Questions and Answers

If you have any questions or concerns that relate to speech language pathology in any way, at any level....just ask.
I will answer them to the best of my ability on my blog.
Contact me at tsmotherof3@verizon.net.

Friday, March 7, 2008

Speech and Language Workbooks that Work

Speech and Language Workbooks that Work
At the Middle School Level

Over the years I have purchased many speech and language workbooks to use in therapy. Some of these books have been extremely helpful and some have been a total waste of money. What I want to do is collect a list of workbooks that are actually helpful in therapy.
Therapists, please submit your recommendations to add to the list. If you have the time please mention, the skills targeted and how you use the book either in therapy or in the classroom setting if you do inclusion.
Here are a few of my favorites.

Saying One Thing, Meaning Another
Author: Cecile Cyrul Spector, Ph.D
This book targets a variety of ambiguous and figurative language tasks. It is organized into sections that focus on targets such as homophones, homographs and figurative expressions. The author begins each new concept with a highlighted section that actually helps to identify and understand. Then Spector adds good variety of practice items to help solidify understanding of the concept presented. I like to use this book as an introduction to ambiguous and figurative expressions then supplement with other games and activities.
Submitted by: Teresa S.

Language Remediation and Expansion
Author: Catharine S. Bush
This is a great book. It provides examples of a variety of language concepts. Some that I remember off the top of my head are rhyming synonyms, analogies, homophones, homographs and analogies. The examples provided in this book are at a teaching level. I often take the information and examples in this book and use them in a variety of ways to provide challenging therapy activities. Unfortunately, this book is old and I am sure it is out of print. Since it is old, some of the examples are a little dated. I just skip the dated examples or give them to the kids for fun, then explain. If you have a copy of this book sitting around your office, dust it off and take a good look at it.
Submitted by: Teresa S

HELP 3
Authors: Andrea Lazzari and Patricia Myers Peters
If you are a speech and language pathologist in the public schools, you have to be familiar with the HELP books. HELP 1 and 2 were the first books I bought when I started my career and I used them a lot with younger students or lower functioning students. With the older kids, I use Help 3, which focuses on Concepts, Parapharsing, Critical Thinking and Social Language. The book is organized so it is easy to pick and choose appropriate tasks. I really like the paraphrasing tasks and the way they build from synonyms to paraphrasing paragraphs. When used appropriately, this book helps to demonstrate how to be flexible with language.
Submitted by: Teresa S

Tasks of Problem Solving-Adolescent
Authors: Linda Bowers, Rosemary Huisingh, Carolyn LoGiudice
This is the newest workbook in my collection. When I ordered the updated Test of Problem Solving this book was recommended as a companion purchase. It aligns itself with many of the tasks found on the TOPS. Some of the items might be a little too easy for the sophisticated student with pragmatic issues and there are not always enough examples. However, so far this is the best workbook I have found targeting pragmatic issues with the middle school crowd.
Submitted by: Teresa S

Monday, February 18, 2008

Vocabulary Development Is Key to Understanding Higher Level Language

In therapy, I talk a lot to my students about being flexible with language. You may not find much on flexibility with language if you did a search but I think it is one of the most important parts in developing higher level language skills. I just started using the term "flexibility with language" and the kids seemed to get it. I use the term to refer to the ability to look at language in different ways……

  • to understand language can have different meanings in different contexts
  • to know how to use to use language in different ways to convey a variety of different meanings.

This is all part of developing higher level language abilities. Developing a mature vocabulary is just a first step toward efficient higher level language skills. Below are some simple suggestions to encourage strong vocabulary development during the middle school years.

Vocabulary Development Ideas
After a certain age, children primarily expand their vocabularies through reading. For a child with language or reading disabilities this usually does not come naturally. Children who do not like to read or are not encouraged to read will also have difficulty expanding their vocabulary skills. Without good vocabulary development, students will have little understanding that a word may have two meanings and various spellings. They will not realize that every little change, in how a word is used, can vary the meaning or the message conveyed.
A poor vocabulary affects all areas of language and learning. During the middle school years, a student’s vocabulary should grow by leaps and bounds. Around 7th grade text books become more technical and teachers naturally step up their own use of language. Conversations with peers are becoming more mature and topics kids talk about are more controversial. Without good vocabulary skills, kids will have more difficulty understanding the subtleties or humor in language.

Things to do at home with your middle schooler to encourage vocabulary development:

  • Obviously, encourage your child to read. If your child struggles with reading, consult with their teacher about appropriate books at their reading level.
  • Vary their reading material. Magazines are wonderful and often peak a child’s interest. Comic books, have your read one lately? Comic books often appear juvenile but some contain a lot of higher level vocabulary and language.
  • Talk to your child about current events. Provide some explanation about what is going on and why. Talk to them about your opinions and ask them theirs. Driving in the car is a great time to do this because you have a captive audience.
  • Talk about different categories of words. Homonyms, homophones and Homographs to be specific.
  • Homonyms are words that sound alike but are spelled different. An example would be: the word bark-the bark of a tree or the bark of a dog http://www.cooper.com/alan/homonym_list.html
  • Homophones are words with two spellings and two meanings but only one pronunciation. An example would be: buy/by/bye
    http://az-aall.org/AALL/Pages/Lessons/Support/HomophoneList.pdf
  • Homographs are words which have one spelling but two pronunciations and two different meanings depending on how the word is used. An example would be: Let’s wind up the kite string before the wind gets too wild. http://myweb.tiscali.co.uk/wordscape/wordlist/homogrph.html
  • Do crossword puzzles together and explain answers
  • Books on tape are real good. Just keep in mind that reading is still important
  • Watch movies with subtitles on when possible. Overwhelming for some kids multi-sensory approach for others.
  • Keep checking back I will occasionally add other ideas.

Friday, February 8, 2008

Develop Those Higher Level Language Skills!

During the middle school years, students are beginning to develop higher level language abilities. Most students do this so naturally we do not even notice. Teachers do their best to help students gradually develop mature language skills. However, students with language disabilities or just weak academic habits may have difficulty acquiring these higher level language skills.

What are some higher level language skills?

• Development of mature vocabulary
• Understanding of word relationships such as homophones and homographs
• Understanding and use of figurative expressions
• Organization of mature sentences (oral and written)
• Understanding and use of mature grammatical structures (oral and written)
• Ability to draw conclusions and inferences
• Ability to paraphrase and rephrase with ease
• Ability to reason
• Looking at things from another’s perspective

Concerns when Students do not attain higher level language skills.

• Difficulty with comprehension (oral and written)
• Unable to understand and make connections and associations
• Difficulty understand jokes, riddles and humor in general
• Inability to organize language
• Writing skills will suffer
• Poor problem solving skills
• Inability to be flexible with language ( I will explain more about that later)
• Academic success is effected
• Immature pragmatic abilities (social speech skills)

Many simple activities can help foster development of higher level language skills. Keep an eye on my blog. I will continue to provide information and suggestions for intervention. If you need me to address an area ASAP or you have specific questions drop me a comment.

Teresa

A Fun Blog for Moms

Sunday, February 3, 2008

Game Modifications That Work


Game Modifications That Work

Over the past 20 years, I have purchased many games out of therapy catalogs. Few of these specially designed games have lived up to my expectations. Out of sheer desperation for creative therapy ideas that were relevant, would give the students a lot of opportunity to practice the target skill with in a short therapy session and were inexpensive, I began to pull games off our own shelves at home. I was able to take many of my games and modify them to fit my student’s needs.
Even mildly language disabled children might struggle with traditional board games. Language disabled kids are usually not very quick on the draw so playing higher level skill games with peers is not a lot of fun. However, with some simple modifications board games can become fun and educational. Every week, until I run out of ideas I will try to profile a game that I have modified and used successfully in therapy. These modifications are simple and there are obviously no set rules. You can use my suggestions in therapy or at home, with only one child or with a group of children. I have often modified board games for an entire class. Keep in mind that modifications are always based on the child’s specific needs. Modifications that work for one individual or group might not for the next. I know this sounds like a simple idea. It is. Sometimes you just need the idea to get your own creativity flowing.

Saturday, January 26, 2008

Sunrise: Manchester By The Sea on a cold January morning and topics to come

Ok so I like to take pictures too. I realize this does not have anything to do with Middle School topics. Topics to come include: Games that actually encourage language development but might not say they are "educational games", the need to development flexibility with language and talking with your child to encourage higher level language skills, mature interests and a better parent child relationship.



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Wednesday, January 16, 2008

Chronic Otitis Media and Risk of Reading Failure

While this paper does not specifically pertain to Middle School Students, I would have to guess that approximately 60-70% of my middle school caseload, at any specific time, have a history of Chronic Otitis Media also known as ear infections. Many of these students also have associated reading difficulties or history of reading difficulties.
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Chronic Otitis Media and Risk of Reading Failure
by Teresa Sadowski MA/SLP-ccc
May 2007

Having worked as a Speech Language Pathologist for over 20 years, it always amazes me the number of students on my caseloads, that have a history of chronic otitis media or a history of excessive fluid in the middle ear. Perhaps it is not that that unusual. Statistics show that 70% of children will have at least one bout of otitis media commonly known as an ear infection before the age of 3. For many children ear infections are a recurring problem. It would not matter what level I was working with. I can state with some certainty that at least 50% of my public school caseload at any given time had a significant history of fluctuating hearing loss early on due to fluid in the middle ear because of chronic ear infections or chronic allergies. Let me make some generalizations about these kids. During my preschool experience, the students usually presented with articulation difficulties, had trouble with rhyming, had trouble remembering the right words to songs and many of them always seemed one step behind when responding verbally. Preschoolers may still be dealing with occasional ear infections, effecting hearing acuity and requiring treatment. During my kindergarten through 5th grade experience, the underlying language issues demonstrated by these students developed into actual reading problems. Simple articulation errors usually resolved but difficulty with phonics emerge. These students usually receive additional support services, specific reading instruction and tutoring. Often even with specific reading instruction, these kids were slow to have any kind of success with reading. During grade school, hearing usually stabilizes but it is not unusual for these students to still suffer with an occasional ear infection or fluid filled ears (especially during allergy season). In middle school my students continue to struggle with reading, they can usually decode consonants but vowels might be a problem. Difficulties with reading comprehension become very obvious. Most also demonstrate poor fluency when they read. These students have not naturally acquired the higher level language skills such as understanding ambiguous and figurative language. Their overall vocabulary is weak. These are the kids who miss the nuances and subtleties in language, they don’t get the jokes and they are not very flexible with their own use of language.

So what is the common thread that keeps kids with chronic ear infections or chronic allergies from becoming proficient readers? The answer could be very simple. Both groups experience fluctuating hearing loss early on. Ear infections occur through out childhood but the incidence of ear infections actually peaks between 6 and 12 months of age. When a child has fluid in his middle ear sounds can become seriously muffled, high frequency sounds cannot be heard. As a result, kids might miss a lot of what is said to them or miss a lot of environmental sounds that convey meaning. When hearing is effected, sounds, words and sentences are easily missed and/or misunderstood. A baby or young child obviously can’t tell you what they are missing. They can’t ask you to repeat yourself. They can’t tell you they can’t hear you because background noise is too loud. Their hearing can fluctuate so much that we can not figure out what they are missing or when. Children learn language through direct contact with others and through imitation. If their hearing is distorted, imagine how they might perceive individual sounds both speech and environmental. I have always felt that these babies and kids miss critical information or do not develop critical listening skills that in some way effects the development of language and later on development of reading/spelling/writing skills. Basically, they may have missed critical developmental periods where they are learning to listen to, learn about and discriminate phonemes or individual speech sound.

It is surprising that so little research has been done around the very common correlation between fluctuating hearing loss and difficulties acquiring reading skills. One very interesting study, completed by Dr. Heather Winskel, from the University of Western Sydney, Australia, found that if a child experiences a middle ear infection during the crucial first years of life, it may have long-term effects on subsequent language and literacy development. In her study, she compared two groups of 43 children between the ages of 6 and 8. One group had an early history of repeated episodes of otitis media and the control group was matched for age, gender and socio-economic status. Children were tested on three different linguistic levels - phonological awareness, semantic knowledge and narration and reading ability. The children with a history of ear infections tended to achieve lower scores on phonological awareness skills of alliteration, rhyme and non-word reading, semantic skills of expressive vocabulary and word definitions and reading compared to non-otitis media children. Research agrees strongly that phonological awareness or phonemic awareness is a necessary skill that children need to begin reading. Could poor development of phonemic awareness be the key factor why children with a history of fluctuating hearing have difficulty learning to read naturally, using traditional methods?
So what is phonological or phonemic awareness? Scholars differ on what exactly to call it, but it is the same thing, here we will use the term phonemic awareness. Phonemic awareness is the ability to identify individual sounds and their order within words, underlies self-correction in word attack, word recognition and spelling: the ability to go from whole to the parts (Lindamood and Lindamood 1998). Phonemic awareness is not only correlated with learning to read, but research indicates a stronger statement is true: phonological awareness appears to play a causal role in reading acquisition. Phonological awareness is a foundational ability underlying the learning of spelling-sound correspondences (Stanovich, 1993-94). Basically, phonological or phonemic awareness is the ability to identify the sounds in words, not the letters but the sounds. For most of us, we acquired this skill so naturally we did not know we were doing it or we have practiced this skill for so many years it is second nature. Phonemic awareness develops long before our ability to put sounds and letters together. Adams in 1990 described 5 levels of honemic awareness in terms of abilities:
to hear rhymes and alliteration as measured by knowledge of nursery rhymes
to do oddity tasks (comparing and contrasting the sounds of words for rhyme and alliteration)
to blend and split syllables
to perform phonemic segmentation (such as counting out the number of phonemes in a word)
to perform phoneme manipulation tasks (such as adding, deleting a particular phoneme and regenerating a word from the remainder).

Scholars will also differ slightly on the levels of phonemic awareness or use different words to describe each level but they all pretty much agree that rhyming is when children show initial phonemic awareness. As a speech language pathologist, I would have to differ saying phonemic awareness begins much earlier. I believe phonemic awareness begins when the child begins to recognize and acquire sounds in their native language. However, when any of the 5 levels of phonemic awareness mentioned above are not achieved, reading difficulties are sure to develop. In some students, this can be so obvious that specific testing is just to confirm what the specialist already knows.

One reason why educators are so interested in phonemic awareness is that research indicates that it is the best predictor of the ease of early reading acquisition (Stanovich, 1993-94), better even than IQ, vocabulary and listening comprehension. This is a very interesting statement and echoed often in various research. What can be done to aid reading acquisition in children with fluctuating hearing loss? First of all children who suffer with chronic ear infections and chronic seasonal allergies should be considered at risk for reading failure and monitored closely. Parents should consult with early intervention or local public preschool to make sure developmental milestones are reached at the proper time. Public Schools also recommend and provide assessment in all learning and language areas. A full hearing evaluation by a licensed audiologist is essential. However, be aware a one time hearing evaluation can not predict how hearing may fluctuate or what the child is missing at any specific time. While a pediatrician will treat a child during an ear infection, if a child has chronic ear infections or fluid filled ears it is in the child’s best interest to consult a specialist. An Otolaryngologist (ear nose and throat doctor) along with the audiologist can determine how much fluid is in the ears, keeping the ear drum from moving efficiently. Depending on the situation, the Otolaryngologist may recommend the insertion of Pressure Equalization tubes through the ear drum. It is a very common procedure to help keep the middle ear fluid free. Without fluid in the middle hearing should return and remain consistent. When an early intervention or preschool child is identified as having difficulty developing speech and language, direct services are often recommended. A good therapist will present a variety of activities that “play with sounds and language” encouraging awareness and development of sounds and language while also focusing on specific needs. The speech therapist is often the first person to recognize that a child is at risk for reading difficulties.

Unfortunately, most reading difficulties are not identified and addressed until the student fails, usually the second half of first grade. Typical students easily acquire phonemic skills often without being specifically taught. They are ready to learn to read anywhere between 5 and 7 years of age. There are other developmental factors that determine whether a child is ready to learn reading so time might be given to see if a student can “catch up on their own”. This might be a good rule some of the time. However, if a student has a history of fluctuating hearing loss and has not developed phonemic awareness, reading is not going to emerge on its own. I do not have a lot of experience with reading programs but I have noticed that traditional reading programs do not always work for children who have deficits with phonemic awareness. These children do better with programs that use a multi-sensory approach and begin with a phonemic awareness component. The Lindamood Phoneme Sequencing Program (LIPS), uses a very strong multi-sensory phonemic awareness model. LIPS not only teaches the children to listen for the individual sounds it teaches the students how to feel the sounds and what the sounds look like. As the program, progresses the children are taught how to blend and break apart real and nonsense words. Teachers and specialists who are trained in this program and feel comfortable using it report wonderful successes for their students. My own child who has a history of fluctuating hearing did very well with a reading program called Project Read. I am less familiar with this program but remember it had a multi-sensory component that cued for sound and syllable production. Our local grade school uses Project Read with good results.
How does a parent know their child is developing appropriate phonemic awareness? There some very simple skills things to look for.

Awareness of Rhyming Words (age 3-4)Can your child….identify words that rhyme. For example, "Put your thumbs up if these two words rhyme, pail-tail or cow-pig?" or "Finish this rhyme, Red bed, blue ____."
Awareness of Syllables (age 4-5)Can your child…..identify that words are made up of syllables. For example, "Can you clap and count the syllables or the word parts in rainbow?"
Awareness of Onsets and Rhymes-Sound Substitution (age 6)Can your child….identify onsets and rhymes in words. For example, "What rhymes with /at/ and begins with /f/?"
Sound Isolation - Awareness of Beginning, Middle and Ending Sounds (age 6)Can your child….Identify beginning, middle, and ending sounds in words. For example, "What is the beginning sound in neck?" "What is the ending sound in jog? "What sound do you hear in the middle of kitten?"
Phonemic Blending (age 6)Can your child….blend phonemes heard auditorily into a word. For example, after hearing /c/ /a/ /t/ said in a stretched pronunciation, the child says cat.
Phoneme Segmentation (age 6-7)Can your child….count the sounds in a word (age 6). For example, "How many sounds do you hear in the word dog?"Is able to identify the sounds heard in a word. For example, "What sounds do you hear in the word man?"
Phoneme Manipulation (Age 7+)Can your child omit or substitute phonemes to make new words. For example, "What word would we have if we changed the /t/ in Tommy to an /m/?" (mommy) or "What word would we have if we left out the /t/ in the middle of stand?" (sand)

Parents can provide their child with the ultimate “phonological” experience. If hearing loss of any kind is suspected, make sure parents know to have the child’s attention and look directly at the child when they speak. Provide children with lots of opportunities to listen and respond. This may sound simple but reading, learning, memorizing and reciting nursery rhymes and singing songs are excellent for developing phonemic awareness. Reading to children is also key to developing phonemic awareness. Keep background noise to a minimum. Do not keep the radio or TV on all the time. Parents should not be afraid to express their concerns to their pediatrician. Most pediatricians are not aware of the implications fluctuating hearing loss has in learning to read. Parents should seek out services through early intervention or your local public schools. Both agencies are required to screen and/or test students to determine if a disability exists.

Phonemic awareness is one of the first steps to success in reading. When a child has not developed efficient phonemic awareness because of fluctuating hearing early on, the risk of reading failure is very real. With the right intervention, involving multi-sensory tasks that focus on improving the child’s awareness of individual sounds and how they work together, these children have a better chance of becoming proficient readers.









Referances
Adams, Marilyn Jager (1990). Beginning to Read: Thinking and Learning about Print. Cambridge, MA: Bolt, Beranek, and Newman, Inc. ED 317 950
Lindamood, Patricia and Lindamood, Phyllis (1998). The Lindamood Phoneme Sequencing Program Teachers Manual. Austin TX. Pro-ed.
Sensenbaugh, Roger Phonemic Awareness: An Important Early Step in Learning To Read. THE EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC). http://www.kidsource.com/kidsource/content2/phoemic.p.k12.4.html#contents
Stanovich, Keith E. (1993-94). "Romance and Reality (Distinguished Educator Series)." Reading Teacher, 47(4), 280-91. EJ 477 302
Winskel, Dr. Heather. Study reveals recurrent middle ear infections can have a major impact on children's development. Research Australia. Feb 2007. http://www.eurekalert.org/pub_releases/2007-02/ra-srr020407.php
Los Angeles County Office of Education Website. Teams Educational Resources. Levels of Phonemic Awareness. http://teams.lacoe.edu/documentation/classrooms/patti/k-1/teacher/assessment/levels.html