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7 Common Myths of Childhood Apraxia of Speech (CAS)

May 23, 2014 in Special Education Articles by Jess

Proper diagnosis of a language concern is crucial to effective and appropriate treatment. Childhood apraxia of speech (aka developmental apraxia of speech/dyspraxia/verbal apraxia) is frequently both over, and under-diagnosed.  Ineffective and inefficient treatment can result.

Introduction:

Childhood apraxia of speech (CAS) is a difficulty coordinating and planning out the production of sounds.  It is a disorder of motor planning. The child knows what he or she wants to say, but can’t get his or her mouth to do what the brain wants.

Specific signs of CAS include, but are not limited to: Read the rest of this entry →

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Likely Story

September 25, 2012 in Special Education Articles by Jess

My daughter was an early talker, but through a series of medical issues which included many bouts of otitis media, she completely stopped speaking. This would be a distressing event for any mother, but it was mind altering for me, a Speech-Language Pathologist. I had been a public school Speech Therapist and Resource Specialist, professions in which I tried to rely on evidence-based practices for both oral and written language problems, but it was only after she was born that I began the journey to tie these areas together. At the time so were researchers, therefore I read everything in the exploration for ways to help. Her oral language did come back, but with typical language disorder markers such as problems with irregular past tense verbs, simplistic sentence formation and irregular sequencing. Her abilities to relate what happened at school, explain what I had just read to her (even when shown the pictures), or to tell something she really wanted to explain were all lost in a sea of confusion. To be sure, her articulation was clear and it seemed she had enough words, but her oral language was off kilter, mixed up and difficult to follow. Then, later in school she had enormous difficulty learning to read and write. My journey with her and the many students I worked with agreed with the researchers.

The good news is that today she is a psychologist with a deep understanding of her many clients. The sad news is that even after years of continuous solid research in literacy, my own rewarding private practice utilizing that research, and then reentering the public schools as a Speech-Language Pathology supervisor, I am finding that there is still this crazy separation between oral and written language services. To be sure, it is not the case everywhere, but is typical. In special education, this division is usually fostered by a predictable pattern of a state’s educational code which dictates the type of assessment a particular professional does, then to service delivery, programs and expenditures. Many special education teams do not understand or even collaborate on what all their combined testing results mean, how together they form a picture of a student’s learning profile or how that profile should guide particular remediation strategies or programs.

The usual suspect is a child who is first referred in preschool for speech or language problems, who then follows the typical story of entering kindergarten and having difficulty learning to read. This trouble prompts a second referral to the school study team where a variety of ideas might be tried. For example, some type of after school tutoring might be advised or the student might receive Response to Intervention services. The young learner goes off to be drilled in reading/writing from an instructor or assistant, with most of them having little or no training in language development. Rarely do the Speech-Language Pathologist and instructor/assistant collaborate. Most times the designated service provider never sees the Speech-Language Pathologist, let alone reads the speech report. I have to be honest here and admit that really there is just so much time available, caseloads are highly impacted, and to make matters very complicated, we have a nation of bilingual learners. However, after trying this tutoring approach and finding the child still struggling, further testing usually reveals a learning problem requiring a Resource Specialist. Again, this professional is frequently not trained in language development, has a one-size fits all reading program that may or may not be relevant to each student, and typically does not work closely with the Speech-Language Pathologist. Everyone is really busy with many students, tons of paperwork and numerous meetings.

The US Department of Education Statistics in 2011 showed learning disabilities accounted for half of all documented disabilities, with speech-language disorders a close second. But, the initial, first referred language problem does not just go away. It just changes its name to learning disability. Therefore, the student’s oral speech and language skills can outwardly seem to improve, as did my daughter’s, but the underlying cognitive language deficit remains, spreading its mighty limbs into written language. There many students stay, lodged amongst professionals, none of whom understands their vital reliance on each other, even though oral and written language skills are as intertwined as brain tendrils.

In 1998, a report titled “What Reading Does for the Brain” (Cunningham, A. and Standovich, Keith, American Educator) discussed the relationship between verbal growth and reading. Research has documented a reciprocal connection between reading and oral language. We learn to read, talk about what we learn, write about it and discuss it in class or with family and friends. Reading increases vocabulary knowledge and cognitive skills. The typical classroom is linguistically based and language driven. The artificial delineation of oral and written language in special education hampers the very reason children are qualified for services.

More than 30 years ago, McCarthy wrote: The most important decision you will make is that of definition- because that definition will dictate for you the terminology to be used in your program, the prevalence figure, your selection criteria, the characteristics of your population and the appropriate remediation procedures.

A student’s oral narrative production provides an integrated picture of several language skills at the same time, thus allowing a comparison of words, sentences, and narrative structure (Liles, 1993; Liles, Duffy, Merritt, & Purcell, 1995; Miller, 1981; Miller & Chapman, 1981; Miller, Heilmann, Nockerts, Iglesias, Fabiano, & Francis, 2006). Studies have demonstrated that the oral narratives produced by learning disabled children are likely to be shorter in length (Leadholm & Miller, 1995), use fewer different words (Miller, 1991) have less complex syntax (Gillam & Johnson, 1992), and lack a cohesive structure (Catts, 1993; Catts, Fey Tomblin, & Zhang, 2002). A study in 2007 by Foley, Wasik and Justice on children’s oral narratives and connections to reading comprehension showed that high passage comprehenders as compared to low passage comprehenders scored higher on number of words, number of different words, number of propositions, number of nouns, number of episodic events, and reference cohesion at the sentence level. In a comprehensive assessment, these language skills may be further contrasted with non-verbal cognitive skills, memory, processing, reading and writing scores.

Oral narratives are integral to literacy development and are contained within the continuum of state grade level standards starting as early as preschool. Take, for example, the following excerpt from the CA Language Arts Content Standards in Reading for Kindergarten-

  1. Ask and answer questions about key details in a text.
  2. With prompting and support, retell familiar stories, including key details.
  3. With prompting and support, identify characters, settings, and major events in a story.

In order to ask and answer key questions about a story read in class, a student must have a fundamental knowledge of stories in general. In order to retell a familiar story, whether fictional or a real life experience, a student must be able to sequence events, use a variety of words and be able to tie all of the parts of the story together. Shared assessments among team members and the subsequent program goals within the area of narrative discourse would help eliminate the division among professional assessments, provide a framework for close collaboration and direct therapeutic strategies. The chart below shows the development of literacy as it moves through the grades.

Oral and written narrative ability is embedded in all languages and cultures, uses all of the components of language and is part of every state’s curriculum standards at every grade level, whether for English language learners or English only learners. It has been demonstrated to be crucial for overall reading comprehension. By working together, understanding what all the assessment means and striving for narrative goals, we are achieving collaboration and are focused on developing the student’s language skills within the framework of the content standards. We are devising a likely story of success for every learner.

References:

Catts, H. W., Fey, M. E., Tomblin, J. B., & Zhang, X. A Longitudinal Investigation of Reading Outcomes in Children with Language Impairments, Journal of Speech, Language, and Hearing Research, Vol. 45, 2002.

Foley, Joan, Wasik, Barbara, and Justice, Laura M. Barbara A. Wasik, & Laura M. Justice. Children’s Oral Narratives: Are There Connections to Reading Achievement, Presented at the American Speech-Language-Hearing Association Annual Convention, 2007.

Gillam, R. B., & Johnston, J. Spoken and Written Language Relationships in Language/Learning-Impaired and Normally Achieving School-Age Children. Journal of Speech and Hearing Research, Vol. 35, 1992.

Hedberg, N. L., & Westby, C. E. Analyzing Story Skills: Theory to Practice, Tucson, AZ: Communication Skills Builders, 1993.

Leadholm, B. J., & Miller, J. F. Language Sample Analysis: The Wisconsin Guide, Madison: Wisconsin Department of Public Instruction, 1995.

Lilies, Betty Z. Narrative Discourse in Children With Language Disorders and Children with Normal Language, A Critical Review of Literature, Journal of Speech and hearing Research, Vol. 36, 1993.

Liles, Betty Z., Duffy, Robert J., Merritt, Donna D. and Purcell, Sherry. Measurement of Discourse Ability in Children with Language Disorders, Journal of Speech and Hearing Research, Vol. 38, 1995.

Miller, J. F. Assessing Language Production in Children. Baltimore, MD: University Park Press, 1981.

Miller, J., & Chapman, R. The Relation Between Age and Mean Length of Utterance in Morphemes. Journal of Speech and Hearing Research, Vol.24, 1981.

Miller, J., Heilmann, J., Nockerts, A., Andriacchi, A., & Iglesias, A. Can Language Sample Analysis Be Standardized?, Presented at the annual meeting for the American Speech-Language-Hearing Association, Miami, FL, November, 2006.

Miller, J., Heilmann, J., Nockerts, A., Iglesias, A., Fabiano, L., & Francis, D. Oral Language and Reading in Bilingual Children. Learning Disabilities Research and Practice, Vol. 21, 2006.

Carol Murphy, MA, CCC-SLP
Board Certified Educational Therapist
Licensed and Credentialed Speech-Language Pathologist
Learning Disability Consultant
www.carolmurphy.org

 

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What is a Learning Disability, Really?

July 1, 2012 in Special Education Articles by Jess

When a parent attends an IEP meeting and the educational experts tell them their child has a learning disability, most times there is confusion.  The reason is because the term can seem so broad that it can render itself almost meaningless.  Several years ago a study was undertaken with professionals, teachers and parents asked to define the term “learning disabilities”.  The results listed nearly 100 different definitions, almost as varied as the people who tried to define the term.  Although some parents feel comfortable with finally having a name for their child’s problem, or a teacher might find a diagnosis helpful to at last getting a student help,  it might be more useful to fully describe the issues and development, or lack thereof, that most students experience before finally being labeled learning disabled.  Read the rest of this entry →

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