning, problem-solving, storytelling, etc. Furthermore, games such as Hedbanz are fantastic for improving executive function skills in the areas of emotional control, self-monitoring, organization, task initiation, etc.

Summer may be a time when learning slows down, but it doesn’t have to stop! Children can still accomplish a great deal of learning through read alouds, educational outings, fun language promoting games, and much, much more!

FOR A PDF HANDOUT FOR PARENTS PLEASE CLICK HERE

References:

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Improving Accountability of ASHA Approved Continuing Education Providers

Image result for accountabilitySeveral days ago I had a conversation with the Associate Director of Continuing Education at ASHA regarding my significant concerns about the content and quality of some of ASHA approved continuing education courses. For many months before that, numerous discussions took place in a variety of major SLP related Facebook groups, pertaining to the non-EBP content of some of ASHA approved provider coursework, many of which was blatantly pseudoscientific in nature.

The fact is while there is a rigorous process involved in becoming an ASHA approved continuing education provider, once that approval is granted, ASHA is not privy to course content. In other words, no staff member at ASHA is available to screen course documents (pdfs, pptx, handouts, etc.) to ensure that it is scientifically supported and is free of pseudoscientific and questionable information.

Furthermore, in order to account for the lack of review of course content, ASHA has an explicit disclaimer, which is placed on all the accredited promotional CEU material. It states that: “ASHA CE Provider Approval does not imply endorsement of course content, specific products, or clinical procedures.”

However, this creates a significant disconnect between what is being ‘preached’ and what is being ‘practiced’. This is especially important because many SLPs are spending their hard-earned money on ASHA approved courses, which they leave not only feeling significantly disappointed and disillusioned but also feeling like they had completely wasted their money.

As a result, it is very important for ASHA to know when the SLPs has taken a particularly disappointing and pseudoscientific slanted course. For a review of what constitutes pseudoscientific practices, I highly recommend becoming familiar with the body of work of Dr. Gregory Lof as well as reading a serious of block posts on this topic by Mary Huston.

 So if you are unhappy with an ASHA approved continuing education course (PRESENT or PAST) because its content him is/was heavily biased and unscientific in nature, it is important that ASHA knows about it! Be as vocal as you can in order to raise the alarm about pseudoscientific CEUs from ASHA approved providers.  Below are some ways members can complain to ASHA (these complaints can be copied and pasted to save time).

Provider Complaint Submission Form:https://www.asha.org/Form/CE-Provider-Complaint-Submission/

SLP Advisory Council: https://www.asha.org/About/governance/Speech-Language-Pathology-Advisory-Council-Members/

Audiology Advisory Council: https://www.asha.org/About/governance/Audiology-Advisory-Council-Members/

Provide Feedback to the Board of Directors:http://www.asha.org/Form/Board-of-Directors-Feedback/

SLPs can also access a letter template in the files section of the SLPs for Evidence-Based Practice group on Facebook, to voice their dissatisfaction when encountering questionable coursework presented by ASHA  approved providers.

Remember that you are not obligated by any means to take ASHA Approved CEU Courses in order to maintain your certification!  As such, you do NOT have to spend your hard earned money on low-quality coursework! Continuing education is a significant revenue stream for ASHA. Refusing to participate, unless a meaningful change is implemented, will go a long way in delivering a serious message to the association that things cannot remain as they are now.

So go ahead and make your voice heard! ASHA relies on member feedback in order to implement meaningful and constructive change. Don’t depend on others to complain, get involved yourself first, and make sure that ASHA hears you loud and clear. The first step on the long road to making a difference needs to be taken by you!  Please take it!

 

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Some Facts About ASHA CEUs, Registry, and Approved Provider Courses

Related imageTypically, approximately twice a year, right around late December or at the start of summer vacation in the schools, a flurry of SLPs begin to inquire on a variety of social media forums regarding “free or cheap ASHA CEU’s”.

So today I wanted to take the opportunity to talk about how these CEUs can be acquired in accordance with ASHA compliance.  For newly graduating SLPs as well as Clinical Fellows, CEU’s or Continuing Education Units are the continuing education hours needed by speech pathologists to stay abreast of current developments in the field and maintain their Certificate of Clinical Competence or CCCs. ASHA requires that all holders of CCCs “accumulate 30 Certification Maintenance Hours (CMHs) of professional development during each 3-year certification maintenance interval in order to maintain their ASHA Certificates of Clinical Competence (CCC).”

Wait a minute you might say. Weren’t you just talking about continuing education units? And the truth is, I was, but ASHA does not require you to specifically obtain CEU’s from ASHA Approved Providers in order to maintain your credentials. According to ASHA what you need to accrue are your professional development hours, which you can obtain from a number of sources.

Let’s look at the difference between CEU’s and CMH’s. CEU’s are continuing education units.  You can obtain them by going to conferences and workshops presented by ASHA approved providers.  In contrast, CMH’s are your Certification Maintenance Hours -1 contact hour (60 minutes)=1 CMH.

Image result for certificate of trainingHere before the continue, it is very important to discuss the role of the ASHA registry, you know the one for which you pay $28 a year.  The ASHA registry is a paid service provided by ASHA.  The way it works is as follows. You find a conference being offered by an ASHA approved provider, attended it and earn your CEUs. The conference organizers will then forward the information that you attended the conference to ASHA and if you are presently paying for an ASHA registry, CEUs will be recorded in your transcript. Essentially this works similarly to a college registrar office. You accumulate CEUs, ASHA maintains a record of your CEUs, and forwards you an official transcript once a year upon request.  According to the ASHA website there are numerous benefits to their service (you can see them all HERE).

But must you absolutely purchase the ASHA registry? The answer is absolutely NOT!  Here is where we can go back to our discussion of CEU’s and CMH’s.   As mentioned before CMHs are professional development hours. ASHA will accept them, no questions asked, provided they are one of the following activities:

  • Teacher Trainings 
  • Private Practice Training/Seminars
  • Supervisor Trainings
  • Employer-sponsored in-services 
  • State association workshops
  • College/university course work

All you need to do is to obtain a certificate of attendance and keep it for your records in case you are audited. That’s it!  You do not need to pay for these courses if they are offered through your job for free (or if you can find them for free)!   As long as you can provide proof of PD attendance, ASHA will accept it and will grant you your certificate renewal.

Image result for liability insuranceOf course, there may be several instances in which it may be desirable for SLPs to maintain their ASHA registry in addition to the pure convenience of not keeping one’s own records.  SLPs who take a significant amount of continuing education coursework through ASHA approved providers are eligible for the ACE award, which is given by ASHA after 7.0 ASHA CEUs (70 contact hours) are accumulated in the period of three years or less.  One practical reason why the ACE award is desirable, beyond the overall recognition of the SLPs diligence in pursuing continued education, is that upon its receipt, SLPs are eligible for professional liability insurance discount of 15% (by possessing CCC+ACE).

However, for SLPs who attain less than 7.0 CEUs in a three-year period (or less), the ASHA Registry represents pure convenience at best, and not much else. So, if you want to save $28, and are willing to keep your own CEU records, not only do you not have to pay for the CEU registry, you don’t even have to take courses from ASHA approved continuing education providers in order to maintain your certificate of clinical competence.

For more information regarding obtaining evidence-based coursework in speech pathology as well as current controversies pertaining to the evidence base of select ASHA-approved CEU providers, visit SLPs for Evidence-Based Practice on Facebook for a variety of discussions on this topic.

 

 

 

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Speech, Language, & Literacy Disorders in School Aged Children with Psychiatric Impairments

Recently I did a presentation for Rutgers University on the subject of  “Speech, Language, & Literacy Disorders in School-Aged Children with Psychiatric Impairments“. The learning objectives for this presentation were as follows:  

  • Explain the comorbidity between language impairments and psychiatric disturbances of school-aged children
  • Describe language and literacy deficits of school-aged children with psychiatric impairments
  • List warning signs of language and literacy deficits in school-aged children that warrant a referral to speech-language pathologists for a potential assessment

It focused on the fact that health professionals need to be aware of a significant comorbidity between psychiatric impairments and language disorders, in order to appropriately refer relevant children for potential assessment and treatment services to improve their social and academic outcomes.

This presentation was video recorded and can be accessed in its entirety below as we as on Youtube. You can also access the handouts which accompany the video HERE

References:

  • Angus, L. E., & McLeod, J. (Eds.) (2004). The handbook of narrative and psychotherapy. London, UK: Sage Publications
  • Aram, D.M., Ekelman, B.E., & Nation, J.E. (1984). Preschoolers with language disorders: 10 years later. Journal of Speech and Hearing Research, 27, 232-244.
  • Baltaxe,  C.  A. M., & Simmons,  J.  Q. (1988b).  Pragmatic deficits in  emotionally  disturbed  children  and  adolescents.  In  R. Schiefelbusch & L. Lloyd  (Eds.), Language perspectives (2nd ed.,  pp. 223-253).  Austin, TX: Pro-Ed.
  • Baker,  L.,  & Cantwell,  D. P. (1987b).  A prospective psychiatric  follow-up  of children  with  speech/language  disorders. Journal of the American Academy  of Child and Adolescent Psychiatry, 26, 546-553.
  • Beitchman, J., Cohen, N., Konstantareas, M., & Tannock, R. (Eds.) (1996). Language, learning and behaviour disorders: Developmental, biological and clinical perspectives. Cambridge, NY: Cambridge University Press.
  • Benner, G.J., Nelson, R., & Epstein, M.H. (2002). Language skills of children with EBD: a literature review-emotional and behavioral disorders- statistical data included. Journal of Emotional and Behavioral Disorders, 10, 43-59.
  • Bishop, D. V., & Baird, G. (2001). Parent and teacher report of pragmatic aspects of communication: Use of the Children’s Communication Checklist in a clinical setting. Developmental Medicine & Child Neurology, 43(12), 809–818.
  • Brosnan, M.J. et al. (2004) Gestalt processing in autism: failure to process perceptual relationships and the implications for contextual understanding. The Journal of Child Psychology and Psychiatry, 45, 459–469
  • Bryan, T. (1991). Social problems and learning disabilities. In B. Y. L. Wong (Ed.), Learning about learning disabilities (pp. 195-229). San Diego, CA: Academic Press.
  • Cohen, N. & Barwick, M. (1996) Comorbidity of Language and Social-Emotional Disorders: Comparison of Psychiatric Outpatients and Their Siblings. Journal of Clinical Child Psychology, 25(2), 192-200.
  • Cohen, N., Barwick, M., Horodezky, N., Vallance, D., & Im, N. (1998). Language, achievement, and cognitive processing in psychiatrically disturbed children with previously identified and unsuspected language impairments. Journal of Child Psychology and Psychiatry, 39, 865–877.
  • Cohen, N., & Horodezky, N. (1998). Prevalence of language impairments in psychiatrically referred children at different ages: Preschool to adolescence [Letter to the editor]. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 461–262.
  • Emde, R., Wolf, D., & Oppenheim, D. (Eds.) (2003). Revealing the inner worlds of young children—The MacArthur story stem battery. New York, NY: Oxford University Press.
  • —Gallagher, T. M. (1999). Interrelationships  among children’s language, behavior,  and emotional problems. Topics in  Language Disorders, 19, 1–15.
  • Gardner, R. (1993). Storytelling in psychotherapy with children. London, UK: Jason Aronson.
  • —Gilmour J, et al (2004). Social communication deficits in conduct disorder: a clinical and community study. J Child Psychol Psychiatry45: 967– 78.
  • Goldman, L. G. (1987). Social implications of learning disorders. Reading, Writing and Learning Disabilities, 3, 119-130.
  • —Gurney, D., Gersten, R., Dimino, J. & Carnine, D. (1990). Story grammar: Effective literature instruction for high school students with learning disabilities. Journal of Learning Disabilities, 23, 335-348.
  • Happé, F. G. E. (1994). An Advanced Test of Theory of Mind: Understanding of Story Characters’ Thoughts and Feelings by Able Autistic, Mentally Handicapped and Normal Children and Adults. Journal of Autism and Developmental Disorders, 24, 129-154.
  • Hill, J. W., & Coufal, K. L. (2005). Emotional/behavioral disorders: A retrospective examination of social skills, linguistics, and student outcomes. Communication Disorders Quarterly27(1), 33–46.
  • Hollo, A., Wehby, J. H., & Oliver, R. O.  (2014). Unsuspected language deficits in children with emotional and behavioral disorders: A meta-analysis. Exceptional Children, Vol. 80, No. 2, pp. 169-186.
  • Hummel, L. J., & Prizant, B. M. (1993) A socioemotional perspective for understanding social difficulties of school-age children with language disorders. Language, Speech, and Hearing Services in Schools, 24, 216–224
  • Hyter, Y. D. (2003). Language intervention  for children with emotional or behavioral disorders. Behavioral  Disorders, 29, 65–76.
  • —Hyter, Y. D., et al (2001). Pragmatic language intervention for children with language and emotional/behavioral disorders. Communication Disorders Quarterly, 23(1), 4–16.—
  • Langton,S et al, (2000) Do the eyes have it? Cues to the direction of social attention. Trends in Cognitive Sciences, 4 (2) 50-59.
  • Losh, M., & Capps, L. (2003). Narrative ability in high-functioning children with autism or Asperger’s syndrome. Journal of Autism and Developmental Disorders, 33, 239–251.
  • Nelson, J. R., Benner, G. J., & Cheney, D. (2005).An investigation of the language skills of students with emotional disturbance served in public school settings. Journal of Special Education39, 97–105.
  • Pearce, P. et al. (2014). Use of narratives to assess language disorders in an inpatient pediatric psychiatric population. Clin Child Psychol Psychiatry, 19(2) 244-259.—
  • Prizant, B.M., et al. (1990). Communication disorders and emotional/behavioral disorders in children and adolescents. The Journal of Speech and Hearing Disorders, 55, 179-192.
  • —Semrud-Clikeman, M., & Glass, K. (2010).  The Relation of Humor and Child Development: Social, Adaptive, and Emotional Aspects.  Journal of Child Neurology, 25, 1248-1260.
  • Sanger, D., Maag, J. W., & Shapera, N. R. (1994). Language problems among students with emotional and behavioral disorders. Intervention in School and Clinic30(2), 103–108.
  • —Tallal, P., Dukette, D,. and Curtiss, S (1989) Behavioral Emotional Profiles of Preschool language impaired children. Development and Psychopathology (1) 51-67.
  • Toppelberg, C., & Shapiro, T. (2000). Language disorders: A 10-year research update review. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 143–152.
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On the Disadvantages of Parents Ceasing to Speak the Birth Language with Bilingual Language Impaired Children

ChildrenDespite significant advances in the fields of education and speech pathology, many harmful myths pertaining to multilingualism continue to persist. One particularly infuriating and patently incorrect recommendation to parents is the advice to stop speaking the birth language with their bilingual children with language disorders.

There is a plethora of evidence available regarding how bilingualism facilitates, increases, and improves language gains in children with developmental language disorders (DLD) as well as genetic conditions and syndromes (e.g., ASD, DS, FXS, etc.) Numerous researchers have released results of studies indicating the advantages of being bilingual for language impaired children (see this issue of Journal of Communication Disorders for starters for some studies on this subject).

But today in addition to briefly reiterating these advantages, I’d like to also explicitly discuss the disadvantages, which can result when parents are told to stop speaking the birth language with their language impaired children and switch to English-only interactions.

Cognitive advantages of maintaining the birth language for bilingual children with language impairments  (whose parents are able to provide them with that opportunity in the home) include increased attentional control and working memory, as well as perspective taking abilities. Linguistic advantages include increased awareness of vocabulary and grammar. Even social skills of these children have been reported to be more advanced as compared to monolingual only peers (See Pena, 2016, pp. 88-89 for a review of pertinent studies)

But what happens when parents decide to speak English only to their language impaired bilingual child? In the words of Helen Lester’s ‘Pookins’, lots! And I don’t mean it in a good way!

—Research indicates that children with language disorders will have language deficits in all the languages that they speak. As such, no matter which language is being used, the child will still present with some difficulty acquiring it and will do so at a much slower pace (Kohnert, 2010).

The problem is that NOT using the native language, can limit language and early literacy practices at home during sensitive periods of language acquisition. This will result in poorer language outcomes as compared to bilingual language impaired peers whose birth language continued to be supported at home. (Ijalba, 2010)

“There is also evidence to show that young minority L1 learners with impaired language systems are even more vulnerable than unaffected bilingual peers to loss or early plateaus in the home language if it is not supported ().” (Kohnert, 2010, p. 8)

“Minority-language families are especially affected since English is usually recommended as the target language.”  (Yu, 2016, p. 424) Some studies have reported that: “parents expressed personal loss and sadness (Fernandez y Garcia et al., 2012) if they chose to speak only English to their child with ASD.” Other studies have reported that “some [parents] also expressed discomfort and difficulty when speaking a non-native language with their child (Yu, 2013) or said they talked less frequently to their child when they used the majority language because it felt less natural.” (Bird, Genesee, Verhoeven, 2016. p. 5)

Perhaps the most disturbing findings are the studies that show that eliminating speaking birth language at home causes an emotional disconnect between immediate and extended family members and the child in question (Kouritzin, 1999; Tseng & Fuligni, 2000; Wharton et al 2000). Wharton and colleagues found that immigrant parents were more affective and engaging with their autistic children when they used their native language Wharton et al (2000).  Contrastingly, Kremer-Sadlik (2005) found that parents are less likely to engage their children in conversation when they cannot use their native language and that it further isolates a child who needs help with interactive skills.

“The advice to stick with a language that the family doesn’t speak well only intensifies the alienation experienced by these children.”  “You’re taking a child who is already socially isolated and you’re making them even more isolated”. Consequently, “development of heritage languages and bilingual competencies may be especially important for children with ASD given their core challenges in socialization, communication, and relational development.” (Yu, 2016, p. 434)

Given the combined results of the above studies, it is hugely important for professionals to appropriately support the parents of bilingual children with language and learning needs when it comes to offering them relevant recommendations on the topic of language use in the home. This can be accomplished by sharing with them the synthesis of currently available studies on the topic of bilingualism and language disorders, as well as encouraging them to speak the birth language in the home if they are willing and able to, rather than embracing English only practices, which may result in significant detrimental effects for both bilingual children and their families.

FOR A PDF HANDOUT FOR PARENTS AND PROFESSIONALS PLEASE CLICK HERE

Select Parent-Friendly Resources:

 References:

  1. Fernandez y Garcia, E., Brelau, J., Hansen, R., & Miller, E. (2012). Unintended consequences: An ethnographic narrative case series exploring language recommendations for bilingual families of children with autistic spectrum disorders. Journal of Medical Speech-Language Pathology, 20, 10–16.
  2. Hakansson G, Salameh E, Nettelbladt U. (2003) Measuring language development in bilingual children: Swedish-Arabic children with and without language impairmentLinguistics. 41:255–288.
  3. Ijalba, E (2010) Supporting early-literacy and language acquisition among bilingual children in HeadStart ASHA Convention Handout: Philadelphia, PA.
  4. Kay-Raining Bird, E, Genesee, F & Verhoeven, L (2016) Bilingualism in children with developmental disorders: A narrative review.  Journal of Communication Disorders, (63), pp. 1-14.
  5. Kohnert, K. (2010). Bilingual children with primary language impairment: Issues, evidence and implications for clinical actions. Journal of Communication Disorders43, 465–473.
  6. Kouritzin, S (1999) Face[t]s of First Language Loss. Routledge.
  7. Kremer-Sadlik, T. (2005). To be or not to be bilingual: Autistic children from multilingual families. Proceedings of the 4th International Symposium on Bilingualism, ed. James Cohen, Kara T. McAlister, Kellie Rolstad, and Jeff MacSwan, 1225-1234.
  8. Peña, E (2016) Supporting the home language of bilingual children with developmental disabilities: From knowing to doing. Journal of Communication Disorders, (63), pp. 85-92.
  9. Restrepo MA, Kruth K. (2001) Grammatical characteristics of a Spanish-English bilingual child with specific language impairment. Communication Disorders Quarterly. 21:66–76.
  10. Salameh E, Hakansson G, Nettelbladt U. (2004) Developmental perspectives on bilingual Swedish-Arabic children with and without language impairment: A longitudinal study. International Journal of Language & Communication Disorders. 39:65–91
  11. Tseng, Vivian. & Fuligni, Andrew J.(2000). Parent-adolescent language use and relationships among immigrant families with east Asian, Filipino and Latin American background. Journal of Marriage & Family, Vol. 62, No. 2,
  12. Wharton, R et al. (2000). Children with special need in bilingual families: A developmental approach to language recommendations. ICDL Clinical Practice Guidelines. The Unicorn Children’s Foundation: ICDL Press, Ch. 7. Pp 141-151.
  13. Yu, B. (2013). Issues in bilingualism and heritage language maintenance: Perspectives of minority-language mothers of children with Autism Spectrum Disorders. American Journal of Speech-Language Pathology, 22, 10–24.
  14. Yu, B. (2016). Bilingualism as conceptualized and bilingualism as lived: A critical examination of the monolingual socialization of a child with autism in a bilingual family. Journal of Autism and Developmental Disorders, 46, 424-435.

For more information on Evidence-Based Practices in Speech-Language Pathologists, SLPs can check out SLPs for Evidence-Based Practice 

For more Smart Speech LLC bilingual resources and topics click HERE

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Analyzing Discourse Abilities of Adolescents via Peer Conflict Resolution (PCR) Tasks

A substantial portion of my caseload is comprised of adolescent learners. Since standardized assessments possess significant limitations for that age group (as well as in general), I am frequently on the lookout for qualitative clinical measures that can accurately capture their abilities in the areas of discourse, critical thinking, and social communication.

One type of an assessment that I find particularly valuable for this age group is a set of two Peer Conflict Resolution Tasks. First described in a 2007 article by Dr. Marylin Nippold and her colleagues, they assess expository discourse of adolescent learners.

Expository discourse is the use of language to convey information (Bliss, 2002). As per Nippold and colleagues, “expository discourse occurs, when a speaker describes the steps and outcome of a biology experiment, explains how to operate the equipment at a medical lab, or gives directions on how to travel by train from one city to another.” (Nippold, Mansfield, & Billow, 2007, p. 180).  Not only does expository discourse require the “facility with complex syntax”, it also taps into the speaker’s social communication and critical thinking abilities, which is why I employ these tasks on a regular basis when assessing adolescent students.

Here is what these tasks entail. First, the tasks are introduced to the student: “People are always running into problems with others at school, at work, and at home. Everyone has to work out ways to solve these problems. I am going to read you two different stories that illustrate these types of problems. I would like you to listen carefully and be ready to tell each story back to me, in your own words. Then I will ask you some questions about the story. There are no penalties for incorrect answers. I just want to know what you think about the issues and how they should be handled.” (adapted from  Selman et al., 1986, p. 459)—

Below are the descriptions of actual tasks straight from the article.

Image result for model airplane clipartStory A: “The Science Fair” John’s (Debbie’s) teacher assigned him (her) to work with three other boys (girls) on a project for the science fair. The boys (girls) decided to build a model airplane that could actually fly. All of the boys (girls) except one, a boy (girl) named Bob (Melanie), worked hard on the project. Bob (Melanie) refused to do anything and just let the others do all the work. This bothered John (Debbie) very much. Now I’d like you to tell the story back to me, in your own words. Try to tell me everything you can remember about the story… Now I’d like to ask you some questions about the story:

  1. What is the main problem here?
  2. Why is that a problem?
  3. What is a good way for John (Debbie) to deal with Bob (Melanie)?
  4. Why is that a good way for John (Debbie) to deal with Bob (Melanie)?
  5. What do you think will happen if John (Debbie) does that?
  6. How do you think they both will feel if John (Debbie) does that?

Image result for fast food restaurant clipartStory B: “The Fast-Food Restaurant” Mike and Peter (Jane and Kathy) work at a fast-food restaurant together. It is Mike’s (Jane’s) turn to work on the grill, which he (she) really likes to do, and it is Peter’s (Kathy’s) turn to do the garbage. Peter (Kathy) says his (her) arm is sore and asks Mike (Jane) to switch jobs with him (her), but Mike (Jane) doesn’t want to lose his (her) chance on the grill. Now I’d like you to tell the story back to me, in your own words. Try to tell me everything you can remember about the story… Now I’d like to ask you some questions about the story:

  1. What is the main problem here?
  2. Why is that a problem?
  3. What is a good way for Mike (Jane) to deal with Peter (Kathy)?
  4. Why is that a good way for Mike (Jane) to deal with Peter (Kathy)?
  5. What do you think will happen if Mike (Jane) does that?
  6. How do you think they both will feel if Mike (Jane) does that?”(Nippold, Mansfield, & Billow, 2007, p. 187)

When presenting each task, the authors recommend that clinicians use male names with male students and female names with female students, as this may increase the chance that the students will better relate to the “characters’ actions, challenges, and emotions“. (187)

Let’s take a look at the analysis of one of the PCR tasks in action. Below are the responses of a 15-4-year-old student with suspected social communication impairment who was presented with the above mentioned Fast Food Restaurant prompt. He was asked to retell the situation in his own words and then answer a set of questions which incorporated aspects of peer interaction, as well as interpersonal conflict and resolution. 

Below is the student’s retelling of the “The Fast-Food Restaurant” story in his own words: “One guy wants works on grill the other guy wants takes out the trash. Guy breaks… has a sore arm and asks another guy to do do his job but other guy didn’t want other guy didn’t want to do lose the job”       

Here’s how this student answered the accompanying questions:

Image result for analysisAnalysis of ‘The Fast Food Restaurant’: The student’s discourse abilities were judged to be impaired for his age/grade level. His retelling was vague and nonspecific and was punctuated by frequent false starts characteristic of word retrieval difficulties.  To illustrate, he first began to state that one of the boys had a broken arm but then self-corrected and was able to explain that the arm was merely sore.  Rather than displaying appropriate anaphoric referencing and referring to both boys by names, he nonspecifically referred to both of them as “one guy” and “another guy”.

The student also did not adequately delve into the complexity of the social scenario. Rather than adequately explaining that one boy’s chance at a preferred activity at his job is jeopardized by his friend’s supposed injury, he imprecisely responded “One’s one’s ah Mike is not you know he’s (unintelligible) he is not being very generous. Also, also the other one is getting all wound up over a sore arm”, which is an inadequate explanation of the problem in the presented scenario.

The student’s answers were nonspecific as he did not appropriately identify the problem in the scenario nor offer an effective solution to it. His response in reference to the lack of cooperation between the two boys lacked concrete details, and his solution: “bargain” and “talk” was too vague to qualify as an adequate response to the scenario.

The student presented with difficulty assuming perspectives of both characters in the scenario (Mike and Peter) and had difficulty explaining what type of a mutually agreeable solution both boys could possibly reach.  The student’s sentence structure lacked adequate syntactic complexity and contained a number of awkwardly phrased sentences marked by significant word retrieval difficulties in the form of word phrase revisions, repetitions as well as pauses.

Impressions: Informal discourse analysis revealed deficits in the areas of semantics, syntax, word finding, problem-solving, perspective taking as well as social communication. Therapeutic intervention is strongly recommended to improve these abilities for social and academic purposes.

As you can see from the above sample, the PCR tasks possess terrific versatility and can reveal a great deal of information about adolescent students’ discourse, problem-solving, social communication abilities. Consequently, I highly recommend them as part of the adolescent language and literacy assessments.

References:

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Identifying Word Finding Deficits in Narrative Retelling of School-Aged Children

Image result for word-finding In the past, I have written several posts on the topic of word finding difficulties (HERE and HERE) as well as narrative assessments (HERE and HERE) of school-aged children. Today I am combining these posts  together by offering suggestions on how SLPs can identify word finding difficulties in narrative samples of school-aged children.

Word finding difficulties can manifest via a variety of ways, including pauses, semantic (e.g., ‘wolf’ for ‘fox’) and phonological substitutions of words (e.g., ‘dicar’ for ‘guitar’), use the fillers (e.g., ‘um’, ‘like’), use of mazes (nonspecific vocabulary, circumlocutions, or revisions), iconic gestures (e.g., miming a word) as well as gestures of frustration (e.g., hand on head in frustration, hand waving, etc.), etc (German, 2005).  Furthermore, for many children, word finding difficulties may not be very apparent at the word level, when only a retrieval of one vocabulary word is required during confrontational naming tasks. However, their word-finding difficulties may become very glaring when these children have to engage in discourse as well as produce a variety of narratives.

Students may also display a significant variability in their word-finding profiles. They could present with both slow and inaccurate retrieval of words (take more processing time to produce language and produce it imprecisely). They could also be fast and inaccurate retrievers (speak without pauses but use an imprecise choice of words).  Finally, they could be slow but accurate retrievers (take more processing time to produce language but produce it precisely) (German, 2005).

Below is a narrative reassessment of a 4th-grade student who was read a book by William Steig entitled: “Dr. De Soto” (Plot Summary). He was then asked to retell the story without the benefit of visual support.  The following was the narrative produced by him:

Image result for dr de sotoAnalysis: This student’s narrative retelling was judged to be significantly impaired for his age. With respect to macrostructure, his narrative lacked a number of story grammar elements including a definitive introduction, a problem, as well as a definitive conclusion which is significantly below age-level. While the student’s story followed a semblance of chronological order, it was also significantly decontextualized.  Furthermore, the student displayed very limited use of perspective taking vocabulary. He was able to reference several emotional reactions (e.g., ‘pain’, hurts’, ‘smiled’), but was unable to demonstrate consistent perspective taking (insight into the characters’ feelings, beliefs, and thoughts) throughout his narrative as is commensurate with age.

The student’s microstructure was also significantly adversely affected and was characterized by numerous syntactic errors (e.g., poorly constructed sentences, mazes, etc.), limited use of cohesive ties (e.g., and), as well as a lack of temporal markers denoting the sequence of narrative events  (e.g., first, next, then, finally). His vocabulary was judged to be immature as evidenced by usage of reduced number and variety of words throughout his narrative.

Finally, this student demonstrated severe word finding deficits characterized by fast but inaccurate word-retrieval marked by excessive presence of metacognitive comments (“what was it” produced 21 times during a 2-minute retelling sample), overuse of select phrases (e.g., ‘And they um’), fillers (e.g. uh), false starts (‘sm-help’), word repetitions (e.g. it, it,) as well as form-related word substitutions (‘Dr. Ricotto’/ ‘Dr. Risotto’ vs. ‘Dr. De Soto’ ).

It is also noteworthy to mention that the present testing was actually a reassessment. Interestingly, this particular student had always presented with significant expressive language formulation difficulties.  However, the nature of his difficulties differed between assessments. When assessed previously several years before, this student presented with significantly incoherent and disorganized discourse. However, at that time his narrative abilities were tested via the usage of another book (‘Pookins Gets Her Way’ by Helen Lester) with the benefit of visual support. As a result, his word-finding deficits in narratives were not as glaring as they were during the present retesting. In contrast, the production of narratives in the absence of visual support is far more complex and contextually demanding, as a result of which this student’s narrative was marked by a significant increase in word-finding errors. 

A student of this chronological age (10-0) is expected to produce Second Level True Narratives (Hegberg and Wesby (1993), characterized by subjective and/or objective summarization and categorization of stories.    Continuation of therapeutic intervention is strongly recommended to continue improving the student’s as well as addressing his word-finding deficits in discourse and narratives. 

I hope you found the above narrative example useful for your word-finding assessment purposes. Please feel free to share in the comments section of this post, how you perform word-finding assessments and what materials you use for this purpose.

References:

  • German, D.J. (2005) Word-Finding Intervention Program, Second Edition (WFIP-2)  Austin Texas: Pro.Ed
  • Hedberg, N.L., & Westby, C.E. (1993). Analyzing storytelling skills Theory to Practice. Tucson, AZCommunication Skill Builders.
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Analyzing Narratives of School-Aged Children

Related imageIn the past, I have written about why narrative assessments should be an integral part of all language evaluations.  Today, I’d like to share how I conduct my narrative assessments for comprehensive language testing purposes.

As mentioned previously, for elicitation purposes, I frequently use the books recommended by the SALT Software website, which include: ‘Frog Where Are You?’ by Mercer Mayer, ‘Pookins Gets Her Way‘ and ‘A Porcupine Named Fluffy‘ by  Helen Lester, as well as ‘Dr. DeSoto‘ by William Steig.

Depending on the child’s age, I may read the story to the child or ask the child to read the story to me. One of the reasons why I like to utilize the second option is because it also allows me to ascertain, to some extent, the child’s reading skills in the areas of phonological awareness, phonics, reading fluency, vocabulary, as well as reading comprehension.

After that, I ask the child to retell the story back to me. Once again, depending on the child’s age as well as the estimated extent of his/her language severity, I may show the pictures from the story (and cover up the words) or ask the child to tell the story back to me without the benefit of visual support

Frog Where Are You IntroAs the child is retelling the story I digitally record his/her narrative so I can later transcribe and analyze it.  As the child is retelling the story, I may use verbal prompts such as: ‘What else can you tell me?’ and ‘Can you tell me more?’ to elicit additional information. However, I try not to prompt the child excessively; otherwise, the child is merely producing heavily prompted responses vs. telling me a spontaneous story. I then transcribe the child’s narrative verbatim and include all the pauses, mazes, linguistic reformulations, etc. This is particularly important for the purpose of determining the extent of the child’s word finding difficulties (if any) as well as in order to establish whether the child can retell a story with ease or if s/he struggles significantly during this task.

Here’s an example of what my transcription and analysis look like for first-grade students. Below narrative was produced by a 6-year-old student after I’ve read to her a script of  ‘Frog Where Are You?’ by Mercer Mayer.     Image result for frog where are youAnalysis: This student’s narrative was judged to be immature and decontextualized for her age.  The student’s strengths included the inclusion of all the relevant story grammar elements (for her age), some dialogue (e.g., “Frog! Where are you?”), as well as limited use of perspective taking (e.g., /mad/; /the boy checked that the dog was OK/, etc.). However, her narrative was very difficult to follow due to its limited coherence and cohesion.  The presence of grammatical, syntactic, and pragmatic errors, tangential story production, as well as abrupt and confusing shifts between settings and characters made it further confusing and difficult to follow.

With respect to microstructure, the student’s story was composed of numerous partially produced phrases and simple sentences, had limited temporal markers (e.g., then), and did not contain an adequate number of complex and compound sentences as is appropriate for a child her age (Paul, 1981). Throughout her narrative student inconsistently used anaphoric referencing. She was observed to overuse the pronoun ‘he’, which resulted in lack of clarity regarding which characters – the dog, the boy, or the turtle, she was referring to.  She also at times evidenced pronoun confusion (referred to the boy as ‘it’).

Image result for frog where are youThroughout her narrative, the student also evidenced a number of word finding difficulties manifested via word/phrase repetitions and revisions, use of fillers (e.g., “um”), and pauses, which made her story difficult for listeners to follow. Usage of invented vocabulary (e.g., stairpass) as well as target word substitutions (e.g., /roof/ vs. /cliff/) was also noted (German, 2005).

Summary: A 6-0-year-old student is expected to be at the True Narratives Level I (Hedberg & Westby, 1993), characterized by a well-developed plot, character development, clear sequencing of events, and consistent perspectives which focus around an incident in a story. Weaknesses in the area of narrative ability possess adverse impact on academic performance in the areas of oral language, reading, and written expression. Narrative weaknesses also significantly correlate with social communication deficits (Norbury, Gemmell & Paul, 2014), which this student is currently displaying. In order to facilitate academic and social success in this area, therapeutic intervention is strongly recommended.

Please note that the above analysis is by no means exhaustive. Furthermore, there are numerous other ways one can analyze a narrative sample. Nevertheless, I hope you found the above example useful for your language assessment purposes. Stay tuned for another example of my narrative analysis, to be posted shortly. Meanwhile, feel free to share in the comments section of this post, how you perform narrative assessments and what materials you use for this purpose.

References:

Helpful Smart Speech Therapy Resources: 

 

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Do Our Therapy Goals Make Sense or How to Create Functional Language Intervention Targets

In the past several years, I wrote a series of posts on the topic of improving clinical practices in speech-language pathology.  Some of these posts were based on my clinical experience as backed by research,  while others summarized key point from articles written by prominent colleagues in our field such as Dr. Alan KamhiDr.  David DeBonnisDr. Andrew Vermiglio, etc.

In the past, I have highlighted several articles from the 2014 LSHSS clinical forum entitled: Improving Clinical Practice. Today I would like to explicitly summarize another relevant article written by Dr. Wallach in 2014, entitled “Improving Clinical Practice: A School-Age and School-Based Perspective“, which discusses how to change the “persistence of traditional practices” in order to make our language interventions more functional and meaningful for students with language learning difficulties.

Image result for geraldine wallachDr. Wallach begins her article by describing 3  fairly typical to the schools’ scenarios.  In the first one,  a group of second graders with narrative retelling goals are working on a sequencing activity (“First the soup is on the counter, next it is opened, then it is cooked on the stove, last it is put in a bowl and ready to eat.”).

In the second scenario,  a group of fourth graders are working on following directions presented to them by the clinician (“Pick up the red triangle before you touch the large, green circle.”)

Image result for ambiguous newspaper headlinesIn  the third scenario,  a group of middle schoolers  are working on interpreting  newspaper headlines (“Jazz Helps Lakers Become Mellow in Victory.”)

Dr. Wallach then poses several overarching questions:

  • Do these goals make sense in the current context of research pertaining to language, learning, and literacy?
  • ‘Are the targets relevant to language and academic contexts beyond the “speech room” (i.e., are the choices, curriculum, and classroom relevant)?’
  • ‘Are they relevant to language learning in general?’
  • ‘Is the intervention’s focus encouraging performance (short-term learning that is context-bound) or long-term and context-independent learning?’ (p. 128)

She then delves deeper into where these goals come from as well as presents some suggestions regarding how these goals could be altered in order to make them more functional.

She begins by explaining that labeling SLP  provided school-based services as “speech” “creates artificial barriers, inaccurate perceptions, and inappropriate intervention recommendations that exacerbate an already complex situation, that is, meeting the language learning and literacy needs of students across a changing landscape of required knowledge and skills needed to succeed academically.” (128)

From there,  she explains why targets in the first two scenarios are inaccurate and not functional.  She explains that while working on improving narrative abilities is functional,  working on isolated sequencing abilities is not functional since in the context of her present scenario the child was not retelling an actual story. Furthermore, ‘the clinician’s focus on sequencing as an underlying skill comes from sources that are unknown’ and ‘the “transfer” to producing and comprehending temporal and causal narratives from the soup scenario is an assumption that research fails to support” (128) She adds, that  “Duke and Pearson (2008/2009) mirror these notions when they state that the “transfer [of taught skills and strategies] decreases as a function of distance from the original information domain” (p. 113).”    Then, of course, there is the usage of “expository text (i.e., a sequential text) rather than narrative text,”  further indicating that the goal is not functionally transferable.  The second graders are receiving a message that we are working on storytelling skills,  when in reality that is not what is taking place in the session.

To balance the above criticism, Dr. Wallach does describe a number of positive elements involved in what her fictional clinician in her scenario is doing: (e.g, using expository text knowledge, talking about language, etc.), but she also asks: (1) Is the activity developmentally appropriate? and (2) Are the metalinguistic task aspects too complex for children that age? (129).

Now, let’s move on to multiple step commands, a persistent intervention meme, created because our students have difficulty understanding instructions, paying attention in class, as well as processing and completing classroom assignments.

The problem is that the processing of multistep directions is influenced by a number of contextual, semantic, and linguistic factors.  By far, not all multistep directions are created equal. Some are far more contextually related and semantically constrained than others (e.g., “After you open the book, turn to page 120” vs. “Pick up the red triangle before you touch the large, green circle.”) (p. 129). Consequently, “following directions” is not a simple task of “memorizing the steps”, rather it is a complex process which involves activation of available semantic and syntactic knowledge, comprehension of sentences with a variety of clauses, as well as numerous other linguistic factors.

Unfortunately, the provision of decontextualized directions will not meaningfully assist the students with comprehension of school work and navigation of the classroom environment. As such, rather than teaching the students multiple step directions which will not meaningfully transfer to other settings it may be far more appropriate to teach the students how to request clarification from their speakers in order to break up complex instructions into manageable chunks of information.

In contrast, the goals and procedures in the 3rd scenario (see pgs. 127-128 for full details ) are actually supported by research in developmental disorders.  The SLP is helping students to be actively involved in language by activating their background knowledge, use new strategies, reduce competing resources, heighten the students’ metalinguistic abilities, as well as incorporating aspects of both language and literacy into sessions, making her intervention highly relevant to the curriculum.

Dr. Wallach then moves on to provide constructive suggestions regarding how intervention services can be improved in the school setting. This includes: “(a) creating intervention goals that are knowledge-based and help students connect known and new information; (b) balancing content knowledge and awareness of text structure in functional, authentic tasks that optimize long-term retention and transfer across grades and content-area subjects; and (c) matching students’ language goals and objectives to the “outside world” of curricular and classroom contexts.” (p. 130)

First, “research suggests that engaging students in prior knowledge activities increases the comprehension and retention of information” (p. 130). In other words, “when too much is new, comprehension and retention suffer; something has to “give” or be modified to facilitate learning” (p. 130).  She suggests using a familiar high-interest topic to teach a discrete amount of new information.  Here, the role of background knowledge is hugely important when it comes to learning. “Engaging students in prior knowledge activities that include questioning and other meaning-based strategies encourage them to use and express what they do know, talk about what they need to know and become more actively involved in interacting with spoken and written text (Wallach et al., 2014)” (p. 131).

To illustrate, Dr. Wallach provides an example from a ninth-grade science textbook, laden with complex information. She then explains how to “use of evidence-based strategies including self-questioning and clinician-led discussions to guide students” in better understanding the material via use of various frameworks (e.g., K-W-L) (p. 131). She also emphasizes how within a collaborative framework SLPs can focus on aspects of text structure to ask relevant questions about content.

From there she segues into a fifth-grade history text and explains that  “No kit or program from the hundreds that appear in ASHA Convention exhibit halls year after year will come to our rescue” (131), As such, SLPs need to teach their clients both macro (text organization) and micro (syntax, morphology, etc.) components of language so they could successfully navigate complex texts. A number of researchers (e.g., A. Kamhi, C. Scott, M. Nippold, B. Ehren, etc.) have highlighted the fact that our middle school and high school students lack the comprehension of complex morphosyntax. Hence, explicitly teaching it to out students will significantly improve both our clinical practice and their academic outcomes. Here, Dr. Wallach also recommends the work of “McKeown and her colleagues (e.g., Beck, McKeown, & Worthy, 1995McKeown et al., 2009McKeown, Beck, Sinatra, & Loxterman, 1992) when trying to understand the complex interaction between content and structure knowledge.” (p. 132)

After that Dr. Wallach segues into a discussion on how our clients’ language goals can be better aligned with the academic curricular demands. She states that SLPs need to delve deeper (or at all) into disciplinary literacy (teaching our students subject-specific comprehension and vocabulary). Here, collaboration with content-area teachers is very important. “For example, science involves many technical terms and definitions and requires clear and concise cause and effect thinking (Fang, 2004Halliday, 1993). “The noun phrases [in science texts] contain a large quantity of information that in more commonsense language of everyday life would require several sentences to express” (Fang, 2012, p. 24). ” (132). “Alternatively, social studies involves being able to put events into a context, comparing sources, and understanding the biases of the writer. Unlike science, authorship is important in history.” (132)

Dr. Wallach suggests a number of questions clinicians can ask selves about our students when determining therapy targets:

  1. Can they handle complex syntactic forms that are more common in written language than spoken language?
  2. Do they have an understanding of word derivations?
  3. Do our students know how to write a compare and contrast expository piece?
  4. Are they able to evaluate sources information?
  5. Do they use prior knowledge and experience to help them comprehend new information?

She then offers SLPs valuable ideas on how to create a thoughtful balance between general and subject-specific language targets (see pg 133 for complete details).

Dr. Wallach concludes her article with the following points.

  • Students with language learning disabilities are at a disadvantage in school due to having reduced/limited background knowledge and language proficiency as compared to typically developing peers. Hence “school-based SLPs must consider ways that students’ language abilities influence and interact with their academic success (Wallach et al., 2014). Our intervention should be seen as developing a set of language initiatives focused toward content-area learning (A. S. Bashir, personal communication, 2012; Wallach et al., 2009). ” 
  • Staying focused on the continuum of change across the grades is an important aspect of clinical practice in the school years. Likewise, as suggested by many authors, connecting our preschool endeavors to the horizon of school-age demands underpins our work over time
  • As we look to changes in service delivery models in schools including research that supports response-to-intervention (RtI) models (e.g., Wixson, Lipson, & Valencia, 2014), we can be optimistic that less relevant and nonfunctional practices will die natural deaths.” (pgs. 133-134)

There you have it! Numerous practical suggestions as well as functional clarifications from Dr. Wallach so SLPs can improve their treatment practices with school-aged children.  And for more information, I highly recommend reading the other articles in the same clinical forum, all of which possess highly practical and relevant ideas for therapeutic implementation.

They include:

References:

  • Beck, I. L., McKeown, M. G., & Worthy, J. (1995). Giving text a voice can improve students’ understanding. Reading Research Quarterly30, 220–238.
  • Duke, N. K., & Pearson, P. D. (2008/2009). Effective practices for developing reading comprehension. Journal of Education189, 107–122.
  • Fang, Z. (2004). Scientific literacy: A systematic functional linguistics perspective. Science Education89, 335–347. 
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