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

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

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

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

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

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

Dr. Wallach then poses several overarching questions:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Wallach concludes her article with the following points.

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

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

They include:

References:

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

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Components of Qualitative Writing Assessments: What Exactly are We Trying to Measure?

Writing! The one assessment area that challenges many SLPs on daily basis! If one polls 10 SLPs on the topic of writing, one will get 10 completely different responses ranging from agreement and rejection to the diverse opinions regarding what should actually be assessed and how exactly it should be accomplished.

Consequently, today I wanted to focus on the basics involved in the assessment of adolescent writing. Why adolescents you may ask? Well, frankly because many SLPs (myself included) are far more likely to assess the writing abilities of adolescents rather than elementary-aged children.

Often, when the students are younger and their literacy abilities are weaker, the SLPs may not get to the assessment of writing abilities due to the students presenting with so many other deficits which require precedence intervention-wise. However, as the students get older and the academic requirements increase exponentially, SLPs may be more frequently asked to assess the students’ writing abilities because difficulties in this area significantly affect them in a variety of classes on a variety of subjects.

So what can we assess when it comes to writing? In the words of Helen Lester’s character ‘Pookins’: “Lots!”  There are various types of writing that can be assessed, the most common of which include: expository, persuasive, and fictional. Each of these can be used for assessment purposes in a variety of ways.

To illustrate, if we chose to analyze the student’s written production of fictional narratives then we may broadly choose to analyze the following aspects of the student’s writing: contextual conventions and writing composition.

The former looks at such writing aspects as the use of correct spelling, punctuation, and capitalization, paragraph formation, etc.

The latter looks at the nitty-gritty elements involved in plot development. These include effective use of literate vocabulary, plotline twists, character development,  use of dialogue, etc.

Perhaps we want to analyze the student’s persuasive writing abilities. After all, high school students are expected to utilize this type of writing frequently for essay writing purposes.  Actually, persuasive writing is a complex genre which is particularly difficult for students with language-learning difficulties who struggle to produce essays that are clear, logical, convincing, appropriately sequenced, and take into consideration opposing points of view. It is exactly for that reason that persuasive writing tasks are perfect for assessment purposes.

But what exactly are we looking for analysis wise? What should a typical 15 year old’s persuasive essays contain?

With respect to syntax, a typical student that age is expected to write complex sentences possessing nominal, adverbial, as well as relative clauses.

With the respect to semantics, effective persuasive essays require the use of literate vocabulary words of low frequency such as later developing connectors (e.g., first of all, next, for this reason, on the other hand, consequently, finally, in conclusion) as well as metalinguistic and metacognitive verbs (“metaverbs”) that refer to acts of speaking (e.g., assert, concede, predict, argue, imply) and thinking (e.g., hypothesize, remember, doubt, assume, infer).

With respect to pragmatics, as students  mature, their sensitivity to the perspectives of others improves, as a result, their persuasive essays increase in length (i.e., total number of words produced) and they are able to offer a greater number of different reasons to support their own opinions (Nippold, Ward-Lonergan, & Fanning, 2005).

Now let’s apply our knowledge by analyzing a writing sample of a 15-year-old with suspected literacy deficits. Below 10th-grade student was provided with a written prompt first described in the Nippold, et al, 2005 study, entitled: “The Circus Controversy”.   “People have different views on animals performing in circuses. For example, some people think it is a great idea because it provides lots of entertainment for the public. Also, it gives parents and children something to do together, and the people who train the animals can make some money. However, other people think having animals in circuses is a bad idea because the animals are often locked in small cages and are not fed well. They also believe it is cruel to force a dog, tiger, or elephant to perform certain tricks that might be dangerous. I am interested in learning what you think about this controversy, and whether or not you think circuses with trained animals should be allowed to perform for the public. I would like you to spend the next 20 minutes writing an essay. Tell me exactly what you think about the controversy. Give me lots of good reasons for your opinion. Please use your best writing style, with correct grammar and spelling. If you aren’t sure how to spell a word, just take a guess.”(Nippold, Ward-Lonergan, & Fanning, 2005)

He produced the following written sample during the allotted 20 minutes.

Analysis: This student was able to generate a short, 3-paragraph, composition containing an introduction and a body without a definitive conclusion. His persuasive essay was judged to be very immature for his grade level due to significant disorganization, limited ability to support his point of view as well as the presence of tangential information in the introduction of his composition, which was significantly compromised by many writing mechanics errors (punctuation, capitalization, as well as spelling) that further impacted the coherence and cohesiveness of his written output.

The student’s introduction began with an inventive dialogue, which was irrelevant to the body of his persuasive essay. He did have three important points relevant to the body of the essay: animal cruelty, danger to the animals, and potential for the animals to harm humans. However, he was unable to adequately develop those points into full paragraphs. The notable absence of proofreading and editing of the composition further contributed to its lack of clarity. The above coupled with a lack of a conclusion was not commensurate grade-level expectations.

Based on the above-written sample, the student’s persuasive composition content (thought formulation and elaboration) was judged to be significantly immature for his grade level and is commensurate with the abilities of a much younger student.  The student’s composition contained several emerging claims that suggested a vague position. However, though the student attempted to back up his opinion and support his position (animals should not be performing in circuses), ultimately he was unable to do so in a coherent and cohesive manner.

Now that we know what the student’s written difficulties look like, the following goals will be applicable with respect to his writing remediation:

Long-Term Goals:  Student will improve his written abilities for academic purposes.

  • Short-Term Goals
  1. Student will appropriately utilize parts of speech (e.g., adjectives, adverbs, prepositions, etc.)  in compound and complex sentences.
  2. Student will use a variety of sentence types for story composition purposes (e.g., declarative, interrogative, imperative, and exclamatory sentences).
  3. Student will correctly use past, present, and future verb tenses during writing tasks.
  4. Student will utilize appropriate punctuation at the sentence level (e.g., apostrophes, periods, commas, colons, quotation marks in dialogue, and apostrophes in singular possessives, etc.).
  5. Student will utilize appropriate capitalization at the sentence level (e.g., capitalize proper nouns, holidays, product names, titles with names, initials, geographic locations, historical periods, special events, etc.).
  6. Student will use prewriting techniques to generate writing ideas (e.g., list keywords, state key ideas, etc.).
  7. Student will determine the purpose of his writing and his intended audience in order to establish the tone of his writing as well as outline the main idea of his writing.
  8. Student will generate a draft in which information is organized in chronological order via use of temporal markers (e.g., “meanwhile,” “immediately”) as well as cohesive ties (e.g., ‘but’, ‘yet’, ‘so’, ‘nor’) and cause/effect transitions (e.g., “therefore,” “as a result”).
  9. Student will improve coherence and logical organization of his written output via the use of revision strategies (e.g., modify supporting details, use sentence variety, employ literary devices).
  10. Student will edit his draft for appropriate grammar, spelling, punctuation, and capitalization.

There you have it. A quick and easy qualitative writing assessment which can assist SLPs to determine the extent of the student’s writing difficulties as well as establish writing remediation targets for intervention purposes.

Using a different type of writing assessment with your students? Please share the details below so we can all benefit from each others knowledge of assessment strategies.

References:

  • Nippold, M., Ward-Lonergan, J., & Fanning, J. (2005). Persuasive writing in children, adolescents, and adults: a study of syntactic, semantic, and pragmatic development. Language, Speech, and Hearing Services in Schools, 36, 125-138.

 

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FREE Resources for Working with Russian Speaking Clients: Part III Introduction to “Dyslexia”

Image result for дислексияGiven the rising interest in recent years in the role of SLPs in the treatment of reading disorders, today I wanted to share with parents and professionals several reputable  FREE resources on the subject of “dyslexia” in Russian-speaking children.

Now if you already knew that there was a dearth of resources on the topic of treating Russian speaking children with language disorders then it will not come as a complete shock to you that very few legitimate sources exist on this subject.

Related imageFirst up is the Report on the Russian Language for the World Dyslexia Forum 2010 by Dr. Grigorenko, the coauthor of the Dyslexia Debate. This 25-page report contains important information including Reading/Writing Acquisition of Russian in the Context of Typical and Atypical Development as well as on the state of Individuals with Dyslexia in Russia.

Related imageNext up is this delightful presentation entitled: “If John were Ivan: Would he fail in reading? Dyslexia & dysgraphia in Russian“. It is a veritable treasure trove of useful information on the topics of:

  • The Russian language
  • Literacy in Russia (Russian Federation)
  • Dyslexia in Russia
    • Definition
    • Identification
    • Policy
  • Examples of good practice
    • Teaching reading/language arts
      • In regular schools
      • In specialized settings
    • Encouraging children to learn

Image result for orthographyNow let us move on to the “The Role of Phonology, Morphology, and Orthography in English and Russian Spelling” which discusses that “phonology and morphology contribute more for spelling of English words while orthography and morphology contribute more to the spelling of Russian words“. It also provides clinicians with access to the stimuli from the orthographic awareness and spelling tests in both English and Russian, listed in its appendices.

Finally, for parents and Russian speaking professionals, there’s an excellent article entitled, “Дислексия” in which Dr. Grigorenko comprehensively discusses the state of the field in Russian including information on its causes, rehabilitation, etc.

Related Helpful Resources:

  1. Анализ Нарративов У Детей С Недоразвитием Речи (Narrative Discourse Analysis in Children With Speech Underdevelopment)
  2. Narrative production weakness in Russian dyslexics: Linguistic or procedural limitations?

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References:

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

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

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

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

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

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

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

Now, let’s talk about why that is!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References:

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

Helpful Social Media Resources:

SLPs for Evidence-Based Practice

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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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What Should be Driving Our Treatment?

Today  I want to talk treatment.  That thing that we need to plan for as we are doing our assessments.   But are we starting our treatments the right way? The answer may surprise you. I often see SLPs phrasing questions regarding treatment the following way: “I have a student diagnosed with ____ (insert disorder here). What is everyone using (program/app/materials) during therapy sessions to address ___ diagnosis?”

Of course, the answer is never that simple. Just because a child has a diagnosis of a social communication disorder, word-finding deficits, or a reading disability does not automatically indicate to the treating clinician, which ‘cookie cutter’ materials and programs are best suited for the child in question. Only a profile of strengths and needs based on a comprehensive language and literacy testing can address this in an adequate and targeted manner.

To illustrate,  reading intervention is a much debated and controversial topic nowadays. Everywhere you turn there’s a barrage of advice for clinicians and parents regarding which program/approach to use. Barton, Wilson, OG… the well-intentioned advice just keeps on coming. The problem is that without knowing the child’s specific deficit areas, the application of the above approaches is quite frankly … pointless.

There could be endless variations of how deficits manifest in poor readers. Is it aspects of phonological awareness, phonics, morphology, etc. What combination of deficits is preventing the child from becoming a good reader?

Let’s a take a look at an example, below. It’s the CTOPP-2 results of a 7-6-year-old female with a documented history of extensive reading difficulties and a significant family history of reading disabilities in the family.

Results of the Comprehensive Test of Phonological Processing-2 (CTOPP-2)

Subtests Scaled Scores Percentile Ranks Description
Elision (EL) 7 16 Below Average
Blending Words (BW) 13 84 Above Average
Phoneme Isolation (PI) 6 9 Below Average
Memory for Digits (MD) 8 25 Average
Nonword Repetition (NR) 8 25 Average
Rapid Digit Naming (RD) 10 50 Average
Rapid Letter Naming (RL) 11 63 Average
Blending Nonwords (BN) 8 25 Average
Segmenting Nonwords (SN) 8 25 Average

However, the results of her CTOPP-2 testing clearly indicate that phonological awareness, despite two areas of mild weaknesses, is not really a significant problem for this child.  So let’s look at the student’s reading fluency results.

Reading Fluency: “LG’s reading fluency during this task was judged to be significantly affected by excessive speed, inappropriate pausing, word misreadings, choppy prosody, as well as inefficient word attack skills.  While she was able to limitedly utilize the phonetic spelling of unfamiliar words (e.g., __) provided to her in parenthesis next to the word (which she initially misread as ‘__’), she exhibited limited use of metalinguistic strategies (e.g., pre-scanning sentences to aid text comprehension, self-correcting to ensure that the read words made sense in the context of the sentence, etc.), when reading the provided passage. To illustrate, during the reading of the text, LG was observed to frequently (at least 3 times) lose her place and skip entire lines of text without any attempts at self-correction. At times she was observed to read the same word a number of different ways (e.g., read ‘soup’ as ‘soup’ then as ‘soap’,  ‘roots’ as ‘roofs’ then as ‘roots’, etc.) without attempting to self-correct. LG’s oral reading rate was also observed to be impaired for her age/grade levels. Her prosody was significantly adversely affected due to lack of adequate pausing for punctuation marks (e.g., periods, commas, etc.).  Instead, she paused during text reading only when he could not decode select words in the text.  Though, LG was able to read 70 words per minute, which was judged to be grossly commensurate with grade-level, out of these 70 words she skipped 2 entire lines of text, invented an entire line of text, as well as made 4 decoding errors and 6 inappropriate pauses.”

So now we know that despite quite decent phonological awareness abilities, this student presents with quite poor sound-letter correspondence skills and will definitely benefit from explicit phonics instruction addressing the above deficit areas. But that is only the beginning!   By looking at the analysis of specific misreadings we next need to determine what other literacy areas need to be addressed. For the sake of brevity, I can specify that further analysis of this child reading abilities revealed that reading comprehension, orthographic knowledge, as well as morphological awareness were definitely areas that also required targeted remediation. The assessment also revealed that the child presented with poor spelling and writing abilities, which also needed to be addressed in the context of therapy.

Now, what if I also told you that this child had already been receiving private, Orton-Gillingham reading instruction for a period of  2 years, 1x per week, at the time the above assessment took place? Would you change your mind about the program in question? 

Well, the answer is again not so simple! OG is a fine program, but as you can see from the above example it has definite limitations and is not an exclusive fit for this child, or for any child for that matter. Furthermore, a solidly-trained in literacy clinician DOES NOT need to rely on just one program to address literacy deficits. They simply need solid knowledge of typical and atypical language and literacy development/milestones and know how to create a targeted treatment hierarchy in order to deliver effective intervention services. But for that, they need to first, thoughtfully, construct assessment-based treatment goals by carefully taking into the consideration the child’s strengths and needs.

So let’s stop asking which approach/program we should use and start asking about the child’s profile of strengths and needs in order to create accurate language and literacy goals based on solid evidence and scientifically-guided treatment practices.

Helpful Resources Pertaining to Reading:

 

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