Beyond Articulation: The Broader Scope of Speech and Language Therapy

 

We are delighted to welcome back guest blogger, Craig Selinger, M.S. CCC-SLP, Speech Language Pathologist, who will share important information about speech-language therapy. Craig has nearly 20 years of experience in the field and is presently CEO and Founder of Brooklyn Letters, serving NYC metro area families with at-home in-person 1:1 specialized services.

Introduction

When most people think of speech therapy, they envision helping children pronounce words correctly. However, speech and language therapy encompasses much more than articulation. For students facing literacy, expressive language, and comprehension challenges, speech-language pathologists (SLPs) address fundamental components that impact communication and academic success. This expanded scope of therapy is crucial, especially when considering the overlap between conditions like dyslexia and other learning challenges.

Expanding the Focus: Key Components of Speech and Language Therapy

SLPs work with students on several essential areas beyond articulation to improve language processing and literacy outcomes. Here's a deeper look at the crucial components:

Phonology: The Sound Structure of Language

Phonology refers to a language's sound system and the rules for combining sounds. SLPs work with students to develop phonemic awareness, essential for decoding words and improving reading and spelling skills. Children who struggle with phonology may find it challenging to manipulate sounds within words, impacting their literacy development. This becomes even more critical when addressing dyslexia, a condition characterized by word reading difficulties.

Morphology: The Structure of Words

Morphology focuses on the smallest units of meaning in language, such as roots, prefixes, and suffixes. Research indicates that a high percentage of English words consist of multiple morphemes. For example, the word walked contains two morphemes, "walk" and "ed." Poor morphological awareness can lead to difficulties recognizing and comprehending morphologically complex words, which is common in written text. Studies show that explicit, systematic instruction in morphology can significantly enhance literacy outcomes by improving decoding and comprehension skills.

Four Components of Morphology Impacting Literacy:

• Morphological Awareness: Understanding how morphemes function in spoken and written forms aids students in decoding and comprehending unfamiliar words.
• Syntactic Morphological Knowledge: This involves recognizing how affixes, such as "un" and "ate," change parts of speech, which is crucial for reading accurately and writing effectively.
• Semantic Morphological Knowledge: Understanding the meanings of words based on their morphemic components supports comprehension.
• Orthographic/Phonological Morphological Knowledge: This knowledge helps with spelling and pronunciation, impacting overall written literacy skills.

Syntax: Sentence Structure and Grammar

Syntax refers to the arrangement of words to form meaningful sentences. It plays a significant role in reading comprehension and written expression. Written syntax is more complex than oral syntax, and understanding sentence structure, length, and complexity affects the cognitive load during reading. Research highlights that syntactic and morphological knowledge have the strongest predictive relationship with reading comprehension, making syntax a key area of focus in literacy development.

    

Semantics: Understanding and Using Vocabulary

Semantics involves the meaning of words and sentences. A strong semantic foundation helps students understand word relationships, multiple meanings, and contextual usage. This understanding is crucial for effective reading comprehension and expressive language skills. Explicit vocabulary instruction, as supported by the Every Student Succeeds Act (ESSA), is essential for enhancing language structure and reading outcomes.

Pragmatics: Social Use of Language

Pragmatics refers to the rules governing the use of language in social contexts. It involves understanding how to initiate and maintain conversations, use appropriate tone and gestures, and interpret social cues. Pragmatic skills are closely tied to Theory of Mind—the ability to understand and attribute thoughts, beliefs, and emotions to oneself and others. This skill is crucial for perspective-taking, which is key to social-emotional growth and effective communication.

Connecting Pragmatics to Reading Comprehension and Social-Emotional Development: Children with strong pragmatic skills are better equipped to grasp characters' perspectives and emotions in stories, enhancing their reading comprehension. Students who understand different viewpoints and emotions can engage in richer discussions about texts and build stronger connections to the material. Moreover, perspective-taking is foundational for social-emotional growth, allowing children to form meaningful relationships and respond empathetically in various situations.

Narrative Skills: Bridging Oral and Written Language

Narrative skills involve organizing and conveying information logically. Storytelling is not just about recounting events; it helps students understand sequencing, main ideas, and cause-and-effect relationships. This ability is a vital link between oral expressive language and written language development. As children improve in organizing and expressing their thoughts clearly, these skills transfer to written expression, enhancing creativity and structure in their writing. Furthermore, strong narrative abilities are closely linked to social communication skills and reading comprehension, making them a central focus in language intervention.

Spelling: A Sensitive Measure of Language-Based Skills

Spelling is not merely a mechanical skill; it is a highly sensitive measure that provides unique and detailed insights into various language-based skills involved in decoding and encoding. When assessing spelling abilities, SLPs can gain valuable data on the following components:

Phonological Awareness: The ability to recognize and manipulate sounds within words. Children who struggle with spelling often struggle to isolate and identify sounds, indicating phonological awareness gaps.

Orthographic Pattern Awareness: Understanding common patterns in written language. This awareness involves recognizing spelling conventions and rules, such as silent letters or vowel-consonant combinations, contributing to accurate spelling and decoding.

Vocabulary and Semantic Awareness: Students should be aware of word meanings and relationships. As they expand their vocabulary, their spelling accuracy improves, especially with homophones and words with multiple meanings.

Morphological Awareness: The recognition of word roots, prefixes, and suffixes. Breaking down and spelling morphologically complex words demonstrates a student's understanding of how morphemes contribute to word formation and meaning.

Orthographic Lexical Word Forms in Long-Term Memory: The mental storage of familiar word spellings. Students rely on their mental lexicon to accurately spell common words they have encountered frequently, highlighting the role of long-term memory in spelling proficiency.

Spelling errors can reveal where breakdowns occur in these areas, providing SLPs with a deeper understanding of students' specific challenges. Addressing these components through targeted intervention improves spelling and strengthens overall literacy skills.

Connecting Oral and Written Language

A fundamental goal of speech and language therapy is to bridge the gap between oral and written language. Students who develop strong oral expressive language skills often find translating their thoughts into written words easier. Through structured storytelling and narrative activities, SLPs guide students in building coherent and detailed written narratives that reflect their verbal storytelling abilities.These narrative-based interventions are especially significant in the cases of dyslexia and other learning differences. While dyslexia primarily affects decoding and word recognition, students with other learning differences often struggle with organizing and expressing their ideas orally and in writing. By focusing on narrative development, SLPs help students create a cohesive link between oral and written language, essential for effective communication and academic success.

Receptive Language and Reading Comprehension

Receptive language encompasses the skills required to understand and process auditory information. This includes listening comprehension, following directions, and processing spoken language. In the context of reading comprehension, students need strong receptive language skills to decode words and understand the broader meaning of what they read.

SLPs focus on improving listening comprehension, which directly supports reading comprehension. As children enhance their ability to process auditory information and grasp spoken language, they become better equipped to understand written texts. This connection between receptive language and reading comprehension is vital for students with a wide range of learning differences, who may face challenges in both listening and reading. By targeting these foundational skills, SLPs can improve students' comprehension abilities, fostering a deeper understanding of the material they encounter in both oral and written formats.

Why Work with a Certified Speech-Language Pathologist (SLP)?

If a student has a language disorder or shows signs of dyslexia, working with a licensed speech-language pathologist (SLP) with expertise in these areas is essential. SLPs have the qualifications and training to accurately assess and treat language disorders, such as expressive language disorder, mixed expressive-receptive disorder, and dyslexia. Their specialized knowledge allows them to design individualized therapy plans to improve the student's language, cognitive-communication, and literacy skills, providing targeted support that addresses current challenges and long-term development.

Importance of Explicit, Systematic Instruction

Explicit, systematic instruction is crucial to effectively addressing these areas. This involves teaching students how to decode words, understand their meanings, and recognize syntactic rules to improve reading and literacy outcomes. Instructional techniques like sentence combining, word building, and conversational recasts are more effective than isolated drills, as they embed learning within meaningful contexts.

Considerations for Culturally and Linguistically Diverse Students

When working with culturally and linguistically diverse students, it's important to refrain from directly translating English assessments, as differences in phonology, morphology, and syntax between languages can yield inaccurate results. Tailoring literacy assessments and interventions to the needs of diverse learners ensures accurate identification of strengths and areas needing support.

Conclusion

Speech and language therapy is far more comprehensive than correcting pronunciation. By addressing phonology, morphology, syntax, semantics, pragmatics, narrative skills, and receptive language abilities, SLPs can significantly boost comprehension, processing, and literacy outcomes.

What Does a Speech-Language Therapist Do?

We are delighted to welcome a guest blogger, Craig Selinger, M.S. CCC-SLP, Speech Language Pathologist, who will share important information about speech-language therapy. Craig has nearly 20 years of experience in the field and is presently CEO and Founder of Brooklyn Letters, serving NYC metro area families with at-home in-person 1:1 specialized services.

A speech-language therapist (SLT), speech-language pathologist (SLP), or simply language therapist is someone who specializes in human communication and how it impacts individuals at school, home, and work. It is a licensed field governed by the state. To become a licensed SLP, one must complete a masters in Communicative Disorders, pass a national examination, and complete a Clinical Fellowship Year. Many people don’t realize the breadth and scope of what SLPs do. Some SLPs are also trained in bilingualism and multilingualism. A speech-language therapist’s main responsibility is to prevent, assess, diagnose, and treat speech, language, cognitive-communication, social communication as well as voice and swallowing disorders.

Speech-language therapy involves evaluation, assessment, and treatment of communication and speech and language disorders in young children, school age students, including working with teenagers, and adults. Speech language disorders may begin during infancy and progress into adulthood. In other instances, certain impairments may have resulted from a sudden injury or illness.

WHAT ARE SPEECH DISORDERS?

A speech disorder is characterized by difficulties with speech production, including articulation and enunciation. These include:

• Articulation disorders - Difficulties producing the correct sounds, such as consonants or vowels, in the beginning, middle, or end of words.
• Phonological disorders - Refers to systematic speech production error. A common example of this in children is the dropping of the /p/ sound at the beginning of words or substituting sounds, like /w/ for /r/.

On the other hand, communication disorders, which are not considered speech disorders, include:

• Fluency disorders also referred to as stuttering: These difficulties include partial-word repetitions (“t-t-two”) in which the flow of speech is interrupted by unusual stops, prolonging syllables and sounds (s-s-s-s-shape), and sometimes blocks.
• Voice resonance disorders: Problems with voice resonance make it challenging for someone to be understood by listeners. These involve difficulties with pitch, volume, or quality of the voice.

WHAT ARE LANGUAGE DISORDERS?

A language disorder refers to difficulties or problems in understanding spoken language compared to peers. It also involves trouble with putting words or sentences together to communicate ideas. A language disorder can impact individuals at various levels such as slow acquisition of grammar, word-finding difficulties, and telling less coherent narratives.

Language disorders involve vocabulary, grammar (verbs and sentence construction), and social language use. They are classified as:

• Expressive language disorder – Refers to difficulties with finding the right words and using age-appropriate grammar when speaking with others or expressing oneself compared to peers. It can also include children who produce less robust narratives, have reduced vocabulary, and demonstrate difficulties with social language.

• Mixed expressive-receptive disorder – A combination of expressive and receptive language disorders characterized by difficulties in listening, understanding, and expression. Someone with a mixed expressive-receptive disorder will typically have trouble, compared to peers, following directions, listening to stories, and understanding sequential information.

• Cognitive communication disorders – These are difficulties in communication skills that involve attention, memory, perception, regulation, organization, and problem-solving.

WHAT ARE DEVELOPMENTAL DISABILITIES?

Someone with a developmental disability is born with it and it is hopefully discovered in early childhood development. Developmental disorders become more apparent when a child has a significant delay compared to peers and doesn’t seem to outgrow it. Some of the most common developmental disabilities are:

• Autism spectrum disorders (ASD) – A neurodevelopmental disorder that affects social communication and interaction and involves restricted and repetitive behaviors. People with autism will often have trouble with joint attention, responding to social situations, and using verbal and nonverbal communication compared to peers.

• Attention-deficit Hyperactivity Disorder (ADHD) – A neurodevelopmental disorder characterized by lack of attention, hyperactivity, and impulsiveness, ADHD is diagnosed in childhood but also occurs in adults. ADHD interferes with how a student regulates their attention in a variety of settings.

WHAT DOES A SPEECH-LANGUAGE THERAPIST DO?

A speech-language therapist provides speech-language therapy to individuals of all ages, from babies to adults. They conduct therapy sessions on a one-on-one basis as well as provide information to families, support groups, and the public.

A speech-language pathologist is equipped and licensed to perform a variety of therapies or treatments to address a patient’s difficulties. These include:

• Language Intervention Practices: For younger patients, the SLP uses play, casual conversation, illustrations (such as pictures, books, objects), or on-going events to stimulate language development. A speech language therapist will teach and model the proper use of grammar and vocabulary and use repetition exercises to build up language skills. These interventions are targeted at students who struggle with their language skills.

• Literacy: SLPs help students with all aspects of literacy: reading comprehension, decoding, spelling, and writing skills. Many students who need help with their reading comprehension and writing skills also receive executive function support from their SLPs as well.

• Articulation Treatment: Articulation or sound production exercises involve having the therapist teach and model the correct sounds in sounds, syllables and words during play activities. The level of conditioning and exercises is individualized, age-appropriate, and targeted.

• Swallowing and Feeding Therapy: The SLP teaches how to use the lips, tongue, and jaw to handle food and liquids. The SLP can also introduce different food textures and temperatures to extend a child’s oral awareness during eating and swallowing.

WHO NEEDS SPEECH-LANGUAGE THERAPY?

An individual with the following conditions may consider speech language therapy:

• Learning difficulties

• Difficulties with producing age-appropriate vocabulary, sentences, stories, social language use.

• Difficulties with understanding age-appropriate vocabulary, directions, understanding stories, misinterpreting social language cues.

• Students who struggle with reading comprehension and their expressive writing skills.

• Articulation issues

• Cleft lip or cleft palate

• Fluency e.g. stuttering

• Cognitive (intellectual, thinking) or other developmental delays

• Autism

• Hearing impairments

• Traumatic brain injury

• Feeding and swallowing disorders

• Respiratory problems (breathing disorders)

• Chronic hoarseness (voice)

And more!

Many students with speech language disorders also demonstrate co-morbity with other disorder, such as ADHD.

Therapy should begin as soon as possible. Children who receive speech language therapy early on (before five years old) demonstrate more progress or results than those who begin therapy at a later stage.

 

HOW CAN PARENTS HELP?

Parents and family members play a vital role in the success of a child’s speech or language therapy. When parents are actively involved, children will progress more than when parents are less involved in speech language therapy.

With the SLP’s guidance, parents can further support their children by doing exercises and activities at home. Finally, it’s essential for parents and household members to understand that overcoming speech and language disorders will take time, effort, and patience. Many students with language disorders will struggle with language throughout their lifespan but language therapy will offer strategies to help overcome these language challenges.

Finally, parents who are concerned about their child’s speech, language, and communication development can seek the help of a speech-language therapist.

To learn more about speech language therapy, contact the American Speech Language Association (ASHA) for more information. You can also contact your insurance for in-network and out-of-network options as well. Each state also offers free Early Intervention services (birth-3 years of age). For children three and older, find out about free services can be provided through your child's school for children who have IEP's or Section 504 Plans. 

Gillen Brewer School

Your blogger had the opportunity to attend a professional open house last week at Gillen Brewer School, a special education school for young children located in Manhattan's Upper East Side. The school serves children from just under three years of age through age 10, in ungraded preschool and elementary classes. The staff and the school itself were most impressive and the education and support offered to the students clearly met each child at his or her own level and worked to make them more independent and to help them learn.

Gillen Brewer was founded to serve children with challenges with speech and language, gross and fine motor skills, learning, and sensory and social-emotional development. As the Head of School, Donna Kennedy explained to our visiting group, the children at Gillen Brewer "need adult support around functional use of skills." In addition, the school believes in the importance of partnering with parents and families and offers workshops and events through its School-Home Partnership Program.

The school provides that support for its students with numerous speech and language pathologists, occupational therapists, and doctoral level psychologists (five of each profession, for a student body of less than 100 children), as well as special subject teachers. Students come to Gillen Brewer (named for the grandmothers of the founders) with a variety of challenges and functional levels and the school offers two class models for its elementary students. Those students with more significant impairments, including those who lack functional communication and who need augmented communication devices, are served in a class of not more than six students, with one head teacher and two assistant teachers. Those students who have functional language and need adult support to communicate not more than around 30 percent of the time are served in a slightly larger class of up to 10 students, with one head teacher and two assistant teachers.

The school takes advantage of its New York City location with athletic activities at Asphalt Green, workshops with Alvin Ailey American Dance Theater and field trips to numerous city locations.

Among the students Gillen Brewer serves are those with medical issues (the school has three nurses on staff, to enable them to serve students who are nurse dependent) and those with mild to moderate autism, although Ms. Kennedy noted that the school does not utilize the ABA approach with its students with autism and that those students they will serve best will have mostly speech and language deficits. The school cannot serve students who are explosive or whose issues include aggression, wandering, or “running away.”

Such intensive support and remediation does not come cheap and the school is seeking to add a legal parent advocate position to assist its families and their attorneys with obtaining reimbursement from public school districts via Carter funding. In addition, the school will endeavor to offer Connors funding where parents are unable to lay out tuition while they await reimbursement, something they believe is important to their mission to maintain a diverse student body. Gillen Brewer no longer accepts referrals directly from school districts as an approved nonpublic school, although students who were enrolled by their districts are still "grandfathered in" to this status. The issue, one faced by most private approved schools, is that the difference between what New York State will pay them and their actual costs is significant and cannot be sustained by the school long term.

One good way to get a sense of how Gillen Brewer advances its mission is to view some of the videos on its YouTube channel. They showcase a school and staff dedicated to improving the life of students with significant challenges.

Related Services

Both the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 1973 (Section 504), the two federal laws that families rely upon when their children need help in school because of learning or other disabilities, mandate that children be provided with "special education and related services." We've written before about both of these laws and how they work, but our focus here is on the related services that both laws require schools to provide for students.


What are related services? The IDEA defines such services as:

"...transportation, and such developmental, corrective, and other supportive services (including speech-language pathology and audiology services, interpreting services, psychological services, physical and occupational therapy, recreation, including therapeutic recreation, social work services, school nurse services designed to enable a child with a disability to receive a free appropriate public education as described in the individualized education program of the child, counseling services, including rehabilitation counseling, orientation and mobility services, and medical services, except that such medical services shall be for diagnostic and evaluation purposes only) as may be required to assist a child with a disability to benefit from special education, and includes the early identification and assessment of disabling conditions in children.

The IDEA specifically notes that related services do not  include a medical device that is surgically implanted, or the replacement of such device. These devices can include a cochlear implant for students with hearing loss or an insulin pump for students with diabetes. Section 504 refers to "related services" without such an extensive definition, but districts generally apply the same definitions as they do to IDEA services.

Let's look at each of these services and see how they might apply to your child.

Transportation above and beyond regular bus service provided for all children may include bus service to and from school in a regular bus, or service in a bus with a bus aide, or transportation to school related activities. For students who have been placed by their district or parents in private special education schools, this can include transportation beyond the distances generally allowable to other students. Note that special transportation services must be specifically provided for in a student's IEP or 504 Plan; such service is not automatic.

Speech-language services include a wide variety of services provided by a licensed speech and language pathologist. These services are generally provided in small groups, but can be individual. They go beyond correcting difficulties with articulation and can be very helpful to students with expressive language problems of all kinds. Note that the IEP or 504 Plan needs to specify the frequency and duration of such services and the student-therapist ratio. In an IEP this can look like: "Student will be provided with speech-language services three periods of 45 minutes per week in 5:1 setting (ie: one speech therapist working with a group of five students)." Usually, the smaller the group, the more intensive the services provided.

Audiology, interpreting, and orientation and mobility services are provided to students with hearing and/or vision difficulties or blindness.

Occupational therapy is often provided to students with graphomotor (handwriting) issues and can assist these students with both handwriting and keyboarding.

Physical therapy helps students with mobility, balance, and movement difficulties manage their movements around the school. Note that these services, as well as the other services discussed, all must be specified in the IEP or 504 Plan as to frequency, ratio, and duration.

Other related services that can be included in an IEP or 504 Plan can include counseling, social work, and psychological services, all of which can be provided to any student who needs them. Medical services can also be provided, but are limited to diagnostic services. This distinction between educational and medical services is consistent with the focus of the IDEA on providing only those services which help as student to obtain a benefit from his or her education.

Learning from "The King's Speech"

At this Sunday’s Academy Awards ceremony, The King’s Speech reigned, winning four awards, including Best Picture. Having been touched by the film, I was happy with the Academy’s decision. The movie offers a poignant portrayal of King George VI and his struggles with stuttering. Colin Firth, who won Best Actor for his starring role in the film, reflected that, “I think what Bertie – King George VI – experienced as a child was that his stammer was somehow being connected with his slowness of learning, or the fluency problem was also a lack of wit. And he was anything but witless.”

Too often, children who are struggling with a particular aspect of learning, and who do not understand why school is so hard for them, come to see themselves as globally deficient. In the absence of a thorough understanding of their strengths and challenges, characteristics which everyone has, children may attach negative labels to themselves. Perhaps Firth was right and King George VI saw himself as generally dim rather than, more accurately, quite bright with a particular impediment. The film certainly conveys that the king’s speech difficulties were affecting him emotionally, and at the same time, his emotional stress was worsening the stutter. This type of vicious cycle is one that plagues many struggling young people, whose frustrations can begin to take a toll on their self-esteem, which may in turn negatively impact their future performance.

To break the cycle, parents, clinicians and educators should focus on demystifying students, so that they can learn about what is behind their challenges, and highlighting their assets, so that they can begin to feel better about themselves as learners. Students should be empowered with strategies, based on their particular profiles, to improve or bypass their areas of weakness and strengthen their areas of strength. In doing so, we will promote success by addressing skill-building in tandem with self-confidence-building, with improvement in each area in turn promoting the development of the other.

King George VI’s true power came not from inheriting the throne but from finding his voice. Likewise, children’s academic empowerment should begin from a base of self-understanding.

Do You Hear What I Hear?

A new study appearing in JAMA - The Journal of the American Medical Association confirms the importance of checking the hearing of all young people.

Josef Shargorodsky, MD, MPH and his colleagues at Brigham and Women's Hospital, Boston compared two sets of data on hearing loss from different periods of the National Health and Nutrition Examination Survey, from the periods 1988-1994 and 2005-2006. Although much of the hearing loss they identified was mild, the level of increase was significant. In the earlier study some 14.9% of the target age group had some hearing loss. In the later study, this increased to 19.5%. Another finding of concern was that hearing loss was greater in young people whose families lived below the poverty level.  The authors concluded "The prevalence of hearing loss among a sample of U.S. adolescents aged 12 to 19 years was greater in 2005-2006 compared with 1988-1994. Further studies are needed to determine reasons for this increase and to identify potential modifiable risk factors to prevent the development of hearing loss." 


Screening for vision and hearing problems has always been a part of our comprehensive educational assessments here at the Yellin Center. Students need to be able to see and hear clearly to fully participate in the learning experience in their classrooms. When our screening suggests there may be a problem in either of these areas we suggest that the student be seen by an appropriate professional who can determine whether there is, indeed, a problem and offer appropriate remediation if necessary. 


So what can parents do? There is a good discussion of how to prevent hearing loss in children Noise-Induced Hearing Loss in Children: What Educators Need to Know on the commercial site www.speechandlanguage.com. You may find the link in the article to http://www.noisyplanet.nidcd.nih.gov/ particularly helpful.