Question from Claire Nissenbaum, Executive Director, Atlantic Seaboard Dyslexia Education Center, Rockville, MD:
    Pediatricians and school personnel typically urge parents to wait for a year or more before having a struggling student assessed for language/learning difficulties. How can ASHA address these two groups directly to correct this mistaken advice?

Dr. Diane Paul and Dr. Froma Roth:
    ASHA shares your concern about pediatricians, school personnel, and others who take a ’He’ll outgrow it’ position too readily when parents voice concerns about their child’s delayed speech and language development. ASHA has developed a number of resources to help convey the importance of early identification and intervention to preventing or mitigating later language and learning problems. These resources emphasize the interrelationship among language, literacy, and learning. We have a guide that was written in 1991 directed specifically to physicians: Physician Education: Language, Speech, and Hearing Problems in Children.

More recent publications and resources have been developed and are appropriate for a wide audience. We just completed a DVD on speech, language, and hearing milestones from birth to age 5. (And as a bonus, Claire, you get to see my son and grandchildren in the DVD). We’ve priced it low so that speech-language pathologists will disseminate the DVD widely and put it in physician waiting rooms and provide it to parents, school personnel, and others. We also have posters that can be put in waiting rooms and administrator offices and brochures such as How Does Your Child Hear and Talk, Getting Reading for Reading and Writing, and Literacy and Communication. Some of these brochures have been translated to power point presentations for speech-language pathologists to use with physician groups, school personnel, and related professionals to make sure they are familiar with speech and language norms and the services of speech-language pathologists. They are available at no charge to ASHA members and are on the ASHA Web site: http:// www.asha.org.

The ASHA Web site also has a consumer site with a lot of information to share about communication development and disorders. We have a few for-sale products that can help with physician and school personnel education: Let’s Talk"Speech and Language Development and Disorders: Children and Adolescents. This is a collection of consumer newsletters. We also have Guidelines for Referral to Speech-Language Pathologists. This is a set of tools that communicate the scope of practice of speech-language pathologists for case managers, consumers, physicians, and others who provide referrals. The guidelines cover language, speech, cognitive-communication, voice, fluency, and swallowing.

ASHA tries to provide the needed resources to prevent a wait and see approach when it is not appropriate. Of course, there are times when waiting is the best approach"for example, when a child has skills that are within developmental expectations. For example, I would take a wait and see approach if a 3-year-old child with typical hearing can’t produce the r sound, consonant blends, doesn’t know the alphabet, and has no apparent developmental problems.

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Question from Barbara Davis, SLP, Indian Head Elementary:
    What can I do as the school based SLP to have the most direct impact on my student's literacy skills?

Dr. Diane Paul and Dr. Froma Roth:
    It’s important that school personnel recognize the important roles that speech-language pathologists play in the development of reading and writing skills (e.g., prevention, identification, assessment, and intervention). Here are some specific actions that you as a speech-language pathologist can take to directly influence student literacy skills:

Have a clear understanding of the connections between oral language and literacy and its reciprocal relationship.

Evaluate a student’s language needs and intervention targets in relation to curricular demands and in relation to social needs.

Observe student performance in the classroom to identify language and literacy strengths and needs in the student’s predominant learning context.

Familiarize myself with curricular materials such as text books, assignments to understand the learning demands and expectations.

Collaborate with the teacher to understand the teacher’s perceptions of student’s difficulties and priorities for instruction and intervention.

Consider using collaborative models on intervention such as team teaching and demonstration lessons.

ASHA has documents that delineate the roles and responsibilities of speech-language pathologists in reading and writing. The Literacy Gateway has a list of available resources: http://www.asha.org/about/publications/literacy.

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Question from Julie Touchberry, Early childhood Special Education Teacher, Redford Union schools:
    Is there research that suggests that children with early language delays are more likely to present as learning disabled once in elementary school?

Dr. Diane Paul and Dr. Froma Roth:
    Children with early language delays in the preschool years show a significantly higher incidence of reading problems than children without language problems (Bishop & Adams, 1990; Bishop & Edmondson, 1987; Catts & Kamhi, 1999; Gallagher, Frith & Snowling 2000; Hatcher & Hulme, 1999;; Stothard, Snowling, Bishop, Chipchase & Kaplan, 1998). This means that children who enter school with weaker verbal abilities are much more likely to experience difficulties learning to read and write than their typically developing peers (Catts, Fey & Tomblin 1997; Scarborough, 2001; Scarborough & Dobrich, 1990). In fact, problems in oral language skill in preschool and kindergarten predict reading ability in the early elementary grades (Perfetti, Beck, Bell & Hughes, 1987; Torgesen & Davis, 1996; Roth, Speece, & Cooper, 2002).

Moreover, early literacy difficulties are persistent. It is estimated that between 65 - 88% of children identified as having a reading problem in early grades continue to read poorly throughout the school-age years and into adulthood (Francis, Shaywitz, Stueberg, Shaywitz & Fletcher, 1994, 1999; Juel, 1988; Scarborough, 1998).

For example, Juel (1988) found that 88% of poor readers in first grade were poor readers at the end of fourth grade and their difficulties remained stable over time from first grade though high school. Further, language problems are not only the cause but the consequence of literacy problems, which results in a cycle of failure, described by Stanovich’s (1986) Matthew principle as "the rich get richer, and the poor get poorer." Children enter school with reduced oral language knowledge have difficulty learning basic reading skills, have unrewarding early reading experiences, read slower because they do not acquire the ability to read fluently which hinders their reading comprehension (reading for meaning), read fewer and less challenging texts, and avoid or merely tolerate practicing their literacy skills. This downward spiral then has significant consequences for the reciprocal connection between oral language and reading, because children learn new vocabulary and syntactic forms from reading texts, books, and other forms of written text.

Finally, many children with early language delays may not be diagnosed as learning disabled, but continue to experience problems in a variety of language-related skills including reading, writing, mathematics, and more advanced oral semantic forms (e.g., figurative language such as idioms, metaphors, humor and more advanced syntactic forms (e.g., complex sentences, cohesion).

The transcript of this chat, which will be posted at http://www.LDTalk.org in the next few days, will include all of the references for this research.

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Question from Teresa Lehman, Disability Manager, CTSA Head Start, Shawnee, Oklahoma:
    What age should a child be given a speech/language screen?

Dr. Diane Paul and Dr. Froma Roth:
    It's never too early if there are concerns about a child's communication. Developmental expectations for communication, speech, and language development begin at birth. By the time the child is 3-4 years of age he or she should be talking in 3-4 word sentences and understanding much of what is said. Speech should be intelligible to most listeners--familiar and unfamiliar. For resources related to developmental milestones, check the American Speech-Language-Hearing Associaton (ASHA)Web site at www.asha.org. ASHA has a brochure with the developmental milestones from birth to age 5 years, How Does Your Child Hear and Talk? and has a DVD on speech, language, and hearing milestones from birth to age 5 years. There is also a brochure and power point presentation called Getting Ready for Reading and Writing.

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Question from Trish Orlovsky, Special Ed Advocate, Massachusetts:
    How can a school assess levels of literacy for a child with developmental delays and speech apraxia (grade 1)? Standardized testing will not fit this child and we're trying to develop a literacy program the team can implement.

Dr. Diane Paul and Dr. Froma Roth:
    Assessment of reading and writing is possible for any child, including children with developmental delay and apraxia of speech. Because the norms for standardized tests may not be relevant for certain children, more informal assessment approaches should be used. Assessment of literacy should not be based on any single measure"formal or informal"for any child.

Assessment of literacy at the early elementary level may involve administering standardized tests, but they are not always necessary. Informal measures can be obtained by consulting with speech-language pathologists, teachers, and other professionals. This team can combine information from previous educational testing, classroom-based measures such as portfolio assessments, and curriculum-based assessments.

Information also can be obtained through direct observation of a child’s reading and writing. Regardless of the assessment protocol used, the areas most important to assess are skills known to prepare children for reading and writing, including: spoken language (e.g., vocabulary, listening comprehension), phonological awareness, rapid naming, phonological memory, letter identification, and invented spelling. If the child is beginning to read, assessment should also include observation of single word reading, reading connected print, passage comprehension, and written language samples.

Additional information about assessment of literacy and the role of the speech-language pathologist in literacy assessment may be found at http://www.asha.org/NR/rdonlyres/A7F16F0A-422D-4E6F-A329-AB4BE2381790/0/19114_1.pdf

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Question from Gina Kokoska, Speech-Language Pathologist, Private Practice and Public School Clinician:
    What 2 or 3 tasks do you judge to be most important to screen pre-literacy and reading skills of 1) preschoolers, 2)Kindergarteners and 3)1st graders on a speech-language screening.

Dr. Diane Paul and Dr. Froma Roth:
    For insight into preparedness to learn literacy skills:

For preschoolers and kindergarteners to screen pre-literacy:
Phonological awareness
Alphabetic letter knowledge

For first graders
Phonological awareness
Alphabetic letter knowledge
The alphabetic principle (letter-sound correspondences)

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Question from Greg Nelson, Resource Specialist, Baldy Mesa Elementary:
    How do you perceive the interaction of the speech therapist and the classroom as it relates to the current RTI model?

Dr. Diane Paul and Dr. Froma Roth:
    We think the RTI model provides a terrific opportunity for collaboration between the speech-language pathologist and general classroom teacher. Because of the strong interconnection between language and literacy, the speech-language pathologist and teacher can work together (e.g., team teaching) to help all children with reading and writing skills without waiting for a diagnosis. The collaborative partners can provide scientifically-based instruction and intervention and can assist with identification and eligibility determinations. The January-March 2006 edition of Topics in Language Disorders (TLD), which we co-edited, has some information about forming successful literacy partnerships. To read this article, go to http://www.ncld.org/content/view/998.

At the Tier 1 level, the speech-language pathologist can team-teach or supplement the classroom curriculum. In later tiers, more direct, individualized instruction could be provided for children either in small groups or one-on-one. In the final tier, the speech-language pathologists can assist in making the referral and being part of the identification process.

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Question from Gina Kokoska, SLP, Haverford School District, PA:
    re: response to Question from Trish Orlovsky, Special Ed Advocate, Massachusetts When you say rapid naming, do you mean divergent naming or rapid picture labeling?

Dr. Diane Paul and Dr. Froma Roth:
    By rapid naming, we are referring to RAN tasks, which typically involve the rapid automatized naming of pictures, objects, colors, numbers, and letters.

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Question from Giennie Dunn, Mother, Omaha Nebraska:
    I have a 7 year-old boy who has had speech and language difficulty since age 3. He is in public school speech program here in Omaha, NE. We are at a critical point in education because now he is expected to read and be able to explain or comprehend what he read. We know that he understands information but he cannot retrieve it, or remember the right "words" to explain information. I find he gives ups easily and says"I can't remember." What kind of excercises can we do or what kind of learning aids can we use to help him in his education at this time? He has tested for resource help in math and in reading because of this difficulty. As we head into summer I am concerned on how we can continue to stimulate his speech and language so he does not lose what he has accomplished so far?

Dr. Diane Paul and Dr. Froma Roth:
    It's important to check with the professionals who are working with your son. They can provide suggestions for exercises you can do that are tailored to your son's specific needs. Hopefully, you are familiar with the treatment goals in your son’s speech and language program. The speech-language pathologist can tell you what to reinforce at home based on current goals.

When you work with your son, your interactions should be fun. It's not necessary to provide drills and make your time together seem like work. Your son shouldn’t fear forgetting or making errors. For example, if your son needs to build his vocabulary, you can play word games " have him name objects rapidly that are around the house or outside; read a lot to your son and pair words and pictures; play card games like War and Go Fish with vocabulary words written"and with pictures on cards; play matching games, matching printed words and pictures. Focus on what interests your son in selecting the games, books, and activities to reinforce learning. You may be able to borrow books from the classroom. Here are several ways to help your son during regular activities this summer or any time without adding extra time to your day. There also are things you can do during planned play and reading times. Show your children that reading and writing are a part of everyday life and can be fun and enjoyable:

• Talk to your child and name objects, people, and events in the everyday environment and introduce some new words
• Talk to your child during daily routine activities such as bath or mealtime and respond to his questions
• Draw your child’s attention to print in everyday settings such as traffic signs, store logos, and food containers
• Introduce new vocabulary words during holidays and special activities such as outings to a ball game, child museum, etc.
• Read story books that focus on sounds, rhymes, and alliteration Reread your child’s favorite book(s)
• Read and reread your child’s favorite books and books that have well-developed plots (e.g., clearly marked beginnings, middles and endings) and read with expression
• Try some books on CDs during car rides.
• Focus your child’s attention on books by pointing to words as you read
• Encourage your child to describe or tell a story about his/her drawing and write down the words.

Again, check with the professionals working with your son. You’re certainly right that this is a critical time. In the 4th grade, you’ll see that there is a transition in school from learning to read to reading to learn. Therefore, it's important to do what you can now to help your son as much and as early as possible.

We have assumed in our response to your question that your son has received a comprehensive evaluation that includes a focus on both oral and written language. If this is not the case, we highly recommend that such an evaluation occur. This is important because the kinds of speech and language difficulties exhibited by children change over the course of development (e.g., from preschool to early elementary school) and therefore may impact differently on his ability to acquire literacy skills as well as to learn other academic areas such as math and history. In addition, the demands of the curriculum change as do the expectations for student performance. All of these factors need to be considered and integrated to form a complete profile of your son’s current status and educational needs.

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Question from Prema Rao, Research Scholar, University of Toledo, Ohio:
    What is your suggestion for assessment of phonological awareness in bilingual children who speak languages with different linguistic and script structures? Are there any language-independent measures that could be adopted across different languages?

Dr. Diane Paul and Dr. Froma Roth:
    Phonological awareness must be assessed in the child’s dominant language or in both languages if the child has mastery across languages. Because different languages have different phonological and phonetic systems, there are no language-independent measures to assess phonological awareness.

Diane August with the Center for Applied Linguistics is doing a lot of work in this particular area. The website is http://www.cal.org/delss. This study is to determine the best way for English literacy development in Spanish speaking populations. Is it best for the child to develop literacy in the first language and then transfer that information to the second language? Or do you need to first develop proficiency in English to instruct literacy in English? Or do you teach all at once? There is not a sufficent amount of information to adequately answer these questions. The ¡Colorín Colorado! site at http:// www.colorincolorado.org has some materials that are also useful.

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Question from Joyce Westrich, Consultant, Every Child Succeeds (birth to three):
    At what age should a parent be concerned if the child is not speaking? What are indicators that show if professional help is needed?

Dr. Diane Paul and Dr. Froma Roth:
    There are developmental milestones for speech and language from birth. These milestones are explained in a brochure by the American Speech-Language-Hearing Association (ASHA) entitled, ’How Does Your Child Hear and Talk?’ The information on speech and language development also is available online at http://www.asha.org.
ASHA has a DVD on speech, language, and hearing milestones from birth to age 5 that can be ordered from the ASHA Web site.

Trust your own judgment. If you are concerned about your child’s communication development at any age, seek help from a speech-language pathologist. You can find one through the school system or through ASHA’s Web site at http://www.asha.org (Click "Find a Professional").

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Question from Mary Ellen Lavalette, Reading Mentor, Haskins Laboratories:
    Is there any research on the impact of stuttering on phoneme awareness and or decoding in K and grd. 1?

Dr. Diane Paul and Dr. Froma Roth:
    We are not aware of any research demonstrating a link between stuttering and phonemic awareness and/or decoding.

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Question from Anonymous:
    No matter what you may propose, the issue is finding SLPs to meet the demands. The requirements laid upon school districts and the lack of SLPs wanting to work in schools is demoralizing to those seeking services. What is your organization going to do to address this besides raise the requirments to become an SLP..so I hear. If we can't find therapists, your ideas are not going to be implemented.

Dr. Diane Paul and Dr. Froma Roth:
    This is a complex issue that the ASHA has recognized as being a top priority for its members. As a result, ASHA currently has a Focused Initiative (FI) underway to address personnel shortages in school settings. The 2006 FI on Personnel Issues in Healthcare and Education has a comprehensive work plan that includes many strategies examining the supply and demand of SLPs in school settings across the country. Some of ASHA’s strategies include:

• Collecting state-wide data on personnel shortages to have a better and more complete picture of the extent of the shortage situation.
• Working with targeted states that have been threatened with a reduction of personnel standards because of personnel shortages in their state.
• Co-chairing a new National Coalition on Personnel Shortages in Special Education and Related Services consisting of 20 national organizations that is advocating at the federal level to remedy the personnel shortage and persistent vacancy situation in the professions.
• Convening a Fall Forum to identify innovative local and state programs, university and state efforts, and other collaborative partnerships that have been successful in addressing personnel shortages.
• Developing new recruitment/retention resources to promote the benefits of working in school settings. Some of the resources include:
  • Talking Points on: Why Lower Standards for School-Based Speech- Language Pathologists and Audiologists Will Not Meet the Needs of Students in Schools: available by contacting Susan Karr at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it or Janet Deppe at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it .
  • Information on Innovative Programs to Address Personnel Shortage Issues: A table of programs is available on the ASHA Web site by clicking here.
  • http://www.asha.org/NR/rdonlyres/18939DF1-6695-478B-A93D-C0154C62A1DE/0/Innovative_Programs.pdfRecruitment and Retention Professional Packet (currently being revised) available at: http://www.asha.org/members/slp/schools/prof-consult/slp_recruitment.htm.
  • "Reward Yourself with a Career as a School-Based Speech-Language Pathologist:’ A new brochure developed to entice high school students to choose a career as a school-based speech-language pathologist, attract college graduates to school settings, and to help career SLPs choose school-based practice. ASHA members may receive up to 25 copies free-of-charge by contacting ASHA’s Action Center at: 800-498-2071. Request item # 0804366. For the on-line version, go to the ASHA web site Legislation and Advocacy page and click on ’Schools Recruitment Brochure (pdf format).’
  • ASHA State Vacancy Survey Template: Available for collecting state vacancy data. For more information contact This e-mail address is being protected from spam bots, you need JavaScript enabled to view it or your state association.
  • IDEA Action Center: Web site with the latest news on IDEA '04 including ASHA’s analysis of the law and comments on the proposed regulations at http://www.asha.org/about/legislation-advocacy/federal/idea/#idea.

Additional information on salary supplement initiatives, caseload/workload, supply and demand data and other school-related information is available on the ASHA Web site at: http://www.asha.org/members/slp/schools/. The State Advocacy Guidebook for the Salary Supplement Initiative (Revised 12/01) is available by contacting Anush Mazmanyan at: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it .

Additional information about the FIs can be accessed at: http://www.asha.org/about/Leadership-projects/national-office/focused-initiatives.

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Question from Diane Katakowski, Speech-Language Pathologist, Oakland Intermediate School District:
    When delivering speech and langauge services within a 3-Tier model of support, do you know of any benchmark assessments for oral language skills (similar to DIBELS for literacy) that can be used as a universal screen to guide Tier 1 classroom instruction or identify students needing a Tier 2 level of support? I don't believe the DIBELS Word Use Fluency subtest has normative data as of yet, and I'd like to know what other subtests you might recommend.

Dr. Diane Paul and Dr. Froma Roth:
    Before mentioning specific measures, it’s important to remind ourselves that it’s not appropriate to use a single measure for screening or assessment. Some instruments that are available are the Phonological Awareness of Literacy Screening (PALS). There are three versions: PALS-PreK; PALS-K; and PALS 1-3) which are criterion-referenced measures that screen key emergent and early literacy skills (e.g., print awareness, phonological awareness, alphabet knowledge, word reading, name writing, and comprehension). The PALS also has a Teacher Checklist of Literacy Practices in all of the areas measured. Another tool is the Individual Growth Developmental Indicators (IGDIs) that measure oral language (including vocabulary), print and word awareness, and social interaction. Both of these can be used as benchmark screenings to establish baseline performance and as curriculum-based measures (CBMs) to monitor children’s progress on an ongoing basis. Both of these measures have strong reliability and validity. A final example is the DIAL-3 (Developmental Indicators for the Assessment of Literacy). It assesses four core areas, one of which is receptive and expressive language. It also has strong psychometric properties with percentile cut-off points by chronological age at two-month intervals for total and area scores. The DIAL has both English and Spanish versions.

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Question from Joyce Whitby:
    In a school setting using a response to intervention model (vs discrepancy formula) to determine SLD, what interventions do you feel should be considered for language delayed children struggling with early reading skills? What types of interventions can a classroom teacher use for tier 1 interventions, and if necessary to go to tier 2 and/or 3 - what interventions? who should administer (SLP?) thanks

Dr. Diane Paul and Dr. Froma Roth:
    The type of intervention depends on the age or grade of the student. What’s critical in Tier 1 is to provide high quality language and literacy-rich classroom curriculum with instructional supplements in:
Phonological awareness
Alphabetic knowledge
Print awareness
Vocabulary
Speech-language pathologists can collaborate with general education teachers to provide instruction in these areas.

Tier 2 or higher level services typically are provided by related service professionals such as speech-language pathologists, reading specialists, and special educators, etc. The focus of instruction may be in the same key literacy-related areas, but the instruction typically is more explicit, intense, individualized, and differentiated.

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Question from Linda Dressler, Speech Pathologist, Rainbow Preschool:
    Are there any early signs of dyslexia at preschool age? What are the best strategies for intervention?

Dr. Diane Paul and Dr. Froma Roth:
     The National Joint Committee on Learning Disabilities (NJCLD) provides information about early indicators of learning disabilities in a document on learning disabilities and the preschool child. The report is currently being revised. When the report is available, it will be posted on LD Online. The report provides information about risk indicators and protective factors for young children. We’ve summarized the information below:

There are some early signs in young children that may predict learning disabilities. Some of these risk indicators are:

• Pre-, peri-, and post-natal conditions
  • Low birth weight and/or preterm birth
  • Hospitalization for longer than 24 hours in a Neonatal Intensive Care Unit (NICU)
  • Difficulty with suckling and swallowing
  • Chronic otitis media resulting in intermittent hearing loss
  • Presence of a syndrome associated with learning problems
• Environmental conditions
  • Family history of language and/or learning delays or disabilities
  • Exposure to environmental toxins or other harmful substances
  • Amount and quality of language exposure in home and child care settings
  • Poverty
  • Mismatch between home and educational expectations/norms (e.g., cultural differences)
• Developmental milestones
  • Delay in acquisition of comprehension and/or expression of spoken language
    • Limited receptive vocabulary
    • Reduced expressive vocabulary ("late talkers")
    • Difficulty understanding simple (e.g., one-step) directions
    • Monotone or other unusual prosodic features of speech
    • Reduced intelligibility
    • Infrequent spontaneous communication (vocal, verbal, or nonverbal)
    • Immature syntax
  • Delay in acquisition of emergent literacy skills
    • Slow speed for naming objects and colors
    • Limited phonological awareness (e.g., rhyming, syllable blending)
    • Minimal interest in print
    • Limited print awareness (e.g., book handling, recognizing environmental print)
  • Delay in motor skills
    • Poor coordination, particularly fine motor (e.g., dressing, cutting, stringing beads, coloring)
    • Difficulty copying, drawing, and writing
• Attention and behavior
  • Distractibility/inattention
  • Impulsivity
  • Hyperactivity
  • Difficulty changing activities or handling disruptions to routines
  • Perseveration (i.e., constant repetition of an idea)

There also may be protective factors that mitigate some of these risks:

Protective Factors

• Access to quality pre-, peri-, and post-natal care
• High quality learning opportunities
  • Exposure to rich and varied vocabulary, syntax, and discourse patterns
  • Culturally and linguistically responsive learning environments
  • Engagement with print
  • Structured and unstructured individual/group play
  • Gross and fine motor activities
• Multiple levels of support
  • Assistance adapted to the child’s responsiveness to instruction or intervention
  • Access to adaptive and assistive technology and services
  • Transition planning between early intervention services (birth to age 3) and preschool programs (ages 3-5), and between preschool and elementary school
  • Service coordination among providers, agencies, etc.

Risk indicators do not necessarily mean that children will have learning disabilities. Similarly, protective factors do not rule out the presence of a disability. Children at risk may or may not have LD, but they often respond positively to high quality instruction and support. Therefore, these risk indicators should encourage substantial and serious efforts to facilitate early learning success.

The second part of the question asked about intervention strategies. We suggest consulting with the appropriate professional based on the risk factors seen. For example, if the child has receptive or expressive language problems or a lack of emergent literacy skills, seek the assistance of a speech-language pathologist. Referrals can be found on the Web site of the American Speech-Language-Hearing Association (ASHA) www.asha.org (click on Find a Professional). Or go through your local school system through Child Find. Tips for encouraging speech and language can be found at http://www.asha.org/public/speech/development/Parent-Stim-Activities.htm As another example, if a child is experiencing motor problems, seek the assistance of a physical therapist. Often a team will be involved and will include the parents, other caregivers, and professionals based on individual needs.

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Question from Ann Davis, Director of Special Services, Abbeville County Schools:
    Our speech therapists have been trained that pullout speech therapy equals intervention - What training and service delivery options to you recommend to change that pattern?

Dr. Diane Paul and Dr. Froma Roth:
    The predominant model of service delivery in speech-language pathology in schools has been and continues to be a pull-out approach. It often is difficult to convince parents and teachers that other models may be more appropriate for the development of speech and language skills. Communication services can take many forms ranging from traditional pull-out services to more indirect collaborative approaches. The prevailing view in clinics and education settings is that collaboration and team approaches are the appropriate and preferred practice.

Diane has summarized the three main service delivery models used in school speech-language pathology practice in a chapter in the book Early childhood inclusion: Focus on change , edited by M. J. Guralnick and published by Brookes.

We’ll provide brief descriptions here:

Pull-Out Model. Speech-language pathologist provides direct treatment in a separate therapy room with an individual or small group. Communication goals typically are separate from the classroom curriculum, but may be integrated. Reasons for a pull-out model may be (a) teaching certain skills requiring repetitive drills, (b) teaching a new behavior, (c) working with children who are easily distracted, or (d) working with children who have more severe disabilities. Some children also may prefer to receive special services out of the view of peers. Another reason for the prevalence of the pull-out model is the opportunity afforded to the speech-language pathologist to control communication variables by limiting auditory and visual distractions and structuring conversational exchanges. Problems inherent to a pull-out model are the isolation of the child, the difficulty with generalization to natural environments, and the lack of meaningful social-communication interactions. However, only a few studies have tested these assumptions.

Classroom-Based Model. The speech-language pathologist provides service directly in the classroom in coordination with the classroom teacher. The teacher, speech-language pathologist, parents, and others work together to select goals and determine appropriate intervention strategies. Possible advantages of a classroom-based model of service delivery include (a) targeting language goals more relevant to classroom needs; (b) better generalization of new skills; (c) the opportunity for professionals other than the speech-language pathologist to work with a student, thereby increasing the frequency of intervention; (d) alleviation of problems incurred by pulling the student out of the classroom; and (e) provision of services to students at-risk, but not identified or receiving services for a communication disorder.

Collaborative Consultation Model. Collaborative consultation models in speech-language pathology involve problem-solving and mutual goal setting from multiple perspectives that are relevant to a child's communication needs. Typically, the teacher is responsible for direct implementation, and the speech-language pathologist plays a more indirect role, offering information and guidance. The speech-language pathologist assists with decision points and changes in treatment plans. The responsibility, accountability, and resources are all shared in this model. With an indirect approach, the speech-language pathologist needs to make certain that teachers are implementing communication strategies in the classroom that support communication goals and that the strategies are used consistently and frequently.

Any one of these service delivery models may be used singly or in combination depending on a student’s communication needs over time. All service providers need to be familiar with the variety of service delivery models available and the ways each can be used to best meet the communication student needs. So how do you convince parents, teachers, administrators, others professionals, and even some speech-language pathologists to use classroom-based and collaborative consultation models in addition to pull-out approaches? One of the main barriers to the use of alternative service models is simply a natural resistance to change. Here are a few suggestions:

Provide in-service education and mentoring Through educational forums and informal exchanges, speech-language pathologists can motivate others by conveying information about the value of alternative service delivery models. Such in-service education programs are particularly important because graduate programs for speech-language pathologists have only recently started to provide course work and some clinical practicum opportunities with classroom-based and collaborative consultation service delivery models. Speech-language pathologists with more background and experience with alternative service delivery models could assist with in-service programs and follow-up by serving as mentors for other professionals.

Form collaborative partnerships Speech-language pathologists could form collaborative alliances with teachers, parents, and others who could serve as a guiding team and encourage and assist others. Strong leadership from the speech-language pathologist and the guiding team is critical to monitor progress, reinvigorate people with new ideas and strategies, and make necessary policy and practice changes. The most recent issue of Topics in Language Disorders focuses on developing and implementing collaborative partnerships in school-based settings to foster literacy.

Solicit administrative support In order to work within a common philosophy that is consistent with the use of a variety of service delivery models, it is crucial to have administrative support and leadership. If a collaborative guiding team is in place, this team can develop a plan to gain administrative support for the program. Necessary components of such a plan include: (a) providing clear information about goals and the rationale for the service models proposed, and (b) offering regular and frequent communication about child outcomes and program advances based on regular program evaluation. Goodin and Mehollin (1990) also have suggested elements of an administrative plan of action: (1) seek grant funds for pilot programs; (2) establish a district-level task force or teaming project with other programs that use alternative service models; (3) develop a plan for documenting program outcomes, including methods of instituting program changes, data collection, and program evaluation; and (4) address key issues, such as transitions from traditional to alternative models, flexibility in service delivery formats, caseload size, guidelines and procedures for referral, data collection, assessment, intervention, and placement.

Provide time for collaboration Speech-language pathologists and teachers need time to coordinate communication goals and objectives in conjunction with the classroom curriculum. They also need time to discuss student progress and modifications in intervention plans.

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Question from rene sorrentino, parent:
    When a child has a speech and language disorder diagnosed in early childhood but has not been given the proper intervention by the school district over the years, what can be done when the child is an adolescent and the language disorger effects his writing and other academics? Is it too late? My son writes like he speaks and cannot recognise impropper syntax in his reading.

Dr. Diane Paul and Dr. Froma Roth:
    It's not too late. Appropriate instruction and intervention can result in significant gains. The relationship between oral and written language is reciprocal and ongoing. This is critical because, for example, some students may be able to read accurately and automatically but may not be able to engage in inferential text comprehension. Likewise, possessing a good vocabulary does not guarantee the ability to handle the content of different text structures. It is also important to remember that older students may be functioning at an emergent or early literacy level and may require basic instruction in reading and writing. If this is the case, it is essential that the materials are not only developmentally appropriate but age appropriate. These examples demonstrate that students need competence in individual skills as well as their integration to handle the literacy demands of middle and high school. Some of the critical areas of focus are listed below. The following information is based on information from a report on adolescent literacy being prepared by the National Joint Committee on Learning Disabilities (NJCLD). Selection of the specific targets, of course, depends upon the strengths and needs of each individual student.

• Phonology, including phonological processing
• Semantics
• Syntax
• Pragmatics

These linguistic subsystems must be taught directly not only at the level of oral language, but also in reading and written expression.

• Reading (single word, fluency, and comprehension)
• Writing (spelling, handwriting/keyboarding, writing conventions, and written composition)

In addition, a variety of instructional strategies has been shown to be effective in effecting learning gains by older students especially when implemented in an explicit and intentional manner:

• Guided reading practice
• Reciprocal teaching
• Comprehension monitoring
• Graphic organizers (semantic networks, story maps, story grammar)
• Repeated reading
• Summarizing
• Paraphrasing

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Question from Mrs. Parker:
    I have a question concerning a 7 year old boy. He has a very difficult time with speech. He has trouble putting sentances together, he has a limited vocabulary, and he has difficulty putting his thoughts into words. He mixes up he and she often. He usually leaves out words such as "I going to school". He seems to make faster progress with reading than with speech development, although he struggles with reading also. Is this common? And what should be expected with his speech and reading development?

Dr. Diane Paul and Dr. Froma Roth:
    We highly recommend a comprehensive speech and language evaluation by a certified speech-language pathologist and a reading specialist. Such an evaluation may be provided in the school or by private practitioners. The American Speech-Language-Hearing Association (ASHA) provides a list of certified speech-language pathologists in your area. Go to http://www.asha.org and click on ’Find a Professional."

ASHA also provides information about typical speech, language, reading, and writing development in its brochure on Literacy and Communication: Expectations From Kindergarten Through Fifth Grade. This information is also on the Web site at http://www.asha.org.

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Question from Christine Russell, School Psychologist, Hopkins Pubilc Schools (Michigan):
    Our schools are using DIBELS (Dynamic Indicators of Basic Early Literacy Skills) assessments to help drive instruction, problem-solving, and decision making. We are finding that our students with speech needs are typically low on Phonemic Segmentation - a measure of overall phonemic awareness. Based on research, this is an essential skill to master for later reading success. Is are of deficit typical based on your knowledge of students with speech needs? How can our speech therapist increase her interventions in this area? What type of push-in services would be helpful?

Dr. Diane Paul and Dr. Froma Roth:
    Yes, phonemic segmentation is a difficult task for children with language impairments and children at risk for or with identified learning disabilities. It requires a child to understand that words are made up of individual sounds and requires the ability to explicitly parse words into individual phonemes. Please refer to other answers in this chat for specific suggestions for a speech-language pathologist.

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Question from Myrlane Ball, Special Education Teacher, Torrent River Academy:
    I used several strategies in order to enhance skills in phonological awareness to 2 students who are mainstreamed in grades 2 and 3. They are experiencing difficulty in this area. Can you suggest strategies I can use with them that will develop skills in phonological awareness?

Dr. Diane Paul and Dr. Froma Roth:
    Here is a sample of some suggestions for activities and resources.

1. Use tunes of popular children’s songs to draw children’s attention to the sound system. For example, ’Old MacDonald Had a Farm’ can be adapted to ’What’s the sound that starts these words, turtle, time and tooth?’ to foster alliteration. Following a response from the class, the song is completed in unison: ’/t/ is the sound that starts these words: turtle, time and tooth. With a /t/, /t/ here, and a /t/, /t/ there; Here a /t/, there a /t/, everywhere a /t/, /t/. /t/ is the sound that starts these words: turtle, time and tooth.’ Initially, a single sound can be emphasized throughout the entire song, and gradually, each verse can focus on a different sound (Yopp, 1992).

2. Other songs and song adaptations also work well. For example, the 1965 pop song The Name Game by Shirley Ellis, is an excellent way to practice sound substitution skills with the names of the students in a class (’Let’s do Donna, Donna Donna Bo Bonna Banana Fanna Fo Fonna, Fe Fi Mo Monna, Donna’). Repetition with student names and objects in the room encourage children to think about sounds in words.

3. Adams, Foorman, Lundberg, and Beeler (1998) provide a curriculum written for classroom teachers of well-explained activities that follow a developmental sequence for young children. Initial activities involve listening to environmental sounds and progress to rhyming and alliteration, and beyond. Materials include familiar songs, poems, rhyming books, finger plays, and chants, including ’This Old Man’, ’One Potato, Two Potato’, ’Two Little Feet’, and ’Teddy Bear, Teddy Bear’. Many of these materials also have accompanying motor movements to emphasize the target sound segments. The difficulty level can be increased gradually by changing the task to a cloze procedure in which the class is expected to supply the final rhyming or alliterative words.

4. Game-like formats also can be effective vehicles for promoting early sound awareness. Burns, Griffin and Snow (1999) offer the SNAP game, in which one ’player’ says two words. If the words share an initial sound (or rhyme), the other players say ’snap’ and snap their fingers; if not, everyone remains quiet. To be most effective, non-alliterative (or non-rhyming) pairs should be interspersed for contrast to maximize the children’s attention to the target sound properties.

5. Yopp and Yopp (2000) present sample activities that are appropriate for preschool, kindergarten, and first grade classrooms. An important feature of their work is the emphasis on providing phonological awareness instruction that is tied to meaningful literacy activities.

There also are a number of commercial programs and materials for teaching phonological awareness are available for use with students requiring additional support.

1. The Phonological Awareness Kit-Primary (PAK-P; 1995) is a program that provides individualized and sequenced phonological awareness instruction, and includes a section on rhyming intervention.

2. Phonological Awareness Training for Reading (1994) includes rhyming activities that are designed to focus children’s attention on the sounds of words. Detailed descriptions of each activity are given as well as precise instructions for implementing each activity.

3. DaisyQuest (1992) offers computer-based instruction with high quality graphics, engaging music and digitized speech to train rhyming skills. In this game-like format, rhyming instruction is embedded into the main game objective of finding a magical dragon.

4. Children’s literature provides another excellent source (Fitzpatrick’s 1997) book: Phonemic awareness: Playing with sounds to strengthen beginning reading skills) has a list of books by sound awareness category (e.g., rhyming, phoneme manipulation). It also contains a ’calendar’ of activities that can be conducted in class and then sent home to encourage family involvement.

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Question from Prema Rao, Research Scholar, University of Toledo, Ohio:
    Are there any alternate indicators to written language awareness that could be effectively implememented in a non-literate community?

Dr. Diane Paul and Dr. Froma Roth:
     Perhaps two of the best indicators are oral phonological processing skills and vocabulary knowledge. These can be used as alternate indicators because proficiency in both areas is predictive of literacy (i.e., reading and writing). There are three main phonological processing skills areas that can be assessed: (1) phonological awareness (implicit awareness of the sound structure of words), lexical retrieval (speed and accuracy of naming a series of items), and working memory (skill at repeating a series of digits).

Here are some resources that may be helpful:

• ASHA continuing education for-sale product: Toward an Understanding of Literacy Issues in Multicultural School-Age Populations by Joyce Harris
• Brice, A.(2002). The Hispanic child: Speech, language, culture, and education. Boston: Allyn & Bacon. This book has a short section entitled Enhancing literacy skills in Hispanic students with LLD.
• ASHA journal articles:
  • Scheffner, Hammer, C., Miccio, A. W., & Wagstaff, D. A. (2003). Home literacy experiences and their relationships to bilingual preschoolers’ developing English literacy abilities: An initial investigation. Language, Speech, and Hearing Services in Schools, 34, 20-30.
  • Laing, S. P., & Kamhi, A. (2003). Alternative assessment of language and literacy in culturally and linguistically diverse populations. Language, Speech, and Hearing Services in Schools, 34, 44-55.

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Question from Laura Pieper, LCSW Middlesex Hospital:
    Has there been a correlation between delays due to multiple ear infections (lack of hearing) in infancy and toddlerhood and LD later in school?

Dr. Diane Paul and Dr. Froma Roth:
    The research on this subject has produced mixed results. Some studies have found a relationship and others have not. A good resource on this topic is a meta-analysis by Michael W. Casby published in the American Journal of Speech-Language Pathology Vol.10, 65-80, February 2001, entitled ’Otitis Media and Language Development: A Meta-Analysis.’ This article can be found online at http://ajslp.asha.org/cgi/content/abstract/10/1/65
Other resources also are available on the ASHA Web site (type otitis media and language development in the search box).

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Question from Diane Katakowski, Speech-Language Pathologist, Oakland Intermediate School District:
    Oral language skills such as vocabulary knowledge, comprehension, and phonological awareness are some of the important building blocks of literacy development. What specific early intervention strategies targeting these oral language areas give the best outcomes for reading and writing skills in school?

Dr. Diane Paul and Dr. Froma Roth:
    It's important to follow principles of evidence-based practice when selecting intervention strategies: consider the best available scientific research in combination with professional expertise, and parent and family preferences and values. ASHA has developed a family of documents on reading and writing that provide information pertinent to this question. The ASHA guidelines, "Roles and Responsibilities of SLPs With Respect to Reading and Writing in Children & Adolescents," is based on a review of the literature and it discusses ways that SLPs can enhance preliteracy skills by working with children, parents and others to increase opportunities at home, in play groups, and in preschools and other natural environments. Strategies for supporting emergent literacy and preventing literacy problems include (a) joint book reading, (b) environmental print awareness, (c) conventions/concepts of print, (d) phonology and phonological processing, (e) alphabetic/letter knowledge, (f) sense of story, (g) adult modeling of literacy activities, and (h) experience with writing materials.’ Here are some suggested activities from the ASHA guidelines:

(a) Joint book reading: encourage shared reading experience between parent/other caring adult and child. During the interaction, they share the content, language, and images of children’s books. Frequent, regular storybook reading, starting at an early age, is an important factor in predicting later success with reading and writing tasks. During joint-book readings, adults make comments or ask the child questions about what has been read or what might be happening next to facilitate vocabulary development and comprehension.

(b) Environmental print awareness: helping children recognize familiar symbols and learn that print carries meaning (as in familiar logos and signs for fast food restaurants, street signs (STOP, EXIT), movie theatre signs, logos on cereal boxes and toys, familiar words in environmental contexts (e.g., "milk" on milk carton; "happy birthday" on greeting card).

(c) Conventions of print: helping children recognize print conventions and accepted standards or practices for interacting with printed materials by focusing on book handling experiences that highlight the following: left-right orientation of English print; front-to-back directionalilty of book reading by asking (for example, "Show me where I should start reading"); different forms of writing (for example, a letter versus a recipe); spaces between words by pointing them out and talking about them; punctuation in printed materials and its influence on how we read questions and exclamations.

(d) Phonology and phonological processing: playing with sounds in spoken language in nursery rhymes, alliteration, poems, finger plays, chants and television jingles, rhymes for children's names

(e) Alphabetic/letter knowledge: help children demonstrate knowledge of the alphabetic principle, relating printed letters and their equivalents in spoken language, when they show that they recognize printed letters of the alphabet and the sounds they make in words including naming letters, numbers, and frequent words; using letter blocks, finger painting, or sponges letters to make words; sorting pictures that begin with the same letter; making lists of words that begin with the same letter.

(f) Sense of story: helping children develop a sense of the narrative by seeing if they can answer questions about the story, retell it, or produce story-like sequences spontaneously. This helps with vocabulary development and comprehension and can be accomplished through reading storybooks that have well-developed story structures and a logical plot sequence that leads to a clear conclusion. Suggested books include wordless picture books that provide awareness of story, character, and other plot elements; predictable stories with repetitive themes and rhyme sequences; familiar daily sequence events; familiar stories and tales.’

(g) Adult modeling of literacy activities: encourage the child’s observation of adults in natural interactions with language, such as, writing down phone numbers, following recipes, writing a grocery list, looking up words in a dictionary, reading game instructions before playing a new game/toy, and doing word searches on the computer of interesting animals or children's characters.

(h) Experience with writing materials: make attractive writing implements and assorted paper available to children, and encourage the following: scribbling, drawing, writing letters/numbers, writing pretend notes (e.g., to the tooth fairy), copying environmental print, dictating a story to a wordless picture book, using children's writing software programs.

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Deanna Stecker (Moderator):
    The hour is up and we need to bring this LDTalk to a close. Thank you to everyone who submitted questions and to all who joined in and followed the discussion.

A very special thanks to our guests for sharing their expertise with us. A transcript of today's chat will be available at www.LDTalk.org very soon.

Please be sure to visit NCLD's Web site, www.LD.org for information about upcoming events.

You can also learn more about the relationship between early speech-language development and learning disabilities on the May 2006 LDTalk articles page.

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