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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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On the Disadvantages of Parents Ceasing to Speak the Birth Language with Bilingual Language Impaired Children

ChildrenDespite significant advances in the fields of education and speech pathology, many harmful myths pertaining to multilingualism continue to persist. One particularly infuriating and patently incorrect recommendation to parents is the advice to stop speaking the birth language with their bilingual children with language disorders.

There is a plethora of evidence available regarding how bilingualism facilitates, increases, and improves language gains in children with developmental language disorders (DLD) as well as genetic conditions and syndromes (e.g., ASD, DS, FXS, etc.) Numerous researchers have released results of studies indicating the advantages of being bilingual for language impaired children (see this issue of Journal of Communication Disorders for starters for some studies on this subject).

But today in addition to briefly reiterating these advantages, I’d like to also explicitly discuss the disadvantages, which can result when parents are told to stop speaking the birth language with their language impaired children and switch to English-only interactions.

Cognitive advantages of maintaining the birth language for bilingual children with language impairments  (whose parents are able to provide them with that opportunity in the home) include increased attentional control and working memory, as well as perspective taking abilities. Linguistic advantages include increased awareness of vocabulary and grammar. Even social skills of these children have been reported to be more advanced as compared to monolingual only peers (See Pena, 2016, pp. 88-89 for a review of pertinent studies)

But what happens when parents decide to speak English only to their language impaired bilingual child? In the words of Helen Lester’s ‘Pookins’, lots! And I don’t mean it in a good way!

—Research indicates that children with language disorders will have language deficits in all the languages that they speak. As such, no matter which language is being used, the child will still present with some difficulty acquiring it and will do so at a much slower pace (Kohnert, 2010).

The problem is that NOT using the native language, can limit language and early literacy practices at home during sensitive periods of language acquisition. This will result in poorer language outcomes as compared to bilingual language impaired peers whose birth language continued to be supported at home. (Ijalba, 2010)

“There is also evidence to show that young minority L1 learners with impaired language systems are even more vulnerable than unaffected bilingual peers to loss or early plateaus in the home language if it is not supported ().” (Kohnert, 2010, p. 8)

“Minority-language families are especially affected since English is usually recommended as the target language.”  (Yu, 2016, p. 424) Some studies have reported that: “parents expressed personal loss and sadness (Fernandez y Garcia et al., 2012) if they chose to speak only English to their child with ASD.” Other studies have reported that “some [parents] also expressed discomfort and difficulty when speaking a non-native language with their child (Yu, 2013) or said they talked less frequently to their child when they used the majority language because it felt less natural.” (Bird, Genesee, Verhoeven, 2016. p. 5)

Perhaps the most disturbing findings are the studies that show that eliminating speaking birth language at home causes an emotional disconnect between immediate and extended family members and the child in question (Kouritzin, 1999; Tseng & Fuligni, 2000; Wharton et al 2000). Wharton and colleagues found that immigrant parents were more affective and engaging with their autistic children when they used their native language Wharton et al (2000).  Contrastingly, Kremer-Sadlik (2005) found that parents are less likely to engage their children in conversation when they cannot use their native language and that it further isolates a child who needs help with interactive skills.

“The advice to stick with a language that the family doesn’t speak well only intensifies the alienation experienced by these children.”  “You’re taking a child who is already socially isolated and you’re making them even more isolated”. Consequently, “development of heritage languages and bilingual competencies may be especially important for children with ASD given their core challenges in socialization, communication, and relational development.” (Yu, 2016, p. 434)

Given the combined results of the above studies, it is hugely important for professionals to appropriately support the parents of bilingual children with language and learning needs when it comes to offering them relevant recommendations on the topic of language use in the home. This can be accomplished by sharing with them the synthesis of currently available studies on the topic of bilingualism and language disorders, as well as encouraging them to speak the birth language in the home if they are willing and able to, rather than embracing English only practices, which may result in significant detrimental effects for both bilingual children and their families.

FOR A PDF HANDOUT FOR PARENTS AND PROFESSIONALS PLEASE CLICK HERE

Select Parent-Friendly Resources:

 References:

  1. Fernandez y Garcia, E., Brelau, J., Hansen, R., & Miller, E. (2012). Unintended consequences: An ethnographic narrative case series exploring language recommendations for bilingual families of children with autistic spectrum disorders. Journal of Medical Speech-Language Pathology, 20, 10–16.
  2. Hakansson G, Salameh E, Nettelbladt U. (2003) Measuring language development in bilingual children: Swedish-Arabic children with and without language impairmentLinguistics. 41:255–288.
  3. Ijalba, E (2010) Supporting early-literacy and language acquisition among bilingual children in HeadStart ASHA Convention Handout: Philadelphia, PA.
  4. Kay-Raining Bird, E, Genesee, F & Verhoeven, L (2016) Bilingualism in children with developmental disorders: A narrative review.  Journal of Communication Disorders, (63), pp. 1-14.
  5. Kohnert, K. (2010). Bilingual children with primary language impairment: Issues, evidence and implications for clinical actions. Journal of Communication Disorders43, 465–473.
  6. Kouritzin, S (1999) Face[t]s of First Language Loss. Routledge.
  7. Kremer-Sadlik, T. (2005). To be or not to be bilingual: Autistic children from multilingual families. Proceedings of the 4th International Symposium on Bilingualism, ed. James Cohen, Kara T. McAlister, Kellie Rolstad, and Jeff MacSwan, 1225-1234.
  8. Peña, E (2016) Supporting the home language of bilingual children with developmental disabilities: From knowing to doing. Journal of Communication Disorders, (63), pp. 85-92.
  9. Restrepo MA, Kruth K. (2001) Grammatical characteristics of a Spanish-English bilingual child with specific language impairment. Communication Disorders Quarterly. 21:66–76.
  10. Salameh E, Hakansson G, Nettelbladt U. (2004) Developmental perspectives on bilingual Swedish-Arabic children with and without language impairment: A longitudinal study. International Journal of Language & Communication Disorders. 39:65–91
  11. Tseng, Vivian. & Fuligni, Andrew J.(2000). Parent-adolescent language use and relationships among immigrant families with east Asian, Filipino and Latin American background. Journal of Marriage & Family, Vol. 62, No. 2,
  12. Wharton, R et al. (2000). Children with special need in bilingual families: A developmental approach to language recommendations. ICDL Clinical Practice Guidelines. The Unicorn Children’s Foundation: ICDL Press, Ch. 7. Pp 141-151.
  13. Yu, B. (2013). Issues in bilingualism and heritage language maintenance: Perspectives of minority-language mothers of children with Autism Spectrum Disorders. American Journal of Speech-Language Pathology, 22, 10–24.
  14. Yu, B. (2016). Bilingualism as conceptualized and bilingualism as lived: A critical examination of the monolingual socialization of a child with autism in a bilingual family. Journal of Autism and Developmental Disorders, 46, 424-435.

For more information on Evidence-Based Practices in Speech-Language Pathologists, SLPs can check out SLPs for Evidence-Based Practice 

For more Smart Speech LLC bilingual resources and topics click HERE

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FREE Resources for Working with Russian Speaking Clients: Part II

Image result for ресурсы для логопедииA few years ago I wrote a blog post entitled “Working with Russian-speaking clients: implications for speech-language assessment” the aim of which was to provide some suggestions regarding assessment of bilingual Russian-American birth-school age population in order to assist SLPs with determining whether the assessed child presents with a language difference, insufficient language exposure, or a true language disorder.

Today I wanted to provide Russian speaking clinicians with a few FREE resources pertaining to the typical speech and language development of Russian speaking children 0-7 years of age.

Below materials include several FREE questionnaires regarding Russian language development (words and sentences) of children 0-3 years of age, a parent intake forms for Russian speaking clients, as well as a few relevant charts pertaining to the development  of phonology, word formation, lexicon, morphology, syntax, and metalinguistics of children 0-7 years of age.

It is, however, important to note that due to the absence of research and standardized studies on this subject much of the below information still needs to be interpreted with significant caution.

Select Speech and Language Norms:

Image result for развитие речи детей

Select Parent Questionnaires (McArthur Bates Adapted in Russian):

  • Тест речевого и коммуникативного развития детей раннего возраста: слова и жесты (Words and Gestures)
  • Тест речевого и коммуникативного развития детей раннего возраста:  слова и предложения (Sentences)
  • Анкета для родителей (Child Development Questionnaire for Parents)

Материал Для Родителей И Специалистов По  Речевым
Нарушениям contains detailed information (27 pages) on Russian child development as well as common communication disrupting disorders

Stay tuned for more resources for Russian speaking SLPs coming shortly.

Related Resources:

 

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It’s a Fairy Tale (Well, Almost) Therapy!

I’ve always loved fairy tales! Much like Audrey Hepburn “If I’m honest I have to tell you I still read fairy-tales and I like them best of all.” Not to compare myself with Einstein (sadly in any way, sigh) but “When I examine myself and my methods of thought, I come to the conclusion that the gift of fantasy has meant more to me than any talent for abstract, positive thinking.”

It was the very first genre I’ve read when I’ve learned how to read. In fact, I love fairy tales so much that I actually took a course on fairy tales in college (yes they teach that!) and even wrote some of my own (though they were primarily satirical in nature).

So it was a given that I would use fairy tales as a vehicle to teach speech and language goals to the children on my caseload (and I am not talking only preschoolers either). Continue reading It’s a Fairy Tale (Well, Almost) Therapy!

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Smart Speech Therapy Black Friday Sale!

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Back to School SLP Efficiency Bundles™

September is practically here and many speech language pathologists (SLPs) are looking to efficiently prepare for assessing and treating a variety of clients on their caseloads.

With that in mind, a few years ago I created SLP Efficiency Bundles™, which are materials highly useful for SLPs working with pediatric clients. These materials are organized by areas of focus for efficient and effective screening, assessment, and treatment of speech and language disorders.

A.  General Assessment and Treatment Start-Up Bundle contains 5 downloads for general speech language assessment and treatment planning and includes:

  1. Speech Language Assessment Checklist for a Preschool Child
  2. Speech Language Assessment Checklist for a School-Aged Child
  3. Creating a Functional Therapy Plan: Therapy Goals & SOAP Note Documentation
  4. Selecting Clinical Materials for Pediatric Therapy
  5. Types and Levels of Cues and Prompts in  Speech Language Therapy

B. The Checklists Bundle contains 7 checklists relevant to screening and assessment in speech language pathology

  1. Speech Language Assessment Checklist for a Preschool Child 3:00-6:11 years of age
  2. Speech Language Assessment Checklist for a School-Aged Child 7:00-11:11 years of age
  3. Speech Language Assessment Checklist for Adolescents 12-18 years of age
  4. Language Processing Deficits (LPD) Checklist for School Aged Children 7:00-11:11 years of age
  5. Language Processing Deficits (LPD) Checklist for Preschool Children 3:00-6:11 years of age
  6. Social Pragmatic Deficits Checklist for School Aged Children 7:00-11:11 years of age
  7. Social Pragmatic Deficits Checklist for Preschool Children 3:00-6:11 years of age

C. Social Pragmatic Assessment and Treatment Bundle  contains 6 downloads for social pragmatic assessment and treatment planning (from 18 months through school age) and includes:

  1. Recognizing the Warning Signs of Social Emotional Difficulties in Language Impaired Toddlers and Preschoolers
  2. Behavior Management Strategies for Speech Language Pathologists
  3. Social Pragmatic Deficits Checklist for School Aged Children
  4. Social Pragmatic Deficits Checklist for Preschool Children
  5. Assessing Social Pragmatic Skills of School Aged Children
  6. Treatment of Social Pragmatic Deficits in School Aged Children

D. Multicultural Assessment and Treatment Bundle contains 2 downloads relevant to assessment and treatment of bilingual/multicultural children

  1. Language Difference vs. Language Disorder:  Assessment  & Intervention Strategies for SLPs Working with Bilingual Children
  2. Impact of Cultural and Linguistic Variables On Speech-Language Services

E. Narrative Assessment Bundle contains 3 downloads relevant to narrative assessment

  1. Narrative Assessments of Preschool and School Aged Children
  2. Understanding Complex Sentences
  3. Vocabulary Development: Working with Disadvantaged Populations

F. Fetal Alcohol Spectrum Disorders Assessment and Treatment Bundle contains 3 downloads relevant to FASD assessment  and treatment

  1. Orofacial Observations of At-Risk Children
  2. Fetal Alcohol Spectrum Disorder: An Overview of Deficits
  3. Speech Language Assessment and Treatment of Children With Alcohol Related Disorders

G. Psychiatric Disorders Bundle contains 7 downloads relevant to language  assessment  and treatment in psychiatrically impaired children

  1. Recognizing the Warning Signs of Social Emotional Difficulties in Language Impaired Toddlers and Preschoolers
  2. Social Pragmatic Deficits Checklist for School Aged Children
  3. Social Pragmatic Deficits Checklist for Preschool Children
  4. Assessing Social Skills in Children with Psychiatric Disturbances
  5. Improving Social Skills of Children with Psychiatric Disturbances
  6. Behavior Management Strategies for Speech Language Pathologists
  7. Differential Diagnosis Of ADHD In Speech Language Pathology

You can find these bundles on SALE in my online store by clicking on the individual bundle links above. You can also purchase these products individually in my online store by clicking HERE.

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The Importance of Narrative Assessments in Speech Language Pathology (Revised)

Image result for narrativeAs SLPs we routinely administer a variety of testing batteries in order to assess our students’ speech-language abilities. Grammar, syntax, vocabulary, and sentence formulation get frequent and thorough attention. But how about narrative production? Does it get its fair share of attention when the clinicians are looking to determine the extent of the child’s language deficits? I was so curious about what the clinicians across the country were doing that in 2013, I created a survey and posted a link to it in several SLP-related FB groups.  I wanted to find out how many SLPs were performing narrative assessments, in which settings, and with which populations.  From those who were performing these assessments, I wanted to know what type of assessments were they using and how they were recording and documenting their findings.   Since the purpose of this survey was non-research based (I wasn’t planning on submitting a research manuscript with my findings), I only analyzed the first 100 responses (the rest were very similar in nature) which came my way, in order to get the general flavor of current trends among clinicians, when it came to narrative assessments. Here’s a brief overview of my [limited] findings. Continue reading The Importance of Narrative Assessments in Speech Language Pathology (Revised)

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Phonological Awareness Screening App Review: ProPA

pro-pa-img1Summer is in full swing and for many SLPs that means a welcome break from work. However, for me, it’s business as usual, since my program is year around, and we have just started our extended school year program.

Of course, even my program is a bit light on activities during the summer. There are lots of field trips, creative and imaginative play, as well as less focus on academics as compared to during the school year. However, I’m also highly cognizant of summer learning loss, which is the phenomena characterized by the loss of academic skills and knowledge over the course of summer holidays.

Image result for summer learning loss

According to Cooper et al, 1996, while generally, typical students lose about one month of learning, there is actually a significant degree of variability of loss based on SES. According to Cooper’s study, low-income students lose approximately two months of achievement. Furthermore, ethnic minorities, twice-exceptional students (2xE), as well as students with language disorders tend to be disproportionately affected (Graham et al, 2011;  Kim & Guryan, 2010; Kim, 2004). Finally, it is important to note that according to research, summer loss is particularly prominent in the area of literacy (Graham et al, 2011).

So this summer I have been busy screening the phonological awareness abilities (PA) of an influx of new students (our program enrolls quite a few students during the ESY), as well as rescreening PA abilities of students already on my caseload, who have been receiving services in this area for the past few months.

Why do I intensively focus on phonological awareness (PA)? Because PA is a precursor to emergent reading. It helps children to manipulate sounds in words (see Age of Aquisition of PA Skills). Children need to attain PA mastery (along with a host of a few literacy-related skills) in order to become good readers.

When children exhibit poor PA skills for their age it is a red flag for reading disabilities. Thus it is very important to assess the child’s PA abilities in order to determine their proficiency in this area.

While there are a number of comprehensive tests available in this area, for the purposes of my screening I prefer to use the ProPA app by Smarty Ears.

pro-pa-img14

The Profile of Phonological Awareness (Pro-PA) is an informal phonological awareness screening. According to the developers on average it takes approximately 10 to 20 minutes to administer based on the child’s age and skill levels. In my particular setting (outpatient school based in a psychiatric hospital) it takes approximately 30 minutes to administer to students on the individual basis. It is by no means a comprehensive tool such as the CTOPP-2 or the PAT-2, as there are not enough trials, complexity or PA categories to qualify for a full-blown informal assessment. However, it is a highly useful measure for a quick determination of the students’ strengths and weaknesses with respect to their phonological awareness abilities. Given its current retail price of $29.99 on iTunes, it is a relatively affordable phonological awareness screening option, as the app allows its users to store data, and generates a two-page report at the completion of the screening.

The Pro-PA assesses six different skill areas:

  • Rhyming
    • Identification
    • Production
  • Blending
    • Syllables
    • Sounds
  • Sound Isolation
    • Initial
    • Final
    • Medial
  • Segmentation
    • Words in sentences
    • Syllables in words
    • Sounds in words
    • Words with consonant clusters
  • Deletion
    • Syllables
    • Sounds
    • Words with consonant clusters
  • Substitution
    • Sounds in initial position of words
    • Sounds in final position of words

pro-pa-img21After the completion of the screening, the app generates a two-page report which describes the students’ abilities as:

  • Achieved (80%+ accuracy)
  • Not achieved (0-50% accuracy)
  • Emerging (~50-79% accuracy)

The above is perfect for quickly tracking progress or for generating phonological awareness goals to target the students’ phonological awareness weaknesses. While the report can certainly be provided as an attachment to parents and teachers, I usually tend to summarize its findings in my own reports for the purpose of brevity. Below is one example of what that looks like:

pro-pa-img29The Profile of Phonological Awareness (Pro-PA), an informal phonological awareness screening was administered to “Justine” in May 2017 to further determine the extent of her phonological awareness strengths and weaknesses.

On the Pro-PA, “Justine” evidenced strengths (80-100% accuracy) in the areas of rhyme identification, initial and final sound isolation in words, syllable segmentation, as well as substitution of sounds in initial position in words.

She also evidenced emerging abilities (~60-66% accuracy) in the areas of syllable and sound blending in words, as well as sound segmentation in CVC words,

However, Pro-PA assessment also revealed weaknesses (inability to perform) in the areas of: rhyme production, isolation of medial sounds in words, segmentation of words, segmentation of sounds in words with consonant blends,deletion of first sounds,  consonant clusters, as well as substitution of sounds in final position in words. Continuation of therapeutic intervention is recommended in order to improve “Justine’s” abilities in these phonological awareness areas.

Now you know how I quickly screen and rescreen my students’ phonological awareness abilities, I’d love to hear from you! What screening instruments are you using (free or paid) to assess your students’ phonological awareness abilities? Do you feel that they are more or less comprehensive/convenient than ProPA?

References:

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A Focus on Literacy

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

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

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

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

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

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

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

Helpful Smart Speech Therapy Resources:

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What Research Shows About the Functional Relevance of Standardized Language Tests

Image result for standardized language testsAs an SLP who routinely conducts speech and language assessments in several settings (e.g., school and private practice), I understand the utility of and the need for standardized speech, language, and literacy tests.  However, as an SLP who works with children with dramatically varying degree of cognition, abilities, and skill-sets, I also highly value supplementing these standardized tests with functional and dynamic assessments, interactions, and observations.

Since a significant value is placed on standardized testing by both schools and insurance companies for the purposes of service provision and reimbursement, I wanted to summarize in today’s post the findings of recent articles on this topic.  Since my primary interest lies in assessing and treating school-age children, for the purposes of today’s post all of the reviewed articles came directly from the Language Speech and Hearing Services in Schools  (LSHSS) journal.

We’ve all been there. We’ve all had situations in which students scored on the low end of normal, or had a few subtest scores in the below average range, which equaled  an average total score.  We’ve all poured over eligibility requirements trying to figure out whether the student should receive therapy services given the stringent standardized testing criteria in some states/districts.

Of course, as it turns out, the answer is never simple.  In 2006, Spaulding, Plante & Farinella set out to examine the assumption: “that children with language impairment will receive low scores on standardized tests, and therefore [those] low scores will accurately identify these children” (61).   So they analyzed the data from 43 commercially available child language tests to identify whether evidence exists to support their use in identifying language impairment in children.

Turns out it did not!  Turns out due to the variation in psychometric properties of various tests (see article for specific details), many children with language impairment are overlooked by standardized tests by receiving scores within the average range or not receiving low enough scores to qualify for services. Thus, “the clinical consequence is that a child who truly has a language impairment has a roughly equal chance of being correctly or incorrectly identified, depending on the test that he or she is given.” Furthermore, “even if a child is diagnosed accurately as language impaired at one point in time, future diagnoses may lead to the false perception that the child has recovered, depending on the test(s) that he or she has been given (69).”

Consequently, they created a decision tree (see below) with recommendations for clinicians using standardized testing. They recommend using alternate sources of data (sensitivity and specificity rates) to support accurate identification (available for a small subset of select tests).

The idea behind it is: “if sensitivity and specificity data are strong, and these data were derived from subjects who are comparable to the child tested, then the clinician can be relatively confident in relying on the test score data to aid his or her diagnostic decision. However, if the data are weak, then more caution is warranted and other sources of information on the child’s status might have primacy in making a diagnosis (70).”

Fast forward 6 years, and a number of newly revised tests later,  in 2012, Spaulding and colleagues set out to “identify various U.S. state education departments’ criteria for determining the severity of language impairment in children, with particular focus on the use of norm-referenced tests” as well as to “determine if norm-referenced tests of child language were developed for the purpose of identifying the severity of children’s language impairment”  (176).

They obtained published procedures for severity determinations from available U.S. state education departments, which specified the use of norm-referenced tests, and reviewed the manuals for 45 norm-referenced tests of child language to determine if each test was designed to identify the degree of a child’s language impairment.

What they found out was “the degree of use and cutoff-point criteria for severity determination varied across states. No cutoff-point criteria aligned with the severity cutoff points described within the test manuals. Furthermore, tests that included severity information lacked empirical data on how the severity categories were derived (176).”

Thus they urged SLPs to exercise caution in determining the severity of children’s language impairment via norm-referenced test performance “given the inconsistency in guidelines and lack of empirical data within test manuals to support this use (176)”.

Following the publication of this article, Ireland, Hall-Mills & Millikin issued a response to the  Spaulding and colleagues article. They pointed out that the “severity of language impairment is only one piece of information considered by a team for the determination of eligibility for special education and related services”.  They noted that  they left out a host of federal and state guideline requirements and “did not provide an analysis of the regulations governing special education evaluation and criteria for determining eligibility (320).” They pointed out that “IDEA prohibits the use of ‘any single measure or assessment as the sole criterion’ for determination of disability  and requires that IEP teams ‘draw upon information from a variety of sources.”

They listed a variety of examples from several different state departments of education (FL, NC, VA, etc.), which mandate the use of functional assessments, dynamic assessments criterion-referenced assessments, etc. for their determination of language therapy eligibility.

But are the SLPs from across the country appropriately using the federal and state guidelines in order to determine eligibility? While one should certainly hope so, it does not always seem to be the case.  To illustrate, in 2012, Betz & colleagues asked 364 SLPs to complete a survey “regarding how frequently they used specific standardized tests when diagnosing suspected specific language impairment (SLI) (133).”

Their purpose was to determine “whether the quality of standardized tests, as measured by the test’s psychometric properties, is related to how frequently the tests are used in clinical practice” (133).

What they found out was that the most frequently used tests were the comprehensive assessments including the Clinical Evaluation of Language Fundamentals and the Preschool Language Scale as well as one word vocabulary tests such as the Peabody Picture Vocabulary Test. Furthermore, the date of publication seemed to be the only factor which affected the frequency of test selection.

They also found out that frequently SLPs did not follow up the comprehensive standardized testing with domain specific assessments (critical thinking, social communication, etc.) but instead used the vocabulary testing as a second measure.  They were understandably puzzled by that finding. “The emphasis placed on vocabulary measures is intriguing because although vocabulary is often a weakness in children with SLI (e.g., Stothard et al., 1998), the research to date does not show vocabulary to be more impaired than other language domains in children with SLI (140).

According to the authors, “perhaps the most discouraging finding of this study was the lack of a correlation between frequency of test use and test accuracy, measured both in terms of sensitivity/specificity and mean difference scores (141).”

If since the time (2012) SLPs have not significantly change their practices, the above is certainly disheartening, as it implies that rather than being true diagnosticians, SLPs are using whatever is at hand that has been purchased by their department to indiscriminately assess students with suspected speech language disorders. If that is truly the case, it certainly places into question the Ireland, Hall-Mills & Millikin’s response to Spaulding and colleagues.  In other words, though SLPs are aware that they need to comply with state and federal regulations when it comes to unbiased and targeted assessments of children with suspected language disorders, they may not actually be using appropriate standardized testing much less supplementary informal assessments (e.g., dynamic, narrative, language sampling) in order to administer well-rounded assessments.  

So where do we go from here? Well, it’s quite simple really!   We already know what the problem is. Based on the above articles we know that:

  1. Standardized tests possess significant limitations
  2. They are not used with optimal effectiveness by many SLPs
  3.  They may not be frequently supplemented by relevant and targeted informal assessment measures in order to improve the accuracy of disorder determination and subsequent therapy eligibility

Now that we have identified a problem, we need to develop and consistently implement effective practices to ameliorate it.  These include researching psychometric properties of tests to review sample size, sensitivity and specificity, etc, use domain specific assessments to supplement administration of comprehensive testing, as well as supplement standardized testing with a plethora of functional assessments.

SLPs can review testing manuals and consult with colleagues when they feel that the standardized testing is underidentifying students with language impairments (e.g., HERE and HERE).  They can utilize referral checklists (e.g., HERE) in order to pinpoint the students’ most significant difficulties. Finally, they can develop and consistently implement informal assessment practices (e.g., HERE and HERE) during testing in order to gain a better grasp on their students’ TRUE linguistic functioning.

Stay tuned for the second portion of this post entitled: “What Research Shows About the Functional Relevance of Standardized Speech Tests?” to find out the best practices in the assessment of speech sound disorders in children.

References:

  1. Spaulding, Plante & Farinella (2006) Eligibility Criteria for Language Impairment: Is the Low End of Normal Always Appropriate?
  2. Spaulding, Szulga, & Figueria (2012) Using Norm-Referenced Tests to Determine Severity of Language Impairment in Children: Disconnect Between U.S. Policy Makers and Test Developers
  3. Ireland, Hall-Mills & Millikin (2012) Appropriate Implementation of Severity Ratings, Regulations, and State Guidance: A Response to “Using Norm-Referenced Tests to Determine Severity of Language Impairment in Children: Disconnect Between U.S. Policy Makers and Test Developers” by Spaulding, Szulga, & Figueria (2012)
  4. Betz et al. (2013) Factors Influencing the Selection of Standardized Tests for the Diagnosis of Specific Language Impairment