Posted in Intervention, Reading

A Review of Reading Programs

Last month our Developmental Language Disorders class participated in a Twitter chat where we discussed our thoughts on a variety of reading programs. This chat was collated by our professor, Dr. Lisa Archibald, and can be read at the following link: https://storify.com/larchiba6/westerndld2

These are the reading programs we discussed:

Progressive Phonics
http://www.progressivephonics.com

Empower Reading Program
http://www.sickkids.ca/LDRP/Empower-Reading/Program-description/index.html

RAVE-O
http://www.voyagersopris.com/curriculum/subject/literacy/rave-o/overview

CORI
http://cori.umd.edu/

The Balanced Literacy Diet
http://www.oise.utoronto.ca/balancedliteracydiet/Home/

The Florida Center for Reading Research
http://fcrr.org/resources/resources_sca.html

Promoting Adolescents Comprehension of Text (PACT)
http://www.meadowscenter.org/projects/detail/promoting-adolescents-comprehension-of-text-pact

Posted in Assessment, Cognition & Executive Function, Special Populations

Special Populations: Navigating Diagnoses

I think one of the most interesting parts of finally practicing as an SLP will be having the opportunity to work with children who have speech and language concerns as just one part of a broader disorder or disability. Some of the disorders that we learned are commonly co-morbid with developmental language disorder (DLD) include:

Attention Deficit Hyperactivity Disorder (ADHD)
Primary symptoms of ADHD include inattention, hyperactivity, and distractibility.
• Although ADHD and DLD have similar prevalence rates, awareness of ADHD is much greater and only ADHD rates are being tracked in healthcare service data.
• Studies have shown that children with ADHD show increased maze behaviour during conversation.
• Executive function and continuous performance measures do not clearly differentiate DLD from ADHD due to concerns around their validity (i.e., some children with ADHD will not have executive function deficits).
• Informant ratings (i.e., from parents, teachers, etc.) of the child’s attention, impulsivity, and defiance appear to be more useful measures for differentiating ADHD from DLD (especially when language-loaded items are removed from analysis).

Auditory Processing Disorder (APD)
Children with APD tend to have difficulties processing information and speech in noise.
• When differentiating children with APD and DLD, Ferguson et al. (cited below in Additional Resources) found that the following measures did not differentiate the two disorders:
– Structural language
– Social/pragmatic
– Attention ratings (item analysis suggested possible qualitative differences)
– Speech intelligibility in quiet or noise (despite being the most commonly reported symptom of APD)
– Intelligence (verbal or nonverbal)
– Reading
• Thus, Ferguson et al. concluded that the child’s diagnosis of APD or DLD was determined based on the referral route (i.e., referred to an audiologist vs. a speech-language pathologist)

Autism Spectrum Disorder (ASD)
ASD is characterized by impairments in social communication and social reciprocity, and by the presence of restricted interests and repetitive behaviours.
• DLD can occur co-morbidly with ASD, but ASD cannot occur co-morbidly with social communication disorder (SCD).

Social (Pragmatic) Communication Disorder (SCD)
SCD is defined by a primary deficit in the social use of nonverbal and verbal communication.
• Individuals with SCD may be categorized as having difficulty in using language for social purposes, appropriately matching communication to the social context, following rules of the communication context (e.g., turn-taking), understanding non-literal language (e.g., jokes, idioms, metaphors), and integrating language with nonverbal communicative behaviours.
• Sufficient language skills must be developed before higher-order pragmatic deficits can be detected, so a diagnosis of SCD should not be made until children are 4–5 years of age.
• DLD can occur co-morbidly with SCD, but SCD and ASD are mutually exclusive disorders (the presence of one means the other cannot occur co-morbidly).
• SCD may be considered by some as the “middleman” on a continuum between DLD and ASD

This graphic created by Dr. Lisa Archibald demonstrates some of the shared characteristics between DLD and the above-mentioned disorders. Difficulties with pragmatic and social communication skills (i.e., identifying nonverbal communication markers, following conversational rules, etc.) are present in all of the disorders, which I think highlights how a very diverse variety of skills influences an individual’s ability to be socially competent (i.e., executive functions like attention, language, ability to process information, etc.).

disorders

For more information, check out these additional resources:
Ferguson, M. A., Hall, R. L., Riley, A., & Moore, D. R. (2011). Communication, listening, cognitive and speech perception skills in children with auditory processing disorder (APD) or specific language impairment (SLI). Journal of Speech, Language, and Hearing Research, 54(1), 211-227.

Redmond, S. M. (2016;2015;). Markers, models, and measurement error: Exploring the links between attention deficits and language impairments. Journal of Speech, Language, and Hearing Research, 59(1), 62.

Swineford, L. B., Thurm, A., Baird, G., Wetherby, A. M., & Swedo, S. (2014). Social (pragmatic) communication disorder: A research review of this new DSM-5 diagnostic category. Journal of Neurodevelopmental Disorders, 6(1), 41.

CanChild’s Autism Classification System of Functioning: Social Communication
https://www.canchild.ca/en/resources/254-autism-classification-system-of-functioning-social-communication-acsf-sc

The Communication Matrix
https://communicationmatrix.org/Matrix/About#forPractitioners
• An assessment tool for children who are not speaking or writing to communicate

Posted in Assessment, Perspectives from the Field

Perspectives from the Field: A Private Practice SLP’s Take on Assessment

I recently spoke to a private practice SLP with great insights regarding the assessment process. Due to this SLP’s extensive experience in the field prior to working in private practice (some of her previous experience includes working in the school board, at the Geneva Centre for Autism, as part of a preschool speech and language initiative, in acute and long-term care facilities, etc.), the information she shared with me was based on many years of experience working with a diverse population of clients.

Before seeing the child and parent, this SLP conducts a phone screening to gather information when she receives a new referral. This is especially helpful in cases where the child’s L1 (Native of first language) may not be English, so that she can learn about the child’s exposure to English and other language(s) as well as the child’s expression style (i.e., communicates in L2 but understands L1) prior to the assessment. She will occasionally use parents as translators (when the parents have good mastery of English, and after providing careful instruction regarding what the parent can and cannot say to the child) during the assessment of bilingual/multilingual children, but will note this in the report since there could be issues with reliability using this method. Sometimes she will conduct informal observation during language-based play for most of the first visit with the child, in order to determine which areas need to be investigated further using the appropriate standardized test(s). However, she mentioned that tests like the CELF-4 (or even using a few of the subtests of the CELF) are helpful to get an idea of a wide variety of language skills.

One important consideration which impacts this SLP’s assessment process is the family’s financial resources (i.e., if a family has limited insurance coverage for SLP services, and cannot afford to pay for more services beyond this coverage). For this reason, the SLP stated that she approaches assessment as “diagnostic therapy” – similar to what we have been discussing in class as ‘dynamic assessment’. I think this is a good strategy to ensure that too many hours and dollars aren’t spent on assessment, since many parents bring their children to my course partner’s private practice because their child is not receiving/did not receive direct intervention in the school board (the SLP mentioned that many school board SLPs in the GTA only provide consultation and Tier 1 or Tier 2 intervention).

The SLP also stressed the importance of observing children during assessment because these observations can reveal valuable information beyond raw scores. For example, if you asked a child to complete a written sample in two minutes and the child only produced two sentences, this may have been due to motivation (child quickly wrote two sentences and then was looking around and fidgeting for the rest of the time) rather than actual difficulties with production (child took two minutes to slowly write out each word in the sentences), or vice versa. Beyond observation, she mentioned that we should listen and ask children what they find difficult too, because sometimes they are able to effectively describe why they find a certain task or skill difficult.

Posted in Intervention

The Importance of Social Competence

Social communicative competence is an important aptitude for children to possess because it allows them to interpret social situations and productively interact with their peers and others (i.e., to engage in play, resolve conflict, etc.). Social communication skills are supported by the child’s executive functions, language abilities, and social cognitive processes. Timler, Vogler-Elias, and McGill (cited below in the Additional Resources) discuss two outcomes which social communication interventions should target in order to be effective:
• Enhancement of language and social skills (with a particular focus on pragmatics)
• Generalization of social skills during authentic interactions with peers

Timler et al. describe 4 intervention contexts (from most to least naturalistic) in which social communication can best be targeted, which include:

  1. Environmental arrangement
  • Intervention in this context has typically occurred within preschool classrooms
  • This context involves arranging the classroom to include social toys (i.e., dress up clothes, board games, etc.) and centers to promote cooperative and pretend play
  • Through this arrangement, children with a range of social skills will have more opportunities to interact with each other in a natural context
  • The effectiveness of interventions in this context may be reduced in non-inclusive settings (i.e., children with disabilities segregated from typically-developing peers)
  1. Teacher-mediated intervention
  • This form of intervention focuses on increasing the classroom teacher’s use of verbal strategies which will promote peer interactions (i.e., “redirect” strategy where teachers encourage children to redirect requests from the teacher to a peer)
  • This method can increase peer interactions, after providing teachers with a relatively small amount of professional development on verbal strategies (however, teacher buy-in is necessary in order to see results!)
  1. Peer-mediated intervention
  • This type of intervention focuses on having the SLP recruit typical and pro-social peers to interact with children with social communication difficulties
  • Previous studies have shown that when children with social communication problems attempt to initiate interactions with typical peers, they are more likely to be rejected or ignored by these typical peers
  • Thus, in this case the typical peers are trained and receive “intervention”
  • The increased interaction between the trained peers and children with social communication problems is meant to provide the latter group with more opportunities to develop social communication skills
  • This method has primarily been used with children with ASD and has showed positive outcomes in terms of higher response rates by children with ASD and higher initiation rates of typical peers
  1. Clinician-mediated intervention
  • This mode of intervention involves individual or small group sessions with the child with social communication difficulties
  • Intervention components include:
    – Direct instruction
    – Modelling of desired behaviours
    – Role-play
    – Corrective feedback and praise to shape and reinforce skills
  • Timler et al. note that intensive instruction and concentrated practice, including opportunities where children can learn “when” and “how” to use social skills (i.e., contexts like peer group entry, cooperative play groups, conflict resolution, etc.), is crucial to help children acquire social skills
  • Typical peers can still be used in this form of intervention, however they do not receive training and are instead involved to allow the child with social communication difficulties to practice his/her newly acquired skills

I think that each of these contexts can create an effective framework to develop a child’s social communication skills. However, I feel that some important considerations when selecting an intervention context include:

  • After observing classroom dynamics, does the class seem to include children with a diverse range of social skills (i.e., are there pro-social children which could be selected for a peer-mediated intervention)?
  • Does the teacher appear to have the motivation to apply verbal strategies in the classroom (i.e., would you feel confident that a child’s social communication skills could improve with teacher-mediated intervention alone)?
  • What type of prompting hierarchy may be needed to have the child work towards independently and effectively using social communication skills (i.e., starting with a visual cue, a verbal prompt in the form of a direct request, a verbal prompt in the form of a direct model, etc.)?
  • Is the child able to self-monitor their use of the targeted skill or does self-monitoring need to be explicitly taught?

For more information, check out these additional resources:
Adams, C., Gaile, J., Lockton, E., & Freed, J. (2015). Integrating language, pragmatics, and social intervention in a single-subject case study of a child with a developmental social communication disorder. Language, Speech, and Hearing Services in Schools, 46(4), 294.

Timler, G. R., Vogler-Elias, D., & McGill, K. F. (2007). Strategies for promoting generalization of social communication skills in preschoolers and school-aged children. Topics in Language Disorders, 27(2), 167-181.

Winner, M. G. & Crooke, P. J. (2009). Social Thinking: A developmental treatment approach for students with social learning/social pragmatic challenges. Perspectives on Language Learning and Education, 16(2), 62-69.
https://www.socialthinking.com/Articles?id=3d555633f16f4396a5f0c22987bb9951
• This article presents great information on social communication development and the ILAUGH Model of Social Thinking

https://www.youtube.com/user/TDSocialSkills
• This YouTube channel provides several videos about social skills.

http://www.pbis.org/school
• This site provides information on promoting social competence at a school-wide level

Social Communication Intervention Project (University of Manchester)
http://research.bmh.manchester.ac.uk/scip/projectoverview
• This website provides information about a social communication intervention program which addresses the interactions between social understanding, language pragmatics, and language processing.

Posted in Intervention

Oral Language Goals for Older Students

Although promoting oral language is often discussed in the context of working with young children, it can also be an important intervention goal for older students. In ‘Communication Solutions for Older Students: Assessment and Intervention Strategies’, authors Vicki Lord Larson and Nancy L. McKinley provide potential goals for intervention for older students who need to strengthen their oral language. Below is a list of some goals for intervention aimed at intervention taken from the above-mentioned text:

Production of Linguistic Features
The student:
• Uses simple and complex sentences
• Uses appropriate sentence fragments
• Avoids using too many run-on sentences that are connected using and or and then
• Uses a variety of question forms (i.e., wh- questions, tag questions, interrogative reversals, and questions marked by rising intonation)
• Uses figurative language (i.e., slang, idioms, jargon, metaphors, similes, language for humour/entertainment)
• Avoids overusing nonspecific language (i.e., thing, stuff, and everybody) and can rephrase using more specific language if asked
• Displays few to no word-retrieval problems

Functions of Communication
The student:
• Gives an appropriate amount of information
• Gets information (i.e., by asking questions)
• Can describe an ongoing event with appropriate amount of detail for listeners
• Gets listener to do, believe, or feel something (i.e., persuade)
• Can express his/her ideas, perspective, and feelings
• Can indicate a readiness for further communication
• Uses language to solve problems
• Uses language to entertai

Fluency
The student:
• Avoids an excessive amount of verbal mazes that interfere with communication
• Avoids an excessive amount of false starts or abandoned utterances that interfere with communication

Conversations
The student:
• Applies the rules of conversation
• Initiates conversation in a variety of situations
• Selects appropriate topics
• Can maintain a topic over several turns between speaker and listener
• Switches topics in an appropriate manner
• Terminates conversations in a timely manner

Narrations
The student:
• Summarizes stories
• Categorizes stories
• Understands and produces complex stories with multiple embedded narratives
• Analyzes stories (13-15 years old)
• Can provide statements about the story’s theme or message (16 years-adulthood)
• Uses story grammar elements (i.e., can identify story’s characters, setting, events, goal, consequences, actions of characters, etc.)

Expository
The student:
• Integrates visual and verbal information
• Makes predictions
• Reasons logically
• Lists items relevant to a topic
• Justifies a position or decision
• Can compare and contrast ideas

These are some important considerations when targeting any of these goals:
Recruit related processes: This reduces the processing load on the child’s linguistic system.
Teach to a child’s strengths: This allows you to capitalize on a child’s natural abilities to facilitate learning. Using more effective cognitive processes allows the child to complete tasks using alternate strategies, or supports weaker processes as they work to complete the task.
•  Utilize dual coding if appropriate: For some children, being provided with auditory and visual cues can more effectively facilitate learning than receiving either of these cues in isolation. However, for other children dual coding may impose a greater load on their system and hinder learning. Thus, you need to analyze the child’s individual profile to determine if this will dual coding can better support them.

For more information, check out these additional resources:
Larson, V. L., & McKinley, N. L. (2007). Communication solutions for older students: Assessment and intervention strategies. Greenville, SC: Thinking Publications.

Posted in Perspectives from the Field, Reading

Perspectives from the Field: Speaking to a School Board SLP (Part III)

I recently spoke to an SLP in the Peel District School Board about her thoughts on service delivery in the school board.

Reading Programs
The SLP mentioned that over 50% of her referrals are students who can’t read, and thus she spends quite a bit of time targeting goals related to the “Big 5” of reading. The SLP mentioned that she has found the following reading programs useful (prices may vary; the prices included were estimates from the SLP):

Explode the Code (https://www.explodethecode.com/):
This program offers workbooks which provide phonics instruction (i.e., vowel rules, spelling rules, etc.). It can also be accessed through an online subscription instead of purchasing the physical workbooks for children. The SLP mentioned that she sometimes suggests the program to parents who want to give their child more practice with reading (i.e., As an alternative to expensive tutoring or Kumon sessions, since the online subscription option is $65 USD), or it is used in small groups in the classrooms.

Empower Reading (http://www.sickkids.ca/empower/):
This program focuses on decoding strategies. The SLP doesn’t directly deliver this intervention (she mentioned that teachers are typically trained in the program and it is quite costly to complete the training…about $5000) but supports teachers who are implementing it with students who have reading disabilities.

Teach Your Child to Read in 100 Easy Lessons:
This book is about $20 from Chapters and provides a step-by-step phonics-based reading program. The SLP mentioned that it is a quick option for parents to use at home (i.e., Parent only needs to spend 20 minutes doing a lesson with the child).

Apps & the Use of Technology
What’s “app” with all these iPads in schools nowadays? Technology now seems to play a significant role in most classrooms across schools, particularly the use of iPads and educational apps. For this reason, I wanted to get the SLP’s thoughts on the use of apps with clients. She mentioned that iPads are very popular and abundant in the PDSB. She stated that there are no apps she swears by to target a specific speech or language concern, especially for phonological awareness, and instead tends to look for apps which can be used as a “game” or tool to support language development. For example, Toca Boca and My Playhome are apps where children can interact with certain settings (i.e., hair salon, kitchen, etc.), but the apps themselves don’t produce any speech, which allows the SLP and child to use their own language while interacting with the settings (i.e., To support practice with wh- questions or prepositions while interacting with the kitchen: “Where should we put the pot? On the stove?”).

Service Delivery Delivery Challenges
In terms of challenges when delivering intervention, the SLP stated that the main challenge is that many staff and administrators in the school board don’t really understand what therapy and the SLP’s role entails. The role of the school board SLP may be further confused because a child’s CCAC SLP may be playing a different role in the school (i.e., targeting articulation and less involved in the classroom). The SLP stated that it’s important that the teacher understands why she is there (to help the child succeed in the classroom…not just to help with articulation issues, which is what some teachers may think!) and that SLPs establish a partnership with the teacher. These partnerships can also create more opportunities for Tier 1 and Tier 2 interventions, since the teacher can appreciate the role an SLP can play in the classroom setting. Speaking to this school board SLP helped me better understand what types of resources and constraints can shape an SLP’s practice.

Reflecting on Intervention in the School Board
As an SLP, I think the school board would be an exciting work environment because you can integrate so many creative resources and programs into practice. In the case of school boards with larger SLP teams, you can also consult with knowledgeable colleagues from diverse professional backgrounds to strengthen your own evidence-based practice. I also enjoy the opportunity to work with parents and an inter-disciplinary team of professionals, including teachers, psychologists, and social workers, since my school board placement at the Thames Valley District School Board made me realize how each of these team members brings unique findings and insight regarding how to best help the child succeed. I’m glad I received some valuable insights from an SLP actually working in the school board setting this term!

Posted in Reading

The ‘Big 5’ of Reading

The ‘Big 5’ of reading is a fun way of describing the five core areas of reading instruction. These areas include:

1. Phonemic Awareness

• Phonemic awareness refers to the ability to hear, identify, and manipulate individual sounds, or phonemes, in spoken words.
• Phonemic awareness is important because it improves children’s word reading and reading comprehension. It also helps them learn to spell.
• Phonemic awareness instruction is most effective when children are taught to manipulate phonemes using letters of the alphabet, and when instruction only focuses on one or two (rather than several types) types of phoneme manipulation.
• The phoneme manipulation tasks which are commonly used to assess or teach children phonemic awareness include:
Phoneme isolation: The ability to recognize individual sounds in words (i.e., “Tell me the first sound in boat. That’s right, it’s /b/.”).

Phoneme identification: The ability to recognize the common sound in different words (i.e., “Tell me the sound that is the same in hike, hut, and hill. That’s right, it’s /h/.”).

Phoneme categorization: The ability to recognize the word with the “odd” sound in a set of three or four words (i.e., Which word doesn’t belong: bus, bun, rug. That’s right, rug doesn’t belong because it doesn’t start with/b/.”).

Phoneme blending: The ability to listen to a sequence of separately spoken sounds and combine them to form a recognizable word (i.e. For example, “What word is /s/ /k/ /u/ /1/?” (school)

Phoneme segmentation: The ability to break a word down into its sounds by tapping out/counting the sounds or by pronouncing and positioning a marker for each sound (i.e., “How many phonemes are there in ship? That’s right, there are three, sh-i-p.”).

Phoneme deletion: The ability to recognize what word remains when a specified phoneme is removed (i.e., “Say smile. Now say it again but don’t say /s/. That’s right, you get mile.”).

Phoneme substitution: The ability to replace one phoneme with another to make a new word (i.e., “Say book. Now say it again but change /u/ to /a/. That’s right, you get back.”).

Phoneme addition: The ability to add a phoneme to an existing word to make a new word (i.e., “What word do you have if you add /s/ to the beginning of park? That’s right, you get spark.”).

2. Phonics
• Phonics is the understanding that there is a predictable relationship between phonemes (individual sounds of spoken language) and graphemes (letters of written language).
• Phonics instruction involves teaching students how to use these letter-sound correspondences to read and write words.
• Phonemic awareness is needed before children can benefit from phonics instruction (since phonemes should be understand at the spoken word level before transitioning to relating phonemes to graphemes in written words)
• In order to be effective, phonics instruction programs should be systematic (include a carefully selected set of well-organized, letter-sound relationships) and explicit (teachers given precise directions on how to teach the relationships).
• Phonics instruction helps improve children’s word recognition, spelling, and reading comprehension, and is most effective when started in kindergarten or grade one.

3. Fluency
• Fluency refers to the ability to read a text accurately and quickly.
• Fluent readers are able to focus their attention on comprehension (i.e., making connections between the ideas in a text and their background knowledge), while less fluent readers are focused on decoding individual words and have little attention left for comprehending the text.
• Reading fluency can be developed by modeling fluent reading and having students engage in repeated oral reading.
• Some activities for repeated oral reading practice include:
Student-adult reading: Reading one-on-one with an adult who provides a model of fluent reading, helps with word recognition, and provides feedback.

Choral reading: Reading aloud simultaneously in a group.

Tape-assisted reading: Reading aloud simultaneously or as an echo with an audio-taped model.

Partner reading: Reading aloud with a more fluent partner (or with a partner of equal ability) who provides a model of fluent reading, helps with word recognition, and provides feedback.

Readers’ theatre: Rehearsing and performing a dialogue-rich script derived from a book to an audience.

4. Vocabulary
• Vocabulary refers to the words we must know to communicate effectively.
• Oral vocabulary describes words we use in speaking or recognize in listening, while reading vocabulary refers to words we recognize or use in print.
• Vocabulary is important because it forms a foundation which allows comprehension to occur.
• Vocabulary instruction should focus on teaching the following types of words:
Important words: Words that must be known to understand main concepts or the text.

Useful words: Words which students are likely to see and use again.

Difficult words: Words with multiple meanings and idiomatic expressions tend to be particularly difficult for students.

5. Text Comprehension
• Text comprehension is the goal of reading, and thus children must be able to move beyond reading individual words in order to comprehend texts.
• Text comprehension can be improved by instruction that helps readers use specific comprehension strategies. These strategies include:
Monitoring comprehension: Students should be aware of what they do understand, identify what they do not understand, and use the necessary “fix-up” strategies (i.e., look back through text, restate difficult sentence in own words, etc.) to resolve comprehension problems.

Using graphic and semantic organizers: Graphic organizers can help students write well-organized summaries, focus on text structure as they read, and visually represent relationships.

Answering questions: Having students answer questions can help teachers guide and monitor children’s learning, focus students’ attention on important information, encourage comprehension monitoring, and help students think actively as they read.

Generating questions: Having students generate their own questions demonstrates if they understand what they have read and can improve their active processing.

Recognizing story structure: Story structure describes the way the content and events of a story are organized into a plot. Recognizing story structure improves students’ comprehension and memory of stories.

Summarizing: Summarizing requires students to identify the most important ideas in a text and describe these ideas in their own words.

Now that the basics are covered, I’ll be providing information about reading programs which address the ‘Big 5’ in a future post!

For more information, check out these additional resources:

National Institute for Literacy: Put Reading First (Kindergarten to Grade 3)
https://lincs.ed.gov/publications/pdf/PRFbooklet.pdf
• This resource provides detailed information about the ‘Big 5’ of reading and strategies to teach each of the five core areas.