I treat literacy impairments. This means I help children learn to read. It’s an area of passion for me. Similar to communication, which is weaved into EVERYTHING we do on a daily basis, so is reading. 

We read menus at restaurants, signs on the road, instructions when installing something new at home, building legos or the weekly school newsletters. We read emails. We read texts. We read things on television too. We especially do a lot of reading when we travel to new places we’ve never been to before. It’s easy to get stuck in the mindset of children must learn to read for book-reading purposes but that is only one tiny bit of the reading we do every single day. 

Often, however, I get the side-eye skeptical look paired with the question: a speech therapist treats reading?? Sure do, and it’s an area that I specialize in. Children with speech sound production impairments are at a much higher risk for reading acquisition problems. Any speech sound production problem puts them at higher risk for reading acquisition problems but some disorders– phonological and apraxia impairments–put children at an even higher risk for reading struggles.

This is why having a child with speech production issues evaluated when they are young is so so important. Speech sound production issues that persist take longer to remediate and eventually have a negative impact on reading and even writing. The academic demands upon children are vastly different today than even 20 years ago, which means reading demands are much higher at younger ages. Children who have reading acquisition struggles can develop negative feelings about reading pretty quickly, and well, it can make their academic road ahead treacherous. 

Reading is within the scope of practice for speech-language pathologists, which is often surprising to many people. However, if you really start thinking about it–we work with children to help them blend and segment words/speech sounds for communication purposes long before any reading expectations are upon them. Reading and writing are part of communication as a child ages and advances in school.

Additionally, reading is based on individual speech sounds. Yes, you read that correctly. Speech sounds are the basis for reading and writing. In English, it’s incredibly challenging sometimes to learn to read because the language itself was developed with influences from many other languages. This means there are a lot of what I like to call “rule-breakers” because the word doesn’t follow the ‘typical’ pattern.

In schools there is a HUGE focus on teaching reading from a letter perspective. In pre-school and kindergarten, there is a focus on letters and their sounds. This alone is a disservice to children because the 26 letters in the English alphabet only represent 23 sounds of the more than 44 total sounds in English. We have written representation of those additional sounds but they are not introduced until children are ‘older’ (think late first grade and second grade). Yet at the end of kindergarten and throughout first grade we want their reading fluency to be getting smoother and smoother. How can that happen when they are only given a fraction of the sounds they may encounter in a book? 

Sometimes this is done through ‘books’ created to include only words students should know but this isn’t necessarily very functional. Road signs, after all, don’t take into account what words a driver may or may not know/be able to read. Subway directions don’t either. Neither does a restaurant menu or a job application. 

Seeking out help with literacy treatment can be overwhelming. There is no shortage of information ‘out there’ when parents are looking. No shortage of opinions. No shortage of reading programs that promise this, that or the other thing in 2 weeks. No shortage of reading apps that will solve the world’s reading deficits. 

All of those options have limits. While some might be fantastic for one child, it might be awful for another child. It also gets much more complicated when a child has OR HAD a diagnosis related to a speech production issue–this could be articulation, phonological impairment, apraxia of speech, delayed language, etc. 

While many reading programs may be helpful to some, they are developed as a one-size-fits-all program. Those who become certified in them are strongly encouraged (told to be ‘certified’ they must follow the program to a tee) to ONLY follow the program and to NOT deviate from it, or introduce anything beyond what is strictly written into the program. This inflexibility is what often hinders student growth and progress. Especially for children with or a history of speech and language impairments. 

As a speech-language pathologist, treatment for any disorder is responsive in nature. That means treatment changes moment to moment to meet the child’s needs to help them achieve success. Sometimes this means, the most elaborate session plans that were created and prepped in advance are tossed to the side and the whole session is spent doing something else. It’s not because there was bad planning, it’s because it wasn’t working for the child. So change is needed. In the moment. 

Reading intervention needs to have a structured approach. This means that the intervention has organization, is cumulative and connected–if it’s scattered, that only further confuses the child. Some of the big name programs aim to provide that ‘structure’ to the interventionist but reading intervention doesn’t have to be boring or monotonous. In fact, in my clinical experience, the more fun, exciting and silly instruction is, the more quickly a new skill is acquired and mastered, and most importantly, not forgotten. Structure means that the intervention includes explicit instruction for each skill area while helping build/create connections of the skill within reading. 

All of speech therapy is this way–structured AND responsive to the student’s need with a focus on how to help the student achieve whatever goal it is he or she is working on. While the big name programs are trying to achieve structure, when the program cuts out the responsiveness, it’s providing a one-size-fits-all approach. For those it helps, it’s an amazing program, but for every person it helps, there are likely 3-5 people who ‘failed’ at it because it didn’t help. Intervention without responsiveness isn’t intervention by definition. Reading programs are only one tool in the treatment toolbox for speech language pathologists, not the only tool

When a child is learning to read and they have a history of speech production problems, those can surface again–even those production issues that were resolved or remediated. A speech-language pathologist who treats reading disorders is able to discern when a child is having a production problem versus a reading problem, and then able to provide the appropriate help to get through that moment and work on it so next time, it’s easier. 

A perfect example involves words that have consonant clusters–an inside term referring to when a word has more than one consonant in a row. Those are considered more difficult to produce for speaking purposes. If a child struggled with those for production purposes and now in reading is not producing one of the consonants, the story is interrupted. The child is unlikely to understand the word for its meaning but they might be skipping it because they don’t know how to sequence those consonants for production purposes. A speech language pathologist is able to address the speech production piece and then also make the connection with the reading portion with the ‘graphemes’–another inside term referring to the written representation of speech sounds. 

Reading is a culmination of many many skills. It requires visual tracking. It requires knowing speech sounds and their written representation. It requires attention to the writing. It requires comprehension and vocabulary knowledge. It requires self-monitoring. It requires flexibility and sometimes, just like babies have to learn how to stack and restock blocks many times to get them to balance, reading requires the willingness to try and try again. It’s not a one-size-fits-all skill that is turned on and turned off. It’s a skill that requires a great deal of coordination and effort, which is why responsive treatment is necessary. 

Questions about speech-language pathologists treating reading surface all the time. From parents, from other professionals, from teachers, from reading specialists, even from other speech-language pathologists, if you can believe it. One big reason, in my opinion, is that in public schools, speech-language pathologists are very much utilized to treat speaking, listening and language only while the designated reading specialist (often a teacher with extended training in this area) is slated to deal with ALL of the reading deficits. For a good portion of the children, the reading specialist teacher is exactly what they need, they get the boost and then they are done receiving reading support.

However, for those children receiving speech therapy services and reading support in schools, it would likely make a dramatic difference in the outcome and progress of the child if the speech-language pathologist were to treat reading in addition to the goals in their IEP related to speech production and language. This is not a small unique issue–it’s more of an educational system issue–that’s how it’s been set up and, of course, there are some sensitivities that surface about everyone’s specific role/responsibilities within the school setting. However, everyone would certainly still have a caseload I promise. If this shift would happen, many children would likely achieve success in reading more quickly. 

Isn’t that the point of support services of any kind anyway? Help the child be successful at a certain skill as soon as possible with the least support possible? That’s my goal and that’s part of why I love treating children with reading disorders. I want children to be able to experience success with it and experience joy with reading–it’s part of why I’ve chosen to specialize in it. The key to any reading treatment should be a responsive approach rather than scripted steps outlined by one program.

Reading is not a recipe or a set of directions. It’s a learned skill that requires specific support to the specific child and their specific needs. It’s about helping them in the moment to achieve success. Each moment then builds on the next and pretty soon, voila, they are reading. At home. At school. While riding their bike down the street. In a restaurant. At the doctor’s office. Everywhere. 

Sara Martin is a certified speech-language pathologist at Speech With Sara LLC based in Grosse Pointe, Michigan. She is licensed in Michigan and Pennsylvania offering individual speech therapy specializing in literacy impairments, speech sound disorders, early language deficits and orofacial myofunctional disorders. Contact her for additional information at sara@speechwithsara.com. 

Literacy: Seek Responsive Treatment, Not Scripted

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