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Comprehensive Assessment of Elementary Aged Children with Subtle Language and Literacy Deficits

Image result for confused childrenLately, I’ve been seeing more and more posts on social media asking for testing suggestions for students who exhibit subtle language-based difficulties. Many of these children are typically referred for initial assessments or reassessments as part of advocate/attorney involved cases, while others are being assessed due to the parental insistence that something “is not quite right” with their language and literacy abilities, even in the presence of “good grades.” Continue reading Comprehensive Assessment of Elementary Aged Children with Subtle Language and Literacy Deficits

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Clinical Assessment of Reading Abilities of Elementary Aged Children

Image result for child readingSeveral years ago I wrote a post about how to perform clinical reading assessments of adolescent students. Today I am writing a follow-up post with a focus on the clinical reading assessment of elementary-aged students. For this purpose, I often use the books from the Continental Press series entitled: Content Reading for Geography, Social Studies, & Science.   Texts for grades 2-7 of the series are perfect for assessment of struggling elementary-aged readers. Continue reading Clinical Assessment of Reading Abilities of Elementary Aged Children

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Neuropsychological or Language/Literacy: Which Assessment is Right for My Child?

Related imageSeveral years ago I began blogging on the subject of independent assessments in speech pathology. First, I wrote a post entitled “Special Education Disputes and Comprehensive Language Testing: What Parents, Attorneys, and Advocates Need to Know“, in which I used  4 different scenarios to illustrate the importance of comprehensive language evaluations for children with subtle language and learning needs. Then I wrote about: What Makes an Independent Speech-Language-Literacy Evaluation a GOOD Evaluation?” in order to elucidate on what actually constitutes a good independent comprehensive assessment. Continue reading Neuropsychological or Language/Literacy: Which Assessment is Right for My Child?

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Clinical Fellow (and Setting-Switching SLPs) Survival Guide in the Schools

Related image It’s early August, and that means that the start of a new school year is just around the corner.  It also means that many newly graduated clinical fellows (as well as SLPs switching their settings) will begin their exciting yet slightly terrifying new jobs working for various school systems around the country.  Since I was recently interviewing clinical fellows myself in my setting (an outpatient school located in a psychiatric hospital, run by a university), I decided to write this post in order to assist new graduates, and setting-switching professionals by describing what knowledge and skills are desirable to possess when working in the schools. Continue reading Clinical Fellow (and Setting-Switching SLPs) Survival Guide in the Schools

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Helpful Smart Speech Therapy Site Searching Tips

Related imageOver the years this blog has amassed many posts on a variety of topics pertaining to the assessment and treatment in speech-language pathology. With over 300 posts and over 130 search categories it’s no wonder that some of you have reached out to ask about effective ways of finding relevant information quickly. As such, in addition to the existing categories pertaining to specific topics (e.g., writing, social communication, etc.) I have created two specific categories which were asked about by numerous blog subscribers in recent emails. Continue reading Helpful Smart Speech Therapy Site Searching Tips

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How Early can “Dyslexia” be Diagnosed in Children?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

TEWL-3_EM-159

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

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

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

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

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

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

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

It has 3 composites:

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

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

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

Image result for child reading

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why are nonsense words important?

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

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

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

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

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

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

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

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

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

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

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

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

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

Myth 2: A doctor can diagnose dyslexia!

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

Myth 3: Speech Pathologists cannot perform dyslexia testing!

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

So what are the dyslexia battery components?

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

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

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

Image result for language testingLANGUAGE TESTING

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

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

Listening Comprehension (with a verbal response component)

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

Semantic Flexibility

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

Narrative Production:

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

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

Social Pragmatic Language

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

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

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

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

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

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