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Test Review: Clinical Assessment of Pragmatics (CAPs)

Today due to popular demand I am reviewing the Clinical Assessment of Pragmatics (CAPs) for children and young adults ages 7 – 18, developed by the Lavi Institute. Readers of this blog are familiar with the fact that I specialize in working with children diagnosed with psychiatric impairments and behavioral and emotional difficulties. They are also aware that I am constantly on the lookout for good quality social communication assessments due to a notorious dearth of good quality instruments in this area of language.

I must admit when I first learned about the existence of CAPs in May 2018, I was definitely interested but quite cautious. Many standardized tests assessing pragmatics and social language contain notable psychometric limitations due to the inclusion of children with social and pragmatic difficulties into the normative sample. This, in turn, tends to overinflate test scores and produce false negatives (a belief that the child does not possess a social communication impairment due to receiving average scores on the test).  Furthermore, tests of pragmatics such as Test of Pragmatic Language -2 (TOPL-2) tend to primarily assess the child’s knowledge of rules of politeness and knowing the right thing to say under a particular set of circumstances and as such are of limited value when it comes to gauging the child’s ability to truly assume perspectives and adequately showcase social cognitive abilities.

The CAPs is a unique test as compared to others with a similar purpose, due to the fact that the testing administration (which can take between 45-60 mins) is conducted exclusively via videos. The CAPs consists of 6 subtests and 3 indices.

Subtests (You can read up more on the comparison of the CAPs subtests HERE ):

Instrumental Performance Appraisal (IPA) subtest (Awareness of Basic Social Routines) is a relatively straightforward subtest which examines the student’s ability to be polite in basic social contexts. The student is asked to first identify “if anything went wrong in the presented scenario?” After that, the student is asked to explain, what went wrong and how s/he knows? Targeted structures include greeting and closure, making requests, responding to gratitude, requesting help, answering phone calls, asking for directions, asking permission, etc.  Goals: can the student discern between appropriate and inappropriate language and then provide a verbal rationale in a coherent and cohesive manner.

Score types: (2) correct identification of problem or lack of thereof + correct justification; (1) correct identification but incorrect rationale; (0) incorrect identification.

Social Context Appraisal (SCA) subtest (Reading Context Cues) requires the student to engage in effective perspective taking (assume mutual vs. individual perspectives) by identifying sarcasm, irony, and figurative language in the presented video scenarios. The student is then asked to provide a coherent and cohesive verbal explanation and effectively justify own response.

Score types: (3) correct identification of the problem or lack of thereof + identification of idiom or sarcasm + reference to both characters actions; (2) correct identification of the problem or lack of thereof + identification of idiom or sarcasm + reference to one character’s actions; (1) correct identification of the problem or lack of thereof but an inability to verbalize the problem in the situation; (0) for incorrect identification.

Paralinguistic Decoding (PD) subtest (Reading Nonverbal Cues) assesses the students’ ability to notice and interpret micro-expressions and nonverbal language.  The aim of this subtest is to have the students grasp what went wrong vs. well in the presented videos, assume mutual perspectives,  as well as verbally justify their responses providing adequate and relevant details.

Score types: (3) correct identification of the problem or lack of thereof + explanation of situation + reference to both characters facial expressions and tone of voices; (2) correct identification of the problem or lack of thereof + explanation of situation  + reference to one character’s facial expression and tone of voice  (1) correct identification of the problem or lack of thereof but an inability to explain actions and/or nonverbal body language; (0) for incorrect identification.

Instrumental Performance (IP) subtest (Use of Social Routine Language) assesses the student’s ability to use rules of politeness (e.g., make requests, respond to gratitude, answer phone calls, etc.) by providing adequately supportive responses using first-person perspectives relevant to various social situations.

Score types: (2) appropriate introduction + use of supportive statements; (1) appropriate introduction without the use of supportive statements; (0) inappropriate intent of message or use of impolite language 

Affective Expression (AE) subtest (Expressing Emotions) assesses the student’s ability to effectively display empathy, gratitude, praise, apology, etc., towards affected peers in the video scenario. It requires the usage of relevant facial expressions, tone of voice, as well as stating appropriately supportive comments.

Score types: (2) expresses empathy, praise, apology, gratitude, etc. along with supportive statements +appropriate facial and prosodic affect; (1) expresses empathy, praise, apology, gratitude, etc. + appropriate facial and prosodic affect without relevant supportive statements;   (0) provides an approrpiate response but lacks adequate prosody and affect, or message contains inappropriate intent 

Paralinguistic Signals (PS) subtest (Using Nonverbal Cues)assesses the student’s ability to appropriately use facial expressions, gestures, and prosody (act out vs. recognize and interpret facial expression and gestures). This includes showing appropriate expression of empathy, frustration, alarm, excitement, gratitude, etc., exhibiting relevant inflection in prosody as well as showing appropriate to the situation facial expression (vs. having inappropriate message intent, be monotone, have flat affect, etc.)

Score types: (2) appropriately expresses urgency, empathy apology, etc. +exhibits inflections in prosody and shows relevant facial expressions; (1) appropriately expresses urgency, empathy apology, etc. +exhibits inflections in prosody without showing relevant facial expressions  (0)   inappropriate intent of message or monotone prosody. 

Indices (information regarding the student’s pragmatic proficiency):

  1. Pragmatic Judgement (Sum of IPA, SCA & PD scaled scores)
  2. Pragmatic Performance (Sum of IP, AE & PS scaled scores)
  3. Paralinguistic (Sum of PD, AE & PS scaled scores)

Based on the administration of this test the following goals can be formulated for remediation purposes:

Long Term Goal: Student will improve pragmatic abilities for social and academic purposes

Short-Term Objectives: 

  1. The student will verbally identify instances of politeness or impoliteness in presented social routines
  2. The student will provide relevant justifications explaining which aspects of the presented scenarios were appropriate vs. inappropriate
  3. The student will verbally identify sarcasm, irony, and figurative language in presented social scenarios
  4. The student will effectively explain sarcasm, irony, and figurative language in presented social scenarios
  5. The student will verbally interpret micro-expressions and nonverbal body language  (e.g., they feel disgusted; the girl is smirking, the man’s hands are crossed, etc.)
  6. The student will effectively use rules of politeness and provide adequately supportive responses using first-person perspectives pertaining to various aspects of social scenarios
  7. The student will display a range of emotional expressions via the use of relevant facial expressions, tone of voice when providing supporting responses
  8. The student will state appropriately supportive comments regarding relevant social scenarios
  9. The student will use a range of facial expressions, gestures, and relevant prosody pertinent to the provided social scenarios

Furthermore, this test comes with a Contextualized Assessment of Pragmatics Checklist as well as a downloadable  Free Report Template.

Multiple videos posted by the Lavi Institute showcasing individual subtest administration can be accessed by clicking on the above-highlighted links as well as on YouTube.

Psychometrics: the normative sample consisted of 914 individuals out of which 137 (or 15%)  included individuals with atypical language development: ASD: N-18; SLI: N-27; Other (Learning Disabilities): N-92.

Excellent Sensitivity and Specificity Cut Scores (at 1, 1.5 & 2 SD) for clients with ASD ONLY:

Impressions:  To date, I have used this assessment with only 3 students. As such, expect multiple updates of this post as I continue to document how well it suited to identify children with social communication difficulties. Below are my preliminary impressions on how well this test is suited for children with varying pragmatic profiles.

A. Initial Assessment: 8-3-year-old male diagnosed with Autism

The CAPs had captured the student’s display of pragmatic deficits extremely well.  It was able to highlight the student’s relative strengths as well as pervasive pragmatic needs.  Based on the results of the CAPs, I was able to generate relevant pragmatic goals to target with this student in therapy.

B.  Yearly Reassessment: 8-11-year-old diagnosed with Anxiety:

I definitely had some trepidation about how well the CAPs will be able to capture this student’s pragmatic difficulties. This student was initially assessed via the Social Language Development Test-Elementary (SLDTE), which did show deficits in the areas of making inferences, interpersonal negotiation, as well as multiple interpretations of social situations. However, subsequent to his assessment that student did exceptionally well in treatment and had improved exponentially. While I knew that the student was not done with the treatment quite yet, I wasn’t certain if the CAPs was capable of picking up his subtle social pragmatic difficulties. Much to my surprise, the CAPs was effective in highlighting my student’s difficulties on a number of subtests including those pertaining to the effective reading and use of context and nonverbal cues, comprehension  and interpretation of irony and sarcasm, effective support of peers via a variety of statements relevant to social situations (coherent and cohesive sentence formulation given relevant details), as well as use of relevant prosody, facial expressions, tone of voice, and nonverbal cues.

C. Initial Assessment: 11-year-old student with suspected language and literacy deficits 

This was definitely the trickiest assessment subject from my small sample. Based on the collected data I suspected the student had social communication deficits, however, given his relative strengths in a variety of areas and that the fact that no one had previously brought it up, I truly did not anticipate that CAPs will effectively and accurately identify his pragmatic needs. As expected, the student did quite well on that “easier” subtests of the CAPs: (IPA, IP, and AE). However, I was very pleasantly surprised that the CAPs had accurately picked up on the fact that the student presented with difficulty reading both context and nonverbal cues as well as using nonverbal cues to effectively answer the presented questions.

Summary: While my sample of subjects has been quite small to date, I fully intend to continue using the CAPs with students of varying ages with varying diagnoses in order to continue refining profile of students who will significantly benefit from CAPs administration for assessment and reassessment purposes.

MISC:

Current Cost $149

Where to purchase: Effective 1/7/19 on the WPS Publishing website

There you have it! These are my impressions of using the CAPs in my settings. How about you? Have you used this test with any of your students to date? If yes, what are some strengths and limitations you are noticing?

 

 

 

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Speech, Language, and Literacy Fun with Karma Wilson’s “Bear” Books

In my previous posts, I’ve shared my thoughts about picture books being an excellent source of materials for assessment and treatment purposes. They can serve as narrative elicitation aids for children of various ages and intellectual abilities, ranging from pre-K through fourth grade.  They are also incredibly effective treatment aids for addressing a variety of speech, language, and literacy goals that extend far beyond narrative production.

In the past, I’ve shared several posts regarding how to incorporate both fiction and nonfiction picture books into contextual language intervention sessions, with the most recent posts describing how I incorporate Helen Lester‘s as well as Julia Cook‘s picture books into therapy sessions.

Today I wanted to share how I implement books by Karma Wilson into my treatment sessions with preschool, kindergarten aged, as well as early elementary aged children.

Though these books are intended for younger children (3-8 years; pre-K-3rd grade), older children (~10 years of age) with significant language and learning difficulties and/or intellectual disabilities can significantly benefit from reading/listening to them and enjoy working with them as well.

Much like Helen Lester’s books, Karma Wilson’s books possess tremendous versatility with respect to what goals can be targeted via their use.

Themes:

  • Ms. Wilson’s books are terrific for discussing a variety of seasonal events and happenings.
    • Bear Feels Sick’, ‘Bear Feels Scared’ and ‘Bear Says Thanks‘ take place in the fall.
    • Bear Can’t Sleep’, ‘Bear Stays Up’, and ‘Bear Snores On‘ take place in the winter.
    • Bear’s New Friend’ and Bear’s Loose Tooth‘ take place in the Spring and Summer.
  • They are great for discussing illness and visits to the dentist (‘Bear Feels Sick’ and Bear’s Loose Tooth’), hibernation ( ‘Bear Snores On‘), holidays such as Thanksgiving and Christmas (‘Bear Says Thanks‘ and ‘Bear Stays Up‘).
  • They are also great for select social themes such as feeling frightened and making new friends (‘Bear Feels Scared’ and ‘Bear’s New Friend’).
  • Finally, ‘Bear Wants More‘ is great for working on nutrition as well as on making healthy food choices, in addition to reviewing a variety of food groups as well as food categories.

Speech Production: Bear books are terrific for the production of a variety of sounds in words in sentences including /r/ in all books, /s/ (‘Bear Feels Sick’, ‘Bear Feels Scared’), /th/ (‘Bear Says Thanks‘ ), etc.

Language: There are numerous language goals that could be formulated based on Karma Wilson’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:Vocabulary: For the ages/grades that there’ve written for (3-8 years; pre-K-3rd grade), Ms. Wilson’s books are laden with a wealth of sophisticated vocabulary words such as vale, crooked, trail, lumbers, prowl, howl, spooks, wails, dimmer, squeaks, lair, roam, perch, prepare, trembles, longs, flounce, squawk, cluster, etc. (From the ‘Bear Feels Scared’ book)
  • Social Communication: ‘Bear’s New Friend’, ‘Bear’s Loose Tooth’, and ‘Bear Says Thanks’ are especially terrific for addressing a variety of social themes such as rules of politeness, making new friends (and accepting them for who they are), as well as helping out friends in difficult circumstances.

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.

  • Select 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 (From the ‘Bear Feels Sick’ book: achy, autumn, stuffed, sneezes, heap, wheezes, whiffs, mutters, mumbles, moans, broth, squeezes, whispers, cloth, gopher, coax, herbs, smidgen, fuss, fret, etc. 
    • Morphology: There’s a terrific opportunity to introduce a discussion on simple affixes when using Ms. Wilson’s books to discuss how for example, select suffixes (e.g., –s, -ly, ‘ed, etc.) can change root words.  (From the ‘Bear Stays Up’ book: soundly, stays, gathered, etc.) 
    • Spelling: There is a terrific opportunity for children to practice spelling numerous spelling patterns to solidify their spelling abilities. From the ‘Bear’s New Friend’ book:  -00-, -ee-, -ea-,-oo-, -oe-, -ou-, -le, -ff-, -mm-, -tt-, etc.

As mentioned in previous posts, 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 Image result for bear says thanks

  • 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)

Here 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 select Free TPT resources to supplement my sessions with book-related visuals as related materials.

There you have it! Just a few of the reasons why I really like using Karma Wilson’s books for language and literacy treatment purposes with younger children. How about you? Do you use any of her books for 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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Why “good grades” do not automatically rule out “adverse educational impact”

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

At first glance, the issue of academic impact appears to be rather straightforward. For example, many SLPs will readily assert that if a child is receiving good grades (A’s and B’s) in the school setting and is not exhibiting any “significant” maladaptive and challenging behaviors, then there is no evidence of adverse academic impact, and screening/evaluation/intervention services are unnecessary.

Unfortunately, things are not as “crystal clear” as they appear. That is because of the relative subjectivity pertaining to the grading practices of the students’ work in the school setting. Now, before you accuse me of inventing a problem where there is none, please hear me out.

In this post, I would like to illustrate how the subjectivity of grading practices can obfuscate the issue of academic impact to such an extent that students with significant language and learning needs may not be identified as being in need of help until it’s far too late – if identified at all.

Related imageLet’s begin with reading, an incredibly complex and deeply misunderstood process, especially in settings which do not utilize scientifically informed practices (e.g., synthetic phonics) when teaching young children to read.  When it comes to the teaching and assessment of reading, it is an absolute Wild West out there! And no one is more familiar with it, than parents of reading impaired children.

One of the first things these parents notice about their children in the early grades is that their reading abilities are highly inconsistent and are not commensurate with those of their peers.  These parents will notice that it takes their kids an extraordinary amount of time to master the alphabetic principle (remember the letters of the alphabet, match letters to sounds, etc.). They will notice that their children have an extraordinarily difficult time blending simple three letter words involving initial and final consonants with a medial vowel (e.g., “nob”). They will complain that their children display inconsistent knowledge of “sight words” from day to day, as well as misread and skip words when reading.

Here is the problem though, unless objective measures are used to test their children’s phonemic awareness and phonics abilities, there is a very strong possibility that these issues will persist well into upper elementary years, completely unnoticed in the school system, given the subjectivity involved in assessing reading mastery.

Indeed, numerous studies highlight the lack of efficacy of build-in assessments in programs such as Fountas and Pinnell, Reading Recovery, as well as the utility of utilizing Running Records, for reading assessment purposes.  My clinical observations of struggling readers in a variety of school settings, as part of the independent evaluation process, certainly support and corroborate available research on the subject. Namely, in many educational disputes, there’s a significant mismatch between teacher claims “S/he is reading at grade level as per (insert subjective method here)”  and observed student’s abilities (child is functionally illiterate) during reading tasks in the classroom. 

Related imageNow, let’s move on to discuss the subjectivity of the weekly spelling test. A number of scientific studies on this subject have shown that spelling instruction needs to be direct, explicit and systematic in order to be effective for struggling learners. When teaching spelling, best instruction practices involve consistently addressing and grouping words according to specific spelling patterns rather than teaching random “grade level” or topically related words. However, in the vast majority of instances, the weekly spelling test continues to consist of random words which are expected to be memorized by students. As a result of these memorization practices, numerous students will attain high marks on spelling tests but will be absolutely unable to correctly spell these words in a variety of writing assignments even a week later.

Image result for children taking a testThe practice of teaching to the test is certainly not restricted to spelling.  I have also seen similar practices pertaining to the subjects of science and social studies, whereas children are provided with specific handouts pertaining to a particular topic to memorize for the test. While this allows these children to perform well on such tests, unfortunately, their topic knowledge remains minimal to nonexistent given the fact that the memorized information will be long forgotten in a period of just a few weeks, if not sooner.

Similarly, science projects and social studies book reports may not even be necessarily completed by the children themselves. Many parents of struggling learners will readily acknowledge the mammoth work they had contributed to such projects just so their children could attain good marks which were worth a significant percentage of the overall class grade.

Many parents of struggling learners will also readily admit their significant involvement in the homework process and how stressful and frustrating it is on the students. They report spending numerous hours each day explaining information, their children’s tears of frustration and rage, significant tantrum behavior, and in some extreme cases even visits to a hospital, subsequent to accidental injuries stemming from challenging behaviors.

Finally, the subjectivity of grading written assignments is another important factor that needs to be explicitly acknowledged. Many parents and professionals tasked with the evaluation of the students’ spontaneous written work will readily confirm that oftentimes the grades some struggling learners receive on written assignments appear to be almost ridiculously overinflated.  Despite seemingly clear rubrics provided to the students explaining the breakdown of points for a particular written composition, many students end up receiving much higher marks than they deserve.  I myself have observed this phenomenon firsthand by reviewing the written work of my clients in private practice following parental complaints of grade inflation.

Related imageWe’re talking essays, blatantly lacking in coherence and cohesion, peppered with run-on and fragmented sentences, lacking subject-verb agreement, and full of grammatical errors, given A- and B+ grades, when the grading rubrics which came with the assignment, clearly indicate that the work is at the best deserving of a C- or a D+ grade.

These are just some of the many reasons why students of all ages with very noticeable language and learning needs, may end up being denied much-needed language and literacy assessments to determine the extent of their difficulties in order to receive targeted assistance.

Further complicating this issue is the fact that even when these students are finally tested in the school setting, due to the relative “mildness”  of their deficits,  coupled with the use of general (vs. targeted), often psychometrically weak tests, a lack of or under-identification of their deficit areas often occurs.

So what can parents and professionals do with this information? For starters, all are encouraged to examine the available information through a critical lens, albeit in different ways. Parents are encouraged to collect the samples of the child’s work (independent writing and spelling, audio samples of their reading, etc.) highlighting the discrepancies between the grades they receive and their actual abilities. They should absolutely request child study team assessments and if they are unsatisfied with the results of those tests they can seek out independent evaluations pertaining to the child’s areas of concern.

Image result for high sensitivity high specificitySimilarly, SLPs are encouraged to review their testing practices to ensure that they accurately reflect the students’ deficit areas. They are also strongly encouraged to review the psychometric properties of the tests they are using to better understand the sensitivity and specificity of these instruments with respect to the appropriate identification of language disorders. Finally, SLPs are strongly encouraged to familiarize themselves with the language and literacy expectations of older students and utilize clinical assessment procedures which reflect more sensitive assessment practices.

Image result for falling dominoesSo the next time someone has concerns regarding the language and literacy abilities of students with seemingly good grades, do not be so hasty in dismissing their worries due to a “lack of academic impact”. Depending on the setting and testing in question,  that impact may be far greater than we know!

Helpful Related Posts: 

  1. Special Education Disputes and Comprehensive Language Testing: What Parents, Attorneys, and Advocates Need to Know
  2. What Makes an Independent Speech-Language-Literacy Evaluation a GOOD Evaluation?
  3. What Research Shows About the Functional Relevance of Standardized Language Tests
  4. Part II: Components of Comprehensive Dyslexia Testing – Phonological Awareness and Word Fluency Assessment
  5. On the Limitations of Using Vocabulary Tests with School-Aged Students
  6. It’s All Due to …Language: How Subtle Symptoms Can Cause Serious Academic Deficits
  7. Dear Reading Specialist, May I Ask You a Few Questions?
  8. Help, My Student has a Huge Score Discrepancy Between Tests and I Don’t Know Why?
  9.  The Reign of the Problematic PLS-5 and the Rise of the Hyperintelligent Potato
  10. Components of Qualitative Writing Assessments: What Exactly are We Trying to Measure?

 

 

 

 

 

 

 

 

 

 

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Updated: 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.

Image result for ida dyslexiaAccording to the definition set forth by the International Dyslexia Association“Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.”

Thus, despite the significant controversy over the use of the label “dyslexia”, as being ‘unscientific and conceptually problematic’, the above definition affirms the fact that it is undisputedly a linguistically based disability.   While it is true that merely using the term “dyslexia” does not automatically evoke our understanding of what type of specific reading-related deficits the child is experiencing, which prevents him/her from reading effectively, it does alert us right away to the fact that a reading disability exists.

In this post, rather than utilizing the term “dyslexia”, I will use a more broad term “literacy deficits” to refer to children who develop trouble reading, writing, and spelling.

Image result for genetic inheritanceSo who exactly are those children? Well, with respect to genetic inheritance, children with immediate and/or extended family members who have in the past received diagnoses such as “dyslexia”, “reading disability”, “learning disability” or who had experienced special education placements during school years are significantly more at risk of developing literacy based deficits than children with no history of above problems in the family.

Unfortunately, the situation is further complicated by the fact that some children with no recognizable family history of learning disabilities, may be at risk for future literacy deficits if they display a pattern of linguistic difficulties during early development (e.g., delayed developmental milestones).

Below is the approximate hierarchy of language development in young children:

  • Exploration of the environment (early socio-emotional development)
  • Play (continuation of socio-emotional development)
  • Receptive Language
    • Comprehension of  words, phrases, sentences, stories
  • Expressive Language
    • Speaking single words, phrases, sentences, engaging in conversations, producing stories
  • Social Emotional Development (Pragmatics) continues to be refined and becomes more sophisticated
  • Reading
    • Words, sentences, short stories, chapter books, etc.
    • General topics
    • Domain specific topics (science, social studies, etc)
  • Spelling
  •  Writing
    • Words, sentences, short stories, essays

The fact is that if the child experiences any deficits in the foundational language areas such as listening and speaking, s/he will most certainly experience difficulties in more complex areas of language: reading, writing, and spelling.

So now that we know that children with a history of language delay/disorder are at a significant risk of having the disorder turn into a learning disability when they’re older, let’s talk about how early can these children be assessed in order to better plan their future literacy based interventions for optimal functional outcomes.

The first scenario is a more obvious one.  If a child has a documented history of language impairments and is receiving services from a very early age (e.g., early intervention, preschool, etc.) then given what we know about the connection between language disorders and learning disabilities, professionals can begin administering phonological awareness/emergent reading interventions during the early preschool years in order to optimally facilitate the child’s literacy outcomes.

Image result for detective clipartNow our second scenario is not so clear-cut. In our second scenario, the child may have never been identified as having language difficulties during toddlerhood or even early preschool years. However, as the child grows older (e.g., 4-5 years of age) his/her parents may be noticing some subtle difficulties such as difficulty remembering nursery rhymes and songs, trouble remembering the letters of the alphabet, trouble recognizing simple rhyming words, etc.  A such, even without a pertinent family history of literacy disabilities it may be important for a child to undergo an early literacy assessment in order to determine whether intervention is warranted.

Now let’s talk about various assessment options available for preschool children with suspected literacy deficits.  Firstly, if the child has never received a language assessment it is paramount that the child’s language abilities in the areas of listening comprehension, verbal expression, problem-solving and social communication be assessed prior to assessment of literacy  to ensure that the child does not present with any unrecognized/previously undetected deficits in any of the above areas.  This is done in order to ensure optimal intervention outcomes as failure to address gaps/deficits in foundational language areas may significantly impede any potential literacy gains even when the child is provided with optimal literacy based interventions (click HERE to view my post discussing select speech-language tests for preschool children 2-6 years of age).

Now that we’ve covered some basics let us move on to discuss how early can select literacy tests be administered.  Luckily, there are a number of tests pertaining to literacy which can be administered to children as young as 3:6 years of age.

Image result for asa pearsonTo illustrate: The Auditory Skills Assessment (ASA) can be administered to children 3:6—6:11 years of age. Present controversy over CAPD notwithstanding, it does assess important areas related to early phonological awareness development including nonsense word repetition, phonemic blending, as well as rhyming.

Image result for ctoppThe Comprehensive Test of Phonological Processing-2 —(CTOPP-2), starts at 4 years of age and assesses such areas as:

  • 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 

(—Assesses the ability to manipulate real and *nonsense words)

(—Assesses word fluency skills via a host of rapid naming tasks)

Image result for Emerging Literacy & Language Assessment®For children 4:6 years of age and older the  Emerging Literacy & Language Assessment (ELLA) deserves a mention. It assesses the following literacy related abilities:

  • Section 1 – Phonological Awareness and Flexibility assesses rhyming (awareness and production), initial sound identification, blending and segmenting sounds, words, and syllables, and deleting and substituting sounds in the initial and final positions of words.
  • Section 2 – Sign and Symbol Recognition and Interpretation assesses environmental symbol identification, letter-symbol identification, word reference association, and reading comprehension for one to three sentences.
  • Section 3 – Memory, Retrieval, and Automaticity assesses rapid naming, word associations (name items that start with the “S” sound), and story retell (includes three story levels based on the child’s age).

For children between 5:0-9:11 years of age, —The Phonological Awareness Test-: NU (PAT 2: NU assesses the following areas:

  • —Rhyming:  Discrimination and Production—identify rhyming pairs and provide a rhyming word
  • —Segmentation:  Sentences, Syllables, and Phonemes—dividing by words, syllables and phonemes
  • —Isolation:  Initial, Final, Medial—identify sound position in words
  • —Deletion:  Compound Words, Syllables, and Phonemes—manipulate root words, syllables, and phonemes in words
  • —Substitution With Manipulatives—isolate a phoneme in a word, then change it to another phoneme to form a new word
  • —Blending:  Syllables and Phonemes—blend units of sound together to form words
  • —Graphemes—assess knowledge of sound/symbol correspondence for consonants, vowels, consonant blends, consonant digraphs, r-controlled vowels, vowel digraphs, and diphthongs
  • —Decoding—assess  general knowledge of sound/symbol correspondence to blend sounds into nonsense words
  • —Invented Spelling (optional)—write words to dictation to show encoding ability

The new Test of Auditory Processing Skills-4 (TAPS-4) begins at 5 years of age and covers several areas pertaining to phonological awareness including word discrimination of words, phonological deletion and blending segmentation, as well as supplemental syllabic blending abilities.

Furthermore, starting from 5 years of age the —Rapid Automatized Naming and Rapid Alternating Stimulus Test RAN/RAS  tests can be administered in order to assess the child’s word fluency skills.  Decreased word fluency is a significant indicator of reading deficits, which is why this ability is very important to test.

—In addition to the above assessments, there are several tests of early reading and writing abilities which are available for younger children with suspected literacy deficitsThe  Test of Early Reading Ability–Fourth Edition (TERA-4assesses  the emergent reading abilities of children starting from 4-0 years of age. Similarly, the Test of Early Written Language, Third Edition (TEWL-3) assesses  the emergent writing abilities of children also starting from 4:0 years of age.

So there you have it! Now you know that if needed children as young 3:6 years of age can undergo early literacy assessments in order to determine their potential risk of developing literacy deficits when older.

Of course, due to the precociously young age of the children, it is important for examiners to exercise significant caution when it comes to interpretation of standardized testing results. It is a well-documented fact that standardized tests present with numerous limitations when it comes to identification of children with language and literacy disorders.

As such, due to the children’s young age there will be a number of instances when testing may reveal “false negative results” (show that there are no deficits when deficits still exist).  Consequently, in such cases, it is important to carefully monitor the child’s school performance in order to perform a literacy reassessment (if needed) when the child is older and his/her difficulties may be more apparent (click HERE to view my 4-part post discussing Components of Comprehensive Dyslexia Testing for further details).

Finally, it is very important to reiterate that children presenting with language and literacy deficits will not outgrow these deficits on their own. While there may be periods of “illusory recovery” when it looks like children with early language disorders have caught up with their peers, such “spurts” are typically followed by a “post-spurt plateau” (Sun & Wallach, 2014). This is because due to the ongoing challenges and an increase in academic demands “many children with early language disorders fail to “outgrow” these difficulties or catch up with their typically developing peers” (Sun & Wallach, 2014).  That is why it is crucial that we identify language and literacy deficits in children at a very early age in order to ensure their optimal educational outcomes.

Related Posts:

Helpful Smart Speech Therapy Resources Pertaining to Preschoolers: 

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Editable Report Template and Tutorial for the Test of Integrated Language and Literacy

Today I am introducing my newest report template for the Test of Integrated Language and Literacy.

This 16-page fully editable report template discusses the testing results and includes the following components:

  • Table of testing results
  • Recommendations for using severity ratings of percentile ranks
  • Recommendations of which information to include in the background history section of the report
  • Teacher Interview Samples for Adolescent and Elementary Aged Students
  • Classroom Observations Sample
  • Adaptive behavior section sample
  • Assessment findings
    • All subtests descriptions
    • Extensive descriptions of how to analyze error patterns on all subtests
    • Descriptions of how to analyze scenarios when a student obtains average performance but it contradicts academic functioning.
    • Elaborations regarding specific subtests, weaknesses on which are not as apparent or straightforward (e.g., Nonword Repetition, Following Directions, etc.)
    • Recommendations for supplemental testing when the performance on select subtests (e.g., Social Communication) is within the average range despite glaring weaknesses
    • Extensive error descriptions that can be found on the Reading Fluency subtest
    • Extensive footnotes with clarifying information
    • Links to a variety of TILLS FREE tutorials created by the authors
    • Impressions section formulation
    • Possible ICD-10 diagnoses that can result based on TILLS assessment
    • Accommodations Section
    • Adaptive Recommendations Section
    • Maintaining Factors Section
    • Suggested Therapy Long and Short Term Goals Sampler for
      • Listening Comprehension
      • Oral Communication
      • Social Communication
      • Phonological Awareness
      • Phonics
      • Reading Fluency
      • Reading Comprehension
      • Spelling
      • Writing Conventions
      • Writing Composition
      • Reward System and Rationale
      • Expected duration of treatment
      • Prognosis
      • Therapy Discharge Recommendations

You can access it HERE in my online store.  My review of the TILLS is available HERE 

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On the Limitations of Using Vocabulary Tests with School-Aged Students

Those of you who read my blog on a semi-regular basis, know that I spend a considerable amount of time in both of my work settings (an outpatient school located in a psychiatric hospital as well as private practice), conducting language and literacy evaluations of preschool and school-aged children 3-18 years of age. During that process, I spend a significant amount of time reviewing outside speech and language evaluations. Interestingly, what I have been seeing is that no matter what the child’s age is (7 or 17), invariably some form of receptive and/or expressive vocabulary testing is always mentioned in their language report.

Many of you may be wondering, “What’s wrong with having a vocabulary test as part of an assessment battery? Isn’t vocabulary hugely correlated with both language and literacy outcomes?”  The answer is, “It is more complicated than that.” Here’s why.

Children with robust lexicons formulate longer sentences and more interesting stories, better comprehend complex texts, and even compensate to some degree for reading deficits (Colozzo et al, 2011Law and Edwards, 2015; Rvachew and Grawburg, 2006).

In contrast, studies have found that children with Developmental Language Disorder (DLD) (formerly known as Specific Language Impairment or SLI) have limited expressive vocabularies (Leonard, 2014), have trouble learning new words (Alt & Spaulding, 2011; Storkel et al, 2016), and have clinically significant word retrieval deficits (Dockrell, Messer, George, & Wilson, 1998).

Due to these deficits, one-word vocabulary tests are often used in the assessment process to qualify children for speech and language services (Betz, Eickhoff, & Sullivan, 2013). However, studies have found that single word vocabulary tests have poor psychometric properties and/or are not representative of linguistic competence embedded in life-activities (Gray et al., 1999; Ukrainetz & Blomquist, 2002; Bogue, DeThorne, Schaefer, 2014).

Furthermore, because of this, single word vocabulary tests can overinflate testing scores and not represent the child’s true expressive language competence. Finally, even when a student truly has solid or even superior vocabulary knowledge and naming skills, doesn’t mean that s/he can effectively utilize these abilities during the narrative production as well as reading and writing tasks.

Image result for test resultsDon’t believe me?  Consider reviewing language evaluations of current or former students who received outstanding scores on one-word vocabulary tests, yet who were unable to utilize these words to perform semantic flexibility tasks (e.g., name antonyms, synonyms, provide clear definitions as well as define multiple meaning words), produce coherent and cohesive narratives, comprehend these words in the context of read texts, or utilize them during writing composition tasks.

The problem is that numerous SLPs overuse these tests and rely on them for qualification purposes when diagnosing language impairment (Betz, Eickhoff, & Sullivan, 2013). However, the practice of qualifying students based on single-word vocabulary testing in conjunction with psychometrically weak comprehensive testing (visit HERE for a compilation of psychometric data on major SLP testing), can often result in many language-impaired students not being qualified for language therapy services despite desperately needing them.

Image result for informed decisionNow it’s important to understand that I am not recommending elimination of vocabulary tests from SLP assessment batteries.  I am merely suggesting that SLPs use these tests wisely during the assessment process, and utilize them with children who truly benefit from their administration. Such populations include toddlers and preschoolers (under 5 years of age) as well as any children presenting with severe language deficits regardless of age, secondary to intellectual and neuro/developmental impairments such as ASD, DS, FXS, FASD, etc.  They are especially relevant for children with limited vocabularies who are unable to effectively participate in semantic flexibility tasks or produce narratives. As such, we want to learn more about the types of words they know and use on a daily basis to express their wants/needs, so we can increase their lexicon for functional communication purposes and prepare them for effective engagement in both semantic flexibility as well as narrative tasks, in order to further improve their language abilities.

In contrast, for children age 5-6 and older, it is far more practical for SLPs to functionally determine their linguistic flexibility skills as pertaining to the use of language.  This can be accomplished via standardized as well as informal measures. As mentioned above, broadly speaking, linguistic flexibility tasks focus on the manipulation of language.  Tasks such as generation of attributes, production of synonyms and antonyms, formulation of clear and precise definitions of words as well as explanations of multiple meaning, figurative, and ambiguous words and sentences are all examples of language manipulation tasks.

As such, these tasks are far more representative of the student’s language ability in an academic setting versus selecting a picture out of a visual field of four items (receptive identification) or naming a word in the presented picture (expressive generation).

Now there are numerous tests which possess subtests relevant to this purpose.  I, personally, often use select subtests from the below tests:

  • The WORD Tests (Elementary and Adolescent)
    • Associations
    • Antonyms
    • Synonyms
    • Definitions
    • Flexible Meanings
  • Language Processing Test – 3 (LPT-3)
    • Similarities and Differences
    • Multiple Meaning Words
    • Attributes
  • Expressive Language Test – 2 (ELT-2)
    • Metalinguistics
    • Defining Categories
  • Test of Integrated Language and Literacy 
    • Vocabulary Awareness
  • Clinical Evaluation of Language Fundamentals – 5 Metalinguistics (CELF-5M)
    • Multiple Meanings
    • Figurative Language

There are a number of other tests which contain subtests suitable for this purpose. SLPs can also easily create their own informal assessment procedures, similar to the above, for clinical assessment purposes.

However, even these tasks, though a huge improvement over one-word vocabulary tests are not sufficient. In addition to these, research strongly recommends the inclusion of narrative assessment (which is highly correlated with social, reading, as well as academic outcomes), as part of SLP assessment battery.

Related imageNarrative language skills have routinely been identified as one of the single best predictors of future academic success (Bishop & Edmundson, 1987; Feegans & Appelbaum 1986; Dickinson and McCabe, 2001). Language produced during story retelling is positively related to monolingual and bilingual reading achievement (Reese et al, 2010; Miller et al, 2006) Narratives provide insights into child’s verbal expression by tapping into multiple language features and organizational abilities simultaneously (Hoffman, 2009; Ukrainetz, 2006;Bliss & McCabe, 2012). They encompass a number of higher-level language and cognitive skills (Paul et al, 1996) such as event sequencing, text cohesiveness, use of precise vocabulary to convey ideas without visual support, comprehension of cause-effect relationships, etc. Narratives bridge the gap between oral and written language and are needed for solid reading and writing development (Snow et al, 1998).

Contrastingly, poor discourse and narrative abilities place children at risk for learning and literacy-related difficulties including reading problems (McCabe & Rosenthal-Rollins, 1994), while narrative weaknesses significantly correlate with social communication deficits (Norbury, Gemmell & Paul, 2014). As a result, narrative analyses help SLPs with distinguishing children with DLD from their typically developing (TD) peers (Allen et al 2012).

So the next time you are tasked with selecting appropriate language testing to determine whether a student presents with language and literacy deficits, don’t be so hasty in picking up that single-word vocabulary test.  Take a moment to carefully consider its utility for the student in question. After all, it may very well be a determining factor in deciding whether the student will qualify for language therapy services.

References: 

  1. Allen, M,  Ukrainetz, T & Carswell, A (2012) The narrative language performance of three types of at-risk first-grade readersLanguage, Speech, and Hearing Services in Schools, 43(2), 205-221.
  2. Alt, M., & Spaulding, T. (2011). The effect of time on word learning: An examination of decay of the memory trace and vocal rehearsal in children with and without specific language impairmentJournal of Communication Disorders44(6), 640–654
  3. Betz, Eickhoff, & Sullivan,( 2013) Factors Influencing the Selection of Standardized Tests for the Diagnosis of Specific Language Impairment. Language, Speech, and Hearing Services in Schools, 44, 133-146.
  4. Bishop, D. V. M., & Edmundson, A. (1987). Language-impaired 4-year-olds: Distinguishing transient from persistent impairment. Journal of Speech and Hearing Disorders, 52, 156–173.
  5. Bliss, L. & McCabe, A (2012, Oct) Personal Narratives: Assessment and InterventionPerspectives on Language Learning and Education. 19:130-138.
  6. Bogue, E. L., DeThorne, L. S., & Schaefer, B. A. (2014). A psychometric analysis of childhood vocabulary tests. Contemporary Issues in Communication Science and Disorders, 41, 55-69.
  7. Colozzo, P., Gillam, R. B., Wood, M., Schnell, R. D., & Johnston, J. R. (2011). Content and form in the narratives of children with specific language impairment. Journal of Speech, Language, and Hearing Research, 54(6), 1609-1627.
  8. Dickinson D. K., McCabe A. (2001). Bringing it all together: the multiple origins, skills and environmental supports of early literacy. Learning Disabilities Research and Practice. 16, 186–202.
  9. Dockrell, J. E., Messer, D., George, R., & Wilson, G. (1998). Children with word-finding difficulties: Prevalence, presentation and naming problems. International Journal of Language & Communication Disorders, 33, 445–454.
  10. Feegans, L.,& Appelbaum, M (1986). Validation of language subtypes in learning disabled childrenJournal of Educational Psychology78, 358–364.
  11. Gray, S., Plante, E., Vance, R., & Henrichsen, M. (1999). The diagnostic accuracy of four vocabulary tests administered to preschool-age children. Language, Speech, and Hearing Services in Schools30(2), 196–206.
  12. Hoffman, L. M. (2009). Narrative language intervention intensity and dosage: Telling the whole story. Topics in Language Disorders29, 329–343.
  13. Law, F., II, & Edwards, J.R. (2015). Effects of vocabulary size on online lexical processing by preschoolers. Language Learning and Development11, 331–355.
  14. Leonard, L. B. (2014). Children with specific language impairment. Cambridge, MA: MIT Press.
  15. McCabe, A., & Rollins, P. R. (1994). Assessment of preschool narrative skills. American Journal of Speech-Language Pathology, 3(1), 45–56
  16. Miller, J et al (2006). Oral language and reading in bilingual childrenLearning Disabilities Research and Practice, 21, 30–43
  17. Norbury, C. F., Gemmell, T., & Paul, R. (2014). Pragmatics abilities in narrative production: a cross-disorder comparison. Journal of child language, 41(03), 485-510.
  18. Paul R, Hernandez R, Taylor L, Johnson K. (1996) Narrative development in late talkers: early school age. Journal of Speech and Hearing Research, 39(6):1295–1303
  19. Reese E., Suggate S., Long J., Schaughency E. (2010). Children’s oral narrative and reading skills in the first three years of reading instruction. Reading & Writing: An Interdisciplinary Journal, 23, 627–644.
  20. Rvachew S., Grawburg M. (2006). Correlates of phonological awareness in preschoolers with speech sound disorders. Journal of Speech, Language, and Hearing Research, 49: 74–87.
  21. Snow, C.E., Burns, M.S., & Griffin, P. (eds.) (1998). Preventing reading difficulties in young children. Washington, DC: National Academy Press
  22. Ukrainetz, T. A. (2006). Teaching narrative structure: Coherence, cohesion, and captivation. In T. A. Ukrainetz (Ed.), Contextualized language intervention: Scaffolding PreK–12 literacy achievement (pp. 195–246). Austin, TX: Pro-Ed.
  23. Ukrainetz, T. A., & Blomquist, C. (2002). The criterion validity of four vocabulary tests compared with a language
    sample. Child Language Teaching and Therapy, 18, 59–78.

 

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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.

Helpful Select Resources:

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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.

Related image

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.