The clinical scope of speech-language pathologists (S-LPs) is a mystery to many people, especially when it comes to how we work with children who are struggling with reading and writing. The purpose of this post (our first!) is to answer this question: Why and how do S-LPs work with struggling readers?
S-LPs are best known for our work with pediatric speech delays and disorders. When a child has a lisp or is having difficulty saying /r/, people are likely to think of S-LPs. We also work in the area of pediatric language delays and disorders. These are the cases when a child has difficulty with expressing themselves and understanding others due to weaknesses with things like vocabulary and grammar. Speech and spoken language are among the necessary prerequisites for learning to read. For example, phonological awareness (e.g., rhyming, phonemic awareness, blending and segmenting sounds in words) is important for single-word reading - pronouncing the words (Roth, Speece, & Cooper, 2002). Reading comprehension - understanding what the text means - is predicted by semantic skills such as knowledge of word meanings and word retrieval (Roth et al., 2001). Moreover, children with reading deficits may also have speech sound acquisition delays or disorders (Cabbage et al., 2018). If a child is having difficulty distinguishing between speech sounds (e.g., says /k/ as /t/, e.g., 'cape' > "tape"), it will affect their ability to decode the letters that represent these sounds. Whereas speech and spoken language are innate human abilities (most of us are born with these abilities that develop during childhood and adolescence), reading and writing is taught. They're systems that have been developed by people to store and transfer verbal information.
Since reading and writing involves the processing of speech and language, and the mapping of speech sounds and language into a written code (letters and written words), S-LPs are among the professionals who work with children who are having difficulty with reading and writing (American Speech-Language-Hearing Association, n.d.; Hogan, 2018; International Dyslexia Association, n.d.). Other professionals involved include classroom teachers, reading specialists in the schools, and psychologists. Each of these professionals make unique contributions to the detection and management of reading difficulties. Also, sometimes our roles overlap (e.g., phonological awareness can be taught by both a reading specialist or an S-LP).
Different professionals are involved in the identification and diagnosis of reading difficulties. A teacher or parent is often the first to identify when a child is reading below their expected grade level. Once it is known that a child is struggling, the diagnosis of a reading deficit can be made by either a psychologist or an S-LP. The diagnosis of dyslexia (a type of learning disability), evaluation of the impact of a reading deficit on overall academic performance, and assessment and diagnosis of attention deficits and non-verbal information processing is made by a psychologist. A psychologist can also identify when oral language is an area of weakness. An S-LP evaluates oral language expression and comprehension, speech production, written language, reading, and abstract language skills in depth (Speech-Language & Audiology Canada, 2016). Frequently, evaluation by both a psychologist and an S-LP is involved in the identification and evaluation of reading difficulties (International Dyslexia Association, n.d.). This is the approach supported by Shoreline's clinicians.
Treatment for reading deficits is often provided by reading specialists and S-LPs. In many cases, the intervention is carried out by tutors under the direction of these specialists. In cases when a child also has an oral language difficulty (e.g., developmental language disorder) and/or speech acquisition delay or disorder, an S-LP should be involved in intervention. Assessment and intervention for speech and language disorders is provided by S-LPs (Speech-Language & Audiology Canada, 2016). As oral language difficulties frequently contribute to reading comprehension deficits, S-LPs are particularly well suited to assist such children.
There are many approaches to treating reading deficits. The National Reading Panel (2000) recommended that effective reading intervention should include five components: phonological awareness, systematic phonics, fluency, vocabulary, and comprehension. The amount of time spent on each of these areas during treatment depends on what the child's specific areas of need are (Hall & Burns, 2018). For example, one child may require more time on phonics skills, whereas another may require more time on comprehension, and other on vocabulary. While there is evidence that phonics instruction can improve reading accuracy and fluency (McArthur et al., 2018), it only has a slight affect on comprehension, particularly after grade 2.
For children with dyslexia or a phonologically based reading deficit, effective intervention should include a focus on training in letter sounds, phonological awareness, and linking letters and sounds through writing and reading from texts at the appropriate level to reinforce emergent skills (Snowling & Hulme, 2011, 2012). In contrast, children with poor reading comprehension skills require a different 'diet' attuned to their needs and can benefit from training in oral language skills, particularly vocabulary training (Snowling & Hulme, 2011). In fact, after grade 3, children who are struggling with reading are more likely to be having difficulty with reading comprehension and oral language rather than phonological awareness (Suggate, 2016). Some S-LPs choose to use a set structured program for their clients with reading difficulties, whereas others create individualized treatment programs for each client.
(a) S-LPs work with children (and adults) with oral and written language disorders
(b) reading success requires good skills in oral language and speech (including phonological awareness)
(c) identification and characterization of reading deficits frequently involves assessment by both a psychologist and an S-LP
(d) S-LPs can provide treatment for children with reading deficits
(e) S-LPs are particularly well suited to work with children with difficulties with both oral and written language
(f) S-LPs are particularly well suited to work with children with reading comprehension deficits
To read about Shoreline's approach to reading intervention, visit our website: https://www.shoreline-speech.com/reading
Summaries of some specific reading programs can be found here:
What Works Clearinghouse: Literacy
American Speech-Language-Hearing Association (ASHA)
Written Language Disorders: Treatment
National Reading Panel https://www.nichd.nih.gov/sites/default/files/publications/pubs/nrp/Documents/report.pdf
American Speech-Language-Hearing Association. (n.d.). Written language disorders. Retrieved July 14, 2019 from https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942549§ion=Roles_and_Responsibilities
Cabbage, K. L., Farquharson, K., Iuzzini-Seigel, J., Zuk, J., & Hogan, T. P. (2018). Exploring the overlap between dyslexia and speech sound production deficits. Language, Speech, and Hearing Services in Schools, 49, 774-786. doi:10.1044/2018_LSHSS-DYSLC-18-0008
Hall, M. S., & Burns, M. K. (2018). Meta-analysis of targeted small-group reading interventions. Journal of School Psychology, 66, 54-66. https://doi.org/10.1016/j.jsp.2017.11.002
Hogan, T. P. (2018). Five ways speech-language pathologists can positively impact children with dyslexia. Language, Speech, and Hearing Services in Schools, 49, 902-905. https://doi.org/10.1044/2018_LSHSS-DYSLC-18-0102
International Dyslexia Association. (n.d.). Dyslexia assessment: What is it and how can it help? Retrieved July 14, 2019 from https://dyslexiaida.org/dyslexia-assessment-what-is-it-and-how-can-it-help-2/
McArthur, G., Sheehan, Y., Badcock, N. A., Francis, D. A., Wang, H. C., Kohnen, S., Banales, E., . . . Castles, A. (2018). Phonics training for English-speaking poor readers. Cochrane Database of Systematic Reviews, 2018(11), 1-142. doi:10.1002/14651858.CD009115.pub3
Roth, F. P., Speece, D. L., & Cooper H. (2002). A longitudinal analysis of the connection between oral language and oral reading. The Journal of Educational Research, 95, 259-272. https://doi.org/10.1080/00220670209596600
Snowling, M. J., & Hulme, C. (2011). Evidence‐based interventions for reading and language difficulties: Creating a virtuous circle. British Journal of Educational Psychology, 81, 1-23. doi:10.1111/j.2044-8279.2010.02014.x
Snowling, M. J., & Hulme, C. (2012). Interventions for children's language and literacy difficulties. International Journal of Language & Communication Disorders, 47, 27-34. doi:10.1111/j.1460-6984.2011.00081.x
Speech-Language & Audiology Canada. (2016). Scope of practice for speech-language pathology. Retrieved from https://www.sac-oac.ca/sites/default/files/resources/scope_of_practice_speech-language_pathology_en.pdf
Suggate, S. P. (2016). A meta-analysis of the long-term effects of phonemic awareness, phonics, fluency, and reading comprehension interventions. Journal of learning disabilities, 49 (1), 77-96. doi:10.1177/0022219414528540