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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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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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Social Communication and Describing Skills: What is the Connection?

When it comes to the identification of social communication deficits, SLPs are in a perpetual search for quick and reliable strategies that can assist us in our quest of valid and reliable confirmation of social communication difficulties. The problem is that in some situations, it is not always functional to conduct a standardized assessment, while in others a standardized assessment may have limited value (e.g., if the test doesn’t assess or limitedly assesses social communication abilities).

So what type of tasks are sensitive to social communication deficits? Quite a few, actually. For starters, various types of narratives are quite sensitive to social communication impairment. From fictional to expository, narrative analysis can go a long way in determining whether the student presents with appropriate sequencing skills, adequate working memory, age-level grammar, and syntax, adequate vocabulary, pragmatics, perspective taking abilities, critical thinking skills, etc. But what if one doesn’t have the time to record and transcribe a narrative retelling, what then? Actually, a modified version of a narrative assessment task can still reveal a great deal about the student’s social communication abilities.

For the purpose of this particular task, I like to use photos depicting complex social communication scenarios. Then I simply ask the student: “Please describe  what is happening in this photo.”  Wait a second you may say: “That’s it? This is way too simple! You can’t possibly determine if someone has social communication deficits based on a single photo description!”

I beg to differ. Here’s an interesting fact about students with social communication deficits. Even the ones with FSIQ in the superior range of functioning (>130) with exceptionally large lexicons, still present with massive deficits when it comes to providing coherent and cohesive descriptions and summaries.

Here are just a few reasons why this happens. Research indicates that students with social communication difficulties present with Gestalt Processing deficits or difficulty “seeing/grasping the big picture”(Happe & Frith, 2006). Rather than focusing on the main idea, they tend to focus on isolated details due to which they have a tendency to provide an incomplete/partial information about visual scenes, books, passages, stories, or movies. As such, despite possessing an impressive lexicon, such students may say about the above picture: “She is drawing” or “They are outside” and omit a number of relevant to the picture details.

Research also confirms that another difficulty that students with impaired social communication abilities present with is assuming perspectives of others (e.g., relating to others, understanding/interpreting their beliefs, thoughts, feelings, etc.) (Kaland et al, 2007). As such they may miss relevant visual clues pertaining to how the boy and girl are feeling, what they are thinking, etc.

Students with social communication deficits also present with anaphoric referencing difficulties.  Rather than referring to individuals in books and pictures by name or gender, they may nonspecifically utilize personal pronouns ‘he’, ‘she’ or ‘they’ to refer to them. Consequently, they may describe the individuals in the above photo as follows: “She is drawing and the boy is looking”; or “They are sitting at the table outside.”

Finally, students with social communication deficits may produce poorly constructed run-on (exceedingly verbose) or fragmented utterances (very brief) lacking in coherence and cohesion to describe the main idea in the above scenario (Frith, 1989).

Of course, by now many of you want to know regarding what constitutes as pragmatically appropriate descriptions for students of varying ages. For that, you can visit a thread in the SLPs for Evidence-Based Practice Group on Facebook entitled: GIANT POST WITH FREE LINKS AND RESOURCES ON THE TOPIC OF TYPICAL SPEECH AND LANGUAGE MILESTONES OF CHILDREN 0-21 YEARS OF AGE  to locate the relevant milestones by age.

Interested in seeing these assessment strategies in action? Download a FREEBIE HERE and see for yourselves.

References:

  • Frith, U., (1989). Autism: Explaining the Enigma. Blackwell, Oxford.
  • Happe, F. & Frith, U. (2006). The weak coherence account: Detail-focused cognitive style in Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 36 (1), 5-25.
  • Kaland, N., Callesen, K., Moller-Nielsen, A., Mortensen, E. L., & Smith, L. (2007). Performance of children and adolescents with Asperger Syndrome or High-functioning Autism on advanced theory of mind tasks. Journal of Autism and Developmental Disorders. 38, 1112-1123.

 

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Components of Qualitative Writing Assessments: What Exactly are We Trying to Measure?

Writing! The one assessment area that challenges many SLPs on daily basis! If one polls 10 SLPs on the topic of writing, one will get 10 completely different responses ranging from agreement and rejection to the diverse opinions regarding what should actually be assessed and how exactly it should be accomplished.

Consequently, today I wanted to focus on the basics involved in the assessment of adolescent writing. Why adolescents you may ask? Well, frankly because many SLPs (myself included) are far more likely to assess the writing abilities of adolescents rather than elementary-aged children.

Often, when the students are younger and their literacy abilities are weaker, the SLPs may not get to the assessment of writing abilities due to the students presenting with so many other deficits which require precedence intervention-wise. However, as the students get older and the academic requirements increase exponentially, SLPs may be more frequently asked to assess the students’ writing abilities because difficulties in this area significantly affect them in a variety of classes on a variety of subjects.

So what can we assess when it comes to writing? In the words of Helen Lester’s character ‘Pookins’: “Lots!”  There are various types of writing that can be assessed, the most common of which include: expository, persuasive, and fictional. Each of these can be used for assessment purposes in a variety of ways.

To illustrate, if we chose to analyze the student’s written production of fictional narratives then we may broadly choose to analyze the following aspects of the student’s writing: contextual conventions and writing composition.

The former looks at such writing aspects as the use of correct spelling, punctuation, and capitalization, paragraph formation, etc.

The latter looks at the nitty-gritty elements involved in plot development. These include effective use of literate vocabulary, plotline twists, character development,  use of dialogue, etc.

Perhaps we want to analyze the student’s persuasive writing abilities. After all, high school students are expected to utilize this type of writing frequently for essay writing purposes.  Actually, persuasive writing is a complex genre which is particularly difficult for students with language-learning difficulties who struggle to produce essays that are clear, logical, convincing, appropriately sequenced, and take into consideration opposing points of view. It is exactly for that reason that persuasive writing tasks are perfect for assessment purposes.

But what exactly are we looking for analysis wise? What should a typical 15 year old’s persuasive essays contain?

With respect to syntax, a typical student that age is expected to write complex sentences possessing nominal, adverbial, as well as relative clauses.

With the respect to semantics, effective persuasive essays require the use of literate vocabulary words of low frequency such as later developing connectors (e.g., first of all, next, for this reason, on the other hand, consequently, finally, in conclusion) as well as metalinguistic and metacognitive verbs (“metaverbs”) that refer to acts of speaking (e.g., assert, concede, predict, argue, imply) and thinking (e.g., hypothesize, remember, doubt, assume, infer).

With respect to pragmatics, as students  mature, their sensitivity to the perspectives of others improves, as a result, their persuasive essays increase in length (i.e., total number of words produced) and they are able to offer a greater number of different reasons to support their own opinions (Nippold, Ward-Lonergan, & Fanning, 2005).

Now let’s apply our knowledge by analyzing a writing sample of a 15-year-old with suspected literacy deficits. Below 10th-grade student was provided with a written prompt first described in the Nippold, et al, 2005 study, entitled: “The Circus Controversy”.   “People have different views on animals performing in circuses. For example, some people think it is a great idea because it provides lots of entertainment for the public. Also, it gives parents and children something to do together, and the people who train the animals can make some money. However, other people think having animals in circuses is a bad idea because the animals are often locked in small cages and are not fed well. They also believe it is cruel to force a dog, tiger, or elephant to perform certain tricks that might be dangerous. I am interested in learning what you think about this controversy, and whether or not you think circuses with trained animals should be allowed to perform for the public. I would like you to spend the next 20 minutes writing an essay. Tell me exactly what you think about the controversy. Give me lots of good reasons for your opinion. Please use your best writing style, with correct grammar and spelling. If you aren’t sure how to spell a word, just take a guess.”(Nippold, Ward-Lonergan, & Fanning, 2005)

He produced the following written sample during the allotted 20 minutes.

Analysis: This student was able to generate a short, 3-paragraph, composition containing an introduction and a body without a definitive conclusion. His persuasive essay was judged to be very immature for his grade level due to significant disorganization, limited ability to support his point of view as well as the presence of tangential information in the introduction of his composition, which was significantly compromised by many writing mechanics errors (punctuation, capitalization, as well as spelling) that further impacted the coherence and cohesiveness of his written output.

The student’s introduction began with an inventive dialogue, which was irrelevant to the body of his persuasive essay. He did have three important points relevant to the body of the essay: animal cruelty, danger to the animals, and potential for the animals to harm humans. However, he was unable to adequately develop those points into full paragraphs. The notable absence of proofreading and editing of the composition further contributed to its lack of clarity. The above coupled with a lack of a conclusion was not commensurate grade-level expectations.

Based on the above-written sample, the student’s persuasive composition content (thought formulation and elaboration) was judged to be significantly immature for his grade level and is commensurate with the abilities of a much younger student.  The student’s composition contained several emerging claims that suggested a vague position. However, though the student attempted to back up his opinion and support his position (animals should not be performing in circuses), ultimately he was unable to do so in a coherent and cohesive manner.

Now that we know what the student’s written difficulties look like, the following goals will be applicable with respect to his writing remediation:

Long-Term Goals:  Student will improve his written abilities for academic purposes.

  • Short-Term Goals
  1. Student will appropriately utilize parts of speech (e.g., adjectives, adverbs, prepositions, etc.)  in compound and complex sentences.
  2. Student will use a variety of sentence types for story composition purposes (e.g., declarative, interrogative, imperative, and exclamatory sentences).
  3. Student will correctly use past, present, and future verb tenses during writing tasks.
  4. Student will utilize appropriate punctuation at the sentence level (e.g., apostrophes, periods, commas, colons, quotation marks in dialogue, and apostrophes in singular possessives, etc.).
  5. Student will utilize appropriate capitalization at the sentence level (e.g., capitalize proper nouns, holidays, product names, titles with names, initials, geographic locations, historical periods, special events, etc.).
  6. Student will use prewriting techniques to generate writing ideas (e.g., list keywords, state key ideas, etc.).
  7. Student will determine the purpose of his writing and his intended audience in order to establish the tone of his writing as well as outline the main idea of his writing.
  8. Student will generate a draft in which information is organized in chronological order via use of temporal markers (e.g., “meanwhile,” “immediately”) as well as cohesive ties (e.g., ‘but’, ‘yet’, ‘so’, ‘nor’) and cause/effect transitions (e.g., “therefore,” “as a result”).
  9. Student will improve coherence and logical organization of his written output via the use of revision strategies (e.g., modify supporting details, use sentence variety, employ literary devices).
  10. Student will edit his draft for appropriate grammar, spelling, punctuation, and capitalization.

There you have it. A quick and easy qualitative writing assessment which can assist SLPs to determine the extent of the student’s writing difficulties as well as establish writing remediation targets for intervention purposes.

Using a different type of writing assessment with your students? Please share the details below so we can all benefit from each others knowledge of assessment strategies.

References:

  • Nippold, M., Ward-Lonergan, J., & Fanning, J. (2005). Persuasive writing in children, adolescents, and adults: a study of syntactic, semantic, and pragmatic development. Language, Speech, and Hearing Services in Schools, 36, 125-138.

 

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New Products for the 2017 Academic School Year for SLPs

Image result for back to schoolSeptember is quickly approaching and  school-based speech language pathologists (SLPs) are preparing to go back to work. Many of them are looking to update their arsenal of speech and language materials for the upcoming academic school year.

With that in mind, I wanted to update my readers regarding all the new products I have recently created with a focus on assessment and treatment in speech language pathology.

My most recent product Assessment of Adolescents with Language and Literacy Impairments in Speech Language Pathology  is a 130-slide pdf download which discusses how to effectively select assessment materials in order to conduct comprehensive evaluations of adolescents with suspected language and literacy disorders. It contains embedded links to ALL the books and research articles used in the development of this product.

Effective Reading Instruction Strategies for Intellectually Impaired Students is a 50-slide downloadable presentation in pdf format which describes how speech-language pathologists (SLPs) trained in assessment and intervention of literacy disorders (reading, spelling, and writing) can teach phonological awareness, phonics, as well as reading fluency skills to children with mild-moderate intellectual disabilities. It reviews the research on reading interventions conducted with children with intellectual disabilities, lists components of effective reading instruction as well as explains how to incorporate components of reading instruction into language therapy sessions.

Dysgraphia Checklist for School-Aged Children helps to identify the students’ specific written language deficits who may require further assessment and treatment services to improve their written abilities.

Processing Disorders: Controversial Aspects of Diagnosis and Treatment is a 28-slide downloadable pdf presentation which provides an introduction to processing disorders.  It describes the diversity of ‘APD’ symptoms as well as explains the current controversies pertaining to the validity of the ‘APD’ diagnosis.  It also discusses how the label “processing difficulties” often masks true language and learning deficits in students which require appropriate language and literacy assessment and targeted intervention services.

Checklist for Identification of Speech Language Disorders in Bilingual and Multicultural Children was created to assist Speech Language Pathologists (SLPs) and Teachers in the decision-making process of how to appropriately identify bilingual and multicultural children who present with speech-language delay/deficits (vs. a language difference), for the purpose of initiating a formal speech-language-literacy evaluation.  The goal is to ensure that educational professionals are appropriately identifying bilingual children for assessment and service provision due to legitimate speech language deficits/concerns, and are not over-identifying students because they speak multiple languages or because they come from low socioeconomic backgrounds.

Comprehensive Assessment and Treatment of Literacy Disorders in Speech-Language Pathology is a 125 slide presentation which describes how speech-language pathologists can effectively assess and treat children with literacy disorders, (reading, spelling, and writing deficits including dyslexia) from preschool through adolescence.  It explains the impact of language disorders on literacy development, lists formal and informal assessment instruments and procedures, as well as describes the importance of assessing higher order language skills for literacy purposes. It reviews components of effective reading instruction including phonological awareness, orthographic knowledge, vocabulary awareness,  morphological awareness, as well as reading fluency and comprehension. Finally, it provides recommendations on how components of effective reading instruction can be cohesively integrated into speech-language therapy sessions in order to improve literacy abilities of children with language disorders and learning disabilities.

Improving critical thinking via picture booksImproving Critical Thinking Skills via Picture Books in Children with Language Disorders is a partial 30-slide presentation which discusses effective instructional strategies for teaching language disordered children critical thinking skills via the use of picture books utilizing both the Original (1956) and Revised (2001) Bloom’s Taxonomy: Cognitive Domain which encompasses the (R) categories of remembering, understanding, applying, analyzing, evaluating and creating.

from wordless books to reading From Wordless Picture Books to Reading Instruction: Effective Strategies for SLPs Working with Intellectually Impaired Students is a full 92 slide presentation which discusses how to address the development of critical thinking skills through a variety of picture books  utilizing the framework outlined in Bloom’s Taxonomy: Cognitive Domain which encompasses the categories of knowledge, comprehension, application, analysis, synthesis, and evaluation in children with intellectual impairments. It shares a number of similarities with the above product as it also reviews components of effective reading instruction for children with language and intellectual disabilities as well as provides recommendations on how to integrate reading instruction effectively into speech-language therapy sessions.

Best Practices in Bilingual LiteracyBest Practices in Bilingual Literacy Assessments and Interventions is a 105 slide presentation which focuses on how bilingual speech-language pathologists (SLPs) can effectively assess and intervene with simultaneously bilingual and multicultural children (with stronger academic English language skills) diagnosed with linguistically-based literacy impairments. Topics include components of effective literacy assessments for simultaneously bilingual children (with stronger English abilities), best instructional literacy practices, translanguaging support strategies, critical questions relevant to the provision of effective interventions, as well as use of accommodations, modifications and compensatory strategies for improvement of bilingual students’ performance in social and academic settings.

Comprehensive Literacy Checklist For School-Aged Children was created to assist Speech Language Pathologists (SLPs) in the decision-making process of how to identify deficit areas and select assessment instruments to prioritize a literacy assessment for school aged children. The goal is to eliminate administration of unnecessary or irrelevant tests and focus on the administration of instruments directly targeting the specific areas of difficulty that the student presents with.

You can find these and other products in my online store (HERE). Wishing all of you a highly successful and rewarding school year!

Image result for happy school year

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Adolescent Assessments in Action: Informal Reading Evaluation

Image result for adolescentsIn the past several years, due to an influx of adolescent students with language and learning difficulties on my caseload, I have begun to research in depth aspects of adolescent language development, assessment, and intervention.

While a number of standardized assessments are available to test various components of adolescent language from syntax and semantics to problem-solving and social communication, etc. in my experience with this age group, frequently, the informal assessments (vs. the standardized tests)which do a far better job of teasing out language difficulties in adolescents.

Today I wanted to write about the importance of performing an informal reading assessment as part of select* adolescent language and literacy evaluations.

There are a number of standardized tests on the market, which presently assess reading. However, not all of them by far are as functional as many clinicians would like them to be. To illustrate, one popular reading assessment is the Gray Oral Reading Tests-5 (GORT-5).  It assesses the student’s rate, accuracy, fluency, and comprehension abilities. While it’s a useful test to possess in one’s assessment toolbox, it is not without its limitations. In my experience assessing adolescent students with literacy deficits, many can pass this test with average scores, yet still present with pervasive reading comprehension difficulties in the school setting. As such, as part of the assessment process, I like to administer informal reading assessments to students who pass the standardized reading tests (e.g., GORT-5),  in order to ensure that the student does not possess any reading deficits at the grade  text level.

So how do I informally assess reading abilities of struggling adolescent learners?

First, I select one-page long grade level/below grade level text. I ask the student in question to read that text, and time the first minute of their reading in order to analyze the oral reading fluency or words correctly read per minute (wcpm).

Content Reading: ScienceFor this purpose, I often use the books from the Continental Press series entitled: Reading Comprehension for Social Studies & Science.   Texts for grades 5 – 7 of the series are perfect for assessment of struggling adolescent readers. In some cases using a below grade level text allows me to starkly illustrate the extent of the student’s reading difficulties. Below is an example of one of such informal rading assessments in action.

INFORMAL READING ASSESSMENT: 8th Grade Male   

Content Reading: Social ScienceAn informal reading assessment was administered to TS, a 15-5-year-old male, on a supplementary basis in order to further analyze his reading abilities. Given the fact that TS was reported to present with grade-level reading difficulties, the examiner gave TS a 7th-grade text by Continental Press. TS was asked to read aloud the 7 paragraph long text, and then answer factual and inferential questions, summarize the presented information, define select context embedded vocabulary words as well as draw conclusions based on the presented text. (Please note that in order to protect the client’s privacy some portions of the below assessment questions and responses were changed to be deliberately vague).

Image result for reading fluency componentsReading Fluency: TS’s reading fluency (automaticity, prosody, accuracy and speed, expression, intonation, and phrasing) during the reading task was marked by monotone vocal quality, awkward word stress, imprecise articulatory contacts, false-starts, self–revisions, awkward mid-sentential pauses, limited pausing for punctuation, as well as  misreadings and word substitutions, all of which resulted in an impaired reading prosody.

With respect to specific errors, TS was observed to occasionally add word fillers to text (e.g., and, a, etc.), change morphological endings of select words (e.g., read /elasticity/ as /elastic/, etc.) as well as substitute similar looking words (e.g., from/for; those/these, etc.) during reading.  He occasionally placed stress on the first vs. second syllable in disyllabic words, which resulted in distorted word productions (e.g., products, residual, upward, etc.), as well as inserted extra words into text (e.g., read: “until pressure inside the earth starts to build again” as “until pressure inside the earth starts to build up again”). He also began reading a number of his sentences with false starts (e.g., started reading the word “drinking” as ‘drunk’, etc.) and as a result was observed to make a number of self-corrections during reading.

During reading TS demonstrated adequate tracking movements for text scanning as well as use of context to aid his decoding.  For example, TS was observed to read the phonetic spelling of select unfamiliar words in parenthesis (e.g., equilibrium) and then read them correctly in subsequent sentences. However, he exhibited limited use of metalinguistic strategies and did not always self-correct misread words; dispute the fact that they did not always make sense in the context of the read sentences.

TS’s oral reading rate during today’s reading was judged to be reduced for his age/grade levels. An average 8th grader is expected to have an oral reading rate between 145 and 160 words per minute. In contrast, TS was only able to read 114 words per minute. However, it is important to note that recent research on reading fluency has indicated that as early as by 4th grade reading faster than 90 wcpm will not generate increases in comprehension for struggling readers.  Consequently, TS’s current reading rate of off 114 words per minute was judged to be adequate for reading purposes. Furthermore, given the fact that TS’s reading comprehension is already compromised at this rate (see below for further details) rather than making a recommendation to increase his reading rate further, it is instead recommended that intervention focuses on slowing TS’s rate via relevant strategies as well as improving his reading comprehension abilities. Strategies should focus on increasing his opportunities to learn domain knowledge via use of informational texts; purposeful selection of texts to promote knowledge acquisition and gain of expertise in different domains; teaching morphemic as well as semantic feature analyses (to expand upon already robust vocabulary), increasing discourse and critical thinking with respect to informational text, as well as use of graphic organizers to teach text structure and conceptual frameworks.

Verbal Text Summary: TS’s text summary following his reading was very abbreviated, simplified, and confusing. When asked: “What was this text about?” Rather than stating the main idea, TS nonspecifically provided several vague details and was unable to elaborate further. When asked: “Do you think you can summarize this story for me from beginning to the end?” TS produced the two disjointed statements, which did not adequately address the presented question When asked: What is the main idea of this text.” TS vaguely responded: “Science,” which was the broad topic rather than the main idea of the story.

Image result for vocabularyText Vocabulary Comprehension:

After that, TS was asked a number of questions regarding story vocabulary.  The first word presented to him was “equilibrium”.  When asked: “What does ‘equilibrium’ mean?” TS first incorrectly responded: “temperature”. Then when prompted: “Anything else?” TS correctly replied: “balance.” He was then asked to provide some examples of how nature leans towards equilibrium from the story. TS nonspecifically produced: “Ah, gravity.” When asked to explain how gravity contributes to the process of equilibrium TS again nonspecifically replied: “gravity is part of the planet”, and could not elaborate further. TS was then asked to define another word from the text provided to him in a sentence: “Scientists believe that this is residual heat remaining from the beginnings of the solar system.” What is the meaning of the word: “residual?” TS correctly identified: “remaining.” Then the examiner asked him to define the term found in the last paragraph of the text: “What is thermal equilibrium?” TS nonspecifically responded: “a balance of temperature”, and was unable to elaborate further.

Image result for reading comprehensionReading Comprehension (with/out text access):

TS was also asked to respond to a number of factual text questions without the benefit of visual support. However, he presented with significant difficulty recalling text details. TS was asked: When asked, “Why did this story mention ____? What did they have to do with ____?” TS responded nonspecifically, “______.” When prompted to tell more, TS produced a rambling response which did not adequately address the presented question. When asked: “Why did the text talk about bungee jumpers? How are they connected to it?” TS stated, “I am ah, not sure really.” 

Finally, TS was provided with a brief worksheet which accompanied the text and asked to complete it given the benefit of written support. While TS’s performance on this task was better, he still achieved only 66% accuracy and was only able to answer 4 out of 6 questions correctly. On this task, TS presented with difficulty identifying the main idea of the third paragraph, even after being provided with multiple choice answers. He also presented with difficulty correctly responding to the question pertaining to the meaning of the last paragraph.

Image result for impressionsImpressions: Informal below grade-level reading comprehension assessment reading revealed that TS presents with a number of reading related difficulties.   TS’s reading fluency was marked by monotone vocal quality, awkward word stress, imprecise articulatory contacts, false-starts, self–revisions, awkward mid-sentential pauses, limited pausing for punctuation, as well as misreadings and word substitutions, all of which resulted in an impaired reading prosody. TS’s understanding as well as his verbal summary of the presented text was immature for his age and was characterized by impaired gestalt processing of information resulting in an ineffective and confusing summarization.  While TS’s text-based vocabulary knowledge was deemed to be grossly adequate for his age, his reading comprehension abilities were judged to be impaired for his age. Therapeutic intervention is strongly recommended to improve TS’s reading abilities. (See Impressions and Recommendations sections for further details).

There you have it! This is just one of many different types of informal reading assessments, which I occasionally conduct with adolescents who attain average scores on reading fluency and reading comprehension tests such as the GORT-5 or the Test of Reading Comprehension -4 (TORC-4), but still present with pervasive reading difficulties working with grade level text.

You can find more information on the topic of adolescent assessments (including other comprehensive informal write-up examples) in this recently developed product entitled: Assessment of Adolescents with Language and Literacy Impairments in Speech Language Pathology currently available in my online store.

What about you? What type of informal tasks and materials are you using to assess your adolescent students’ reading abilities and why do you like using them?

Helpful Smart Speech Therapy Adolescent Assessment Resources:

 

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Improving Executive Function Skills of Language Impaired Students with Hedbanz

Image result for hedbanzThose of you who have previously read my blog know that I rarely use children’s games to address language goals.  However, over the summer I have been working on improving executive function abilities (EFs) of some of the language impaired students on my caseload. As such, I found select children’s games to be highly beneficial for improving language-based executive function abilities.

For those of you who are only vaguely familiar with this concept, executive functions are higher level cognitive processes involved in the inhibition of thought, action, and emotion, which located in the prefrontal cortex of the frontal lobe of the brain. The development of executive functions begins in early infancy; but it can be easily disrupted by a number of adverse environmental and organic experiences (e.g., psychosocial deprivation, trauma).  Furthermore, research in this area indicates that the children with language impairments present with executive function weaknesses which require remediation.

Image result for executive functions brain

EF components include working memory, inhibitory control, planning, and set-shifting.

  • Working memory
    • Ability to store and manipulate information in mind over brief periods of time
  • Inhibitory control
    • Suppressing responses that are not relevant to the task
  • Set-shifting
    • Ability to shift behavior in response to changes in tasks or environment

Simply put, EFs contribute to the child’s ability to sustain attention, ignore distractions, and succeed in academic settings. By now some of you must be wondering: “So what does Hedbanz have to do with any of it?”

Well, Hedbanz is a quick-paced multiplayer  (2-6 people) game of “What Am I?” for children ages 7 and up.  Players get 3 chips and wear a “picture card” in their headband. They need to ask questions in rapid succession to figure out what they are. “Am I fruit?” “Am I a dessert?” “Am I sports equipment?” When they figure it out, they get rid of a chip. The first player to get rid of all three chips wins.

The game sounds deceptively simple. Yet if any SLPs or parents have ever played that game with their language impaired students/children as they would be quick to note how extraordinarily difficult it is for the children to figure out what their card is. Interestingly, in my clinical experience, I’ve noticed that it’s not just moderately language impaired children who present with difficulty playing this game. Even my bright, average intelligence teens, who have passed vocabulary and semantic flexibility testing (such as the WORD Test 2-Adolescent or the  Vocabulary Awareness subtest of the Test of Integrated Language and Literacy ) significantly struggle with their language organization when playing this game.

So what makes Hedbanz so challenging for language impaired students? Primarily, it’s the involvement and coordination of the multiple executive functions during the game. In order to play Hedbanz effectively and effortlessly, the following EF involvement is needed:

  • Task Initiation
    • Students with executive function impairments will often “freeze up” and as a result may have difficulty initiating the asking of questions in the game because many will not know what kind of questions to ask, even after extensive explanations and elaborations by the therapist.
  • Organization
    • Students with executive function impairments will present with difficulty organizing their questions by meaningful categories and as a result will frequently lose their track of thought in the game.
  • Working Memory
    • This executive function requires the student to keep key information in mind as well as keep track of whatever questions they have already asked.
  • Flexible Thinking
    • This executive function requires the student to consider a situation from multiple angles in order to figure out the quickest and most effective way of arriving at a solution. During the game, students may present with difficulty flexibly generating enough organizational categories in order to be effective participants.
  • Impulse Control
    • Many students with difficulties in this area may blurt out an inappropriate category or in an appropriate question without thinking it through first.
      • They may also present with difficulty set-shifting. To illustrate, one of my 13-year-old students with ASD, kept repeating the same question when it was his turn, despite the fact that he was informed by myself as well as other players of the answer previously.
  • Emotional Control
    • This executive function will help students with keeping their emotions in check when the game becomes too frustrating. Many students of difficulties in this area will begin reacting behaviorally when things don’t go their way and they are unable to figure out what their card is quickly enough. As a result, they may have difficulty mentally regrouping and reorganizing their questions when something goes wrong in the game.
  • Self-Monitoring
    • This executive function allows the students to figure out how well or how poorly they are doing in the game. Students with poor insight into own abilities may present with difficulty understanding that they are doing poorly and may require explicit instruction in order to change their question types.
  • Planning and Prioritizing
    • Students with poor abilities in this area will present with difficulty prioritizing their questions during the game.

Image result for executive functionsConsequently, all of the above executive functions can be addressed via language-based goals.  However, before I cover that, I’d like to review some of my session procedures first.

Typically, long before game initiation, I use the cards from the game to prep the students by teaching them how to categorize and classify presented information so they effectively and efficiently play the game.

Rather than using the “tip cards”, I explain to the students how to categorize information effectively.

This, in turn, becomes a great opportunity for teaching students relevant vocabulary words, which can be extended far beyond playing the game.

I begin the session by explaining to the students that pretty much everything can be roughly divided into two categories animate (living) or inanimate (nonliving) things. I explain that humans, animals, as well as plants belong to the category of living things, while everything else belongs to the category of inanimate objects. I further divide the category of inanimate things into naturally existing and man-made items. I explain to the students that the naturally existing category includes bodies of water, landmarks, as well as things in space (moon, stars, sky, sun, etc.). In contrast, things constructed in factories or made by people would be example of man-made objects (e.g., building, aircraft, etc.)

When I’m confident that the students understand my general explanations, we move on to discuss further refinement of these broad categories. If a student determines that their card belongs to the category of living things, we discuss how from there the student can further determine whether they are an animal, a plant, or a human. If a student determined that their card belongs to the animal category, we discuss how we can narrow down the options of figuring out what animal is depicted on their card by asking questions regarding their habitat (“Am I a jungle animal?”), and classification (“Am I a reptile?”). From there, discussion of attributes prominently comes into play. We discuss shapes, sizes, colors, accessories, etc., until the student is able to confidently figure out which animal is depicted on their card.

In contrast, if the student’s card belongs to the inanimate category of man-made objects, we further subcategorize the information by the object’s location (“Am I found outside or inside?”; “Am I found in ___ room of the house?”, etc.), utility (“Can I be used for ___?”), as well as attributes (e.g., size, shape, color, etc.)

Thus, in addition to improving the students’ semantic flexibility skills (production of definitions, synonyms, attributes, etc.) the game teaches the students to organize and compartmentalize information in order to effectively and efficiently arrive at a conclusion in the most time expedient fashion.

Now, we are ready to discuss what type of EF language-based goals, SLPs can target by simply playing this game.

1. Initiation: Student will initiate questioning during an activity in __ number of instances per 30-minute session given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

2. Planning: Given a specific routine, student will verbally state the order of steps needed to complete it with __% accuracy given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

3. Working Memory: Student will repeat clinician provided verbal instructions pertaining to the presented activity, prior to its initiation, with 80% accuracy  given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

4. Flexible Thinking: Following a training by the clinician, student will generate at least __ questions needed for task completion (e.g., winning the game) with __% accuracy given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

5. Organization: Student will use predetermined written/visual cues during an activity to assist self with organization of information (e.g., questions to ask) with __% accuracy given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

6. Impulse Control: During the presented activity the student will curb blurting out inappropriate responses (by silently counting to 3 prior to providing his response) in __ number of instances per 30 minute session given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

7. Emotional Control: When upset, student will verbalize his/her frustration (vs. behavioral activing out) in __ number of instances per 30 minute session given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

8. Self-Monitoring:  Following the completion of an activity (e.g., game) student will provide insight into own strengths and weaknesses during the activity (recap) by verbally naming the instances in which s/he did well, and instances in which s/he struggled with __% accuracy given (maximal, moderate, minimal) type of  ___  (phonemic, semantic, etc.) prompts and __ (visual, gestural, tactile, etc.) cues by the clinician.

There you have it. This one simple game doesn’t just target a plethora of typical expressive language goals. It can effectively target and improve language-based executive function goals as well. Considering the fact that it sells for approximately $12 on Amazon.com, that’s a pretty useful therapy material to have in one’s clinical tool repertoire. For fancier versions, clinicians can use “Jeepers Peepers” photo card sets sold by Super Duper Inc. Strapped for cash, due to highly limited budget? You can find plenty of free materials online if you simply input “Hedbanz cards” in your search query on Google. So have a little fun in therapy, while your students learn something valuable in the process and play Hedbanz today!

Related Smart Speech Therapy Resources:

 

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A Focus on Literacy

Image result for literacyIn recent months, I have been focusing more and more on speaking engagements as well as the development of products with an explicit focus on assessment and intervention of literacy in speech-language pathology. Today I’d like to introduce 4 of my recently developed products pertinent to assessment and treatment of literacy in speech-language pathology.

First up is the Comprehensive Assessment and Treatment of Literacy Disorders in Speech-Language Pathology

which describes how speech-language pathologists can effectively assess and treat children with literacy disorders, (reading, spelling, and writing deficits including dyslexia) from preschool through adolescence.  It explains the impact of language disorders on literacy development, lists formal and informal assessment instruments and procedures, as well as describes the importance of assessing higher order language skills for literacy purposes. It reviews components of effective reading instruction including phonological awareness, orthographic knowledge, vocabulary awareness,  morphological awareness, as well as reading fluency and comprehension. Finally, it provides recommendations on how components of effective reading instruction can be cohesively integrated into speech-language therapy sessions in order to improve literacy abilities of children with language disorders and learning disabilities.

from wordless books to readingNext up is a product entitled From Wordless Picture Books to Reading Instruction: Effective Strategies for SLPs Working with Intellectually Impaired StudentsThis product discusses how to address the development of critical thinking skills through a variety of picture books utilizing the framework outlined in Bloom’s Taxonomy: Cognitive Domain which encompasses the categories of knowledge, comprehension, application, analysis, synthesis, and evaluation in children with intellectual impairments. It shares a number of similarities with the above product as it also reviews components of effective reading instruction for children with language and intellectual disabilities as well as provides recommendations on how to integrate reading instruction effectively into speech-language therapy sessions.

Improving critical thinking via picture booksThe product Improving Critical Thinking Skills via Picture Books in Children with Language Disorders is also available for sale on its own with a focus on only teaching critical thinking skills via the use of picture books.

Best Practices in Bilingual LiteracyFinally,   my last product Best Practices in Bilingual Literacy Assessments and Interventions focuses on how bilingual speech-language pathologists (SLPs) can effectively assess and intervene with simultaneously bilingual and multicultural children (with stronger academic English language skills) diagnosed with linguistically-based literacy impairments. Topics include components of effective literacy assessments for simultaneously bilingual children (with stronger English abilities), best instructional literacy practices, translanguaging support strategies, critical questions relevant to the provision of effective interventions, as well as use of accommodations, modifications and compensatory strategies for improvement of bilingual students’ performance in social and academic settings.

You can find these and other products in my online store (HERE).

Helpful Smart Speech Therapy Resources:

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New Product Giveaway: Comprehensive Literacy Checklist For School-Aged Children

I wanted to start the new year right by giving away a few copies of a new checklist I recently created entitled: “Comprehensive Literacy Checklist For School-Aged Children“.

It was created to assist Speech Language Pathologists (SLPs) in the decision-making process of how to identify deficit areas and select assessment instruments to prioritize a literacy assessment for school aged children.

The goal is to eliminate administration of unnecessary or irrelevant tests and focus on the administration of instruments directly targeting the specific areas of difficulty that the student presents with.

*For the purpose of this product, the term “literacy checklist” rather than “dyslexia checklist” is used throughout this document to refer to any deficits in the areas of reading, writing, and spelling that the child may present with in order to identify any possible difficulties the child may present with, in the areas of literacy as well as language.

This checklist can be used for multiple purposes.

1. To identify areas of deficits the child presents with for targeted assessment purposes

2. To highlight areas of strengths (rather than deficits only) the child presents with pre or post intervention

3. To highlight residual deficits for intervention purpose in children already receiving therapy services without further reassessment

Checklist Contents:

  • Page 1 Title
  • Page 2 Directions
  • Pages 3-9 Checklist
  • Page 10 Select Tests of Reading, Spelling, and Writing for School-Aged Children
  • Pages 11-12 Helpful Smart Speech Therapy Materials

Checklist Areas:

  1. AT RISK FAMILY HISTORY
  2. AT RISK DEVELOPMENTAL HISTORY
  3. BEHAVIORAL MANIFESTATIONS 
  4. LEARNING DEFICITS   
    1. Memory for Sequences
    2. Vocabulary Knowledge
    3. Narrative Production
    4. Phonological Awareness
    5. Phonics
    6. Morphological Awareness
    7. Reading Fluency
    8. Reading Comprehension
    9. Spelling
    10. Writing Conventions
    11. Writing Composition 
    12. Handwriting

You can find this product in my online store HERE.

Would you like to check it out in action? I’ll be giving away two copies of the checklist in a Rafflecopter Giveaway to two winners.  So enter today to win your own copy!

a Rafflecopter giveaway

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Comprehensive Assessment of Adolescents with Suspected Language and Literacy Disorders

When many of us think of such labels as “language disorder” or “learning disability”, very infrequently do adolescents (students 13-18 years of age) come to mind. Even today, much of the research in the field of pediatric speech pathology involves preschool and school-aged children under 12 years of age.

The prevalence and incidence of language disorders in adolescents is very difficult to estimate due to which some authors even referred to them as a Neglected Group with Significant Problems having an “invisible disability“.

Far fewer speech language therapists work with middle-schoolers vs. preschoolers and elementary aged kids, while the numbers of SLPs working with high-school aged students is frequently in single digits in some districts while being completely absent in others. In fact, I am frequently told (and often see it firsthand) that some administrators try to cut costs by attempting to dictate a discontinuation of speech-language services on the grounds that adolescents “are far too old for services” or can “no longer benefit from services”.  

But of course the above is blatantly false. Undetected language deficits don’t resolve with age! They simply exacerbate and turn into learning disabilities. Similarly, lack of necessary and appropriate service provision to children with diagnosed language impairments  at the middle-school and high-school levels will strongly affect their academic functioning and hinder their future vocational outcomes.

A cursory look at the Speech Pathology Related  Facebook Groups as well as ASHA forums reveals numerous SLPs in a continual search for best methods of assessment and treatment of older students (~12-18 years of age).  

Consequently, today I wanted to dedicate this post to a review of standardized assessments options available for students 12-18 years of age with suspected language and literacy deficits.

Most comprehensive standardized assessments, “typically focus on semantics, syntax, morphology, and phonology, as these are the performance areas in which specific skill development can be most objectively measured” (Hill & Coufal, 2005, p 35). Very few of them actually incorporate aspects of literacy into its subtests in a meaningful way.  Yet by the time students reach adolescence literacy begins to play an incredibly critical role not just in all the aspects of academics but also social communication.

So when it comes to comprehensive general language testing I highly recommended that SLPs select  standardized measures with a focus on not  language but also literacy.  Presently of all the comprehensive assessment tools   I highly prefer the Test of Integrated Language and Literacy (TILLS) for students up to 18 years of age, (see a comprehensive review HERE),  which covers such literacy areas as phonological awareness, reading fluency, reading comprehension, writing and spelling in addition to traditional language areas as as vocabulary awareness, following directions, story recall, etc. However,  while comprehensive tests have  numerous  uses,  their sole  administration will not constitute an adequate assessment.

So what areas should be assessed during language and literacy testing?  Below are  a few suggestions of standardized testing measures (and informal procedures) aimed at exploring the student abilities in particular areas pertaining to language and literacy.

TESTS OF LANGUAGE

TESTS OF LITERACYscreen-shot-2016-10-09-at-2-29-57-pm

It is understandable  how given the sheer amount of assessment choices some clinicians may feel overwhelmed and be unsure regarding the starting point of an adolescent evaluation.   Consequently, the use the checklist prior to the initiation of assessment may be highly useful in order to identify potential language weaknesses/deficits the students might experience. It will also allow clinicians to prioritize  the hierarchy of testing instruments to use during the assessment.  

While clinicians are encouraged to develop such checklists for their personal use,  those who lack time and opportunity can locate a number of already available checklists on the market. 

For example, the comprehensive 6-page Speech Language Assessment Checklist for Adolescents (below) can be given to caregivers, classroom teachers, and even older students in order to check off the most pressing difficulties the student is experiencing in an academic setting. 

adolescent checklist

It is important for several individuals to fill out this checklist to ensure consistency of deficits, prior to determining whether an assessment is warranted in the first place and if so, which assessment areas need to be targeted.

Checklist Categories:

  1. Receptive Language
  2. Memory, Attention and Cognition
  3. Expressive Language
  4. Vocabulary
  5. Discourse
  6. Speech
  7. Voice
  8. Prosody
  9. Resonance
  10. Reading
  11. Writing
  12. Problem Solving
  13. Pragmatic Language Skills
  14. Social Emotional Development
  15. Executive Functioning

alolescent pages sample

Based on the checklist administration SLPs can  reliably pinpoint the student’s areas of deficits without needless administration of unrelated/unnecessary testing instruments.  For example, if a student presents with deficits in the areas of problem solving and social pragmatic functioning the administration of a general language test such as the Clinical Evaluation of Language Fundamentals® – Fifth Edition (CELF-5) would NOT be functional (especially if the previous administration of educational testing did not reveal any red flags). In contrast, the administration of such tests as Test Of Problem Solving 2 Adolescent and Social Language Development Test Adolescent would be better reflective of the student’s deficits in the above areas. (Checklist HERE; checklist sample HERE). 

It is very important to understand that students presenting with language and literacy deficits will not outgrow these deficits on their own. While there may be “a time period when the students with early language disorders seem to catch up with their typically developing peers” (e.g., illusory recovery) by undergoing a “spurt” in language learning”(Sun & Wallach, 2014). These spurts are typically followed by a “post-spurt plateau”. This is because due to the ongoing challenges and an increase in academic demands “many children with early language disorders fail to “outgrow” these difficulties or catch up with their typically developing peers”(Sun & Wallach, 2014).  As such many adolescents “may not show academic or language-related learning difficulties until linguistic and cognitive demands of the task increase and exceed their limited abilities” (Sun & Wallach, 2014).  Consequently, SLPs must consider the “underlying deficits that may be masked by early oral language development” and “evaluate a child’s language abilities in all modalities, including pre-literacy, literacy, and metalinguistic skills” (Sun & Wallach, 2014).

References:

  1. 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.
  2. Sun, L & Wallach G (2014) Language Disorders Are Learning Disabilities: Challenges on the Divergent and Diverse Paths to Language Learning Disability. Topics in Language Disorders, Vol. 34; (1), pp 25–38.

Helpful Smart Speech Therapy Resources 

  1. Assessment of Adolescents with Language and Literacy Impairments in Speech Language Pathology 
  2. Assessment and Treatment Bundles 
  3. Social Communication Materials
  4. Multicultural Materials