Comprehensive Assessment and Treatment of Literacy Disorders In

Comprehensive Assessment and Treatment of Literacy Disorders in Speech-Language Pathology Created by Tatyana Elleseff MA CCC-SLP Smart Speech Therapy LLC For Individual Use Only. Do not resell, copy, or share downloads. Do not remove copyright.

Overview  This presentation describes how speech language pathologists can effectively assess and treat children with literacy disorders, (reading, spelling, and writing deficits including dyslexia) from preschool through adolescence.  It explains the impact of language disorders on literacy development, lists formal and informal assessment instruments and procedures, as well as describes the importance of assessing higher order language skills for literacy purposes.  It reviews components of effective reading instruction including phonological awareness, orthographic knowledge, vocabulary awareness, morphological awareness, as well as reading fluency and comprehension.  Finally, it provides recommendations on how components of effective reading instruction can be cohesively integrated into speech-language therapy sessions in order to improve literacy abilities of children with language disorders and learning disabilities. WWW.SMARTSPEECHTHERAPY.COM Copyright © 2013 Smart Speech Therapy LLC Page ‹#›

Learning Objectives

 At the end of this presentation learners will be able to:  Identify formal literacy assessment instruments sensitive to detection of dyslexia and other literacy deficits in children 3.6-18.0 years of age  Describe informal literacy assessment procedures to supplement formal testing  List components of effective literacy instruction for struggling learners  Explain how to effectively incorporate components of reading instruction into speech language therapy sessions

Hierarchy of Language Development  Receptive Language  Comprehension of words, phrases, sentences, stories  Expressive Language  Speaking single words, phrases, sentences, engaging in conversations, producing stories  Reading  Words, sentences, short stories, chapter books, etc.  General topics  Domain specific topics (science, social studies, etc.)  Spelling  Writing  Words, sentences, short stories, essays  Language develops along a continuum with listening comprehension and oral expression being the foundational framework for development of later more complex abilities such as reading, spelling, and writing  Thus effective language interventions for struggling learners involve working on reading, writing, and spelling (literacy) in conjunction with listening comprehension and oral expression WWW.SMARTSPEECHTHERAPY.COM Copyright © 2013 Smart Speech Therapy LLC Page ‹#›

Why Should SLPs Address Literacy?  ASHA Literacy Gateway: “(SLPs) have the specialized knowledge and experience needed to identify communication problems and to provide the help that children need to build critical language and literacy skills”  As per, Snowling & Hulme, 2012: “Aside from children who ‘can listen and speak well’, yet have difficulty learning to read (dyslexia), the main risk factor for reading disorders is problematic language development” (pg. 27)  Language and phonological skills are the foundations of literacy development  SLPs play a critical role in the identification of children who are likely to go on to have literacy difficulties and are well positioned to intervene  Aspects of oral language ability beyond phonology provide the foundation for reading comprehension (Bowyer-Crane, et al, 2007; Oakhill, Cain, & Bryant, 2003; Muter, Hulme, Snowling, & Stevenson, 2004)  Reading comprehension relies on the interaction of decoding + linguistic comprehension  Variations in linguistic comprehension depend upon a range of factors including vocabulary and grammatical abilities and resources such as attention (Bowyer-Crane, et al, 2007) WWW.SMARTSPEECHTHERAPY.COM Copyright © 2013 Smart Speech Therapy LLC Page ‹#›

Definition of Dyslexia

 As per International Dyslexia Association (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.”  IDA definition affirms the fact that dyslexia is a linguistically based disability

Select Dyslexia Myths

 Myth 1: Dyslexia can be diagnosed based on a single test!  DYSLEXIA CANNOT BE CONFIRMED BY THE ADMINISTRATION OF ONE SPECIFIC TEST. A comprehensive battery of tests (from a single or multiple adequately trained professionals) needs to actually be administered in order to confirm the presence of reading based disabilities  Myth 2: A doctor can diagnose dyslexia!  Physicians do not have adequate training to diagnose learning disabilities, the same way they cannot diagnose speech and language problems. Both lie squarely outside of their scope of practice! A doctor can listen to parental concerns and suggest an appropriate plan of action (recommend relevant professionals to assess deficit areas) but they couldn’t possibly diagnose dyslexia which is made on the basis of multiple assessments.  Myth 3: Speech Language Pathologists cannot perform dyslexia testing!  Speech language pathologists trained in identification of reading and writing disorders are fully qualified to perform significant portions of dyslexia battery.

Dyslexia and the Brain

 Developmental dyslexia is frequently associated with atypical brain structure and function within regions of the left hemisphere reading network.  Reading is supported by a network of regions in the left hemisphere (Price,2012), including the occipito-temporal, temporo-parietal, and inferior frontal cortices. The occipito-temporal cortex holds the “visual word form area.” (IDA)  Both the temporo-parietal and inferiorfrontal cortices play a role in phonological and semantic processing of words, with inferior-frontal cortex also involved in the formation of speech sounds.  Children with dyslexia demonstrate reduced cortical thickness within previously identified reading areas including bilateral occipitotemporal and occipitoparietal regions as well as increased gyrification in left occipitotemporal and right superior frontal cortices (Williams et al, 2017)

Dyslexia and IQ

 Tanaka et al, 2011 found that fMRIs of children with dyslexia with low IQs had the same patterns of brain circuitry abnormalities as those of the children with dyslexia with normal IQs  Both groups had less activity in the two left hemisphere brain regions that are often less active in dyslexics.  Children's reading disability is not related to their IQ alone but to identifiable patterns of abnormal brain function  Regardless of IQ, poor readers have similar kinds of reading difficulties in relation to phonological processing  Children with lower than average IQ should receive the same reading help that is offered to normal IQ children with dyslexia, as they too will benefit from the targeted reading interventions

Dyslexia Controversy

 There’s significant controversy over the use of the label “dyslexia”  In their book: “The Dyslexia Debate” Julian G. Elliott and Elena L. Grigorenko argue that the label is a cultural meme that remains unscientific and conceptually problematic  The end of dyslexia? (article on the topic HERE)  While the term “dyslexia” does not automatically explain what type of specific reading-related deficits the child is experiencing or what prevents him/her from reading effectively, it does alert professionals to the fact that a reading disability EXISTS  For the purpose of this presentation rather than utilizing the term “dyslexia”, a more broad term “literacy deficits” will be used to refer to children who experience difficulty with reading, writing, and spelling

Genetics of Literacy Disorders  Children with immediate and/or extended family members with diagnoses such as “dyslexia”, “reading disability”, “learning disability” or special education placements during school years are significantly more at risk of developing literacy based deficits than children with no history of above family problems  Dyslexia and learning disabilities are due to multifactorial inheritance - combination of genes from both parents interacts with environmental factors  Linked to specific gene FOXP2 (involved in fine motor control)  Dyslexia (Scerri & Schulte-Korne, 2010)  Learning disability (Bishop, 2009)  Speech Sound Disorders (SSD) share genetic contribution with dyslexia and later developing reading difficulties (Stein at al, 2004)

Idiopathic Causation

 A number of children with no recognizable family history of learning disabilities, may be at risk for future literacy deficits if they display a pattern of linguistic difficulties during early development (e.g., delayed developmental milestones)  If the child experiences any deficits in the foundational language areas such as listening and speaking, s/he will most certainly experience difficulties in more complex areas of language: reading, writing, and spelling.

Warning Signs of Literacy Deficits in Young Children

 Documented history of language impairment  Receipt of therapy services from a very early age  Early intervention  Preschool-disabled eligibility  Absence of early-onset linguistic deficits but presence of early-onset literacy difficulties  Difficulty remembering nursery rhymes and songs  Trouble remembering the letters of the alphabet  Trouble recognizing simple rhyming words, etc.  Even without a pertinent family history of literacy disabilities it may be important for a child to undergo an early literacy assessment in order to determine whether intervention is warranted

Where do we begin?

 Data Collection  Referral Forms!!!!!  Preschool  School-Age  Adolescents  Give it to the teacher  Send it home  Can’t Assess Everything  Don’t waster TIME!  Target Deficit Areas ONLY!

Collecting Differential Diagnosis Information

 Prenatal History:  — What was the age of the mother when she gave birth to the child in question?  — How many other pregnancies occurred prior to/post this one?  — How many children does the mother currently have?  — Is there a history of abuse /neglect in the family  — Physical, sexual, emotional?  — — Is there a family history of mental illness/substance abuse?  — What is the maternal (family’s) socioeconomic status?  Is there a history of prenatal illness, trauma or medication use?  Did the mother receive adequate prenatal care?

Background History Collection (cont.)

 Developmental History  Does the child have history of significant medical issues (— Failure to thrive, swallowing/feeding deficits?  Delayed speech/language milestones for: babbling, say first words, using word combinations?  Did the child ever have inconsistent language gains (e.g., had the skill then lost it?)  What is the child motor milestone history?  How are the child’s self-help skills?

Background History Collection (cont.)

 Has a child been diagnosed with any psychiatric disorders?  Differential Diagnosis Issue  Does the child have learning disabilities?  Reading and Writing Deficits  Listening Comprehension/Processing Deficits  Are the child’s language abilities significantly poorer than those of his/her peers?  Does s/he speak in shorter less complex sentences  Has Immature Vocabulary?  Has Impaired Story Telling Skills?

Critical questions to ask the teacher (Crowley et al, 2006)

1. What is student’s grade level achievement in reading and math?  Ask for data 2. What supports does s/he need?  What are student’s strengths and weaknesses? 3. How has he progressed over time?  Do you have a portfolio or examples of his work? 4. How do his language skills compare to those of his classmates? 5. Does the teacher concur with the conclusions the SLP reached as a result of the evaluation? 6. Self Question: Does it seem that the student is receiving an adequate education based upon the teacher interview?

SAMPLE FORM: SPEECH LANGUAGE ASSESSMENT CHECKLIST FOR SCHOOL AGE CHILD

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Sample Abridged Areas from the Checklist

Check all that apply:  Listening Comprehension  ____Difficulty understanding main ideas of presented passages/stories  ____ Difficulty remembering details from books or conversations  ____ Difficulty understanding key points in verbal messages  Memory, Attention and Sequencing  ____ Difficulty recalling previously learned words  ____ Requires increased processing time to respond to questions  ____ Difficulty recalling story events  Expressive Language  ____ Difficulty answering questions without rambling  ____ Difficulty retelling procedures (rules of a sports game or a videogame)  ____Difficulty producing syntactically correct sentences

Review other Assessments and Score Discrepancies

 Review the results of learning (WJ-IV) and psychological evaluations (WISC-IV) in order to  See the whole child and not just their limited functioning in select areas  Determine areas of academic weaknesses  Testing score breakdowns can also reveal significant discrepancies in functioning which may need to be addressed

Select Preschool Language Assessments

 Vocabulary:  Montgomery Assessment of Vocabulary Acquisition (MAVA) (Ages: 3+)  Test of Word Finding-3 (TWF-3) (Ages 4.6+)  General Language:  Preschool Language Assessment Instrument -2 (PLAI-2) (Ages: 3+)  Clinical Evaluation of Language Fundamentals Preschool -2 (CELF-P2) (Ages: 3+)  Test of Auditory Processing Skills-3 (TAPS-3) (Ages 4+)  The Expressive Language Test 2 (ELT-2) (Ages 5+)

Language Sample and Complex Sentences Did you know..?  As per Paul, 1981:  3-3.5 year olds  1-10% complex sentences  3.5-4.0 year olds  10-20% complex sentences  4+ year olds  Over 20% complex sentences (Paul, 2001)  By age 5  Typically developing children use 6-8 different conjunctions in a 15-min speech sample  Lack of or minimal presence of complex sentences in children ages 3-5 is a cause for concern!

Narrative Assessment

 Wordless Story Book  Frog where are you? By Mercer Meyer  Narrative Levels (Hedberg & Westby, 1993)  Stage I: Heaps (2yrs)  Stage II: Sequences (2-3yrs)  Stage III Primitive Narratives (3-4yrs)  Unfocused Chains (4-4 ½ yrs)  Focused Chains (5yrs)  Learn more about how to assess narratives here:  Narrative Assessment Bundle  http://www.smartspeechtherapy.com/shop/narrative-assessments- of-preschool-and-school-aged-children/

Narrative Ages and Stages

Ages Stage Description 2 I: Heaps Collection of unrelated ideas Frequent switch of topic No central theme or cohesive devices Mostly labeling and describing events or actions Repetitive syntax (-ing ending may be used) Limited understanding that the character on the next page is still same

2-3 II: Sequences Labeling or describing events about a central theme May contain a central character, topic, or setting Still arbitrarily link story elements together (no transitions) 3-4 III: Primitive 3 story grammar components Narratives •Initiating event •Attempt or action •Consequences Child begins to interpret/predict events (e.g., use inferences) Discusses the character’s facial expressions, body postures & feelings (early perspective taking) May use pronominal reference or repeat character’s names WWW.SMARTSPEECHTHERAPY.COM Copyright © 2013 Smart Speech Therapy LLC Page ‹#›

Narrative Ages and Stages (cont) Ages Stage Description 4-4 .5 Unfocused Chains A true sequence of events, linked logically or with a cause-effect relationship but without a central character Conjunctions “and,” “but,” and ”because” may be used Rarely produced by children (Westby, 1984) Once they grasp the concept of cause-effect and event sequencing they begin to tell stories at the Focused Chains Level

5 Focused Chains Four story grammar components Initiating event, attempt or action, and consequence + abrupt ending (listener left to interpret) Contains a central character, a logical sequence of events (use of transitions) Events take the form of “adventures”

What can narratives yield about the child?  Sequencing Ability  Story order  Working Memory  Use of relevant details  Grammar  Sentence structure  Limited utterance length vs. run-on sentences  Presence of errors  Use of temporal markers and cohesive ties to connect the story  Vocabulary  Immature vs. age-level  Word retrieval issues vs. lexical fluency  Pragmatics  Topic cohesion /coherence  Use of anaphoric references  Perspective Taking Vocabulary  Insight into character’s feelings, beliefs, thoughts WWW.SMARTSPEECHTHERAPY.COM Copyright © 2013 Smart Speech Therapy LLC Page ‹#›

Tests of Reading, Spelling and Writing: Preschool

Auditory Skills Assessment (ASA)

 ASA assesses important areas related to early phonological awareness development including nonsense word repetition, phonemic blending, as well as rhyming in children ages 3.6+

Test of Auditory Processing Skills–Third Edition (TAPS-3)

 TAPS-3 assesses basic language and phonological awareness abilities in children ages: 4-0 + with subtest order reflecting a developmental progression of tasks, ranging from easiest to most difficult  Subtests  Basic Phonological Skills:  Subtest 1: Word Discrimination  Subtest 2: Phonological Segmentation  Subtest 3: Phonological Blending  Auditory Memory  Subtest 4: Number Memory Forward  Subtest 5: Number Memory Reversed  Subtest 6: Word Memory  Subtest 7: Sentence Memory  Auditory Cohesion:  Subtest 8: Auditory Comprehension  Subtest 9: Auditory Reasoning

Emerging Literacy & Language Assessment (ELLA)

 ELLA evaluates the abilities children ages 4.6 + need to become proficient readers  Section 1 – Phonological Awareness and Flexibility assesses rhyming (awareness and production), initial sound identification, blending and segmenting sounds, words, and syllables, and deleting and substituting sounds in the initial and final positions of words.  Section 2 – Sign and Symbol Recognition and Interpretation assesses environmental symbol identification, letter- symbol identification, word reference association, and reading comprehension for one to three sentences.  Section 3 – Memory, Retrieval, and Automaticity assesses rapid naming, word associations (name items that start with the "S" sound), and story retell (includes three story levels based on the child’s age)

Test of Early Reading Ability–3 (TERA-3)  TERA-3 assesses the emergent reading abilities of children ages 3:6+ and consists of 3 subtests:  Alphabet- measures knowledge of the alphabet and its uses  29 items focused on counting phonemes and syllables and recognizing print displayed in various fonts  Struggling students may omit or add inaccurate sounds to words showing a deficit in their knowledge of the alphabetic principal as well as mispronounce or confuse letters  Conventions- measures knowledge of print conventions  21 items with a focus on student’s knowledge of arbitrary aspects of English print  Struggling students will find print confusing, may overlook punctuation, and may not be able to navigate easily through a book  Meaning-measures the construction of meaning from print  30 items with a focus on comprehension of signs, logos, and words in both figural and situational contexts  Struggling students will miss the significance of a reading passage, rely on word retrieval rather than construct meaning, lose their place when reading, have difficulty making connection to the material and correctly answering reading comprehension questions

Test of Early Written Language-3 (TEWL-3)  TEWL-3 assesses the emergent writing abilities of children starting from 4:0 years of age  Basic Writing. This subtest consists of 70 items ordered by difficulty, which are scored as 0, 1, or 2. It measures a child’s understanding of language including their metalinguistic knowledge, directionality, organizational structure, awareness of letter features, spelling, capitalization, punctuation, proofing, sentence combining, and logical sentences. It can be administered independently or in conjunction with the Contextual Writing subtest.  Contextual Writing. This subtest consists of 20 items that are scored 0 to 3. Two sets of pictures are provided, one for younger children (ages 5-0 through 6-11) and one for older children (ages 7-0 through 11-11). This subtest measures a child’s ability to construct a story given a picture prompt. It measures story format, cohesion, thematic maturity, ideation, and story structure. It can be administered independently or in conjunction with the Basic Writing subtest.  Overall Writing. This index combines the scores from the Basic Writing and Contextual Writing subtests. It is a measure of the child’s overall writing ability; students who score high on this quotient demonstrate strengths in composition, syntax, mechanics, fluency, cohesion, and the text structure of written language. This score can only be computed if the child completes both WWW.SMARTSPEECHTHERAPY.COMsubtests and is at least 5 years of age Copyright. © 2013 Smart Speech Therapy LLC Page ‹#›

Select School-Age Language Assessments  Listening Comprehension (for stories not just sentences)  Listening Comprehension Test -2 (ages 6+)  Listening Comprehension Test-Adolescent (ages 12+)  Assess skills informally through presentation of science or social studies - related grade level passages when applicable  Comprehension of Ambiguous/Figurative Language (idioms, ambiguous expressions, etc.)  Clinical Evaluation of Language Fundamentals -5 Metalinguistics (ages 9+)  Semantic Flexibility Skills (can the student easily generate definitions, synonyms, antonyms, multiple meaning words, etc.)  Expressive Language Test-2 (ages 5+)  WORD Test 3 Elementary (ages 6+)  WORD Test 2 Adolescent (ages 12+)

Select Assessment Battery Suggestions (cont.)

 Narrative Abilities (can the student coherently and cohesively summarize books or movies)  Obtain an informal narrative sample  Critical Thinking and Problem Solving  Test of Problem Solving-3 (ages 6+)  Test of Problem Solving-2 (ages 12+)  Social Communication Skills  Social Language Development Test Elementary (ages 6+)  Social Language Development Test Adolescent (ages 12+)  Informal Social Thinking Dynamic Assessment Protocol® (ages 8+)  Executive Function Abilities  The Executive Functions Test-Elementary (ages 7+)  Situational Awareness STOP Observation Tool (ages 8+)

School-Age Tests of Reading, Spelling & Writing

General Literacy Testing (TILLS)

 The Test of Integrated Language & Literacy Skills (TILLS) is an assessment of oral and written language abilities in students 6–18 years of age composed of 15 subtests.  Assesses literacy skills such as reading fluency, reading comprehension, phonological awareness, spelling, as well as writing in monolingual as well as simultaneously bilingual school age children.

TILLS (cont.)  Standardized for 3 purposes  to identify language and literacy disorders  to document patterns of relative strengths and weaknesses  to track changes in language and literacy skills over time  Testing subtests can be administered in isolation (with the exception of a few) or in its entirety  Administration time: 1.5 hours for the whole test and ~45 mins for some of the core subtests  Aligned with Common Core Standards  Can be administered as frequently as two times a year for progress monitoring (min of 6 mos post 1st administration).  With respect to bilingualism examiners can use it with caution with simultaneous English learners but not with sequential English learners (see further explanations HERE). Translations of TILLS are definitely not allowed as they will undermine test validity and reliability.  https://www.smartspeechtherapy.com/review-of-the-test-of-integrated- language-and-literacy-tills/ WWW.SMARTSPEECHTHERAPY.COM Copyright © 2013 Smart Speech Therapy LLC Page ‹#›

TILLS Resources

 TILLS FAQ  TILLS Easy-Score  TILLS Correction Document  3 FREE TILLS Webinars  Facebook Page dedicated exclusively to TILLS updates  HERE  Past lectures and presentations pertaining to TILLS are available on the ASHA website as well as on the web  HERE  HERE  HERE

Phonological Awareness Testing  Phonological awareness is a precursor to emergent reading. It allows children to understand and manipulate sounds in order to form or breakdown words. When a child has poor phonological awareness for his/her age it is a red flag for reading disabilities.  Word fluency testing requires the child to rapidly generate words on a particular topic given timed constraints (e.g., name as many animals as you can in 1 minute, etc.). We test this rapid naming ability because we want to see how quickly and accurately the child can process information. This ability is very much needed to become a fluent reader.  Poor readers can name a number of items but they may not be able to efficiently categorize these words. They will produce the items with a significantly decreased processing speed as compared to good readers. Decreased word fluency is a significant indicator of reading deficits. It is frequently observable in children with reading disabilities when they encounter a text with which they lack familiarity. That is why this ability is very important to test.

Phonological Awareness Testing :CTOPP-2

 Comprehensive Test of Phonological Processing-2 (CTOPP-2) for ages 4+  Phonological Segmentation  Blending Words  Sound Matching  Initial, Medial and Final Phoneme Isolation  Blending Nonwords  Segmenting Nonwords  Memory for Digits  Nonword Repetition  Rapid Digit Naming  Rapid Letter Naming  Rapid Color Naming  Rapid Object Naming  Assesses the ability to manipulate real and nonsense words  Assesses word fluency skills via a host of rapid naming tasks

Phonological Awareness Testing : PAT-2

 The Phonological Awareness Test 2 (PAT 2) ages 5+  Rhyming: Discrimination and Production—identify rhyming pairs and provide a rhyming word  Segmentation: Sentences, Syllables, and Phonemes—dividing by words, syllables and phonemes  Isolation: Initial, Final, Medial—identify sound position in words  Deletion: Compound Words, Syllables, and Phonemes—manipulate root words, syllables, and phonemes in words  Substitution With Manipulatives—isolate a phoneme in a word, then change it to another phoneme to form a new word  Blending: Syllables and Phonemes—blend units of sound together to form words  Graphemes—assess knowledge of sound/symbol correspondence for consonants, vowels, consonant blends, consonant digraphs, r-controlled vowels, vowel digraphs, and diphthongs  Decoding—assess general knowledge of sound/symbol correspondence to blend sounds into nonsense words  Invented Spelling (optional)—write words to dictation to show encoding ability

Phonological Awareness Testing : RAN/RAS

 Rapid Automatized Naming and Rapid Alternating Stimulus Test RAN/RAS for ages 5+  Rapid automatized naming tests (Letters, Numbers, Objects, Colors)  Made up of five high-frequency stimuli that are repeated randomly 10 times in an array of five rows for a total of fifty stimulus items.  Two rapid alternating stimulus tests (2-Set Letters and Numbers; 3- Set Letters, Numbers, and Colors).  Made up of 10 and 15, respectively, high-frequency stimuli that are randomly repeated in an array of five rows for a total of 50 stimulus items.  Students are asked to name each stimulus item as quickly as possible without making any mistakes on all tests.  Scores are based on the amount of time that is required to name all stimuli on each test

Informal Phonological Awareness Testing

 Present nonsense words in order of increased length and complexity  Weaknesses in the area of nonword repetition have consistently been associated with language impairments and learning disabilities due to the task’s heavy reliance on phonological segmentation as well as phonological and lexical knowledge (Leclercq, Maillart, Majerus, 2013).  Both monolingual and simultaneously bilingual children with language and literacy impairments will present with patterns of segment substitutions (subtle substitutions of sounds and syllables in presented nonsense words) as well as segment deletions of nonword sequences more than 2-3 or 3-4 syllables in length (depending on the child’s age and abilities), which is an indication of phonological impairment.

Reading Fluency and Reading Comprehension Testing

 Gray Oral Reading Tests-5 (GORT-5) for ages 6+  Rate score is derived from the amount of time in seconds taken by a student to read a story aloud.  Accuracy score is derived from the number of words the student pronounces correctly when reading the passage.  Fluency score is a combination of the student’s Rate and Accuracy scores.  Comprehension score is the number of questions about the stories that the student answers correctly. The open-ended format ensures that the items are passage-dependent.  The Oral Reading Index (ORI) is a composite score formed by combining students’ Fluency and Comprehension scaled scores.  Two forms (A and B) each contain 16 developmentally sequenced reading passages with five comprehension questions each.  Optional miscue analysis system allows to analyze reading errors

Reading Fluency and Reading Comprehension Testing

 The Test of Silent Word Reading Fluency (TOSWRF-2) for ages 6.3+  Consists of rows of words without spaces, ordered by reading difficulty (e.g., dimhowfigblue)  Students are given 3 minutes to draw a line between the boundaries of as many words as possible (e.g., dim/how/fig/blue)  Test of Silent Contextual Reading Fluency (TOSCRF-2) for ages 7+  Text passages with words printed in uppercase letters with no word separations and no punctuation/spaces between sentences.  Students need to use dashes to separate words in a 3 minute period

Reading Fluency and Reading Comprehension Testing

 Test of Reading Comprehension – Fourth Edition (TORC-4) for ages 7+  Relational Vocabulary –the student reads a set of 3 related words then reads another 4 words and chooses 2 words that are related to the first set of 3 words  Sentence Completion – the student reads a sentence that is missing 2 words then reads a list of word pairs and chooses the word pair that best completes the sentence  Paragraph Construction – After reading a list of sentences that are not in logical order, the student must rearrange them to form a coherent paragraph  Text Comprehension – Students read a short passage and then answer 5 multiple- choice questions relative to the passage  Contextual Fluency – This subtest measures how many individual words students can recognize, in 3 minutes, in a series of passages taken from the Text Comprehension Subtest. Each passage, printed in uppercase letters without punctuation or spaces between words, becomes progressively more difficult in content, vocabulary, and grammar. Students draw a line between as many words as they can in the time allotted. (E.g., THE|LITTLE|DOG|JUMPED|HIGH)  Reading Comprehension Index  All reading is silent* WWW.SMARTSPEECHTHERAPY.COM Copyright © 2013 Smart Speech Therapy LLC Page ‹#›

Average Reading Fluency Rates

Reading Comprehension (cont.)  Many children with reading difficulties can read and comprehend short paragraphs containing factual information of decreased complexity but not longer, more complex, and increasingly abstract age-level text.  Reading Comprehension subtest of the CELF-5, allows students to keep the text and refer to it when answering questions. Such option inflates scores and does not provide an accurate view of their comprehension abilities.  GORT-5 contains reading comprehension passages, which the students need to answer after the stimuli booklet has been removed from them. The passages are far more simplistic then the academic texts so the students may do well on this test yet still continue to present with significant comprehension deficits  Woodcock Johnson IV’s Passage Comprehension subtest gives the students sentences with a missing word, and the students are asked to orally provide the word. However, filling-in a missing word does not adequately assess comprehension.  Wechsler Individual Achievement Test®-Third Edition (WIAT-III)’s Reading Comprehension subtest requires the student to read a passage and answer questions by referring back to the text. Just because a student can look up the answers in text does not mean that they understand the text.

Informal Reading Comprehension Assessment

 Comprehension Plus (Grades 1-6)  Continental Press (HERE/HERE)  Reading for Comprehension (Grades 1-8)  General/Specific States (FL,IL, NJ, NY)  Content Reading (Grades 2-8)  Science  Social Science  Geography  Select grade level text  Ask student to read and summarize it  Calculate reading fluency sample (1 minute)  Ask student the main idea of text  Ask student comprehension questions pertaining to the text

Spelling Assessment

 As per Apel 2006, Masterson 2014, Wasowicz, 2015 there is a significant number of linguistic skills involved in spelling.  Good spellers have well-developed abilities in the following areas:  Phonological Awareness – segmenting, sequencing, identifying and discriminating sounds in words.  Orthographic Knowledge – knowledge of alphabetic principle, sound- letter relationships; letter patterns and conventional spelling rules  Vocabulary Knowledge -knowledge of word meanings and how they can affect spelling  Morphological Knowledge- knowledge of “word parts”: suffixes, prefixes, base words, word roots, etc.; understanding the semantic relationships between base word and related words; knowing how to make appropriate modifications when adding prefixes and suffixes  Mental Orthographic Images of Words- clear and complete mental representations of words or word parts

Spelling Assessment (cont.)

 Test of Written Spelling – 5 (TWS-5) (standardized)  2 forms, each containing 50 spelling words drawn from eight basal spelling series and graded word lists  Advantages: No more than 20 minutes to administer (usually less)  Disadvantages: simple, relatively easy to memorize words (e.g., play, eight, hardly, legal, people, pile, strange, etc.); many students pass it and still have glaring spelling deficits

Spelling Performance Evaluation for Language & Literacy-2 (SPELL-2)

 SPELL-2 is a software assessment composed of 11 modules which administers and scores preliminary test items, determines the most appropriate level of assessment, collects a spelling sample for analysis, analyzes students’ patterns of misspelling, determines causes of misspelling, and provides individualized learning objectives for spelling instruction based on assessment results.  Sample Reports  Results  Recommendations  If students were assessed on different workstations as part of a group assessment the software groups students by spelling patterns and word study skills  The software automatically links the assessment data to specific word study activities by listing the corresponding lesson number and activities in the SPELL-Links to Reading & Writing - Word Study Curriculum

Test of Written Language-4

 TOWL-4 is for students 9-18 years of age, takes between 60-90 minutes to administer and examines the following skill areas:  Vocabulary – The student writes a sentence that incorporates a stimulus word. E.g.: For ran, a student writes, “I ran up the hill.”  Spelling – The student writes sentences from dictation, making proper use of spelling rules.  Punctuation – The student writes sentences from dictation, making proper use of punctuation and capitalization rules.  Logical Sentences – The student edits an illogical sentence so that it makes better sense. E.g.: “John blinked his nose” is changed to “John blinked his eye.”  Sentence Combining – The student integrates the meaning of several short sentences into one grammatically correct written sentence. E.g.: “John drives fast” is combined with “John has a red car,” making “John drives his red car fast.”  Contextual Conventions – The student writes a story in response to a stimulus picture. Points are earned for satisfying specific arbitrary requirements relative to orthographic (E.g.: punctuation, spelling) and grammatical conventions (E.g.: sentence construction, noun-verb agreement).  Story Composition – The student’s story is evaluated relative to the quality of its composition (E.g.: vocabulary, plot, prose, development of characters, and interest to the reader).  It has 3 composites:  Overall Writing- results of all seven subtests  Contrived Writing- results of 5 contrived subtests  Spontaneous Writing-results of 2 spontaneous writing subtests

Informal Writing Assessment

 Grade Rubrics using Persuasive/Expository Texts  Mechanics – is there appropriate use of punctuation, capitalization, abbreviations, etc.?  Grammatical and syntactic complexity – are there word/sentence level errors/omissions? How is the student’s sentence structure?  Semantic sophistication-use of appropriate vs. immature vocabulary  Productivity – can the student generate enough paragraphs, sentences, etc. or?  Cohesion and coherence- Is the writing sample organized? Does it flow smoothly? Does it make sense? Are the topic shifts marked by appropriate transitional words?  Analysis – can the student edit and revise his writing appropriately?

Components of Effective Literacy Intervention

 Phonological Awareness – segmenting, sequencing, identifying and discriminating sounds in words.  Orthographic Knowledge – knowledge of alphabetic principle, sound- letter relationships; letter patterns and conventional spelling rules  Vocabulary Knowledge -knowledge of word meanings and how they can affect spelling  Morphological Knowledge- knowledge of “word parts”: suffixes, prefixes, base words, word roots, etc.; understanding the semantic relationships between base word and related words; knowing how to make appropriate modifications when adding prefixes and suffixes  Mental Orthographic Images of Words/Mental Graphemic Representations- clear and complete mental representations of (written) words or word parts

Components of Effective Literacy Intervention (cont.)

 Reading Fluency  Reading Comprehension  What does “S/he can read, really mean?”  If the child can decode all the words on the page, but their reading rate is slow and labored, then they cannot read!  If the child is a fast but inaccurate reader and has trouble decoding new words then they’re not a reader either!  If the child reads everything quickly and accurately but comprehends very little then they are also not a reader!

Supplemental Reading Intervention

 Mathes et al, 2007 conducted 4 studies to test the efficacy of a Tier 2 supplemental early reading intervention for struggling readers  Found that native Spanish-speaking children benefited from explicit, systematic instruction similar to the one effective with native English speakers  Measures  Letter naming and letter sound identification  26 in English;30 in Spanish alphabet  Comprehensive Test of Phonological Processing  Test of Phonological Processing in Spanish  Woodcock Language Proficiency  Dynamic Indicators of Basic Early Literacy Skills  Indicadores Dinamicoś del Exito en la Lectura

Phonological/Phonemic Awareness

 Swanson et al, 2005 examined post-treatment outcomes following direct, systematic phonological awareness instruction for seventh-grade poor readers, most of whom had English as their second language  (n = 35) participated in small-group instruction sessions that emphasized phonological awareness at the phoneme level and incorporated explicit linkages to literacy (12-week period; 45 hours of contact with a trained instructor  Found out the 7th grade poor readers, including bilingual students who have English as their second language, can benefit from direct, systematic instruction that emphasizes phonological awareness and is linked to literacy  Koutsoftas, Harmon, & Gray (2009) studied the effect of Tier 2 intervention for phonemic awareness in (RtI) model in low-income preschool children  (n = 34) Tier 2 intervention for beginning sound awareness was provided twice a week (in 20-minute sessions) for 6 weeks by trained teachers and SLPs.  The intervention was successful for 71% of the children.

Phonological/Phonemic Awareness (cont.)

 Ukrainetz, Ross, & Harm (2009) studied schedules of phonemic awareness treatment for kindergarteners.  3x per week from September- December vs. 1x per week from September-March  Found large, maintained gains in both schedules  Gains made from short, intense treatment were similar to those made from continuous weekly treatment  Goswami, 1998; Branum-Martin, 2006 found that gains transfer from L1 to L2 for phonological awareness and print concepts  Curley & Gorman, 2008 found that phonemic awareness instruction in the stronger language yields greater gains in both the treated and untreated language

Phonological Awareness Tasks

 Recognizing whether two presented words sound same or different  Recognizing which words rhyme and which do not  Generating rhyming words  Counting words in a sentence  Counting syllables in a word  Breaking words into syllables  Isolating beginning sounds in words  Isolating final sounds in words  Isolating medial sounds in words  Manipulating sounds in words (substituting first, middle, or last sounds in word & naming new word)  Blending sounds to make a word (h/a/t says /hat/)  Segmenting nonsense words  Blending nonsense words (e.g., t/e/p says /tep/)

Phonological Awareness Session Activities

 Songs and Nursery Rhymes  http://www.songsforteaching.com/nurseryrhymes.htm  Rhyming Books  “Otter out of water”  “Sheep in a jeep”  “Giraffes can’t dance”  http://www.pbs.org/parents/adventures-in- learning/2014/08/rhyming-books-kids/  Rhyming Games  Rhyming bingo  Picture sorts  Rhyming scavenger hunt  http://fun-a-day.com/rhyming-activities-for-children/

Phonological Awareness Session :Rhyming

 Clinician will introduce rhyming book to students and explain how to recognize rhyming words  Rhyming words are words which endings sound the same  Clinician will present rhyming and non-rhyming word pairs in exaggerated tone of voice and ask students whether these words rhyme or not and what specifically makes the words rhyme/not rhyme  Students get numerous opportunities to recognize and produce rhyming words during the explanation period  For severely impaired children who have profound difficulties recognizing, rhyming words cloze activities may be the answer  Bear Books by Karma Wilson

Phonological Awareness Session :Blending Sounds

 In order to read words, students must know the sounds for each of the letters (alphabetic principle) then blend these sounds together to determine the word.  Sample goal: Students will listen to the orally presented sounds in a words presented with 1 second delay (m/o/p) and then blend the sounds together in sequence aloud to produce the target word (mop)  Supports:  Repeated modeling  Scaffolding as needed  Picture cards with visuals and written words  Suggestion: Start instruction with words that have continuous consonant sounds then switch to those which cannot be prolonged.

Phonics Instruction

 Mapping consonant sounds to letters (e.g., b for /b/)  Mapping single letters to short vowel sounds (e.g., a for /a/)  Mapping vowel combinations to represent single vowel sounds (e.g., ee, ea, ie for/ē/)  Mapping consonant digraphs and trigraphs (e.g., sh for /sh/, ph for /f/, tch for /ch/, dge for /j/, etc.)  Mapping consonant clusters/blends with 2 & 3 sounds in beginnings of words (e.g., /st/, /qu/, /sc/, /str/, /spl/etc.)  Mapping consonant clusters/blends with 2 sounds at the end of words (e.g., /mp/, /nd/, /ft/, etc.)  Mapping silent letter patterns (e.g., kn for /k/, mb for /m/, etc.)  Mapping diphthongs (e.g., /-oi/, /-au/, etc.)  Mapping R-controlled vowel sounds (e.g., /-er/, /-ir/, etc.)

Phonics Instruction Basics

 Firm knowledge of alphabet and sound letter correspondence  Executive function activities to strengthen the knowledge base  Label all the consonants and produce their corresponding sounds  Label only vowels and produce their corresponding sounds  Use of catchy mnemonics for recall

Mathes et al, 2007: Instructional Design Recommendations Ortho-phonemic No more than one grapho-phonemic knowledge aka correspondence or high-frequency word patterns Letter/sound per session. Correspondence Review previously mastered grapho-phonemic correspondence and high-frequency words each session. Introduce first those grapho-phonemic correspondences which occur more frequently in words. Initially separate grapho-phonemic correspondences and sight words which are auditorially and/or visually similar. Then carefully

Suggested Sequence of Teaching Letter/Sound Correspondence

 As per U. Penn Literacy Center Suggestion:  a, m, t, p, o, n, c, d, u, s, g, h, i, f, b, l, e, r, w, k, x, v, y, z, j, q  This sequence was designed to help learners start reading as soon as possible  Letters that occur frequently in simple words (e.g., a, m, t) are taught first.  Letters that look similar and have similar sounds (b and d) are separated in the instructional sequence to avoid confusion.  Short vowels are taught before long vowels.  Lower case letters are taught first since these occur more frequently than upper case letters.  Modifications of the sequence are required to accommodate the learners’ prior knowledge interests (and hearing needs).  http://aacliteracy.psu.edu/index.php/page/show/id/6/

Orthographic Knowledge (Apel, 2011)

 Gr.- correct writing it includes:  Orthographic patterns - how speech is represented in writing  Letters represent speech sounds (alphabetic knowledge)  Sound representation goes beyond one-to-one correspondence (e.g., long vowels, consonant doublets)  Letters can and cannot be combined in certain ways (e.g., jr is not a legal combination in English)  Positional and contextual constraints govern use of letters (in what word positions letters may or may not be used) or orthotactic rules (e.g., tch cannot be written in the word-initial position to represent the /tʃ/ sound)  Mental graphemic representations (MGRs) or stored mental representations of specific written words or word parts  Orthographic awareness refers to individuals' attention to orthographic knowledge includes active and conscious thought and mindful consideration of aspects of the linguistic system

Orthographic Knowledge (Apel, 2011)

Spelling Patterns of Bilingual Children

 Julbe-Delgado et al (2009) analyzed spelling patterns of 20 Spanish speakers in grades 6-8 (No SPED Services just ESL instruction)  Found that Spanish spelling errors were language-specific with little English interference noted  Due to transparency of Spanish language they found less phonological errors (unlike with older English spellers)  Orthographic errors were almost exclusively related to difficulties with complex letter-sound correspondences, word boundaries, accents, and dialects  English misspellings, in many instances, reflected cross-language transfer of direct letter-sound correspondences  Students tended to spell words the way that they pronounced them (Silliman et al, 2009)  English spellers struggled more with consonant doubling, short vowel diagraphs, and vowel errors (Bahr et al, 2009).

Teaching Spelling  Spell-Links Approach is a speech-to-print Connectionist Word Study approach to teaching reading and writing  Uses multi-linguistic and meta-linguistic instruction by "building" literacy with activities that develop, connect, and integrate the different processes and regions of the brain involved in effective reading and writing  Instruction is organized by sounds and letters of words and starts with a sound. The student then discovers common and additional allowable spelling choices for that sound.  Instruction is phonological, orthographic, semantic, and morphological  Focus on direct mapping of spoken syllables with their corresponding letters; words are broken into syllables based on inborn syllable separations of spoken language  SPELL-Links to Reading & Writing complete core program: $349  http://shop.learningbydesign.com/SPELL-Links-to-Reading-Writing- LNX2.htm

Morphological Knowledge

 Numerous studies have shown that children with PLI have word learning difficulties (e.g., Alt, Plante, & Creusere, 2004; Gray, 2003, 2004, 2005; Kan & Windsor, 2010).  English is morphophonemic Language (Carlisle 2003 ; Chomsky and Halle 1968)  Its spelling system represents both phonemes and morphemes  It has an opaque alphabetic orthography (grapheme-phoneme correspondence in English is often indirect or not always transparent)  Growing body of research indicates a positive effect of morphological awareness on vocabulary knowledge, literacy acquisition, spelling, and reading comprehension (Kieffer & Lesaux, 2012; Lam, Chen, Geva, Luo, & Li, 2011; Nagy, Berninger, & Abbott, 2006; Sparks & Deacon, 2015)

Morphological Awareness Studies

 Emergent bilinguals demonstrate an increasing awareness of morphological inflections in L2 across time, together with an ability to recognize and to manipulate them (Geva and Shafman, 2010)  Knowledge of cognates facilitates the transfer of Spanish derivational awareness to English vocabulary and reading comprehension (Ramirez et al, 2013)  The relationship between morphological awareness and reading comprehension was found to strengthen between 4th & 5th grade, and in 5th grade, MA was found to be a significant predictor of reading comprehension. (Kieffer & Lesaux, 2008)

Morphological Intervention (Apel & Diehm, 2013)

Morphological Intervention with Older Children

 Find the root word in a longer word  Fix the affix  Affixes at the beginning of words are called “prefixes”  Affixes at the end of words are called “suffixes”  Word sorts to recognize word families based on morphology or orthography  Explicit instruction of syllable types to recognize orthographical patterns  Word manipulation through blending and segmenting morphemes to further solidify patterns

Mental Graphemic Representations (MGRs)

 MGR is a stored mental image of a written word or a prefix or suffix (Apel & Masterson, 2001)  Used when one needs to know that a part of a word must be spelled a certain way  When students are presented with known written words, they quickly recognize them by matching them to their stored MGRs and then access their meanings (effective reading strategy) (Mayall et al, 2001)  If students MGR’s are well developed they quickly recognize and recall visual representations of words  Frees up memory and attention for comprehending text (Apel, 2009)

MGR-Based Intervention

 “Visualizing” Activities which need to be used for words for which other knowledge (e.g., PA, OK, etc.) cannot be used  Therapist models visualizing using a picture and then an image familiar to student (e.g., pencil)  Using the target word, they both look at written word and talk about its characteristics  Student spells word forward and backward (e.g., cat → tac)  Student stores a “photo” of a word  Student visualizes word, spells it forward, then backward. (Apel, 2011; Based on SPELL-Links to Reading and Writing™)

Vocabulary Knowledge and Instructional Practices  ELLs who experience slow vocabulary development are less able to comprehend text at grade level than English-only peers (August et al, 2005)  Instructional Strategies  Take advantage of students’ first language  Ensure they know meanings of basic words  Review and reinforce  Lovelace & Stewart (2009) found that vocabulary instruction was most effective when children used the words meaningfully in multiple contexts (context embedded)  “Deep level” of word-learning occurred via games and activities in which the words were repeated often  “Deep level” of word-learning occurred when new words were connected to children's prior experiences

Developing a Vocabulary Enriched Classroom Environment with Teacher Collaboration

1. High-quality classroom language 2. Reading aloud 3. Explicit vocabulary instruction 4. Instructional routine for vocabulary 5. Word-learning strategies . Morphological awareness instruction

Free Thematic Vocabulary Collection

Vocabulary Selection Tips

 According to Judy Montgomery “You can never select the wrong words to teach.”  Make it thematic  Embed it in current events (e.g., holidays, elections, seasonal activities)  Classroom topic related (e.g., French Revolution, the Water Cycle, Penguin Survival in the Polar Regions, etc)  Do not select more than 4-5 words to teach per unit to not overload the working memory (Robb, 2003)  Select difficult/unknown words that are critical to the passage meaning, which the students are likely to use in the future (Archer, 2015)  Select words used across many domains

Examples of Spring Related Vocabulary

 Adjectives:  Verbs  Flourishing  Awaken  Lush  Teem Source: Words for Spring  Verdant  Romp  Refreshing  Rejuvenate  Nouns:  Idiomatic Expressions:  Allergies  April Showers Bring May Flowers  Regeneration  Green Thumb  Outdoors  Spring Chicken  Seedling  Spring Into Action  Sapling  Swing into spring

Effective Methods of Vocabulary Instruction

 For students to learn vocabulary directly it is important to explicitly teach them individual words & word-learning strategies (NRP, 2000)  For children with low initial vocabularies, approaches that teach word meanings as part of a semantic field are found to be especially effective (Marmolejo, 1991).  Rich experiences/high classroom language related to the student experience/interests  Explicit vs. incidental instruction with frequent exposure to words  Instructional routine for vocabulary  Establishing word relationships  Word-learning strategies to impart depth of meaning  Morphological awareness instruction

Creating Effective Intervention Materials

 Thematic packet which contains a variety of opportunities for students to practice word usage  Text Page  A story which introduces the topic and contains context embedded vocabulary words  Vocabulary  List of story embedded vocabulary words with definitions, and parts of speech  Multiple-choice questions or open ended questions  Crossword puzzle with a word bank  Fill-in the blank  Synonym/Antonym Matching  Explain the Multiple Meanings Words  Create Complex Sentences (with Story Vocabulary)  https://www.smartspeechtherapy.com/shop/the-water-cycle-a-thematic-language- activity-packet-for-older-students/ ( The Water Cycle Packet))

Components of Effective Vocabulary Interventions

 Read vocabulary words in context embedded in relevant short texts  Teach individual vocabulary words directly to comprehend classroom-specific texts  Definitions  Provide multiple exposures of vocabulary words in multiple contexts  synonyms, antonyms, multiple meaning words, etc.  Maximize multisensory intervention when learning vocabulary to maximize gains  Visual, auditory, tactile, etc.

Explicit Vocabulary Instruction

 Steps to new vocabulary introduction 1. Say the word and ensure the students can pronounce it 2. Provide a dictionary definition and a "student-friendly" explanation 3. Give examples of the definition in a sentence 4. Have the students practice using the word with each other in sentences

Components of Effective Vocabulary Interventions (cont.)

 Use multiple instructional methods for a range of vocabulary learning tasks and outcomes  Read it, spell it, write it in a sentence, practice with a friend, etc.  Usage of morphological awareness instruction  An ability to recognize, understand, and use word parts (prefixes, suffixes that “carry significance” when speaking and in reading tasks  Teacher Training

Instructional Routine for Vocabulary

 Teach students how to figure out unfamiliar words based on context  Context clues  A process that adults use automatically but requires explicit instruction at the elementary level  As early as possible teach the students how to use parts of a word (and sentence) to determine its meaning  Greek and Latin roots of English for kids, how to locate the meaning of the word in early texts  Fancy Nancy series  By 4th grade students need to learn how to use parts of a word (and sentence) to determine its meaning.

Basic Reading Fluency

 The following skills are needed to read at sentence level:  Tracking from left to right in the correct sequence and across multiple lines of text  Efficient decoding/word recognition of all words in the sentence  Maintaining the sequence of words in memory (if slowed reading speed)  Efficient word processing to interpret sentence meaning  Phonological awareness  Phonics knowledge  Vocabulary knowledge  Morphological knowledge  Mental Graphemic Representations  To decode hard to read non-transparent words o Laugh, knob, corps, colonel,

Decoding for Reading Fluency

 The components of fluency are automaticity, prosody, accuracy and speed, expression, intonation and phrasing.  Automaticity refers to accurate, quick word recognition.  In order to decode a word the students must have the following skills:  Recognize all the presented letters in a word  Have the knowledge of sounds associated with each letter  Store these sounds in the exact presented sequence in memory  Then blend these sounds together to form a word  Finally, retrieve the meaning of that word  Instructional materials  Written cards without pictures are best  Nonsense words are recommended to avoid guessing

Reading Fluency Rates: Hasbrouck,& Tindal (2006)

Hasbrouck, J. & Tindal, G. A. (2006). Oral reading fluency norms: A valuable assessment tool for reading teachers. The Reading Teacher. 59(7), 636-644.) WWW.SMARTSPEECHTHERAPY.COM Copyright © 2013 Smart Speech Therapy LLC Page ‹#›

Strategies for Improving Fluency

 Repeated Reading  Select a 100-200 word passage for reading practice (make sure its too long for students to memorize)  Use a 1 minute timer and do an initial reading aloud.  After reading student underlines any unknown words  Therapist marks off the last line read  Count the total number of words read as well as the number of correctly/fluently read words  Multiple re-readings are recommended to reach target rate  Carnine, Silbert, Kame’enui, and Tarver, 2004 suggest a rate ~ 40% higher than the original  If a student read 60 words per minute on the first try, the new target rate would be 60 + 24, or 84 words per minute

Reading Comprehension

 As per Álvarez-Cañizo, Suárez-Coalla, & Cuetos, 2015, children with poorer reading comprehension make:  Inappropriate pauses (including inter-sentential pauses before comma)  Made more mistakes on content words (as compared to peers with good reading fluency)  Struggle with using appropriate pitch at the end of sentences (e.g., pitch declination in declarative sentences)  Prosody plays an important part not just on reading fluency but also reading comprehension

Teaching Specific Reading Comprehension Skills

 Main Idea  Context Clues  Inferring  Predicting Outcomes  Compare and Contrast  Cause and Effect  Fact and Opinion  Sequencing  Order of Events  Steps in a Problem  Paraphrasing  Summarizing  Drawing Conclusions  Generalizing

Informal Reading Comprehension Treatment

 Comprehension Plus (Grades 1-6) Focus on monitoring and understanding complex text now for intervention purposes  Continental Press (HERE/HERE)  Reading for Comprehension (Grades 1-8)  Relatively simpler readability  More common vocabulary (Tier II some Tier III)  Content Reading (Grades 2-8)  Science  Social Science  Geography  Harder to decode and comprehend  More obscure and complex main ideas  Contain more complex vocabulary words (Primarily Tier III)

Tips for Teaching Reading Comprehension

 Use controlled texts no more than 1-2 pages in length even for older more capable students  Determine and circle/underline key words in texts  Review each paragraph  With very impaired students review each sentence  Topic (word/phrase)  Main idea (sentence)  Answer the questions and combined the information  Who  What  Where  Why  How

Free Resources for Teaching Reading Comprehension

 ABC Teach  https://www.abcteach.com/  Newsela  https://newsela.com/  E-Reading Worksheets*  http://www.ereadingworksheets.com/free-reading-worksheets/reading- comprehension-worksheets/  TPT*  https://www.teacherspayteachers.com/Browse/Price- Range/Free/Search:reading+comprehension+  K-12 reader*  http://www.k12reader.com/subject/reading-skills/reading-comprehension/  Read Works  http://www.readworks.org/  * Denotes websites which contain free therapy resources to address other various reading comprehension skills listed on slide 80 - teaching specific skills

Free Resources for Teaching Main Ideas

 K-12 reader*  http://www.k12reader.com/subject/reading-skills/main-idea- worksheets/  E-Reading Worksheets*  http://www.ereadingworksheets.com/free-reading- worksheets/reading-comprehension-worksheets/main-idea- worksheets/  Read Works*  http://www.readworks.org/rw/articles-teach-main-idea  Townsend Press  http://www.townsendpress.com/uploaded_files/tinymce/writing%20 and%20motvn/RWC_chapter4.pdf

Goal Functionality

 Consider which skills the student must gain that will help him/her function better daily in academic/social settings  Influenced by maintaining factors  Factors which may maintain the disorder and delay therapy progress (Klein & Moses, 1999)  Cognitive  Sensorimotor  Psychosocial  Linguistic  If a child has difficulties in any of above 4 areas the SLP must keep it in mind that unless these issues are resolved or compensated for in therapy NO progress can be made in achieving potential goals of therapy.

Maintaining Factors: Cognitive

 Intellectual Disability  Attention  Memory  Abstract Concepts  Problem Solving

Maintaining Factors: Sensorimotor

 Senses  Effective processing of language  Tactile Defensiveness  Tactile Placement Cues  Movement  Gross Motor  Fine Motor

Maintaining Factors: Psychosocial

 Adaptive Behavior  Pragmatics  Social Cognition  Psychiatric Diagnoses  Attention and Behavior Disorders  Mood Disorders  Anxiety Disorders  Autism Spectrum Disorders  Reactive Attachment Disorder  Schizoaffective/ Psychotic Disorders

Maintaining Factors: Linguistic

 What is the extent of the child’s linguistic deficits and their impact on overall function?  How far below developmentally is the child as compared to typically developing children?  What are the affected areas of functioning?  Poor vocabulary knowledge and use  Lack of complex sentences and short sentence length  Significant word retrieval difficulties  Poor discourse and narrative production

Complexity vs. Difficulty

 Complexity  Objective determination based on consideration of the linguistic organization demanded by the task  Difficulty  Perception of how easy or difficult task is depends on  Information processing characteristics as well as skills and attitudes of the individual  When the degree of complexity is consistent the same act may be more difficult for some people vs. others  Degree of performance demand can be manipulated systematically when planning goals for different clients

Linguistic Contexts

 Create a linguistic context that is obligatory for the targeted structures  Model target structures directly in words or sentences  Elicit linguistic structures by modeling indirectly during conversations with client in cooperative session activities  Elicit linguistic structures by reenacting parts of narratives with the support of (e.g., books, worksheets etc)

Nonlinguistic Contexts

 Session Materials  Manipulatives  Toys that replicate real objects  Less representational construction objects  Blocks and chips  Flashcards  Games  Items with increased level of abstraction  Books  Worksheets  Apps  Activities need to be commensurate with client’s age and experience

Prompts vs. Cues

 Prompt  Verbal request to perform an action  Cue  Nonverbal signals given to client  Frequency  How often?  Intensity  How much?

Types of Cues

 Visual  Picture cards  Photos  Comics  Written  Text support  Gestures  Motioning up or down  Spreading hands to indicate size  Tactile/placement cues are used to manipulate structures to produce a response  Placing palm in front of mouth and blowing to demonstrate /f/ sound  Showing how to pucker lips together to illustrate /b/  Using a Q-tip to touch alveolar ridge to show production of /l/ sound

Types of Prompts

 Phonemic  First sound/syllable to help with the word  Semantic  Short descriptions that will aid the client in producing the desired word/definition (‘its long and its green and it grows in the garden)  Cloze sentences  ‘You sleep on a ____”  The continent in the middle of a map made up of 4 letters is ___”  Question prompt follow up makes it easier for the client to respond to the original question  “Do you think…? Where is…?”

Levels of Cues

 What level of cueing will be provided?  Minimal prompts (1 repetition)  Moderate prompts (2-3 repetitions)  Maximum prompts (4+ repetitions)  Hand over hand support  Partial –placing the client’s hand in the general area of target but they can touch target with their finger/s  Full- placing the client’s hand on the target

Writing Measurable Goals: Putting it all Together  Break it down into measurable parts  Given ___time period (1 year, 1 progress reporting period, etc)  Student will be able to (insert specific goal)  With ___accuracy/trials  Given ___ level of  Given _____type of prompts

Instructional Accommodations to Improve Performance

 Attempt to minimize distractions (especially when teaching new information)  Auditory (background noise), visual (excessive clutter), etc.  Gain student’s attention prior to delivery of information  Maintain eye contact (make sure student is looking at speaker) when speaking  Speak slowly and use clear directions no more than ___words in length and  Ask student to repeat the information back to ensure understanding  Repeat (but not reword) information to ensure understanding  Alert student via multiple modalities (e.g., visual, gestural, etc.) when new and important information will be taught/provided

Instructional Accommodations (cont.)

 Pre-teach important concepts if possible  Try to provide new information both orally and visually (e.g., vocabulary, text, directions, etc.)  Allow for controlled increased processing time to retain and verbalize presented information or respond to questions  Use modeling to clearly demonstrate expectations  Use peer partners if possible  Adjust difficulty level and length of assignments  Provide extra cues and prompts if needed  Use non-judgmental verbal feedback  Teach self-advocacy  State when things are too difficult or when requires a break

Effective Goal Related Modifications

 Management  Physical Space  Session Structure  Child Behavior  Session Materials

Physical Space Modifications

 Set up environment  Eliminate visual distractions  Clutter  Eliminate auditory distractions  Noise  Seating Arrangements in Therapy  Facing wall vs. window  Proximity to clinician who can provide the child with visual and or tactile reminders

Session Structure Modifications

 Use of written/picture rules  Clarify expectations  Use positive language  Keep your hands neat vs. “no touching”  Speak softly vs. “no yelling”  Use of schedules  Establish routine  Identify order of activities  Facilitate transitions  Use of Timers  Specify activity length  Several Changes of Activities  +/- 3 per session to reduce frustration

Behavior Modifications

 Incorporate student’s interests into activities  Offer 2 choices* of activities  Give student control  To increase student’s self esteem, catch him/her “being good” and praise her/him for specific vs. general positive behavior such as staying on task or completing an activity (e.g., “Great job on ______!”).  Create a list of predetermined strategies such as what student can say to the therapist when s/he is having trouble when working on a task  Figure out which reinforcements student favorably responds to determine the reward system  Use of fidgets such as ‘thinking putty’ to reduce excessive movement during tasks  Use of non-nutritive sugarless spray candy at intermittent intervals as a reward

Behavior Modifications (cont.)

 Errorless Learning  Use of prompts -most-to-least - to elicit only correct responses  Prompted trials are followed by less prompted trials until the child demonstrates mastery of the skill.  80/20 rule  Try to incorporate known information when teaching new tasks in order not to increase complexity too rapidly  Vary types and levels of prompts and cues (e.g., phonemic, tactile, written, gestural) to use depending on the severity of the student’s deficits .

Session Structure Modifications (cont)

 Seat modifications to reduce hyperactivity and impulsivity  Therapy ball  Disco seat  Wedge cushion  Zuma Rocker  Use of sensory manipulatives in sessions  squeeze/shake  Use of sensory breaks  2-3 min move to music/jumping jacks  Infinity Walk (Dr. Sunbeck)

Session Material Modification

 Goal complexity as well as selection of materials requires the consideration of the client’s maintaining factors (see below) plus  Be at the client’s level  Contain relevant information/pictures  Contain no distractions  What might be the problem?

Paul went to play his new video game. He looked for it next to the TV but it wasn’t there.

Conclusion  Use multiple formal tests and informal procedures to create a balanced assessment which adequately reflects the learner’s difficulties in the classroom  Assessment tasks much be functional  Must determine strengths not just weaknesses to create goals  Provide targeted literacy interventions based on assessment findings  When providing intervention follow a hierarchy of skill attainment and attempt to incorporate goals from various literacy areas in order to make intervention for functional and relevant to your students’ needs

New Smart Speech Therapy Resources

 Best Practices in Bilingual Literacy Assessments and Interventions  Comprehensive Literacy Checklist For School-Aged Children  Dynamic Assessment of Bilingual and Multicultural Learners in Speech Language Pathology  Differential Assessment and Treatment of Processing Disorders in Speech Language Pathology  Practical Strategies for Monolingual SLPs Assessing and Treating Bilingual Children

Helpful Resource Bundles  The Checklists Bundle  General Assessment and Treatment Start Up Bundle  Multicultural Assessment Bundle  Narrative Assessment and Treatment Bundle  Social Pragmatic Assessment and Treatment Bundle  Psychiatric Disorders Bundle  Fetal Alcohol Spectrum Disorders Assessment and Treatment Bundle

More Helpful Resources  Assessment Checklist for Preschool Aged Children  Assessment Checklist for School Aged Children  Speech Language Assessment Checklist for Adolescents  Differential Diagnosis of ADHD in Speech Language Pathology  Creating Functional Therapy Plan  Selecting Clinical Materials for Pediatric Therapy  Social Pragmatic Deficits Checklist for Preschool Children  Social Pragmatic Deficits Checklist for School Aged Children  Language Processing Deficits Checklist for School Aged Children

Contact Information: Tatyana Elleseff MA CCC-SLP

 Website: www.smartspeechtherapy.com  Blog: www.smartspeechtherapy.com/blog/  Shop: http://www.smartspeechtherapy.com/shop/  Facebook: www.facebook.com/SmartSpeechTherapyLlc  Twitter: https://twitter.com/SmartSPTherapy  Pinterest: http://pinterest.com/elleseff/  Email: [email protected]