The difference in treatment of literacy impairments by a speech language pathologist are many. I have struggled with defining these differences when parents have asked–not because they don’t exist, but because it’s difficult to describe what I am doing that others are not. I know what I’m doing and how that works but it’s difficult to describe how what I’m doing differs from say a teacher or a reading specialist at school sometimes. After all, those are the titles of people we expect to know everything there is to know about reading, right?
I recently listed to the podcast Sold A Story. It’s the chilling history of reading instruction specifically in the United States and how the now debunked 3-cuing system derailed reading instruction for nearly the entire U.S. public educational system. Oh, and about how many school districts continue the use of ‘instruction’ and ‘testing’ that is NOT research-based, reliable or even actually helpful to determine a child’s reading ability.
It’s alarming to say the least. However, it along with my own experiences in public schools as well as private practice have helped me to better delineate how my reading instruction differs and why it makes such a difference for the students with whom I work.
First, as a speech language pathologist, my entire professional education and clinical experience is focused on the brain.
- how it works
- how the brain develops
- how the brain stores information
- how the brain retrieves information
- where the brain stores different information
- how the brain connects to the rest of the body
- how the brain ages
- how to rehab skills lost following a brain injury or event (think stroke, car accident, falls, etc.)
- how to stimulate learning a new skill, remember/recall it (creating neural pathways)
- how to assist the brain in remembering new information,
- how to assist the brain in retrieving new or old information
All of this information is used on a daily basis in treatment decisions. My job is to make sure the treatment method I pick will work with the patient’s brain function. For children, this is especially important when a popular method of teaching doesn’t work–we have to try other methods that help the brain function at its best, not just keep trying the most common method over and over again.
Second, this brain-centered education and experience involves the entire life-span–> in utero through end of life stages.
Third, all of this information about the brain helps me as a treatment provider select therapy strategies and methods that best suit the brain’s needs in order to learn, retain and use information it is learning. Therapy includes teaching/re-teaching a skill and then helping patients achieve the skill independently (meaning they can do it on their own without help). Evidence-based practice is a big term within the speech language pathology field. It’s all about using research-based/backed strategies, tools and methods that are proven to be effective. One of the most important parts of making selection of evidence-based materials is that it’s being chosen based on the patient and their needs. Being evidence-based doesn’t mean it universally works for everybody every time. It means if it’s applied with the targeted patient, it can/will have a positive impact. So regardless of what type of disorder we are treating as speech-language pathologists, our practice and treatment is based in science and research.
In treatment, speech language pathologists are responsive to patients and their needs. What this means is that if one method or strategy isn’t working, we change the method we are using at that moment. No waiting to see if it’ll eventually work. We change the method until we find one that works for that patient. Then the progress begins. This is one of the major differences in reading treatment by a speech-language pathologist.
Teachers and random people can get trained or ‘certified’ in specific reading programs that are promoted to the public as the fix all solution for a child with reading programs. While some of those programs might have a positive effect on some students, there isn’t a one-size-fits-all approach to reading. Just like anything else in life, we all learn differently in comparison to each other, which is why one-size-fits-all approaches are not conducive to everyone everywhere every time. The biggest problem with these programs is they try to make their method exclusive by telling their trained users to exclude the use of any other materials from outside the program. Additionally, the programs outline exactly what to teach and when AND there is no straying or changing up the order at all. So children getting reading intervention sometimes get stuck at a level and the specialist believes they cannot move on. As a speech-language pathologist, however, I use a variety of resources, methods, materials purposefully. I also change the order of how I might introduce the skills to best meet the need of the child. In some cases, some aspects of reading might fall into place quickly while other aspects take a while–sometimes they need to jump to another skill, learn it and come back to the other skill. Sometimes once they know more in other areas, it helps to understand the piece that was the disconnect.
So speech-language pathologist not only use multiple methods, materials and strategies, but also all of them are evidence-based related to brain function. They are also independent from one program that dictates what they are and are not allowed to do. That’s why we are diagnostic clinicians–we are constantly reassessing what needs to be done to achieve brain function success. We have to be dynamic in our treatment for all disorders regardless of age.
Another disconnect with reading instruction and intervention is the separation of literacy intervention in schools. Schools assign all reading related intervention to reading specialist teachers and do not want SLPs to be part of that. SLPs are restricted in schools to mainly speech sound production disorders and language disorders, which is only a small slice of our scope of practice. In schools, SLPs are restricted from much of their medical expertise including swallowing, feeding, orofacial myofunctional disorders, reading, etc. This separation leads to misunderstanding by parents and the general public–sometimes even within the field of speech language pathology. I’m sure some of it’s a liability issue for the schools, such as swallowing, but written language and/or reading are easily appropriate within a school setting to be treated by the SLP. Ultimately, it’s a disservice to the children, especially those with concomitant speech and/or language deficits.
Within our professional education, a major focus is the big picture components of reading: phonology, semantics and orthography. These areas are important in their own respect for our purposes but combined, they are the big picture skills required for reading.
- Phonology is the speech sound system (including production of individual sounds as well as team sounds).
- Semantics is the meaning (including vocabulary, background knowledge, syntax, etc.).
- Orthography is the written form of language (including what letters or sets of letters make what individual sound).
This is a very simple overview of how reading happens but it’s a complex task requiring the entwining of many skills that require individual practice as well as collective practice. A nice visual that shows the complexity but also breaks it down a bit is Scarborough’s Reading Rope. This is research-based.
Based on the Sold A Story podcast and the serious reporting completed by education reporter Emily Hanford, many teachers are not provided with much education about how to teach reading. Many are now feeling duped, embarrassed and upset about believing their districts would select research-based curriculum and products only to find out it was quite the opposite. I feel for teachers. It’s an awful place to be in knowing that instruction your district adopted and implemented was not beneficial and even harmful to children they believed they were helping. Unfortunately, the reality is we now have a reading crisis and it’s continuing to unfold. Yet, there are districts near and far that continue to use progress monitoring assessments and programs that are not backed by research.
Another major difference in reading intervention with a speech language pathologist is measurability of skills. Those progress monitoring assessments often involving levels are ambiguous and subjective based on the authors. The “levels” do not specify specific reading skills such as syllable types, phonemic skills, affixes, vocabulary, etc. So when I receive a report from a school interventionist, it often includes their ‘level’ of reading based on this arbitrary line in the sand and it does not easily translate to everyday books that you can check out from the library or purchase at the book store. This is the a gigantic red flag to me–if it’s not easily understood across reading professionals, there is a problem. If you are a reading professional, you know the lingo–you should easily be able to understand where the reader is in their learning journey. This is where measurability comes in. Goals I write (and all speech-language pathologists) are measurable. Meaning, I can give you a percent-to-goal number on all goals for a patient, including those working on reading. These goals are specific skills: identify sound and symbol correspondence (what sound goes to what letter or group of letters), identify vowels and consonants, identify syllable types, etc. These are specific and therefore measurable. Meanwhile, those ‘levels’ do not have any or enough distinct separation to make them meaningful for intervention planning. This is further supported by the variability in scores–a student may score in one level one day because the book was about a favorite topic and the next day score in a lower level because the book was about a topic the child was less familiar with. Reading is a culmination of many skills, which is why structured teaching/intervention is important. Each skill relies on the skill before it to advance.
Due to the complexity of reading and the intersection of so many skill sets and knowledge, it requires explicit, structured teaching. This means specific skills are first taught, then practiced and eventually mastered. As mastery is being reached with that skill, the next skill is first taught, then practiced and eventually reaching mastery. As a speech language pathologist, this is what I do every single day since I began my career. Not just with reading but with every single patient I’ve ever worked with for any deficit. Structured teaching, practice skill and reach mastery. Guessing, as mentioned in my last post, is not a part of the process. I would never ask a child to guess at a word. In fact, I often find myself telling patients to stop guessing and use the tools they’ve acquired during our work to figure out the word.
In the speech-language pathology world, cuing refers to helping a patient be successful with a skill. The use of cuing fades as a patient achieves success with a particular skill and eventually is removed entirely as the patient does a task independently. That debunked 3-cuing system mentioned earlier immediately sounded suspicious to me before I even learned more about what it was–cuing it NOT a strategy but a TOOL to help a patient reach success (i.e. achieve independence.). Also, speech-language pathologists don’t use pictures to guess words–> instead we use pictures to help learn more about the meaning of a word. Pictures provide great context and meaning. It’s a strategy I share with parents of children who are experiencing a language delay because it helps them acquire vocabulary long before reading is ever something they are trying to do.
There is nothing in life that we learn successfully by guessing at it over and over again. Reading is a life skill not an academic one. We use it to access academic information to learn about different places, people, and concepts certainly, but we also use it to figure out what we’ll order for dinner at a restaurant, to read a map while traveling, to figure out the bus schedule to get somewhere, while driving, while playing games, etc. It’s a life skill and my knowledge/practice as a speech-language pathologist are perfectly matched to offer effective assistance in acquiring it.
Brain-focused instruction + explicit, structured intervention + evidence-based methods = reading success. Speech Language Pathologists have always followed the brain science to teach all skills among them is literacy intervention.
Sara Martin is a certified speech-language pathologist and owner of 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 firstname.lastname@example.org.