Written Language Disorders

SPEECH-LANGUAGE PATHOLOGISTS AS UNIQUELY QUALIFIED PROFESSIONALS

Oklahoma Speech-Language Hearing Association (OSHA) October 2018 Nicole Power, M.S., M.Ed., CCC-SLP Advanced Organizer

— What you will learn today ¡ Research and information about written language disorders ¡ How SLPs are uniquely qualified to support struggling readers

— What you will not learn today ¡ The” right way” to approach this ¡ “The” answer Written Language Disorders

— Wait….what do you mean ‘Written Language Disorder’? Written Language Disorders

What is a written language disorder?

ASHA says, “A disorder of written language involves a significant impairment in fluent word recognition (i.e., reading decoding and sight word recognition), reading comprehension, written spelling, or written expression (i.e., written composition; Ehri, 2000; Gough & Tunmer, 1986; Kamhi & Catts, 2012; Tunmer & Chapman, 2007, 2012). A word recognition disorder is also known as dyslexia.

Source: https://www.asha.org/Practice-Portal/Clinical-Topics/Written-Language-Disorders/ There is not a universal definition of dyslexia

“Although researchers have studied dyslexia for over a century, there is still much debate about how dyslexia differs from other reading difficulties and how to support students labeled dyslexic. Nevertheless, dyslexia policy and practice are steeped in authoritative discourse that speaks of a definitive definition, unique characteristics, and prescribed intervention programs that are not well supported by research.” Worthy, J., Svrcek, N., Daly-Lesch, A., S. Tily (2018). “We know for a fact”: Dyslexia interventionists and the power of authoritative Discourse. Journal of Literacy Research, p1-24

Lombardino, L. & Guager, L. (2015). Dyslexia: Why is this diagnosis so challenging? Sig 1 Perspectives ASHA. Popular Definitions- IDA

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

The IDA also defines dyslexia as “…a language-based learning disability. Dyslexia refers to a cluster of symptoms, which result in people having difficulties with specific language skills, particularly reading. Students with dyslexia usually experience difficulties with other language skills such as spelling, writing, and pronouncing words.” https://dyslexiaida.org/definition-of-dyslexia/ https://dyslexiaida.org/dyslexia-basics/ Reid, L., Shaywitz, S., Shaywitz, B. (2003). Defining Comorbidity, Teachers’ Knowledge of Language and Reading. Annals of Dyslexia. 53, page 1. Who’s right?

— No universally accepted definition of reading disorders at this time. — Parents suspect dyslexia and go to Professional A and are told the child doesn’t have dyslexia, but does have written language issues or specific learning disability. So parents then go to Professional B who says the child does have dyslexia. — This is why parents talk among themselves and label Professional A as someone who doesn’t have a clue and Professional B as the one with all the answers. — The reality is that both professionals may be equally competent in assessing the child, but are utilizing different definitions, theoretical frameworks, or discipline specific labels.

Elliott, J., Grigorenko, E (2014). The dyslexia debate. Cambridge University Press. Does anyone agree on anything? Does anyone agree on anything?

— Yes ¡ In general, most professionals agree that a child with Intellectual Disabilities (ID) would not qualify as specific learning disorder, written language disorder, or dyslexia as the primary diagnosis. ¡ Professionals also agree that children with other primary diagnoses would still benefit from the same explicit, systematic, literacy instruction as those with primary diagnosis of dyslexia, written language disorder, SLD, etc. ¡ In general, most professionals look for listening comprehension skills to be significantly higher than the decoding skills and for substantial difficulties with phonological awareness tasks. Yes!

— Although there is disagreement about what terminology to use, there is consensus about symptoms that need further attention ¡ Family history of reading difficulties ¡ Difficulty learning the alphabet song, letters and sounds ¡ Difficulty rhyming ¡ Trouble learning left to right ¡ Trouble identifying individual sounds in words ¡ Poor spelling ¡ Knows a word one day and not the next ¡ Writing on the lines is difficult ¡ Knows phonics rules but can’t apply them effectively ¡ Misreads or omits small words like a, the, of ¡ Substitutes a word for another word with similar meaning when reading

More things we know

— Written language disorders/reading disabilities are often hereditary — Children with speech-language histories are more likely to have reading problems — Reading is language-based — Symptoms of reading struggles can be identified as early as Pre-K and diagnosis of dyslexia/written language disorders is generally acceptable at the end of K/beginning of 1st Myths make things muddy

— Seeing/writing letters backwards is a hallmark sign — Can’t be diagnosed until a child is at least 9yrs old — Children with dyslexia are gifted — Dyslexia is a medical diagnosis so can’t be done in schools — It’s a vision problem and helped with colored overlays Myth-busters

— Myth #1 Children see/write letters backwards ¡ Dyslexia is not a vision problem, or a problem with the eyes ¡ Writing reversals is a typical developmental stage lasting until about the end of 2nd grade — Myth #2 Children can’t be diagnosed until 9yrs ¡ This myth stems from the use of an outdated discrepancy method.

Allison D. Brooks, Virginia W. Berninger & Robert D. Abbott (2011) Letter Naming and Letter Writing Reversals in Children With Dyslexia: Momentary Inefficiency in the Phonological and Orthographic Loops of Working Memory, Developmental Neuropsychology, 36:7, 847-868, Ryder D, Norwich B. What's in a name? Perspectives of dyslexia assessors working with students in the UK higher education sector. Dyslexia. 2018;24:109–127. Myth-busters

— Myth #3 Children with dyslexia are gifted ¡ All children have strengths and weaknesses. Children with dyslexia are not more or less gifted than any other child. — Myth #4 Dyslexia is a medical diagnosis ¡ Doctors are not trained to administer language, literacy, cognitive, or achievement assessments that may be used in dyslexia assessments ¡ Many professionals are qualified to diagnose dyslexia – including SLPs! ¡ “OSERS reiterates that there is nothing in the IDEA or our implementing regulations that would prohibit IEP Teams from referencing or using dyslexia, dyscalculia, or dysgraphia in a child’s IEP. “

Office of Special Education and Rehabilitative Services (OSERS) Letter to Colleagues October 23, 2015.

Myth-busters

— Myth #5 It’s a vision problem ¡ “Most experts believe that dyslexia is a language- based disorder. Vision problems can interfere with the process of learning; however, vision problems are not the cause of primary dyslexia or learning disabilities. Scientific evidence does not support the efficacy of eye exercises, behavioral vision therapy, or special tinted filters or lenses…”

AAP, AAPOS, AACO, AAO. Joint Statement: Learning disabilities, dyslexia, and vision. American Academy of Ophthalmology. July 2014. Are we talking about the same thing?

— When a professional or parent says a child has reading problems, what do they mean exactly? What symptoms are they talking about? — When there is a diagnosis of dyslexia, written language disorder, specific learning disability, read the report. Make sure it is clear what criteria they based the diagnosis on for highest level of understanding between professionals and families. — The same concept must be applied when a child is struggling with literacy, tested, and not found eligible or given a diagnosis. What was the criteria that the child did not meet? — When we are explicit in our conversations about what we mean, then we can be more sure that we are being understood correctly when we are trying to help a child. Reading What’s an SLP got to do with it? SLPs have everything to do with it

Scarborough, H. S. (2001). Connecting early language and literacy to later reading (disabilities: Evidence, theory, and practice. In S. Neuman & D. Dickinson (Eds.), Handbook for research in early literacy (pp. 97–110). New York, NY: Guilford Press. Reading is language based

— The relationship of language to literacy has been demonstrated over decades of research.

— Children with language disorders that were resolved by age 5 ½ were more likely to have average reading and writing. Language issues persisting past this age were more likely to have poor literacy outcomes.

— This means SLPs are first-line triage personnel! An SLP may be the first person to identify language or literacy issues in young children, treat them, and educate the parents about possible future needs.

Snowling, M., Duff, F.., Nash, H., & C. Hulme (Dec 2016). Language profiles and literacy outcomes of children with resolving, emerging, or persisting language impairments. The Journal of Child Psychology and Psychiatry, 57(12), p. 1360-1369. “I’m not the reading teacher” ASHA

— The relationship between language disorders and learning disabilities is intricate, as indicated in the IDEA definition of specific learning disability below: ¡ “The term ‘specific learning disability' means a disorder in one of more of the psychological processes involved in understanding or in using language, spoken or written, which may manifest itself in an imperfect ability to listen, speak, read, write, spell, or do mathematical calculations (Individuals with Disabilities Education Improvement Act [IDEA], 2004).”

— Language disorders are typically diagnosed before learning disabilities and often affect the child's academic performance. Once academic struggles with reading and writing arise, a learning disability label may be used, even though the underlying issue is a language disorder (Sun & Wallach, 2014).

https://www.asha.org/Practice-Portal/Clinical-Topics/Written-Language-Disorders/ ASHA

— “In preschool and kindergarten, children who are at risk for reading disorders are likely to exhibit difficulty with phonological awareness and phonics (Torgensen, 2002, 2004). This problem may continue as they struggle to develop the skills they need for accurate and fluent word recognition.” (ASHA)

— Here’s the thing… ¡ The first signs of dyslexia are often the same as the early signs of language disorders

https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942549§ion=Signs_and_Symptoms There are other people…

— Many SLPs have the notion that there are other professionals who know more about literacy. — There may be other professionals assigned to teach reading, BUT…

¡ Psychologists and reading specialists are in PK and K classrooms, observing and pointing out kids with symptoms of future poor literacy outcomes. ¡ Psychologists, reading specialists, and special education teachers typically concentrate on kids who are already failing reading instruction ¡ Classroom teachers concentrate on meeting grade level expectations and aren’t likely to speak up if a child is meeting them, even if it is “just barely.” ¡ SLPs are highly qualified to observe PK and K language behaviors and understand that they are red flags for future literacy outcomes. ¡ YOU must be the advocate for these kids to not only get the traditional language support they need, but to do everything possible to make sure that we are PREVENTING early literacy indicators from becoming big reading and writing disabilities.

I don’t know about reading

— “One of the most common findings in my studies of teacher knowledge and teacher proficiencies is that even experienced teachers of reading really do not know speech sounds. If I ask them a simple thing like how many speech sounds are in the word ‘no’ and I spell it k-n-o-w, they’ll tell me there’s four speech sounds in the word because they don’t know how to separate their own knowledge of orthography from a specific awareness of speech sounds. Because we’re wired up to process phonology at an automatic level and extract the meaning from speech, there’s no requirement for the average person to be meta-linguistically aware at the phonological level.”

¡ Louisa Moats, Vice President IDA, Author of LETRS

https://childrenofthecode.org/interviews/moats.htm Unique expertise of an SLP Unique expertise of an SLP What do you know that is key in reading?

— Knowledge of the speech-sound system (phonology) — Phoneme-grapheme mapping knowledge — Effective vocabulary instruction — Effective grammar instruction — Effective comprehension instruction — Some prominent reading researchers call the above skills necessary in order to effectively teach reading. And you are experts in this stuff!

Moats, L (2008). Language: A missing foundation in teacher education and what SLPs can do about it. [ASHA conference]. Unique expertise in early literacy

— When compared to the knowledge of reading specialists and special education teachers, SLPs showed remarkably advanced skill in phoneme segmentation, phoneme isolation, and phoneme identification. — Reading specialists and special ed teachers did not have stronger understanding of phonemic awareness than regular education teachers. — So, don’t be shy. You have a lot of knowledge that not everyone else possesses.

Spencer, E., Schuele, M.,Guillot, K, & Lee, M. (2008). Phonemic awareness skill of speech-language pathologists and other educators. Language, Speech, Hearing Services in Schools, 39, p512-520. Skills you learned as an SLP

phonology

writing morphology

Reading

Pragmatics syntax

semantics ASHA Written Language Disorders

— SLPs have a role in the prevention, assessment, diagnosis, planning, treatment, advocacy, education, administration and research of written language disorders including… ¡ “Diagnosing disorders of reading and writing – including dyslexia – and describing the relationship between these disorders and the student’s spoken language difficulties”

Code of Ethics (ASHA, 2016a), SLPs who serve this population should be specifically educated and appropriately trained to do so.

https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942549§ion=Roles_and_Responsibilities Stay in your lane

You are “in your lane.”

“It may have been enough several years ago for SLPs to focus solely on early literacy skills and phonological awareness. This is not the case today. SLPs not only need to collaborate with teachers to develop a comprehensive approach to literacy, but also should be providing direct, explicit instruction of decoding skills for students with language and learning disabilities.”

Kamhi, Alan & M. Allen, Melissa & Catts, Hugh. (2001). The Role of the Speech-Language Pathologist in Improving Decoding Skills. Seminars in speech and language. 22. 175-83; quiz 184. 10.1055/s-2001-16144.

Change the narrative

— Passionate about this area ÷ You can evaluate, diagnose, and treat written language disorders- including dyslexia, provided you gain enough training to feel competent (just like any other area in our scope) — Not interested ÷ Change your narrative from “SLPs don’t do reading” to “Yes, some SLPs do reading, let me get you in touch with one who does that.” ¢ Support your fellow SLPs who have expanded into this area ¢ Provide families, colleagues, and other professionals with accurate information — On the fence ÷ Evaluate literacy as part of a full and complete SLP evaluation ÷ Participate in literacy teams, advocate for your students ÷ You know more than you think Screening for Literacy

— TILLS- Student Language Scales ¡ Age 6.0+ ¡ Paper/pencil with only 12 questions (50 for $35) ¡ Rating Scale for Teachers, Parent ¡ Sensitivity/Specificity for risk of a language/literacy disorder ÷ .90 for teachers; .85/.83 for parents ¡ If 2 or more items are rated below a 5 on the first 8 questions, the student has failed the screen. ¡ It’s marketed towards SLPs and written by SLPs! ¡ Allows you to be collaborative and gather multiple viewpoints from teachers and parents.

Quickly and Reliably Screen Students for Language and Literacy Disorders (including dyslexia) Brookes Publishing 2016. https://www.youtube.com/watch?v=NJPmkbacChs Screening for Literacy

— Mississippi Dyslexia Screener for K and 1st grade ¡ FREE, 15 minutes to administer ¡ Family/School friendly printed results page ¡ MS screens all children spring of K/ fall of 1st grade ¡ University of North Carolina studied this screen and found an inter-rater reliability of 95% ¡ Subtests ÷ Phoneme segmentation ÷ Alphabet knowledge ÷ Nonsense word fluency ÷ Spelling ÷ Rapid Automatic Naming https://www.researchgate.net/publication/301328834_The_Mississippi_Dyslexia_Screener_An_inter- scorer_reliability_study Screening for Literacy

¡ Get Ready to Read- Revised (GRTR-R) Screener ÷ Age 3.0 to 5.11 ÷ Multiple Choice (similar to a PPVT where child points) ÷ 10 minute administration ÷ Subtests ¢ Print knowledge ¢ Book knowledge ¢ Phonological awareness ¢ Phonics ÷ Some data indicate a medium to positive predictive validity ÷ Available from Pearson for about $100/ Available in Spanish

GRTR Guide for Researchers: http://www.getreadytoread.org/screening-tools/research-a-reports/background- information-on-the-grtr-screening-tool Screening Early

— Early screening helps us identify issues before they become big problems — There are not many valid screeners available for the K and earlier children — The results of screening may be a result of lack of exposure in the home environment ¢ Although this may make assessment and ultimate diagnosis more difficult, a failed screening still means a potential problem, regardless of cause. Still important to provide early intervention to these children. Informal Measures

— Using informal measures may yield important information for you and/or your team ¡ Profiles of Phonological Awareness (Pro-PA)-Smarty Ears $35 ÷ Rhyming ÷ Blending ÷ Isolating (first, last, middle) ÷ Segmenting ÷ Deleting ÷ Substituting Informal measures

— Use of an alphabet arc activity can provide information about the child’s understanding of ¡ Letter names ¡ Letter sounds ¡ Sequencing ¡ 1:1 letter/sound correspondence ÷ do they point to l-m-n-o and say each sound as they point to letter ÷ or do they just glaze over it and say “ellemeno” ¡ Letter confusion (b, d, p, q) (l/i) ¡ Do they know the terms ‘vowel’ and ‘consonant’? ¡ Should complete arc in 2 minutes Informal measures

What information could you get from this? Informal Measures

— Print Concepts ¡ Supplemental from the CELF-4 ¡ Many formats available online ¡ If the child has had PK, you would expect most concepts to be mastered, if no PK, these should quickly grow in K ÷ Show me the front of the book ÷ Show me where I would start to read this page ÷ Turn the page for me — RAN ¡ Supplemental from the CELF-4 ¡ Available in the Mississippi Screener Formal Measures

— OK, I have… ¡ Done some research-based trainings ¡ Read recent pertinent journal articles ¡ participated in forums with discussion that cites research ¡ a few people that I can reach out to for help — I feel competent to participate in some formal measures of assessment ¡ Now what? Formal Measures

— If you are just beginning to stretch out into literacy, consider these assessments ¡ Comprehensive Test of Phonological Processing-2 ÷ Age 4-24 years ÷ Can an SLP give this test? Absolutely! ÷ Do I need a formal training? No. You are an SLP trained in the administration of standardized assessments. Read the manual. ÷ Where can I learn more about this test? ¢ Dyslexia and Phonological Processing Technical Webinar • https://www.youtube.com/watch?v=sEs5RezMvfw ÷ Considered by some to be the gold standard phonological processing test ¢ Pro- standard scores and %tiles, phonological memory ¢ Con- still don’t know exactly what early skills to tackle

Formal Measures

— Test of Integrated Language and Literacy Skills ¡ Age 6-18 ¡ Can an SLP give this test? Yes, it’s created by SLPsJ ¡ Assesses language and literacy ¡ Where can I learn more about this test? ÷ http://tillstest.com Treatment

— I haven’t done much phonological awareness, but I know lots of SLPs do this. I think I’ll start here. Phonological Awareness Kid Lips from tools4reading.com by Mary Dahlgren. $40 for cards only. $75 for cards and instructional guide. Local OK company! Learning More

— For an easy understanding of the current reading wars, take a look at these documents ¡ The International Literacy Association Dyslexia Alert ÷ https://www.literacyworldwide.org/docs/default-source/where- we-stand/ila-dyslexia-research-advisory.pdf ¡ The International Dyslexia Association Response to ILA ÷ https://dyslexiaida.org/ida-urges-ila-to-review-and-clarify-key- points-in-dyslexia-research-advisory/ ¡ The ILA addendum: Response to IDA ÷ https://www.literacyworldwide.org/docs/default-source/where- we-stand/ila-dyslexia-research-advisory-addendum.pdf? sfvrsn=85bca08e_4

Trainings

— LETRS (contact Voyager) ¡ Offered for free through SDE to many districts and educators ¡ Does not sell you a program. Solid teaching strategies based on research — Tools4Reading (tools4reading.com) ¡ Local OKC business/former director of Payne Center ¡ LETRS trainer ¡ Provides coaching and professional development — Ascend Learning (www.ascendlearningcenter.com) ¡ Self-paced online training resulting in 15 CMHs ¡ Subscription service for structured literacy manuals and materials. Social media

— SLPs for Evidence Based Practice — Clinical Research for SLPs

Both of these FB forums provide a multitude of research articles, discussion, and resources for SLPs looking for information on literacy grounded in solid research. — Thanks for Listening!

Nicole Power, M.S., M.Ed., CCC-SLP Speech-Language Pathologist Reading Specialist www.educationalinspiration.com [email protected] 405-285-1475