clinical applicationsimages.pearsonclinical.com/images/pdf/all_man_chp_4.pdfpriate intervention that...

41

Chapter

Clinical Applications

Numerous publications have underscored the importance of the early identification of chil-dren who are at risk for language and reading impairments (Badian, 1998b, 2000; Flynn, 2000; National Reading Panel, 2000; Scarborough, 1998, 2002; Scarborough & Dobrich, 1990; Snow, Burns, & Griffin, 1998; Torgesen, 2000, 2004). Early identification insures that children who need the most help in acquiring language and literacy skills for later school success will receive it. Often, children placed in effective prevention programs achieve suf-ficient language and emergent literacy skills to ameliorate or eliminate the need for later intervention (Bowey, 2000; Duncan & Seymour, 2000; Hagtvet, 2000; Vellutino & Scanlon, 2002). This is especially true for children who come from diverse backgrounds and disad-vantaged economic environments (Blachman, Ball, Black, & Tangel, 1994; Brady, Fowler, Stone, & Winbury, 1994; Gee, 2002). Other preschool children, in particular those diag-nosed with severe language difficulties or those who appear to be headed for a diagnosis of specific reading disability (i.e., dyslexia), will benefit from scientifically based intervention practices that are delivered “early, intensively, and appropriately” (Torgesen, 2004, p. 6). Although the literature is clear that these deficits will follow the children throughout their lifetimes, it is also clear that with the appropriate intervention, these children can achieve a level of language and literacy function that will support them in achieving their academic, social, and vocational success (Silliman, Bahr, Wilkinson, & Turner, 2002).

Effective prevention and scientifically based intervention depend first and foremost on an accurate identification and assessment process of those children who exhibit language impairments and those who are at-risk for reading impairments. This process involves not only the identification and diagnosis of impairments, but also the description of the char-acteristics of the impairments including strengths and weaknesses across components of language and emergent literacy. ALL enables such a process and profiles children’s perfor-mance into one of four patterns:

• Profile 1: Language Disorder;

• Profile 2: Language Disorder and Emergent Literacy Deficit;

• Profile 3: Emergent Literacy Deficit; and

• Profile 4: Weak Language and Emergent Literacy Skills.

The value of examining profiles is twofold: (1) profiles established prior to reading acquisition aid in predicting later reading achievement and the nature of future reading difficulties, and (2) profiles provide clinicians with a framework for making informed decisions about the type of prevention or intervention program that is likely to provide optimal success in advancing language and/or emergent literacy skills. Thus, profiles permit clinicians to translate assessment findings into appropriate, quantifiable, and empirically based preven-tion and intervention objectives and methods (Justice & Ezell, 2001).

4

Copyright © 2006 by Harcourt Assessment, Inc.All rights reserved.

Chapter 4

42

The profiles demonstrate a range of the children’s strengths and weaknesses in the areas of language and emergent literacy. Some profiles appear to be similar, such as Profiles 2 and 4, and Profiles 3 and 4. To distinguish between these profiles, clinicians must consider background and developmental history factors that can be obtained by asking caregivers to complete the Caregiver Questionnaire. In the following paragraphs, each profile is briefly described. In addition, case studies are included with guidelines for distinguishing among similar profiles and suggestions for prevention and intervention. The following profiles are based on an integration of the authors’ clinical assessments of young children over many years, along with empirical data from the literature.

Profile 1: Language DisorderChildren who exhibit Profile 1 show deficits in the pragmatic, semantic and/or syntactic domains of language. Often they are identified with Specific Language Impairment (SLI), a classification describing language disorders of an idiopathic nature that are not a con-sequence of intellectual, sensory, or emotional problems (Bloom, 1988; Leonard, 1998). Typically children with language disorders are four to five times more likely to experience reading difficulties during the school years than their typically developing peers (Catts et al., 1999). What characterizes children with Profile 1 is relative strength in phonics knowl-edge, decoding, and word identification during the early stages of reading. Sometimes they may demonstrate a relative weakness on tasks, such as elision, that require working mem-ory skills to manipulate phonological sequences.

Children who fit Profile 1 exhibit deficits in reading comprehension around third and fourth grade. Proficient reading comprehension is built upon a strong foundation of lan-guage that includes knowledge of vocabulary and word relationships and good listening comprehension. Underscoring this point are studies that have shown that otherwise nor-mally developing children who have depressed reading comprehension exhibit comparable skills in reading and listening comprehension (Nation, Clarke, & Snowling, 2002; Stothard & Hulme, 1995).

The following is an example of Profile 1, which shows a child with deficits in language but average skills in the phonological and phonological-orthographic processes.



43

Figure 4.1 Example of Profile 1 Scores: Language Disorder


Chapter 4

44

Figure 4.1 Example of Profile 1 Scores: Language Disorder (continued)



45

InterventionChildren who exhibit language disorders need early intensive and developmentally appro-priate intervention that addresses their specific language deficits. This intervention must take place in the least restrictive and most inclusionary or naturalistic environment (Weiss, 2001). Most preschool and school-age children benefit from a combination of quality, lan-guage-rich, classroom-based intervention as well as one-on-one intervention. The primary goal of preschool classroom-based intervention is the enhancement of language and lan-guage use by embedding instruction in routine, planned or child-initiated activities such as snack time, a trip to the store, or building with blocks (Bricker & Cripe, 1992). At the school-age level, language-based classroom intervention combines naturalistic and struc-tured activities to develop more abstract vocabulary, advanced morphology and complex syntax, classroom discourse, and literate language styles (Paul, 2001). According to Westby (1991), the primary language goal at the school-age level is acquiring a new style or register of language called the literate language style. To achieve this goal, clinicians need to embed language goals in the curriculum; move from oral to written forms of expression; and focus on “meta” activities that bring children’s language and thinking skills to a conscious level of awareness (Paul, 2001). In addition to supporting individual language goals, classroom-based intervention provides numerous opportunities to support general language goals that contribute to both listening and later reading comprehension. These include enhancing world knowledge, oral vocabulary development, use of a variety of sentence types and dis-course structures, story retelling, and book sharing.

In one-on-one language intervention for both preschool and school-age children, clini-cians typically select among three general approaches: clinician-directed, child-centered, and hybrid (Fey, 1986; Paul, 2001). Each of these approaches allows clinicians to target specific pragmatic, semantic, and/or syntactic goals using a variety of materials and activi-ties depending on the individual child’s deficits (Paul, 2001; Weiss, 2001). For better results, language goals may be embedded in a conversational context that not only teaches children “what to say” but also teaches them “to whom,” “where,” and “when to say it.” For the best results, clinicians may collaborate with caregivers and teachers to develop strategies that promote children’s use of language skills at home and in school. For a detailed description of goals, materials, and activities for the development of language in preschool children, clinicians may consult Paul’s Language Disorders from Infancy Through Adolescence (2001) or Weiss’ Pre-school Language Disorders Resource Guide (2001). Similar information on the development of language for kindergarten and first-grade children is also included in Paul’s work.

Profile 2: Language Disorder and Emergent Literacy Deficit

Children who exhibit Profile 2 show deficits in language as well as deficits in emergent literacy. Boudreau and Hedberg (1999) found many young children with SLI who also exhibited difficulty on tasks measuring word rhyming, letter naming, and the association of spoken words with their written counterparts. Once these children begin reading, they may show initial weakness in word recognition, word decoding, and spelling. In the later grades, they show an additional weakness in reading comprehension that can be attributed directly to their poor language foundations.


Chapter 4

46

Children who exhibit Profile 2 may evolve into a pattern of reading disability called garden-variety reading impairment. Garden-variety reading impairment refers to a large proportion of reading disabilities in which children perform poorly in both the language and phonological and/or phonological-orthographic domains necessary for skilled reading, thereby resulting in both poor word recognition and poor reading comprehension (Catts, Hogan, & Fey, 2003). These children belong to a heterogeneous group whose poor read-ing skills appear to be influenced by language deficits and lowered intellectual functioning resulting from weak language processing.

The factors that assist in distinguishing Profile 2 from Profile 4 (Weak Language and Emergent Literacy Skills) include developmental language history, family history of language problems, the nature of the language and literacy environment, and response to intervention. Children who exhibit Profile 2 typically have a history of developmental language problems. In addition, they may have family members who also had early lan-guage problems despite coming from backgrounds that provided adequate exposure to language and literacy experiences. Finally, they may respond poorly to core group prevention programs, requiring more systematic, intensive, and explicit intervention. The following are two sample case studies typical of Profile 2. The first (2a) describes a child in the fall semester of first grade who has a current diagnosis of Specific Language Impairment (SLI). The child has language and phonological deficits. The second (2b) describes a child in the spring semester of kindergarten who has a current diagnosis of SLI. The child has language, phonological, and phonological-orthographic deficits.



47

Figure 4.2 Example of Profile 2a Scores: Language Disorder and Emergent Literacy (Phonological) Deficit


Chapter 4

48

Figure 4.2 Example of Profile 2a Scores: Language Disorder and Emergent Literacy (Phonological) Deficit (continued)



49

Figure 4.3 Example of Profile 2b Scores: Language Disorder and Emergent Literacy (Phonological and Phonological-Orthographic) Deficit


Chapter 4

50

Figure 4.3 Example of Profile 2b Scores: Language Disorder and Emergent Literacy (Phonological and Phonological-Orthographic) Deficit (continued)



51

InterventionChildren who exhibit Profile 2 benefit from the recommendations for developing language skills associated with Profile 1. As in Profile 1, the development of strong language skills lays the foundation for emergent literacy development. As children engage in a language-rich environment to promote growth in vocabulary and grammar, they require a parallel approach to address their weaknesses in emergent literacy skills. These children may respond well to classroom instruction that includes activities at the prekindergarten level for print awareness, phonological awareness, and alphabet knowledge. At the kindergar-ten and first-grade levels, they need continued instruction in phonological and phonemic awareness skills (e. g., rhyming; sound categorization; blending sounds; segmenting sen-tences, syllables, and words; and manipulating sounds) as well as systematic practice with letter-sound correspondences. According to the National Reading Panel (2000), the most effective evidence-based instructional programs combine the use of letters with phonologi-cal awareness activities to demonstrate the impact of phonological awareness principles on reading and writing. In these approaches, children typically receive from 5 to 18 hours of small group instruction, with lessons lasting an average of 25 minutes. Examples of programs that target both phonological awareness and letter-sound correspondence (i.e., phonics knowledge) include Ladders to Literacy: A Preschool Activity Book (Notari-Syverson, O’Connor, & Vadasy, 1998) and its companion, Ladders to Literacy: A Kindergarten Activity Book (O’Connor, Notari-Syverson, & Vadasy, 1998); Phonemic Awareness in Young Chil-dren: A Classroom Curriculum (Adams, Foorman, Lundberg, & Beeler, 1998); and Phonemic Awareness Activities for Early Reading Success (Blevins, 1999) and its companion, Phonics from A to Z (Blevins, 1999).

For children who need more intensive small-group or individual instruction, teachers and clinicians may consult Developmental Reading Disabilities: A Language-Based Approach, 2nd Edition (Goldsworthy, 2003); the Phonological Awareness Training Program for Reading(Torgesen & Bryant, 1994); Road to the Code (Blachman, Ball, Black, & Tangel, 2000); and The Lindamood Phonemic Sequencing Program for Reading, Spelling, and Speech® (LiPS®; Lindamood & Lindamood, 1998). Each of these programs provides more systematic and intensive opportunities for practice and meets the National Reading Panel criteria for effectiveness. For practice in decoding and spelling more advanced letter-sound correspon-dences, syllable patterns, and morpheme patterns, Unlocking Literacy: Effective Decoding and Spelling Instruction (Henry, 2003) offers strategies for teaching letter-sound rules.

For those children who need a long-term integrated approach to their language and emer-gent literacy deficits, Language! A Literacy Intervention Curriculum (Greene, 1995) offers a comprehensive curriculum for grades 1 through 12 that systematically and explicitly teaches the five core components of early reading: phonological awareness, alphabetic knowledge (phonics), fluency, vocabulary, and comprehension.

Profile 3: Emergent Literacy DeficitChildren in Profile 3 are typical of young children who may go on to be diagnosed with developmental dyslexia during the early school years. The term developmental dyslexia, often called specific reading disability, refers to a “specific learning disability that is neurobiological in origin,” and “characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities,” which “typically result from a deficit in the phonological component of language. These children always exhibit a weakness in learning


Chapter 4

52

and remembering phonemic awareness, decoding, and spelling skills. Secondary conse-quences may include reading comprehension difficulties and reduced reading experience that can impede growth of vocabulary and background knowledge” (Lyon, Shaywitz, & Shaywitz, 2003, p. 2). Prior to the onset of reading, children with developmental dyslexia may demonstrate mild deficits in speech and/or language, but typically these deficits go undiagnosed until the children are introduced to the emergent literacy principles (i.e., early phonics, the alphabetic principle). Background and developmental factors frequently reveal a history of minor articulation problems and other subtle language deficits (e.g., word-finding problems), as well as a family history of reading difficulties. During the period between the second half of kindergarten and second grade, unexpected difficulties emerge in word decoding, word recognition, and spelling (Vellutino, Scanlon, & Lyon, 2000). At this initial stage of learning to read, reading comprehension may appear to be somewhat reduced due to the slow, laborious rate at which these children read. This apparent diffi-culty with reading comprehension often resolves to some degree once the children become more fluent readers because their good language foundations and listening comprehen-sion skills enable them to make accurate inferences from reading materials in spite of their reading fluency difficulties. Thus, these children often demonstrate reading comprehension abilities that exceed their word-reading and decoding skills and continue to demonstrate varying levels of difficulty with spelling. Typically, these children fall behind in learning to read even when they receive strong classroom instruction. Because of the serious nature of their impairments, they require instruction that is more intensive, more explicit, and more supportive than can be experienced in a typical classroom (Torgesen, 2004). These children require much more repetition than other children and respond best to one-on-one tutoring (Vellutino, Scanlon, & Tanzman, 1998). Finally, explicit and multi-sensory instruction requires that teachers “leave nothing to chance.” Research acknowledges various explicit and multisensory instructional methods that share a number of underlying principles and are equally effective in promoting reading achievement. They involve comprehensive, sys-tematic, sequential, and direct instruction (Torgesen, 2004).

On ALL there is a clear distinction in performance between children identified with SLI (Profiles 1 and 2) and children who go on to be diagnosed with dyslexia (Profile 3). This distinction is supported by Bishop and Snowling (2004) who concluded that specific lan-guage impairment and dyslexia are separate disorders. The major distinction between these populations occurs on tasks that assess phonological skills (e.g., phonological awareness, decoding, spelling) versus tasks that assess nonphonological language skills (i.e., semantics, syntax). Children with dyslexia have deficits in phonological skills and strengths in non-phonological language skills, especially listening comprehension; whereas, children with SLI show deficits in nonphonological language skills (i.e., semantics, syntax), with (Profile 2) or without (Profile 1) accompanying deficits in phonological skills. What distinguishes chil-dren with dyslexia from children with specific language impairment is their ability to use their relatively good language skills to compensate for their weaknesses at the word reading level (Stothard, Snowling, Bishop, Chipchase, & Kaplan, 1998). Thus, reading comprehen-sion is often far superior to decoding skills.

Profile 3 describes a child in the spring semester of kindergarten who has a current diagno-sis of SLI. This profile characterizes the deficit pattern in young children who may later be diagnosed with developmental dyslexia.



53

Figure 4.4 Example of Profile 3 Scores: Emergent Literacy Deficits


Chapter 4

54

Figure 4.4 Example of Profile 3 Scores: Emergent Literacy Deficits (continued)



55

InterventionChildren who are likely to exhibit developmental dyslexia will require a multisensory approach to reading (Henry, 2003). In multisensory approaches, teaching involves taking advantage of all learning pathways in the brain (visual/auditory, kinesthetic/tactile) simul-taneously to enhance memory and learning. Other features of multisensory approaches include the sequential organization of language content from the easiest, most basic ele-ments to the most difficult; direct teaching of all concepts, with continuous teacher-child interaction; continuous assessment and adjustment of the instructional plan to meet the child’s needs; mastery of concepts to the degree of automaticity; and alternation between synthetic and analytic instruction.

Some of these children need explicit instruction in phonemic awareness prior to instruc-tion in learning to read. One example of a comprehensive multisensory approach to the development of phonemic awareness is the Lindamood Phonemic Sequencing Program for Reading, Spelling, and Speech (LiPS; Lindamood & Lindamood, 1998).

Once phonemic awareness and early phonics skills are in place, teachers may continue instruction with one or another of the commercially available reading programs that are based on the Orton-Gillingham, multisensory philosophy such as The Wilson Reading Sys-tem (WRS; Wilson, 1988) or the Barton Reading and Spelling System (BRSS; Barton, 2000). The WRS is a highly structured reading and writing program for struggling readers in grades 2 through 12. Originally developed for children with developmental dyslexia, it has been expanded to meet the needs of most children who are reading below grade level, but especially English-language learners. The basic goal of the WRS is to teach fluent decoding and spelling skills while providing extensive instruction in the five essential components of Reading First: phonological awareness, alphabetic knowledge (phonics), fluency, vocabulary, and comprehension.

The BRSS provides one-on-one tutoring to improve reading, writing, and spelling skills in children with developmental dyslexia or other language/learning disabilities. It is designed for use by parents, tutors, teachers, and clinicians. Supported by independent scientific research, the BRSS is an Orton-Gillingham influenced approach that meets the criteria for No Child Left Behind.

Profile 4: Weak Language and Emergent Literacy Skills

Children who demonstrate Profile 4 generally show low-average to deficient skills in both language and emergent literacy or in emergent literacy only. Typically, these children have limited exposure to language and emergent literacy experiences prior to entering school. In fact, it is the intent of the authors to reserve Profile 4 for children whose impairments result from an environment that lacks adequate exposure to language and emergent literacy expe-riences. Oftentimes these children do not have a diagnosis and have not received language therapy during the preschool years; however, some may have attended Head Start or similar programs if they came from disadvantaged backgrounds. While children who demonstrate Profile 4 may not be depressed in every skill assessed, the majority of their skills will fall in the low-average to below-average range.


Chapter 4

56

The children described in Profile 4 may appear remarkably similar to children in Profiles 2 and 3; however, it is important to differentiate the children described in Profile 4 from the children in Profiles 2 and 3. Children described in Profile 2 have both language and emergent literacy deficits; whereas, children described in Profile 3 have emergent literacy deficits only. To distinguish accurately among the various profiles, clinicians must consult information on family history, language development, nature of the language and literacy environment, and response to intervention (refer to the Caregiver Questionnaire).

Frequently, the children described in Profile 4 come from environments that do not fos-ter or promote language and emergent literacy skills; thus, they enter school with a broad range of weaknesses in the language and emergent literacy skills that support academic achievement. More specifically, they lack strong phonological awareness and print-related knowledge as well as sufficient background knowledge, well-developed vocabularies, and strong knowledge of complex syntax—all of which are needed for good reading compre-hension from third grade and beyond (Torgesen, 2004). The gap in skills between these children and their more advantaged peers begins early, long before children enter school, and continues to widen as children progress through the grades. By age 2, children from low income families experience large differences in familiarity with unusual words, stan-dard pronunciation, and complex syntax; and by age 3, familial trends in amount of talk, vocabulary growth, and style of interaction are well established (Hirsch, 2001). In fact, many children entering kindergarten from low-income families have heard only half the words and can understand only half the meanings and language conventions that children from working-class families can, and less than one-third of those that children from high income families can. The major reason for this substantial language gap is that children from economically disadvantaged families engage in significantly fewer language and emergent literacy interactions overall during the preschool years and fewer encouraging interactions (Hart & Risley, 1995, 2003). Thus, the nature and magnitude of this problem become painfully apparent. Without intervention, even children from low-income families who learn to read fluently will continue to show substantial deficits in vocabulary and com-prehension (Hirsch, 2001).

The following profile describes a child in the fall semester of prekindergarten who has no previous or current diagnosis for impairments.



57

Figure 4.5 Example of Profile 4 Scores: Weak Language and Emergent Literacy Skills


Chapter 4

58

Figure 4.5 Example of Profile 4 Scores: Weak Language and Emergent Literacy Skills (continued)



59

Prevention and InterventionPrekindergarten children who come from economically or culturally and linguistically diverse backgrounds are at high risk for developing later reading impairments and other academic problems. Many studies show that when these children are immersed in rich communication and emergent literacy activities, they achieve substantial growth in all areas of development (Bunce, 1995; Rice & Wilcox, 1995). Through high-quality, early educa-tional programming, these children achieve the experiences they need to prevent reading failure and to acquire the communication, language, and emergent literacy skills that form the basis for academic achievement throughout the school years. The goal of this early pro-gramming is to ensure that all children are ready to read and ready to learn by third grade. In 2002, the American Speech-Language-Hearing Association’s (ASHA) Literacy Coordinat-ing Research Committee identified six model preschool programs that give young children, especially those from economically or culturally and linguistically diverse backgrounds, a head start toward achieving this goal. These programs include: Language-Learning Early Advantage Program (Roth, 2002); Language Acquisition Preschool Program (Bunce, 1995); Emerging Language and Literacy Program (Children’s Therapeutic Learning Center, 1999); Cabrini-Green Preschool Language and Preliteracy Curriculum (Watkins & Johnson, Uni-versity of Illinois) in conjunction with the written curriculum The Leap Preschool Language and Preliteracy Curriculum (Lybolt, Techmanski, Armstrong, & Gottfred, in press); Early Childhood Speech and Language Programs (Texas Christian University); and Animated Literacy (Stone, 1995). All of these programs focus on the explicit enhancement of oral lan-guage skills (e.g., vocabulary, syntax, story retelling, and listening comprehension) as well as specific emergent literacy skills (e.g., phonological awareness, letter identification, phonics instruction). The successful performance on the language skills included in these programs have been shown to be highly predictive of later reading achievement, especially reading comprehension. See appendix H for more information.

Another program that has proven effective is the Systematic Instruction in Phoneme Aware-ness, Phonics and Sight Words (SIPPS) (Shefelbine & Newman, 2004). It is a structured yet flexible decoding program that develops word recognition strategies and skills for fluent reading. Field tested on diverse learners, including children from urban areas and English-language learners, the program provides three levels of instruction to be used with begin-ning readers who are just learning to make letter and sound associations and with children who are still struggling. The three levels of SIPPS target phoneme awareness, phonics, high-frequency sight words, spelling patterns, and polysyllabic decoding strategies.

For older children in kindergarten and beyond, the key to overcoming the language gap is intensive instruction (Hirsch, 2001). If these children are to make up for lost time in knowledge and vocabulary, instruction must be systematic, analytical, and explicit, and it must begin as early as possible. Further, the content of that instruction has to be enriched with concepts of history, science, mathematics, literature, art, and music so that these chil-dren will acquire the knowledge and motivation to become “readers in the true sense.” One example of a comprehensive and integrated approach to the development of language and literacy skills is Language! A Literacy Intervention Curriculum (Greene, 1995), described pre-viously in Profile 2. The program directly targets all of the language arts strands—listening, speaking, reading, writing, and spelling—and teaches the entire English code in a sequential and cumulative format to the level of automatic application.


clinical applicationsimages.pearsonclinical.com/images/pdf/all_man_chp_4.pdfpriate intervention that...

Documents