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Comprehensive Assessment of Adolescents with Suspected Language and Literacy Disorders

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

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

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

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

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

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

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

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

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

TESTS OF LANGUAGE

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

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

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

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

adolescent checklist

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

Checklist Categories:

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

alolescent pages sample

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

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

References:

  1. Hill, J. W., & Coufal, K. L. (2005). Emotional/behavioral disorders: A retrospective examination of social skills, linguistics, and student outcomes. Communication Disorders Quarterly27(1), 33–46.
  2. Sun, L & Wallach G (2014) Language Disorders Are Learning Disabilities: Challenges on the Divergent and Diverse Paths to Language Learning Disability. Topics in Language Disorders, Vol. 34; (1), pp 25–38.

Helpful Smart Speech Therapy Resources 

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

 

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Thematic Language Intervention with Language Impaired Children Using Nonfiction Texts

FullSizeRender (3)In the past a number of my SLP colleague bloggers (Communication Station, Twin Sisters SLPs, Practical AAC, etc.) wrote posts regarding the use of thematic texts for language intervention purposes. They discussed implementation of fictional texts such as the use of children’s books and fairy tales to target linguistic goals such as vocabulary knowledge in use, sentence formulation, answering WH questions, as well as story recall and production.

Today I would like to supplement those posts with information regarding the implementation of intervention based on thematic nonfiction texts to further improve language abilities of children with language difficulties.

First, here’s why the use of nonfiction texts in language intervention is important. While narrative texts have high familiarity for children due to preexisting, background knowledge, familiar vocabulary, repetitive themes, etc. nonfiction texts are far more difficult to comprehend. It typically contains unknown concepts and vocabulary, which is then used in the text multiple times. Therefore lack of knowledge of these concepts and related vocabulary will result in lack of text comprehension. According to Duke (2013) half of all the primary read-alouds should be informational text. It will allow students to build up knowledge and the necessary academic vocabulary to effectively participate and partake from the curriculum.

So what type of nonfiction materials can be used for language intervention purposes. While there is a rich variety of sources available, I have had great success using Let’s Read and Find Out Stage 1 and 2 Science Series with clients with varying degrees of language impairment.

Here’s are just a few reasons why I like to use this series.

  • They can be implemented by parents and professionals alike for different purposes with equal effectiveness.
  • They can be implemented with children fairly early beginning with preschool on-wards 
  • The can be used with the following pediatric populations:
    • Language Disordered Children
    • Children with learning disabilities and low IQ
    • Children with developmental disorders and genetic syndromes (Fragile X, Down Syndrome, Autism, etc.)
    • Children with Fetal Alcohol Spectrum Disorders
    • Internationally adopted children with language impairment
    • Bilingual children with language impairment
    • Children with dyslexia and reading disabilities
    • Children with psychiatric Impairments
  • The books are readily available online (Barnes & Noble, Amazon, etc.) and in stores.
  • They are relatively inexpensive (individual books cost about $5-6).
  • Parents or professionals who want to continuously use them seasonally can purchase them in bulk at a significantly cheaper price from select distributors (Source: rainbowresource.com)
  • They are highly thematic, contain terrific visual support, and are surprisingly versatile, with information on topics ranging from animal habitats and life cycles to natural disasters and space.
  • They contain subject-relevant vocabulary words that the students are likely to use in the future over and over again (Stahl & Fairbanks, 1986).
  • The words are already pre-grouped in semantic clusters which create schemes (mental representations) for the students (Marzano & Marzano, 1988).

Let’s Read and Find Out Science Level 2 - Weather and Seasons Package | Main Photo (Cover)

For example, the above books on weather and seasons contain information  on:

1. Front Formations
2. Water Cycle
3. High & Low Pressure Systems

Let’s look at the vocabulary words from Flash, Crash, Rumble, and Roll  (see detailed lesson plan HERE). (Source: ReadWorks):

Word: water vapor
Context
: Steam from a hot soup is water vapor.

Word: expands
Context: The hot air expands and pops the balloon.

Word: atmosphere
Context:  The atmosphere is the air that covers the Earth.

Word: forecast
Context: The forecast had a lot to tell us about the storm.

Word: condense
Context: steam in the air condenses to form water drops.

These books are not just great for increasing academic vocabulary knowledge and use. They are great for teaching sequencing skills (e.g., life cycles), critical thinking skills (e.g., What do animals need to do in the winter to survive?), compare and contrast skills (e.g., what is the difference between hatching and molting?) and much, much, more!

So why is use of nonfiction texts important for strengthening vocabulary knowledge and words in language impaired children?

As I noted in my previous post on effective vocabulary instruction (HERE): “teachers with many struggling children often significantly reduce the quality of their own vocabulary unconsciously to ensure understanding(Excerpts from Anita Archer’s Interview with Advance for SLPs).  

The same goes for SLPs and parents. Many of them are under misperception that if they teach complex subject-related words like “metamorphosis” or “vaporization” to children with significant language impairments or developmental disabilities that these students will not understand them and will not benefit from learning them.

However, that is not the case! These students will still significantly benefit from learning these words, it will simply take them longer periods of practice to retain them!

By simplifying our explanations, minimizing verbiage and emphasizing the visuals, the books can be successfully adapted for use with children with severe language impairments.  I have had parents observe my intervention sessions using these books and then successfully use them in the home with their children by reviewing the information and reinforcing newly learned vocabulary knowledge.

Here are just a few examples of prompts I use in treatment with more severely affected language-impaired children:

  • —What do you see in this picture?
  • —This is a _____ Can you say _____
  • What do you know about _____?
  • —What do you think is happening? Why?
  • What do you think they are doing? Why?
  • —Let’s make up a sentence with __________ (this word)
  • —You can say ____ or you can say ______ (teaching synonyms)
  • —What would be the opposite of _______? (teaching antonyms)
  • — Do you know that _____(this word) has 2 meanings
    • —1st meaning
    • —2nd meaning
  • How do ____ and _____ go together?

Here are the questions related to Sequencing of Processes (Life Cycle, Water Cycle, etc.)

  • —What happened first?
  • —What happened second?
  • —What happened next?
  • —What happened after that?
  • —What happened last?

As the child advances his/her skills I attempt to engage them in more complex book interactions—

  • —Compare and contrast items
  • — (e.g. objects/people/animals)
  • —Make predictions and inferences about will happen next?
  • Why is this book important?

“Picture walks” (flipping through the pages) of these books are also surprisingly effective for activation of the student’s background knowledge (what a student already knows about a subject). This is an important prerequisite skill needed for continued acquisition of new knowledge. It is important because  “students who lack sufficient background knowledge or are unable to activate it may struggle to access, participate, and progress through the general curriculum” (Stangman, Hall & Meyer, 2004).

These book allow for :

1.Learning vocabulary words in context embedded texts with high interest visuals

2.Teaching specific content related vocabulary words directly to comprehend classroom-specific work

3.Providing multiple and repetitive exposures of vocabulary words in texts

4. Maximizing multisensory intervention when learning vocabulary to maximize gains (visual, auditory, tactile via related projects, etc.)

To summarize, children with significant language impairment often suffer from the Matthew Effect (—“rich get richer, poor get poorer”), or interactions with the environment exaggerate individual differences over time

Children with good vocabulary knowledge learn more words and gain further knowledge by building of these words

Children with poor vocabulary knowledge learn less words and widen the gap between self and peers over time due to their inability to effectively meet the ever increasing academic effects of the classroom. The vocabulary problems of students who enter school with poorer limited vocabularies only worsen over time (White, Graves & Slater, 1990). We need to provide these children with all the feasible opportunities to narrow this gap and partake from the curriculum in a more similar fashion as typically developing peers. 

Helpful Smart Speech Therapy Resources:

References:

Duke, N. K. (2013). Starting out: Practices to Use in K-3. Educational Leadership, 71, 40-44.

Marzano, R. J., & Marzano, J. (1988). Toward a cognitive theory of commitment and its implications for therapy. Psychotherapy in Private Practice 6(4), 69–81.

Stahl, S. A. & Fairbanks, M. M. “The Effects of Vocabulary Instruction: A Model-based Metaanalysis.” Review of Educational Research 56 (1986): 72-110.

Strangman, N., Hall, T., & Meyer, A. (2004). Background knowledge with UDL. Wakefield, MA: National Center on Accessing the General Curriculum.

White, T. G., Graves, M. F., & Slater W. H. (1990). Growth of reading vocabulary in diverse elementary schools: Decoding and word meaning. Journal of Educational Psychology, 82, 281–290.