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

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

The first question I ask the reading specialists doing the interviewing process is: “Can you please describe how language development influences literacy development?” I do so because language development occurs on the continuum. Hence, strong oral language abilities (e.g., solid vocabulary knowledge, good narrative abilities, etc.) are the building blocks for future reading comprehension success.

Image result for reading componentsNext, I ask them to list the components integral to reading success.  That is because in order for children to become successful readers they require instruction in the following aspects of literacy: phonemic awareness, phonics, vocabulary and semantic awareness, morphological awareness, orthographic knowledge, as well as reading fluency and reading comprehension (the effect of handwriting, spelling, and writing is also hugely important). I am quite happy though if phonemic awareness, phonics, vocabulary, reading fluency and reading comprehension, make the list.

Another question that I always make sure to ask is whether the reading specialist subscribes to a particular instructional approach to reading. Currently, all popular reading instructional practices (e.g., Wilson, Orton-Gillingham, Barton, Reading Recovery, etc.) no matter how evidence-based they are advertised/claimed to be, possess significant limitations if used exclusively and in isolation.  As such, it is very important for parents to understand that it is not the application of a particular approach, which will result in successfully teaching a child to read, but rather knowing how to integrate multiple instructional elements in order to create scientifically informed reading intervention sessions.

Given the proliferation of questionable programs that claim to improve children’s reading abilities, I always ensure to ask whether the reading specialist employees a particular computer program to teach reading. That is because some reading specialists utilize the Fast ForWord program. However, systematic reviews found no sign of a reliable effect of Fast ForWord® on reading. Similarly, the Read Naturally® software used by some reading specialists was found to have “mixed effects on reading fluency, and no discernible effects on alphabetics and comprehension for beginning readers.” That is why systematic and explicit direct instruction is still the most evidenced-based intervention approach for children with language and literacy needs.

To continue, I always ask the reading specialists about the role of morphology in reading intervention. I also ask them whether they utilize spelling interventions to improve the reading abilities of students with reading difficulties. Research indicates that beyond phonemic awareness and phonics, morphological awareness plays a very significant role in improving vocabulary knowledge, reading fluency, reading comprehension as well as spelling abilities of struggling learners (especially beyond 3rd grade).  Similarly, studies show that supplementing reading intervention with spelling instruction will improve and expedite reading gains.

Image result for tracking progressYet another important question pertains to the tracking the progress of struggling learners in order to objectively document intervention effectiveness. There is a variety of nonstandardized tools available on the market to track reading progress. Unfortunately, some of these tools such as the DRA’s are unreliable and too subjective. As such, I am very interested regarding how well versed are the reading specialists in the administration and interpretation of standardized phonological awareness, reading fluency, and reading comprehension measures such as the PAT-2, CTOPP-2, GORT-5, TORC-4, TOWRE-2, TOSCRF-2, TOSWRF-2, etc, for an objective tracking of student progress.

The above is just a very basic list of questions that I like to ask the reading specialists during the initial interview process. There are many more that I like to ask in my determination of their preparation for assessment and treatment of struggling learners, which are tailored to the particular program for which I work and as such are not relevant to this particular post.

When choosing a relevant professional for working with their child it is very important for parents to understand that rigid adherence to a particular instructional method is not necessarily a good thing. Rather, qualified and competent reading specialists may use a variety of approaches when teaching reading, spelling, and writing.  It is not a particular approach which matters per se, but rather the principles behind a particular approach NEED to be scientifically sound and supported by proven research practices.  Overreliance on a particular methodology at the exclusion of all others fails to produce well-rounded, competent, and erudite readers.

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Using Picture Books to Teach Children That It’s OK to Make Mistakes and Take Risks

Image result for children making mistakesThose of you who follow my blog know that in my primary job as an SLP working for a psychiatric hospital, I assess and treat language and literacy impaired students with significant emotional and behavioral disturbances. I often do so via the aid of picture books (click HERE for my previous posts on this topic) dealing with a variety of social communication topics.

Two themes that consistently come up in my therapy sessions are taking risks and making mistakes. Many of my students are very afraid of taking risks and are terrified of trying new things whether educationally or socially. To address the issue of taking risks and changing one’s mindset I like using two books by Julia Cook Bubble Gum Brain’ as well as ‘Don’t Be Afraid to Drop’.

Image result for bubble gum brainBubble Gum Brain’ (video) is a book about two kids: Bubble Gum Brain and Brick Brain, with two drastically different frames of mind. Bubble Gum Brain is a fun fun-loving adventure-taker who makes loads of mistakes, whether falling off a unicycle, striking out at baseball, or playing the harmonica. Even though those things are very difficult, he is not concerned about making mistakes because he realizes that by persevering and not giving up he is learning new things and actually having fun in the process. In contrast, Brick Brain is convinced that “things are just fine the way they are” and trying new things is hard. Brick Brain is hugely reluctant to take any chances in sports, at play, and in life, and is frequently complaining that things are “way too hard”. Then Bubble Gum Brain shows Brick Brain that all he needs to do is to peel off his wrapper, in order to see that he also has a Bubble Gum Brain. After that Brick Brain starts to realize that school and life can be a lot more palatable and even fun even when one is making mistakes.

Book Buddy for Bubble Gum Brain by Julia CookMy favorite part about this book is teaching my students to understand the Power of Yet (“You can’t figure this out …yet”), and explaining to them that with hard work and perseverance they can accomplish just about anything they set their mind to, including the mastery of their language and literacy goals! I teach them to take chances by trying to go just a little bit farther each time and pushing themselves just a tiny bit more in each of their therapy sessions. In addition to asking my students critical thinking questions regarding this text, I at times use a FREE book companion from Technology Tidbits on TPT, to supplement my therapy sessions. It contains a lesson plan overview, a book quiz, a sorting activity, and a few other resources which can wonderfully supplement the session for this book.

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Similar to the above,’Don’t be Afraid to Drop’ (video) is a book about a raindrop who is incredibly comfortable living in his cloud with his friends. He is having a very difficult time letting go of the comforts of his cloud as he doesn’t like change or wants to take a risk. However, with his father’s encouragement, the raindrop is eventually persuaded to leave his comfort zone and jump to the ground to see what he is missing. I really like the positive message in this book regarding welcoming change as well as giving back. “You can have it silver you might end up – I promise, you’ll be just fine you will land where you are needed.” By the end of the book, the raindrop realizes that “dropping” had helped him to grow; that change is an ultimately positive thing; and that giving to others (e.g., watering a flower) helps us all grow!

To continue, a considerable number of my students not only both loath (unwilling, reluctant) and loathe (hate) to make mistakes and be perceived as wrong, but will react in some pretty significant ways when those mistakes occur (e.g., climb under the table and refuse to come out, throw a tantrum and refuse to attend therapy sessions, etc.). To teach my students that mistakes are actually beneficial for learning I like to use books such as ‘The Girl Who Never Made Mistakes!’ by Mark Pett and Gary Rubenstein and ‘Your Fantastic, Elastic Brain‘ by  JoAnn Deak. 

11526654Beatrice Bottomwell is ‘The Girl Who Never Made Mistakes!’ (video) This nine-year-old is perfect in every way, to the point that when she leaves the house she is greeted by her fans, who don’t even know her real name because she’s known to everyone in town as “The Girl Who Never Made Mistakes”.  Beatrice never forgets her math homework, never wears mismatched socks, and has won her school’s talent show by doing her juggling act for three years in a row.  Then one day during cooking class, Beatrice makes an ‘almost mistake’ as she slips on a piece of rhubarb while carrying eggs from the fridge. Even though she manages to catch all the eggs, Beatrice becomes highly preoccupied with her ‘almost mistake’. In fact, she is so perturbed by it that she doesn’t want to ice skate with her friends and can barely eat her food. Later that evening, during the school’s talent show Beatrice’s preoccupation with her ‘almost mistake’ causes her to make a spectacularly huge mistake, which results in her being soaked in water, covered in pepper, with a hamster on her head.  Luckily, rather than getting spectacularly upset, Beatrice comes to a realization that not only do mistakes happen but sometimes they can be pretty hilarious! So rather than crying or getting upset she begins to their end the audience joins in until soon, no can’t quite remember why they were everlasting. This serves as a catalyst for Beatrice not only to have peace of mind but also to mix-and-match her wardrobe choices, make unusual lunches, as well as do plenty of falling during ice-skating. This also precipitates townfolk to finally start calling Beatrice by her real name rather than “The Girl Who Never Made Mistakes”.

Prior to reading this book, I discuss with my students the concept of mistakes, how they feel about when they make mistakes, whether they know people who have never made mistakes, as well as when, do they think it is ok to make mistakes. I spend quite a bit of time on discussing text embedded vocabulary words as well as idiomatic expressions (e.g., ‘stunned’, ‘wobbled’, ‘didn’t miss a beat’, ‘auditorium was packed’, etc.). There is a wealth of amazing FREE materials available to complement this book.  They include but are not limited to: a book companionBloom taxonomy leveled questions for grades Pre-K-5th, as well as an educators guide from the book’s two authors.

Image result for YOUR FANTASTIC ELASTIC BRAIN: STRETCH IT, SHAPE ITIn contrast to all the above books, ‘Your Fantastic, Elastic Brain‘ (video) is a non-fiction book with a focus on describing brain structures and their functions in a very kid-friendly way. The author, who is a psychologist by trade, does a really great job at explaining to children that the brain controls everything we do. She describes the functions of such structures as the cerebrum, cerebellum, hippocampus, amygdala, prefrontal cortex, as well as neurons in very child-friendly terms.  She explains the importance of practicing to get better at doing something, as well as emphasizes that things “get easier when you keep trying”.   I love the stress on the fact that “making mistakes is one of the best ways your brain learns and grows,” and that “if you aren’t willing to risk being wrong, you want to take the chances that S-T-R-E-T-C-H your elastic brain“. In addition to already mentioned science-related words identifying select structures of the brain, the book offers other impressive vocabulary choices such as balance, movement, electrical, signal, cells, neurosculptor, courage, molds, etc.  Beyond understanding why it’s okay to make mistakes, my students feel “really grown-up” because they get the unique opportunity to discuss parts of the brain “even kids in high school don’t know,” as one of my students had put it.

The publishers of the book ‘Little Pickle Press’ have a wonderful 16-page, free lesson plan for educators, intended for children ranging in ages from pre-K through third grade (although it can be easily used with older students with language difficulties as well as intellectual impairment). It is chock-full of educational activities, additional resources, as well as questions which facilitate the growth of meta-cognitive and metalinguistic abilities in elementary aged children. I also use Ned the Neuron Videos to complement book reading as well as book activities. Finally, a handy poster associated with the book can be downloaded HERE.

Image result for Thanks for the Feedback, I thinkIn conjunction with teaching children that it is perfectly acceptable to make mistakes I also attempt to ensure that they react appropriately when provided with constructive feedback.  For the purpose, I like to utilize a book by Julia Cook, entitled: ‘Thanks for the Feedback, I think‘ (video).  While this book primarily deals with helping children  appropriately respond to compliments, there are still several instances in the book when RJ, the main character receives constructive feedback aimed at helping him to get better at certain things such as playing soccer, keeping a lower voice in class, staying in his seat, as well as dawdling less during assignments. One complimentary activity I like to do in conjunction with the book reading is to have my students watch a variety of YouTube videos, in which individuals are receiving some form of feedback from others. It could be anything from the ‘American Idol’ and ‘Voice’ auditions to ‘Chopped’ judges providing feedback to chefs. After watching the clips I ask the students their impressions on how feedback was received by the participants and how did they figure out whether the participants reacted well/poorly to the provided feedback.

Image result for the judgemental flowerTo cap off our discussion on taking risks, making mistakes, and accepting feedback, I also wanted to give an honorary mention to yet another book by the prolific Julia Cook entitled, ‘The Judgmental Flower‘. It teaches children the value of being non-judgemental and being accepting of others’ differences. Because I work with children with significant emotional and behavioral difficulties, this book comes especially handy, when my students are attempting to be quite judgmentally rude to each other. I use this book to teach them to embrace and learn from each other’s differences and emphasize the fact that the world would be very boring is all of us were exactly the same. I also spend some time exploring the notion of “growing in the right direction” as well as on explaining the concept of diversity. I occasionally supplement the book reading with select FREE Activities which can be found HERE and HERE.

Of course, it is important to note that while I use the above books to improve my students’ social communication and executive function abilities, I do so by creating a variety of goals which explicitly target my students’ verbal expression, as well as reading fluency, reading comprehension, spelling, and writing skills. These include answering concrete and abstract questions, defining context embedded vocabulary words, decoding words in books, answering reading comprehension questions given visual support, as well as formulating written sentences based on select words identified in the stories, utilizing appropriate punctuation and capitalization.

Image result for moreSo now that you know what type of books I use in my therapy sessions with a focus on taking risks, making mistakes, accepting feedback, as well as being nonjudgmental, I’d love to expand my list by learning about new titles I am not yet aware of from you. Feel free to comments below regarding what other books you are using to address these themes in therapy.

Helpful Smart Speech Therapy Resources:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References:

Helpful Related Smart Speech Therapy Resources: 

 

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

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

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

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

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

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

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

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

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

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

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

References:

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

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

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

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

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

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

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

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

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

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

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

References:

Helpful Smart Speech Therapy Resources: 

 

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

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

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

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

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

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

Dr. Wallach then poses several overarching questions:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Wallach concludes her article with the following points.

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

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

They include:

References:

  • Beck, I. L., McKeown, M. G., & Worthy, J. (1995). Giving text a voice can improve students’ understanding. Reading Research Quarterly30, 220–238.
  • Duke, N. K., & Pearson, P. D. (2008/2009). Effective practices for developing reading comprehension. Journal of Education189, 107–122.
  • Fang, Z. (2004). Scientific literacy: A systematic functional linguistics perspective. Science Education89, 335–347. 
  • Fang, Z. (2012). Language correlates of disciplinary literacy. Topics in Language Disorders32, 19–34. 
  • Halliday, M. A. K. (1993). Some grammatical problems in scientific English. In Halliday, M. A. K., & Martin, J. R. (Eds.), Writing science: Literacy and discursive power (pp. 69–85). London, England: Falmer.
  • McKeown, M. G., Beck, I. L., & Blake, R. G. K. (2009). Rethinking reading comprehension instruction: A comparison of instruction for strategies and content approaches. Reading Research Quarterly44, 218–253. 
  • McKeown, M. G., Beck, I. L., Sinatra, G. M., & Loxterman, J. A. (1992). The contribution of prior knowledge and coherent text to comprehension. Reading Research Quarterly27, 79–93.
  • Wallach, G. P., Charlton, S. J., & Christie, J. (2009). Making a broader case for the narrow view? Where to begin? Language, Speech, and Hearing Services in Schools40, 201–211. 
  • Wallach, G.P. (2014). Improving clinical practice: A school-age and school-based perspective. Language, Speech, and Hearing Services in Schools, 45, 127-136
  • Wallach, G.P., Charlton, S., & Christie Bartholomew, J. (2014). The spoken-written comprehension connection: Constructive intervention strategies. In C.A. Stone, E.R. Silliman, B.J. Ehren, & G.P. Wallach (Eds). Handbook of language and literacy: Development and disorders (pp. 485-501). NY: Guilford Press.
  • Wixson, K. K., Lipson, M. Y., & Valencia, S. W. (2014). Response to intervention for teaching and learning in language and literacy. InStone, C. A., Silliman, E. R., Ehren, B. J., & Wallach, G. P. (Eds.), Handbook of language and literacy: Development and disorders (2nd ed., pp. 637–653). New York, NY: Guilford Press.

Helpful Social Media Resources:

SLPs for Evidence-Based Practice

 

 

 

 

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Clinical Assessment of Elementary-Aged Students Writing Abilities : Suggestions for SLPs

Image result for child writingRecently I wrote a blog post regarding how SLPs can qualitatively assess writing abilities of adolescent learners. Today due to popular demand, I am offering suggestions regarding how SLPs can assess writing abilities of early-elementary-aged students with suspected learning and literacy deficits. For the purpose of this post, I will focus on assessing writing of second-grade students since by second-grade students are expected to begin producing simple written compositions several sentences in length (CCSS).

So how can we analyze the writing samples of young learners? For starters, it is important to know what the typical writing expectations look like for 2nd-grade students. Here’s is a sampling of typical expectations for second graders as per several sources (e.g., CCSS, Reading Rockets, Time4Writing, etc.)

  • With respect to penmanship, students are expected to write legibly.
  • With respect to grammar, students are expected to identify and correctly use basic parts of speech such as nouns and verbs.
  • With respect to sentence structure students are expected to distinguish between complete and incomplete sentences as well as use correct subject/verb/noun/pronoun agreements and correct verb tenses in simple and compound sentences.
  • With respect to punctuation, students are expected to use periods correctly at the end of sentences. They are expected to use commas in sentences with dates and items in a series.
  • With respect to capitalization, students are expected to capitalize proper nouns, words at the beginning of sentences, letter salutations, months and days of the week, as well as titles and initials of people.
  • With respect to spelling, students are expected to spell CVC (e.g., tap), CVCe (e.g., tape), as well as CCVC words (e.g., trap), high frequency regular and irregular spelled words (e.g., were, said, why, etc),  basic inflectional endings (e.g., –ed, -ing, -s, etc), as well as to recognize select orthographic patterns and rules (e.g., when to spell /k/ or /c/ in CVC and CVCe word, how to drop one vowel (e.g., /y/) and replace it with another /i/, etc.)

Now let’s apply the above expectations to a writing sample of a 2nd-grade student whose parents are concerned with her writing abilities in addition to other language and learning concerns. This student was provided with a  typical second grade writing prompt: “Imagine you are going to the North Pole. How are you going to get there? What would you bring with you? You have 15 minutes to write your story. Please make your story at least 4 sentences long.

The following is the transcribed story produced by her. “I am going in the north pole. I am going to bring food my mom toy’s stoft (stuffed) animals. I am so icsited (excited). So we are going in a box. We are going to go done (down) the stars (stairs) with the box and wate (wait) intile (until) the male (mail) is hear (here).”

Analysis: The student’s written composition content (thought formulation and elaboration) was judged to be impaired for her grade level.  According to the CCSS, 2d grade students are expected to ‘”write narratives in which recount a well-elaborated event or short sequence of events, include details to describe actions, thoughts, and feelings, use temporal words to signal event order, and provide a sense of closure.” However, the above narrative sample by no means satisfies this requirement.  The student’s writing was excessively misspelled, as well as lacked organization and clarity of message.  While portions of her narrative appropriately addressed the question with respect to whom and what she was going to bring on her travels, her narrative quickly lost coherence by her 4th sentence, when she wrote: “So we are going in a box” with further elaborations regarding what she meant by that sentence.  Second-grade students are expected to engage in basic editing and revision of their work. This student only took four minutes to compose the above-written sample and as such had more than adequate amount of time to review the question as well as her response for spelling and punctuation errors as well as for clarity of message, which she did not do. Furthermore, despite being provided with a written prompt which contained the correct capitalization of a place: “North Pole”, the student was not observed to capitalize it in her writing, which indicates ongoing executive function difficulties with the respect to proofreading and attention to details.  

Impressions: Clinical assessment of the student’s writing revealed difficulties in the areas of spelling, capitalization, message clarity as well as lack of basic proofreading and editing, which require therapeutic intervention.   

Now let us select a few writing goals for this student.

Long-Term Goals:  Student will improve her writing abilities for academic purposes.

  • Short-Term Goals
  1. Student will label parts of speech (e.g., adjectives, adverbs, prepositions, etc.)  in compound sentences.
  2. Student will use declarative and interrogative sentence types for story composition purposes
  3. Student will correctly use past, present, and future verb tenses during writing tasks.
  4. Student will use basic punctuation at the sentence level (e.g., commas, periods, and apostrophes in singular possessives, etc.).
  5. Student will use basic capitalization at the sentence level (e.g., capitalize proper nouns, words at the beginning of sentences, months and days of the week, etc.).
  6. Student will proofread her work via reading aloud for clarity
  7. Student will edit her work for correct grammar, punctuation, and capitalization

Notice the above does not contain any spelling goals. That is because given the complexity of her spelling profile I prefer to tackle her spelling needs in a separate post, which discusses spelling development, assessment, as well as intervention recommendations for students with spelling deficits.

There you have it. A quick and easy qualitative writing assessment for elementary-aged students which can help determine the extent of the student’s writing difficulties as well as establish a few 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.

 

 

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It’s All Due to …Language: How Subtle Symptoms Can Cause Serious Academic Deficits

Scenario: Len is a 7-2-year-old, 2nd-grade student who struggles with reading and writing in the classroom. He is very bright and has a high average IQ, yet when he is speaking he frequently can’t get his point across to others due to excessive linguistic reformulations and word-finding difficulties. The problem is that Len passed all the typical educational and language testing with flying colors, receiving average scores across the board on various tests including the Woodcock-Johnson Fourth Edition (WJ-IV) and the Clinical Evaluation of Language Fundamentals-5 (CELF-5). Stranger still is the fact that he aced Comprehensive Test of Phonological Processing, Second Edition (CTOPP-2), with flying colors, so he is not even eligible for a “dyslexia” diagnosis. Len is clearly struggling in the classroom with coherently expressing self, telling stories, understanding what he is reading, as well as putting his thoughts on paper. His parents have compiled impressively huge folders containing examples of his struggles. Yet because of his performance on the basic standardized assessment batteries, Len does not qualify for any functional assistance in the school setting, despite being virtually functionally illiterate in second grade.

The truth is that Len is quite a familiar figure to many SLPs, who at one time or another have encountered such a student and asked for guidance regarding the appropriate accommodations and services for him on various SLP-geared social media forums. But what makes Len such an enigma, one may inquire? Surely if the child had tangible deficits, wouldn’t standardized testing at least partially reveal them?

Well, it all depends really, on what type of testing was administered to Len in the first place. A few years ago I wrote a post entitled: “What Research Shows About the Functional Relevance of Standardized Language Tests“.  What researchers found is that there is a “lack of a correlation between frequency of test use and test accuracy, measured both in terms of sensitivity/specificity and mean difference scores” (Betz et al, 2012, 141). Furthermore, they also found that the most frequently used tests were the comprehensive assessments including the Clinical Evaluation of Language Fundamentals and the Preschool Language Scale as well as one-word vocabulary tests such as the Peabody Picture Vocabulary Test”. Most damaging finding was the fact that: “frequently SLPs did not follow up the comprehensive standardized testing with domain-specific assessments (critical thinking, social communication, etc.) but instead used the vocabulary testing as a second measure”.(Betz et al, 2012, 140)

In other words, many SLPs only use the tests at hand rather than the RIGHT tests aimed at identifying the student’s specific deficits. But the problem doesn’t actually stop there. Due to the variation in psychometric properties of various tests, many children with language impairment are overlooked by standardized tests by receiving scores within the average range or not receiving low enough scores to qualify for services.

Thus, “the clinical consequence is that a child who truly has a language impairment has a roughly equal chance of being correctly or incorrectly identified, depending on the test that he or she is given.” Furthermore, “even if a child is diagnosed accurately as language impaired at one point in time, future diagnoses may lead to the false perception that the child has recovered, depending on the test(s) that he or she has been given (Spaulding, Plante & Farinella, 2006, 69).”

There’s of course yet another factor affecting our hypothetical client and that is his relatively young age. This is especially evident with many educational and language testing for children in the 5-7 age group. Because the bar is set so low, concept-wise for these age-groups, many children with moderate language and literacy deficits can pass these tests with flying colors, only to be flagged by them literally two years later and be identified with deficits, far too late in the game.  Coupled with the fact that many SLPs do not utilize non-standardized measures to supplement their assessments, Len is in a pretty serious predicament.

But what if there was a do-over? What could we do differently for Len to rectify this situation? For starters, we need to pay careful attention to his deficits profile in order to choose appropriate tests to evaluate his areas of needs. The above can be accomplished via a number of ways. The SLP can interview Len’s teacher and his caregiver/s in order to obtain a summary of his pressing deficits. Depending on the extent of the reported deficits the SLP can also provide them with a referral checklist to mark off the most significant areas of need.

In Len’s case, we already have a pretty good idea regarding what’s going on. We know that he passed basic language and educational testing, so in the words of Dr. Geraldine Wallach, we need to keep “peeling the onion” via the administration of more sensitive tests to tap into Len’s reported areas of deficits which include: word-retrieval, narrative production, as well as reading and writing.

For that purpose, Len is a good candidate for the administration of the Test of Integrated Language and Literacy (TILLS), which was developed to identify language and literacy disorders, has good psychometric properties, and contains subtests for assessment of relevant skills such as reading fluency, reading comprehension, phonological awareness,  spelling, as well as writing  in school-age children.

Given Len’s reported history of narrative production deficits, Len is also a good candidate for the administration of the Social Language Development Test Elementary (SLDTE). Here’s why. Research indicates that narrative weaknesses significantly correlate with social communication deficits (Norbury, Gemmell & Paul, 2014). As such, it’s not just children with Autism Spectrum Disorders who present with impaired narrative abilities. Many children with developmental language impairment (DLD) (#devlangdis) can present with significant narrative deficits affecting their social and academic functioning, which means that their social communication abilities need to be tested to confirm/rule out presence of these difficulties.

However, standardized tests are not enough, since even the best-standardized tests have significant limitations. As such, several non-standardized assessments in the areas of narrative production, reading, and writing, may be recommended for Len to meaningfully supplement his testing.

Let’s begin with an informal narrative assessment which provides detailed information regarding microstructural and macrostructural aspects of storytelling as well as child’s thought processes and socio-emotional functioning. My nonstandardized narrative assessments are based on the book elicitation recommendations from the SALT website. For 2nd graders, I use the book by Helen Lester entitled Pookins Gets Her Way. I first read the story to the child, then cover up the words and ask the child to retell the story based on pictures. I read the story first because: “the model narrative presents the events, plot structure, and words that the narrator is to retell, which allows more reliable scoring than a generated story that can go in many directions” (Allen et al, 2012, p. 207).

As the child is retelling his story I digitally record him using the Voice Memos application on my iPhone, for a later transcription and thorough analysis.  During storytelling, I only use the prompts: ‘What else can you tell me?’ and ‘Can you tell me more?’ to elicit additional information. I try not to prompt the child excessively since I am interested in cataloging all of his narrative-based deficits. After I transcribe the sample, I analyze it and make sure that I include the transcription and a detailed write-up in the body of my report, so parents and professionals can see and understand the nature of the child’s errors/weaknesses.

Now we are ready to move on to a brief nonstandardized reading assessment. For this purpose, I often use the books from the Continental Press series entitled: Reading for Comprehension, which contains books for grades 1-8.  After I confirm with either the parent or the child’s teacher that the selected passage is reflective of the complexity of work presented in the classroom for his grade level, I ask the child to read the text.  As the child is reading, I calculate the correct number of words he reads per minute as well as what type of errors the child is exhibiting during reading.  Then I ask the child to state the main idea of the text, summarize its key points as well as define select text embedded vocabulary words and answer a few, verbally presented reading comprehension questions. After that, I provide the child with accompanying 5 multiple choice question worksheet and ask the child to complete it. I analyze my results in order to determine whether I have accurately captured the child’s reading profile.

Finally, if any additional information is needed, I administer a nonstandardized writing assessment, which I base on the Common Core State Standards for 2nd grade. For this task, I provide a student with a writing prompt common for second grade and give him a period of 15-20 minutes to generate a writing sample. I then analyze the writing sample with respect to contextual conventions (punctuation, capitalization, grammar, and syntax) as well as story composition (overall coherence and cohesion of the written sample).

The above relatively short assessment battery (2 standardized tests and 3 informal assessment tasks) which takes approximately 2-2.5 hours to administer, allows me to create a comprehensive profile of the child’s language and literacy strengths and needs. It also allows me to generate targeted goals in order to begin effective and meaningful remediation of the child’s deficits.

Children like Len will, unfortunately, remain unidentified unless they are administered more sensitive tasks to better understand their subtle pattern of deficits. Consequently, to ensure that they do not fall through the cracks of our educational system due to misguided overreliance on a limited number of standardized assessments, it is very important that professionals select the right assessments, rather than the assessments at hand, in order to accurately determine the child’s areas of needs.

References:

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Making Our Interventions Count or What’s Research Got To Do With It?

Two years ago I wrote a blog post entitled: “What’s Memes Got To Do With It?” which summarized key points of Dr. Alan G. Kamhi’s 2004 article: “A Meme’s Eye View of Speech-Language Pathology“. It delved into answering the following question: “Why do some terms, labels, ideas, and constructs [in our field] prevail whereas others fail to gain acceptance?”.

Today I would like to reference another article by Dr. Kamhi written in 2014, entitled “Improving Clinical Practices for Children With Language and Learning Disorders“.

This article was written to address the gaps between research and clinical practice with respect to the implementation of EBP for intervention purposes.

Dr. Kamhi begins the article by posing 10 True or False questions for his readers:

  1. Learning is easier than generalization.
  2. Instruction that is constant and predictable is more effective than instruction that varies the conditions of learning and practice.
  3. Focused stimulation (massed practice) is a more effective teaching strategy than varied stimulation (distributed practice).
  4. The more feedback, the better.
  5. Repeated reading of passages is the best way to learn text information.
  6. More therapy is always better.
  7. The most effective language and literacy interventions target processing limitations rather than knowledge deficits.
  8. Telegraphic utterances (e.g., push ball, mommy sock) should not be provided as input for children with limited language.
  9. Appropriate language goals include increasing levels of mean length of utterance (MLU) and targeting Brown’s (1973) 14 grammatical morphemes.
  10. Sequencing is an important skill for narrative competence.

Guess what? Only statement 8 of the above quiz is True! Every other statement from the above is FALSE!

Now, let’s talk about why that is!

First up is the concept of learning vs. generalization. Here Dr. Kamhi discusses that some clinicians still possess an “outdated behavioral view of learning” in our field, which is not theoretically and clinically useful. He explains that when we are talking about generalization – what children truly have a difficulty with is “transferring narrow limited rules to new situations“. “Children with language and learning problems will have difficulty acquiring broad-based rules and modifying these rules once acquired, and they also will be more vulnerable to performance demands on speech production and comprehension (Kamhi, 1988)” (93). After all, it is not “reasonable to expect children to use language targets consistently after a brief period of intervention” and while we hope that “language intervention [is] designed to lead children with language disorders to acquire broad-based language rules” it is a hugely difficult task to undertake and execute.

Next, Dr. Kamhi addresses the issue of instructional factors, specifically the importance of “varying conditions of instruction and practice“.  Here, he addresses the fact that while contextualized instruction is highly beneficial to learners unless we inject variability and modify various aspects of instruction including context, composition, duration, etc., we ran the risk of limiting our students’ long-term outcomes.

After that, Dr. Kamhi addresses the concept of distributed practice (spacing of intervention) and how important it is for teaching children with language disorders. He points out that a number of recent studies have found that “spacing and distribution of teaching episodes have more of an impact on treatment outcomes than treatment intensity” (94).

He also advocates reducing evaluative feedback to learners to “enhance long-term retention and generalization of motor skills“. While he cites research from studies pertaining to speech production, he adds that language learning could also benefit from this practice as it would reduce conversational disruptions and tunning out on the part of the student.

From there he addresses the limitations of repetition for specific tasks (e.g., text rereading). He emphasizes how important it is for students to recall and retrieve text rather than repeatedly reread it (even without correction), as the latter results in a lack of comprehension/retention of read information.

After that, he discusses treatment intensity. Here he emphasizes the fact that higher dose of instruction will not necessarily result in better therapy outcomes due to the research on the effects of “learning plateaus and threshold effects in language and literacy” (95). We have seen research on this with respect to joint book reading, vocabulary words exposure, etc. As such, at a certain point in time increased intensity may actually result in decreased treatment benefits.

His next point against processing interventions is very near and dear to my heart. Those of you familiar with my blog know that I have devoted a substantial number of posts pertaining to the lack of validity of CAPD diagnosis (as a standalone entity) and urged clinicians to provide language based vs. specific auditory interventions which lack treatment utility. Here, Dr. Kamhi makes a great point that: “Interventions that target processing skills are particularly appealing because they offer the promise of improving language and learning deficits without having to directly target the specific knowledge and skills required to be a proficient speaker, listener, reader, and writer.” (95) The problem is that we have numerous studies on the topic of improvement of isolated skills (e.g., auditory skills, working memory, slow processing, etc.) which clearly indicate lack of effectiveness of these interventions.  As such, “practitioners should be highly skeptical of interventions that promise quick fixes for language and learning disabilities” (96).

Now let us move on to language and particularly the models we provide to our clients to encourage greater verbal output. Research indicates that when clinicians are attempting to expand children’s utterances, they need to provide well-formed language models. Studies show that children select strong input when its surrounded by weaker input (the surrounding weaker syllables make stronger syllables stand out).  As such, clinicians should expand upon/comment on what clients are saying with grammatically complete models vs. telegraphic productions.

From there lets us take a look at Dr. Kamhi’s recommendations for grammar and syntax. Grammatical development goes much further than addressing Brown’s morphemes in therapy and calling it a day. As such, it is important to understand that children with developmental language disorders (DLD) (#DevLang) do not have difficulty acquiring all morphemes. Rather studies have shown that they have difficulty learning grammatical morphemes that reflect tense and agreement  (e.g., third-person singular, past tense, auxiliaries, copulas, etc.). As such, use of measures developed by (e.g., Tense Marker Total & Productivity Score) can yield helpful information regarding which grammatical structures to target in therapy.

With respect to syntax, Dr. Kamhi notes that many clinicians erroneously believe that complex syntax should be targeted when children are much older. The Common Core State Standards do not help this cause further, since according to the CCSS complex syntax should be targeted 2-3 grades, which is far too late. Typically developing children begin developing complex syntax around 2 years of age and begin readily producing it around 3 years of age. As such, clinicians should begin targeting complex syntax in preschool years and not wait until the children have mastered all morphemes and clauses (97)

Finally, Dr. Kamhi wraps up his article by offering suggestions regarding prioritizing intervention goals. Here, he explains that goal prioritization is affected by

  • clinician experience and competencies
  • the degree of collaboration with other professionals
  • type of service delivery model
  • client/student factors

He provides a hypothetical case scenario in which the teaching responsibilities are divvied up between three professionals, with SLP in charge of targeting narrative discourse. Here, he explains that targeting narratives does not involve targeting sequencing abilities. “The ability to understand and recall events in a story or script depends on conceptual understanding of the topic and attentional/memory abilities, not sequencing ability.”  He emphasizes that sequencing is not a distinct cognitive process that requires isolated treatment. Yet many SLPs “continue to believe that  sequencing is a distinct processing skill that needs to be assessed and treated.” (99)

Dr. Kamhi supports the above point by providing an example of two passages. One, which describes a random order of events, and another which follows a logical order of events. He then points out that the randomly ordered story relies exclusively on attention and memory in terms of “sequencing”, while the second story reduces demands on memory due to its logical flow of events. As such, he points out that retelling deficits seemingly related to sequencing, tend to be actually due to “limitations in attention, working memory, and/or conceptual knowledge“. Hence, instead of targeting sequencing abilities in therapy, SLPs should instead use contextualized language intervention to target aspects of narrative development (macro and microstructural elements).

Furthermore, here it is also important to note that the “sequencing fallacy” affects more than just narratives. It is very prevalent in the intervention process in the form of the ubiquitous “following directions” goal/s. Many clinicians readily create this goal for their clients due to their belief that it will result in functional therapeutic language gains. However, when one really begins to deconstruct this goal, one will realize that it involves a number of discrete abilities including: memory, attention, concept knowledge, inferencing, etc.  Consequently, targeting the above goal will not result in any functional gains for the students (their memory abilities will not magically improve as a result of it). Instead, targeting specific language and conceptual goals  (e.g., answering questions, producing complex sentences, etc.) and increasing the students’ overall listening comprehension and verbal expression will result in improvements in the areas of attention, memory, and processing, including their ability to follow complex directions.

There you have it! Ten practical suggestions from Dr. Kamhi ready for immediate implementation! And for more information, I highly recommend reading the other articles in the same clinical forum, all of which possess highly practical and relevant ideas for therapeutic implementation. They include:

References:

Kamhi, A. (2014). Improving clinical practices for children with language and learning disorders.  Language, Speech, and Hearing Services in Schools, 45(2), 92-103

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