When There’s More to the Story An SLP offers insight on why some students with speech sound disorders struggle with the same goals year after year. Overheard
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Overheard  |   July 01, 2016
When There’s More to the Story
Author Notes
  • Kelly Farquharson, PhD, CCC-SLP, is assistant professor and director of the Children Literacy and Speech Sound Lab at Emerson College in Boston. The mission of her research lab is to help children with speech and language disorders achieve classroom success. Prior to pursuing a research degree, she was a school-based clinician in Pennsylvania. She is an affiliate of ASHA Special Interest Groups 10, Issues in Higher Education; and 16, School-Based Issues. kelly_farquharson@emerson.edu
    Kelly Farquharson, PhD, CCC-SLP, is assistant professor and director of the Children Literacy and Speech Sound Lab at Emerson College in Boston. The mission of her research lab is to help children with speech and language disorders achieve classroom success. Prior to pursuing a research degree, she was a school-based clinician in Pennsylvania. She is an affiliate of ASHA Special Interest Groups 10, Issues in Higher Education; and 16, School-Based Issues. kelly_farquharson@emerson.edu×
Article Information
Speech, Voice & Prosodic Disorders / School-Based Settings / Overheard
Overheard   |   July 01, 2016
When There’s More to the Story
The ASHA Leader, July 2016, Vol. 21, online only. doi:10.1044/leader.OV.21072016.np
The ASHA Leader, July 2016, Vol. 21, online only. doi:10.1044/leader.OV.21072016.np
Susan Tonkin: Is a language screener sensitive enough to pick up the language deficits in the children with speech-sound disorders (SSD)? We always screen language during articulation testing, and the children’s language appears to me appropriate at the time of screening.
Kelly Farquharson: Honestly, I think it depends on the age. In kindergarten, it might be sensitive enough. In older grades, language is so much more complex, and they are required to use it in such complex ways—a screener doesn’t often capture those skills (here, I’m thinking of inferencing, etc.).
Carol Rice: I like to do a full language test even if it appears the student is “only artic” because of the chance of missing something with language.
Farquharson: I agree—a full language test is definitely ideal! I’m sensitive to the time pressures of school-based SLPs, though, so I am cautious in recommending that.
Patricia Johnson: This will likely be asking you to make an educated guess, but I am wondering: For the children in your study who showed reduced receptive and expressive vocabulary skills as compared to typically developing children years after dismissal, what do you think a vocabulary assessment at the time of dismissal would have shown? And should we be thinking about addressing and assessing vocabulary routinely for these “just artic” children?
Farquharson: I think if a depressed score on a vocabulary/language test at the time of dismissal had been collected, it could have highlighted some of the emerging areas of weakness that are influencing reading. I don’t necessarily think that a vocabulary test upon dismissal is the recommendation there—but, I do think we need to acknowledge that if a child has had a deficit for five years, it may have “bled into” other areas of the linguistic system. So, at the very least, collecting a language sample, or looking at some curriculum-based measures from the teacher might give us some insight about the child’s classroom performance. Minor errors in spelling and reading are often overlooked, and then they snowball into a larger issue.
Jennifer Vlcek: I have a child on my caseload with a diagnosed reading disability, visual processing problems (they are being addressed) and a learning disability. She also has working-memory deficits. She is 7 and has /r/, “th” and /s/, /s/-blends as errors. When we work on sounds, she can correctly say them, up to the sentence level, but in conversation, it all falls apart. Sometimes I wonder if I should just focus on the language issues and forget working on the sounds because they are not carrying over. I’m concerned that there is not enough time to work on all of her needs during a therapy session. She receives speech therapy at school twice a week and I am her outpatient therapist. She comes to occupational therapy and speech at our facility once a week due to parents’ busy work schedules. The school therapist and I are on the same page with our concerns. What do you think? Keep working on sound carryover? I want to do right by this child.
Farquharson: This is a great example of how complex these situations are. I do suggest continuing to work on sound carryover—but she would likely benefit from a highly contextualized therapy approach that combines her language and reading deficits into speech-sound practice. For instance, working on grade-level vocabulary within sentences or grade-level (or lower in her case) books that give her a chance to practice the sound and pair it with the graphemes. That will help to solidify her representations (at least as I think of it).
Julie Mahon: In my high-school life-skills setting, we have a student with a dual diagnosis of Down syndrome and autism. She is 16 and has recently made gains in her phonological and phonemic skills. Our teaching has been incorporating stories that she dictates about interests/events in her life and she participates in a class book club that includes reading aloud, discussing chapters, and writing and reviewing chapter summaries. Could you comment on what may be going on when students with persistent phonological difficulty and speech production deficits (and intelligibility issues) seem to “get it” and make a leap in skills? Do you have suggestions to ensure that we can keep it going?
Farquharson: Really interesting and complicated case! I know that we all wish we had insight into what happens when something “clicks” with a child. I would guess that for this child, based on what you shared, that the magic happened because you were focusing on something highly contextual that mattered to her. It was probably motivating for her to get to talk about her interests and events she’s experienced. We take for granted how that can influence a child’s motivation for participation. And, of course, that will drastically differ depending on the child!
Hannah Lacey: What should we do when dismissing students from therapy because they have met their articulation goals? Should we be keeping these students on our caseload as consultation only? Or should we just be informally notifying their classroom teachers of potential warning signs?
Farquharson: I don’t think it’s necessary to keep those kids on as consultation (I can just see the caseloads exploding if that were the case). I do think it’s important to have assessed more than just artic, though, in their dismissal. Checking on reading and spelling, in particular, would be important. I would ask the teacher for some examples of their class work—their spelling tests or whatever the teacher has—so that you can see functionally what is happening in the classroom with that child. If you have concerns after talking to the teacher and looking at classwork, then you can consider testing, or collaborating with the reading specialist to do some quick assessments. And yes, I love the idea of informing the teacher that things look good, but to keep an eye out for decoding and spelling issues (and to relay that message to next year’s teacher).
Crystal Pardy: I have parents who want the SLP to test their child for dyslexia. How would you respond to these parents? I have always been told it’s a medical diagnosis.
Farquharson: It is not a medical diagnosis. But, the hard part about the dyslexia diagnosis is that you need a nonverbal IQ (NVIQ) score from an educational psychologist (the “educational” part there is really important). Pair the NVIQ score with a word-reading score, and that can tell you if it’s dyslexia—if word reading is low and NVIQ is normal, that’s dyslexia. It depends on what state you’re in as to how I would recommend responding to the parents. If your state doesn’t use the word dyslexia, you need to be careful. (Although there is a movement with the parent-run organization Decoding Dyslexia to #saydyslexia because it’s a diagnosis we can easily make and that we actually 100 percent know how to help.) So, we should be using the term—but some states/school districts aren’t there yet.
(Editor’s note: Recent guidance from the U.S. Department of Education explains that dyslexia is expressly included as a condition that qualifies as a “specific learning disability” under the Individuals With Disabilities Education Act [IDEA]. The guidance was issued in response to concerns that schools are reluctant to use the term, believing that the condition is not included in IDEA.)
Sharon Downing: How do you address the idea of adverse effect with these students that you worry have language concerns? Our district always says that if the teacher isn’t seeing anything and there isn’t an “adverse effect” evident in the classroom, language therapy isn’t needed.
Farquharson: Ah, yes. Adverse effect. My newest project is examining just that—I could spend the next two hours talking just about that! Interestingly, what we have found so far is that there is substantial variability between and within states with respect to the interpretation of what is “adverse effect” or educational need. Connecticut does a nice job of considering reading aloud in class, peer and teacher perspective, social-emotional well-being, speaking in class, intelligibility, etc. So, think bigger than what their grade in math is. Think about their overall experience in the classroom. Do they avoid reading out loud because they are afraid of being made fun of? That is adverse effect.
Joseph Metzker: Do you have a vocabulary resource book, website, etc., for upper elementary/ middle school students with persistent difficulties?
Farquharson: I love books by Isabel Beck, such as “Bringing Words to Life” and “Creating Robust Vocabulary”.
Lesley Magnus: Which nonverbal tests are you using with your children and how early are you focusing on the language supplemental testing with those kiddos who have severe SSD (preschool years or when they get to school)?
Farquharson: The NVIQ tests that I have given are the Reynolds Intellectual Assessment Scales (RIAS) and the Kaufman Brief Intelligence Test (KBIT). I think any child referred for an SSD should receive comprehensive language testing as a part of the evaluation. I say that with the complete respect and understanding for how much time that will take.
Laura Staley: Can you give some examples of what NVIQ tests require of children?
Farquharson: In particular, I’ve used the RIAS subtests “What’s Missing” and “Odd-Item Out.” “What’s Missing” requires children to look at a picture of a common item with part of its characteristic features missing—like a bird missing its beak. In “Odd-Item Out,” the child sees several objects and has to identify the object that doesn’t fit the pattern of the others. That can be as simple as identifying a circle out of a group of squares or more complex, like identifying a specific pattern within a group of shaded squares. In both, nonverbal reasoning is tested using visualization and spatial reasoning.
Megan Long: As an SLP, have you gotten any negative feedback from performing an NVIQ? This is generally in the school psychologist’s domain.
Farquharson: I do not perform the NVIQ clinically—only for research purposes (and I’m qualified to do that through the publishing company). It is the educational psychologist’s domain in a clinical setting.
Laura Staley: What should I do if I cannot administer a NVIQ test?
Farquharson: Timely! That’s the biggest issue surrounding the NVIQ construct. If you cannot collaborate with a school psychologist (and typically, if you are in a school, you need to refrain from referring to a private educational psychologist!), then I offer two pieces of advice: one is to consider informal measures like play, Piagetian tasks (e.g., perspective taking) and drawing tasks (e.g., “Draw a Person”). The second option is to not worry about it. Make sure that you’re testing language and literacy and let the cognitive stuff come at another time.
Jill Stein-Wirth: Are there age limits as to potential progress with students as they become adults?
Farquharson: Dr. John Bernthal was one of my PhD advisers and he would always say that if they don’t have it by middle school, they aren’t going to get it. I don’t disagree, which is why I think it is so important to provide services earlier—third grade is just too late. However, I get it. I know what a caseload of 110 feels like. So, I have a hard time making blanket recommendations. But, I will say, if the SSD is not due to any organic causes (clefting, syndromes or hearing loss), then there is potential for progress with older children if they are motivated to do the work. That responsibility cannot lie on our shoulders.
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July 2016
Volume 21, Issue 7