Thinking Outside the “Box”: Applying Clinical Skills in Dyslexia Intervention

Heather Caska and Karina Kahdi Thinking Outside the “Box”: Applying Clinical Skills in Dyslexia Intervention

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Kate Grandbois: Hello, everyone. Welcome to SLP Nerdcast. We are really excited to welcome two repeat guests today back onto our show for sort of a part two. We are really excited to welcome Heather Kaska and Kareena Khadi. [00:02:00] Welcome. Hi. Hi. 

Amy Wonkka: Heather and Karina, you're back here on the Nerdcast to discuss how to apply clinical skills in dyslexia and any of our listeners who might not have heard your previous recording with us.

Can you please tell us a little bit about 

Heather Caska: yourselves? 

Karina Kadhi: Sure. I'll kind of, I'll start that. So my name is Karina. I am an SLPA. I've been practicing for about nine years now. And I've only worked, um, in pediatric, so, um, I love working with littles, I have a passion for early language, um, development, and, um, that type of intervention with littles, and Heather was my first, um, supervisor.

For my first job and that's how we met and we quickly became a great team and a great pair. Yes, that's a 

Heather Caska: little bit about myself and I'm Heather. I have been a speech language pathologist for almost 10 years now. I started off my [00:03:00] career in skilled nursing working with adults for about a year and a half, but quickly learned and knew that my heart was with pediatrics and so working in pediatric clinics.

I found a love for literacy and reading and started doing a lot of extra, um, education, uh, continuing education on dyslexia specifically. Um, I'm also the current president for the Arizona branch of the International Dyslexia Association. Um, I live in the Phoenix area and I own a small private practice in addition to our dyslexia education.

Um, platform with Karina, um, and I have two small kids. They have a first grader and a three year old, so we're excited to be here again. Well, we're so excited to have 

Kate Grandbois: you. The first episode that you all did with us was really focused around the role of the SLP in the realm of dyslexia in general. But today you're going to be talking a little bit more about clinical application, which I am very excited to learn about because I know very little.

Um, [00:04:00] so before we get into the good conversation, I do need to read our learning. objectives and disclosures. So let's get through that and then we'll get on to the good stuff. Learning objective number one, list the three principles and six key elements of structured literacy intervention. Learning objective number two, describe three evidence based intervention techniques and approaches to managing dyslexia and learning objective number three, describe three ways to incorporate structured literacy interventions into your current treatment plans.

Disclosures. Heather's financial disclosures. Heather received an honorarium for participating in this course. Heather is the owner of a private practice called HBC language and literacy. Heather is also the co owner of sore with words, LLC, and co manages the sore with words educational platform on teachable Heather's non financial disclosures.

Heather is the current president of the Arizona branch of the international dyslexia association. Heather also co manages the social media accounts for sore with words. Karina's financial disclosures. [00:05:00] Karina received an honorarium for participating in this course. Karina is also the co owner of soar with words, LLC, and co manages the soar with words, educational platform on teachable Karina's non financial disclosures, Karina co manages the social media accounts for sore with words.

Kate, that's me. I am the owner and founder of Grand Bois Therapy and Consulting, LLC, and co founder of SLP Nerdcast. My non financial disclosures, I'm a member of ASHA SIG 12 and serve on the AAC Advisory Group for Massachusetts Advocates for Children. I'm also a member of the Berkshire Association for Behavior Analysis and Therapy.

Amy, 

Amy Wonkka: that's me. My financial disclosures are that I'm an employee of a public school system and co founder of SLP Nerdcast, and my non financial disclosures are that I'm a member of ASHA Special Interest Group 12, AAC, um, and I participate in the AAC Advisory Group for Massachusetts Advocates for Children.

All right! Heather and Karina, I know you're here to talk to us today about intervention, but before we start, [00:06:00] can you start us off by telling us just a little bit about dyslexia, maybe just a brief 

Heather Caska: overview about dyslexia? Yeah, absolutely. So I think one of the most difficult things about dyslexia is there are a lot of common misconceptions about what it is, but one of the biggest issues with dyslexia is just identifying it.

And I think a lot of that comes down to the fact that there's really no one, um, agreed upon definition. So, um, the International Dyslexia Association has a definition, um, Most people go by. However, there's still a lot of disagreement across professionals as far as what really is. include should like criteria should be included in that definition.

So we really like to go by the definition. So Dr. Tiffany Hogan and Dr. Hugh Katz put out a paper in 2021 called dyslexia and ounce of prevention better than a pound of diagnosing and treatment. And so the definition that they kind of proposed is [00:07:00] dyslexia is a severe and persistent difficulty learning to read and spell words, despite adequate opportunity and instruction.

And the reason we really like this definition is because it's not specifying like any distinct causal basis. But it's looking at it like multiple factors. So you're looking at a lot of different, looking at that whole child and what could be some early indicators for dyslexia. So it's really going to fit more in that preventative model, which is what Karina and I are really passionate about that early identification and our role as SLPs and SLPAs on how we can help with that early identification and earlier mediation.

So it's going to allow us to really identify those risk factors early on. Um, and then also, um, It's a big part of it is that definition is it's going to be more easily operationalized in like those educational settings, because we find that most of our educational systems are still set up for that.

Let's wait and see model [00:08:00] that wait to fail model for these students, which is really putting them at a disservice. Um, we talk a lot about the dyslexia paradox, which was, um, kind of a term coined by Dr. Gavin, her colleagues. And what the dyslexia paradox is, is that it's acknowledging that dyslexia is not typically diagnosed until second grade or later, which is past that prime time for intervention.

So we know that research is showing us that, um, reading interventions are significantly more effective in kindergarten and first grade. So most of our. Students, though, we're waiting, you know, let's wait and see, you know, they just need to keep practicing. And so they're not being identified until second or third grade.

So we've already missed that prime window to make them to have the most effective intervention in place for them. Um, so some early like factors or factors that we need to consider when we're Trying to identify these students as family history. So if you know there's an older sibling that you know may have an [00:09:00] IEP or has struggled, that's going to be a big indicator that this is a student is not going to be one that will just catch up, necessarily, we I learned really quick early on when doing.

Evaluations, not to ask specifically about dyslexia, because I would say eight times out of 10, I would get, no, you know, no one, no one has dyslexia in our family, but then as you would ask more questions, you would find out, well, dad got help for reading, you know, in school or so and so didn't, you know, or I didn't like, I really struggled, you know, I didn't like school, you know, as a, as a parent.

And so that right there, I mean, most people didn't get that diagnosis. And so. It's a clear indicator that that there is a family history of learning difficulties, um, and then also just that poor response to adequate instruction. So if they, you know, they've been in preschool and they've been in kindergarten and their attendance is good, you know, but they're still just don't seem to be picking it up.

That's another indicator. 

Karina Kadhi: One gets tricky with what [00:10:00] has gotten tricky recently, huh? With COVID. 

Heather Caska: Absolutely. And that's, that's a, that's such a great point. And so we, we've heard that a lot too, especially, you know, with our second and third graders now, because so that. They haven't been identified, which is not necessarily atypical, but a lot of it goes back to, well, they were, they were kindergarten, they were in kindergarten during COVID.

And absolutely. I mean, I think everyone is struggling now because of what happened in COVID, but we're, we really need to remember to look at all these other factors too, and not just like It's can't just be an automatic. Well, it was cause of COVID because of COVID, like everyone's behind you. Right.

Everyone. Yeah. Yep. There was there, everyone is behind, but we have to make sure we're really doing our due diligence, like looking at the whole child and other early indicators. So, and that could be that family history. Um, delayed speech and language skills, uh, and maybe if, you know, they have some, they're really struggling more with that phonological processing, working memory, [00:11:00] phonological awareness skills, um, some other factors to consider, any visual processing or executive function difficulties, um, and then even trauma, you know, trauma based, um, interventions are going to Um, and I think it would be really helpful for these students to as well as just looking at, um, socioeconomic status as well.

So I think when we're trying to identify these kids early on need to really look at all these other factors that are going on as well. And chances 

Karina Kadhi: are, um, especially like in these early ages, we find that where I were identifying kids that are already on our caseload, um, for speech and language services.

Um, and so then in the intervention and in the time we're already spending with them. Um, we're kind of picking up and noticing some of these other, um, factors and things and that, um, kind of a point we always like to make is that, um, most of these students are already on our caseload for speech and language at that age.

But not yet identified for, [00:12:00] um, those reading difficulties. 

Heather Caska: Well, that's 

Amy Wonkka: such a good point. I, I wonder if you can talk to us a little bit about, I know literacy and reading is within our scope of practice, but when you're in a school in particular, like that's probably not your chief role in that position.

But can you help us understand a little bit about Just the science of reading, structured literacy. Like what are some important things there for a speech language pathologist to be aware of, even if it's not like the hat that we're wearing in our, 

Heather Caska: in our role in that job. 

Karina Kadhi: Absolutely. Like we, that's, um, one of the biggest, that is the biggest piece that we like to, um, bring to awareness is, you know, we're lifelong learners and even you said it perfectly in a school setting.

That's not our main role. Um, we are not the reading interventionalist. We are not the one doing, um. really addressing that. But if we can be aware of how many of those elements of structured literacy fall in [00:13:00] our wheelhouse, we can give like heck of support, right? So when, when we're talking about structured literacy and the science of reading, science of reading refers to just that body of research. That comes from many different professions, and that kind of helps us, um, understand how our brains learn to read, right?

Because if we can understand how we learn to read, then we can intervene, um, better, and we can help students learn better. Um, and so that's what we're referring to for the science of reading, where structured literacy, um, is just, uh, evidence. evidence best practice, evidence based practice approach, um, to teaching, um, those reading skills based off of the science of reading.

Um, so when we're talking about structured literacy, there's, um, six elements of it. So syllables, semantics, phonology, morphology, sound symbols, and syntax, um, are those six areas. And so, um, the, there's two of those that aren't [00:14:00] necessarily Um, closely related to our field or our skill set and that's being syllables and sound symbols.

Um, but we also want to talk to you about how you can support those in intervention as well. But the other four big ones, syntax, semantics, phonology, and morphology, those are language, right? We're already addressing that in the therapy that we're doing in our speech room. And so if we could be more intentional about, um, maybe things we, the supports we embed, the way we scaffold, um, then we're supporting literacy skills in the therapy we're doing.

Um, and so to kind of go along with the, um, Elements of Structured Literacy also has three, um, component or how, how would I describe that, Heather, like three principles. Thank you. Um, so that it's explicit, meaning that there's like direct teaching or not assuming that a kiddo knows something before that we're teaching everything explicitly, um, diagnostic.

And so it's, um, individualized, has individualized instruction. Um, That's [00:15:00] monitored by ongoing assessments and stuff. And then, um, the last principle that it's cumulative and systematic. So it follows a logical order, um, and that each new step builds on concepts that we've already, that we have already explicitly taught that child.

Um, So in a nutshell, that's structured literacy, those six elements and three principles there. And can see we we have a lot of knowledge in most of those elements and not that we have to be the ones doing that direct intervention. Um, but man, we can really support those underlying skills.

Amy Wonkka: Well, and I would think that there, sorry, Kate, I would think that there are just so many opportunities, as you mentioned, many of these students are already on our caseload. We're already providing speech and language services. Many of these six areas are things that we're maybe already working on as part of our speech and language goals and objectives.

And then maybe it's also just a [00:16:00] matter of being very thoughtful about the material and activities that we're selecting, because there are a lot of ways to work on different goals and objectives. Right. Exactly. I mean, I think. The longer you've been in the field, the more you're like, ah, I could, I could work on it with this activity, this activity, this activity, they're all different ways to target these skills.

Um, I didn't know if you wanted to, if you guys wanted to give us some examples of how, how a speech and language session might look a little different when you, when you're being thoughtful about trying to address the literacy component within your activity compared 

Karina Kadhi: to when you're not. Sure. Um, one of, we can, one of the, I think the easiest ones to, um, support is phonology.

Um, especially obviously when we're working on those speech sound, um, goals, whether it's more articulation based or whether it's, um, more of like a phonological process. Um, some of the things that we do to support phonology or that range of phonological awareness rather for [00:17:00] these kids is, um, visual supports and, um, We mentioned last time, um, so different ones like the, um, Bjorm or, um, Lips.

There's, there's different like dedicated programs out there, but really blocks. We love blocks. We love wadded up pieces of Play Doh and, uh, Toilet paper, tissue, whatever we can get our hands on that can serve as a manipulative, um, and to just bring awareness to the individual sound that they're working on, because without awareness, there is no generalizing that skill.

And so we can work with a kid on how to make their F sound so they're blue in the face, but if they don't know when to apply it or when to use it, then we're not going to see that generalized as quickly. So really using manipulatives and visuals to, um. To support their phonological awareness so that they can then apply these, what we're working so hard on with them.

Um, we like to, um, I'm just looking at my pictures here for that. [00:18:00] Some other things that we do in the speech room for that kind of piggyback off of phonology are also, um, support the sound symbol aspect of, um, Structured literacy and those, those same visuals, those sound cue cards, um, can easily be adapted by just writing the grapheme or that orthographic representation on the letter for them by tying that sound to the visual letter, um, is going to support them huge and just writing it out on that is another.

Um, way to support to incorporate that sound symbol aspect of structured literacy without having to teach them the alphabet, right? Like, it's just exposure, just modeling that, um, what are some other ways? I was going to ask 

Kate Grandbois: you, you've mentioned the, the name of this episode that you've proposed is outside of the box.

Is that sort of what you're getting at here? Can you tell us a little bit about how this might [00:19:00] differ from what we would typically think of as literacy 

Heather Caska: instruction? Yeah, I, that's a, um, it's a great question. So I think a lot, a lot of times as SLPs, we, when we get, when someone brings up, you know, dyslexia intervention or reading intervention, our automatic go to is, well, I, I'm not trained.

I'm not trained in like a specific program. I'm not trained in Orton Gillingham. I'm not trained in, um, Linda Mood Bell or the Barton program. You know, there's a lot of really great Commercial programs available that are or in Gillingham based or structured literacy based, um, that are really can you can that are helpful to support these students.

Um, but our whole thing is. Especially in the schools when that's not our primary role, we don't necessarily have to be trained or certified in these specific programs. Like, so thinking outside the box, um, is more of like using our clinical skills. You know, we already know, like Karina mentioned, four out of those six elements [00:20:00] fall, those are in our wheelhouse and these other two, you know, they're fairly closely related, but easy to support once you have some general knowledge about it.

And so you don't necessarily have to be. trained in this program or, you know, certified in a certain type of intervention to support the students on your caseload. Um, as I think, especially in the schools as a school based SLP, it's important to be aware of what curriculum or intervention programs are being used, you know, in the classroom or even in like an ESS classroom.

Um, to just to have a better idea of, you know, what the student is being exposed to, but to necessarily be trained in it, I don't think is necessary to support your students. 

Kate Grandbois: I really appreciate that perspective. What I've learned from you all and from a few other individuals over the years is that literacy can feel very siloed because of the different roles we play, particularly in an education setting where you have a [00:21:00] quote, reading teacher, and that's the person who does the reading intervention.

Right, only them. Right, right. And so I think because we have this I don't know if you, if the word culture is the right word, but because you might have this professional workplace culture or set of standards or norms where reading might be a little siloed, I really, I really appreciate the perspective of sorting of trying to branch out outside of that and generalize some of these or create normalcy around, um, um, um, Intervening, addressing, addressing them.

Exactly. Exactly. 

Karina Kadhi: Yeah. And we, we, we do get a lot of like pushback in, I wouldn't say pushback, but feedback in that. Um, well, that's not my role in a school. I can't look for all these other students. How do I, I can't go add on these additional students and screen more students. And that's why we always like to emphasize like, Yeah.

Chances are they're already in your classroom, right? Like, if we can just focus on that [00:22:00] population, we're making a difference, right? Because, because we might have a little kindergarten or first grader working on these things who's not going to be screened or identified for any, um, literacy related difficulties at that age, you know?

So if we can Um, kind of embrace like be open minded about that and, um, embrace that lifelong learner kind of mentality and bring more, um, awareness to, Hey, what are some other factors that I could, these kids already sitting in my room to help, um, identify that 

Heather Caska: I think. To they so a lot of states now do have legislation in place where you know, you're you have to be screened as universal screeners that are administered to all kindergartners first, it's usually like kinder through third grade.

And so finding out like if you have students on your caseload or if you are, if your school is it has that RTI. where you're doing, you know, RTI with some of these younger students, find out about those [00:23:00] universal screeners, how are they performing? Are they below benchmark? Um, because those are kids too, you know, that might just need extra support.

Here in Arizona, if they are, you know, kind of flagged on these universal screeners, then they are automatically put into a tier two intervention. Um, at one of the charter schools I worked at, you know, I did part of the tier two intervention. We did that. And so we started an RTI group for some of those kids that were, you know, that had more difficulty with the phonological awareness.

And so that's what we were doing, um, as part of that tier two. And I know that's not, you know, realistic For all SLPs, like we have a lot on our plate already, especially in those school settings, but I think just being aware and asking those questions, you know, I have so and so on my caseload, how'd they do, how'd they do on their screener, you know, and then just finding what additional supports you can give them, you know, during your speech and language therapy.

I wonder if 

Amy Wonkka: it makes sense to talk a little bit more in depth about [00:24:00] each of those different structured literacy elements. Um, I don't know which one you guys would like to start with, but I think just giving people an overview of the element and then just talking kind of specifically about it. So, like, I thought, Karina, you gave a great example of just if you're, if you're working on sounds, you could integrate that sound simple correspondence component, you know, so maybe just talking about some of those tips would be really helpful.

Karina Kadhi: Okay, I want to give some more examples for when, how we can incorporate some things we can do in our speech therapy to support that sound symbol element that not. Uh, element that we're maybe that falls under that language domain, um, like a few of the other ones. And so, um, we already mentioned the sound cue cards and, and then just, um, using the visual incorporating that visual grapheme when you're working on your sound.

So just make that associate help them build that association. Um, another thing I like to do is, um, I [00:25:00] like to make sound. cards, I guess you can call them. And so say we have a kiddo working on S. So we might have on, on our little index cards, all the ways that he might come across the sound when he's reading.

So S will be on there. SS is also on there. Cause at the end of words, It comes across that way, C E C I C Y is on that card also, that way he knows visually. These are, when I'm reading, these are all the ones where I'm going to have to use my snake sound or whatever sound I'm working on. But also, I'm just exposing them, um, and, um, and Modeling and just giving, bringing awareness that, hey, this can be represented different ways.

These are all the, it's, I'm not his English teacher. I'm not going to quiz him on it. I'm not going to, it's just one thing that I'm embedding into my therapy to support that sound symbol component of not going to test them or quiz them. Right. But just something I can embed there. And I really like that.

And the kiddos really like it too, because then we can go and do reading tasks and they can search for those and highlight them and then [00:26:00] practice reading at a sentence level, maybe, um, just to con. Oh, 

Amy Wonkka: Nope. I was just gonna say, just to contrast with that, like I can think of an example from when I was working outpatient and I would be working on articulation and I would go through my like super duper articulation cards with the pictures on them.

And I would never draw that connection. I would just never make that explicit connection between the orthography, like the 

Karina Kadhi: written symbols. Yeah. The written representation. And again, that's not, 

Amy Wonkka: we're essentially both doing the same thing and working on that target sound production. But what you've done in your approach is you're just making that that much more visible, giving that student exactly visible.

And I just, I love it. And I think it's, it feels like such a small thing. It seems 

Karina Kadhi: like it's easy, easy. Yes. Yeah. It's an easy thing. And again, we're not fancy when I say no card, usually it's like a ripped piece of printer paper that I'm like, Oh, here's a little square for you. Here's your card. Or, or have them make it right.

They can pick whatever medium they wanna write it on, [00:27:00] and then it's more exciting for them. And so it doesn't, it, you're right, it, it can be very easy, um, and very low prep, uh, to be able to do that. Um, sound wall are another, I personally have never had, um, a sound wall in my speech room. I wish I would have, but, um, I wanna make one and I, and then it's a great, it would be a great resource to even have, um.

Just like in the, maybe collab with teachers and have in the classroom setting, you know, um, those sound walls are, are a great way to help, um, tie in that sound, um, symbol when you're working on your speech sounds. Um, we also, let's see, we won't go into syllables yet, because that one can get, well, nevermind.

Yeah, we will, because this one can be easy. So syllables is probably the one of the, um, the elements that we know the least about as speech therapists. Um, there are different syllable types and also different syllable division [00:28:00] rules. But the most important thing to know about syllables is why it's important, why it's part of structured literacy.

Um, it's because when, uh, when students can predict what sound a vowel is going to make by knowing the type of syllable, it's going to make reading and spelling easier. So knowing how to break that word into syllables essentially makes them easier to read and spell. So if we could explicitly teach them that, we're giving them a tool, um, to support their decoding and spelling.

Um, and so the different syllable, um, division rules, um, they can get kind of It's tricky. But again, that's not our role isn't to learn this and teach them this, but just, we take that approach of that. We're lifelong learners. And if we can have this in our toolbox and we can support kids just one different way.

So we have some pretty good resources that explain this in a little more depth on our Instagram site. Um, and so we have some, um, I think they're called reels pinned, 

Heather Caska: saved on [00:29:00] there, highlighting. 

Karina Kadhi: They're on our highlights. Um, and so you guys can check those out and they'll go into a little bit more depth in, in this syllable component, but, um, We, ways that we have used this in our therapy is like, um, reading comprehension.

Sometimes our kiddos get stuck on decoding bigger words. And so we whip out our syllable division, um, tools and kind of teach them how to segment and break apart those words to make it more manageable for them to read. And then they've decoded an unfamiliar word and now they know context. And so really just functionally using it, right.

Um, And so if we can make our bring this syllable type and syllable division knowledge, just our attention. It's just another way to support them. 

Heather Caska: One thing that I've noticed, um, or that I've a pattern I've kind of seen in the schools too, is oftentimes we are asked like SLPs and SLPs are asked to like, can you give so and so their spelling test this week?

Or like we help [00:30:00] support, you know, administering spelling tests. And so if you do that, this is also another way. Just having this knowledge, that's going to be helpful. So kind of backing up a little too, like the sound symbol. Um, one thing that we found, especially with our older students that, you know, like gaps that we find is just even that basic awareness or knowledge of what a consonant versus a vowel is.

And then even. like long versus short vowel sound. So that's going to also be really important for that syllable division piece because it like certain syllable types, um, like if it's a closed syllable, it's a short vowel. But if your second grader has no knowledge of what a short vowel is, that's not going to be helpful for them either.

So I think that's a big piece that we often miss and overlook that we can be really supporting too, is just that basic knowledge of like a consonant versus a vowel, like, you know, visually looking and can you show me which ones are your bowels, but then even, um, Like orally giving [00:31:00] them a sound like ah, is that a long vowel or a short vowel and really supporting that because one thing I've seen before too is they would give these visual supports for this student who was doing for like spelling tests.

That's that was part of in his IEP where they would just underline for however many sounds there were in the word. There was that many lines. So it was helping him as far as that phonological phonemic awareness, but then they would also put little dots underneath the line that were supposed to be vowel sounds.

And he was still writing, you know, consonants where those dots were, and it was like, well, that's a vowel come to find out the student had no idea what a vowel was like, he could not understand so that those supports weren't even supporting him because he didn't have that. And so I think just even that, you know, that knowledge, um, is, is something that we often overlook, especially in our older kids, um, where I found that that's one of the biggest [00:32:00] pieces that.

You know, hindering, I don't, I don't know if that's the right word, like, um, the barrier. You're right. Yeah. Thank you. That's all right. A barrier to, to them with more of these, like the syllable type this, um, so 

Kate Grandbois: everything that you're both saying is making me think so much about the opportunities for collaboration.

So if that student is already on your caseload. Making time for that five minute conversation with the classroom teacher. Where does this student where, where do you suspect they struggle? What are some of the literacy related goals? Or maybe it's not the special education teacher. Maybe it's the gen ed teacher.

Maybe it's the quote reading specialist or the resource room person. I mean, every district has different labels for this, which is one of the reasons why I find this to be such a murky area, depending on where you are. But. Any collaboration with a literacy oriented [00:33:00] specialist can create so many additional opportunities for generalization.

I have to 

Karina Kadhi: assume. 

Heather Caska: You're absolutely right. And that was a big piece we talked about in, um, like the, the last episode is one of our roles, like under one of our domains is collaboration. And so, especially with these students and you'll get, I mean. I've been fortunate in the schools I've worked in. Um, you know, I come in obviously with a lot of background and knowledge and literacy in this area and was little nervous at first coming into the schools thinking, you know, that they're going to be like, Whoa, like this speech therapist needs to stay in their lane.

Like they're not a reading specialist, but I've been really fortunate in that everyone's been open to, you know, collaborating and discussing and. And suggestions and ideas, but then also me learning from them too. I'm not a teacher, you know, I don't, that's, that's different, you know, that's a whole different wheelhouse.

And so just that collaboration and not only with the teachers, and [00:34:00] I think it's all of the above a reading interventionist, special education teacher, general education teacher, you know, um, but also with the school psychologist. Um, and even the occupational therapist, I mean, really, it's, it's truly a team support and the parents.

I mean, it's, but you know, in the schools, I find it harder when I'm versus my prep, my private clients versus the students I work with in the school, I'm obviously in communication a lot more with my private clients. I see the parents where at school, you don't, you're not, you know, but I think keeping that, um, in mind too, that collaboration with the families as well.

It's so important 

Karina Kadhi: because we do wear so many hats right in a, um, in a, in a school setting or even in a private setting. So um, sometimes that, or a lot of times that even just opens up the door for like divvying up goals. We've seen a lot to where our speech and language goals look really similar to like the, goals that they might have under their [00:35:00] ELA section of their IEP.

And so divvying up things that way we're getting, um, max repetition, max exposure, um, yeah, it's always a great, it's always a great plan for these students and it kind of helps us too. Right. Where we're not trying to have to do all of these things we've made a plan with. The rest of the team and they're going to cover this and they'll help this and, um, so good things come from that 

Heather Caska: for sure.

I think, um, to sometimes, you know, looking at those goals and like Karina said, a lot of times they're very similar or they at least support each other. But then I often see, especially in our older students where they're reading and writing goals like they have a goal for reading comprehension and reading fluency.

But they're still completely missing those basic reading skills as far as just decoding and phonological awareness, but there's no goals for that. And so that's where we can really come in, especially when it comes to like the phonological awareness and support that too, or at least advocate for some of those goals.

Because I can't tell [00:36:00] you how many times I've had a student come, you know, where I've looked at their IEP. Or even in the schools, you know, when they go to write the goals for a second or third grader, the goals are just reading comprehension. We'll answer, you know, WH questions after reading a grade level passage or read so many minutes or so many words per minute.

And I was like, okay, yeah, but that's our end goal. But how are we addressing their decoding skills? Because they're not going to be able to answer those questions if they're focusing so much on what they're decoding, you know, but there's no goals to address that. And so I think that's. That's another piece where we can at least advocate for that or somehow try, try to support those, those goals as well.

So the we've talked about three elements of structured literacy so far.

Um, phonology, which is well within our wheelhouse. I think we're most familiar and even known for that. So teachers are going to come to us and ask for help with phonological awareness and phonology. And then we talked. About, um, sound symbol relationships [00:37:00] and syllables. So the next area that we are pretty familiar with as SLPs and SLPAs is morphology.

And so I think one of the biggest takeaways for morphology is we need to remember that we have to think about their phonological skills too. We had one client specifically that stands out in my mind every time we talk about morphology, that this really, um, was an eye opener for us where we had goals for him.

He had, he came into our clinic. He had goals already. He had had an evaluation. So we were working with him and one of his goals was like regular past tense verbs. Um, you know, wasn't marking those. And so we were, you know, addressing the past tense. And all of a sudden he just was not getting it. And I don't remember exactly what happened, but I was, we had another SLPA who was working with him.

And I remember I was super supervising her session. And all of a [00:38:00] sudden I was like, Oh my gosh, this student has no phonological awareness. And so I was like, okay, hold on, let's take a step back. And so we gave, um, the student a phonological awareness screener and he performed very poorly on it. And I said, here's the thing, like we're trying to teach him what we're teaching him is to like these grammatical markers, you're adding a sound to the end of a word.

But if he has zero awareness, that words are made up of all these different sounds anyway, of course, he's not understanding. Of course, he's not getting it. So we had to back up and take more of a phonological awareness approach with. And versus just like that syntax or morphological approach with him.

And so that was just kind of like a big eye opener, um, For us as therapists and then just kind of keeping that in mind. So, um, I think for us, you know, that's, we're very aware of that, you know, it's part of our, our education, the different types of morph, um, Morpheme, so we have our inflectional or derivational [00:39:00] morphemes, um, and how we can go about building vocabulary and then even just building that syntax with that as well.

But when it comes to more of the structured literacy, the piece we don't have as much knowledge about is when it comes to like those spelling patterns. And so, um, you know, there are rules for when you're adding a suffix. And typically, like if you're adding a suffix like ed or ing that starts with a vowel, there are certain spelling rules and spelling patterns, like if your base word ends with a Y, you know, do you change the Y to an I or do you just keep it and add the suffix to it?

Um, and there's also rules like if, um, if you have, if your word ends in a CVC, do you double that? So think of the word stopped. S T O P P E D. Why are you doubling that P? Versus a word like jumped. You're not doubling the P in jumped, you're just adding E D. So there's, I know, these are things I have [00:40:00] never 

Kate Grandbois: considered.

Exactly. I was 10 years old when I realized how completely ridiculous some of this 

Heather Caska: is. I know. And it is. It really is. And some students really benefit from being explicitly taught those rules. But then other students, it's just even, it's just too complex, overwhelming. It's more, it's very overwhelming. So we do have some resources again, like on our Instagram, like in our bio that just kind of like a cheat sheet of the most common, like spelling rules and spelling patterns as far as, um, like morphology and then just other spelling, spelling patterns too, that are commonly taught in these structured literacy programs, um, just for, just for you to have.

Um, but I mean, again, when I got my training, I did my training through the Academy of Orrin Gillingham, practitioners and educators. It was a 90. Program. Like it was a nine day training. And so, I mean, obviously it's way beyond what we would have time for here. Um, but we do have like a cheat sheet as far as that.

And then we have like a phonics practice sheet. And I, I don't [00:41:00] know if it's linked in our bio, but we can, you can always reach out to us too, and we can send that where you have the opportunity to go through and practice a lot of these skills as far as like identifying syllable types, syllable division that we've kind of talked about, and then even using and practicing some of these spelling patterns.

So we have some opportunities. Opportunities for you to practice again, like Karina keeps reiterating. This is not for you necessarily to now turn around and teach, you know, especially if you're in the school school setting, but more so just that knowledge so you can better support the students and then just have more knowledge as far as like the interventions that they're getting, um, in the class too.

But then you do. I mean, for us, private. practice. Like that's what we focus on. We are the reading intervention, reading intervention, you know, when they come to see us. So maybe you want to take that route and you just want to learn more too. But as far as just getting a little bit of knowledge. So, um, I mean, and again, a lot of times we're already addressing a lot of these issues.

Morphology goals, you know, we have those syntax goals. We're [00:42:00] working on verb tense. We're working on plurals, um, and adding those, but I think again, adding that orthographic piece and really highlighting that is going to be helpful. Just that awareness. Um, and then also just again being aware of their phonological skills and making sure that's not something we've skipped over. 

Karina Kadhi: 

Some things that we've done, um, to work on morphology in our speech and language sessions, um, is, uh, it's always a big hit. We call it past tense basketball. Um, and we usually have three baskets set up. And this is when we're working on like, uh, our past tense.

So it has three, it can sound three different ways, right? To the id, our past tense marker, as in, um, I can never think of examples, y'all. I'm gonna need some help. Um, like painted, walked. And jump. No, that was the same. Hugged. Okay, hugged. There you go. Um, and so, whether, and then depending on what we want to focus on, do we want [00:43:00] to work on that auditory awareness piece?

So then maybe we'll verbally give our kiddos a sound and they have to isolate. So working on phonologic, um, phonemic awareness, again, they have to isolate that marker and think about what they heard. Um, And they have to shoot their basketball into the right basket and they get points if they get it right.

Um, or we might, we might be working on decoding, right? So they might have strips of paper with the different, they're all spelled E D E, right? But they just make different sounds depending on other parts of the word. And so then they have to practice reading it correctly. Um, and then shoot it in the basket that it goes in.

So it's, it's great repetition, great drill. You can target different aspects of that. Um, and we're supporting and addressing that morphology in there and speaking in some great, uh, phonemic and morphological awareness as well. That's always a big hit. Um, and then the other one I'm looking at here, I think you made this one, like that, that book.

The, the suffix book, like fully [00:44:00] 

Heather Caska: lastly. Yeah. So when we're working on some of those morphemes to working on those suffixes and prefixes, some things that we've done with. Our students is we've created like little vocabulary notebooks where we add in like we have the suffix or the prefix, the definition of what it is, but then we always draw a picture to kind of help with.

So like one I have is Lee L Y. Um, and our word that we use was slowly. That was our keyword. And so we drew a picture of a turtle and so kind of just, but again, making it very specific, the child, like letting the student come up with it because individualizing it and making sure it's meaningful to them is.

Um, and that goes back to, to those speech sound cues that we talk about, um, you know, with some of our students that we've, we've worked with, um, we love the beyond speech sound cues. We use those a lot. And we also, um, do use like the lips pictures, but some, sometimes those don't click for our student. And so we let them come up with our own.

And I don't remember if we mentioned this in our last, [00:45:00] um, episode we did, but Karina had a little girl and we were working on her. F and the, um, the mad cat wasn't working. We tried fish just coming up with the keyword instead of the environmental sound, nothing was working. And so her mom helped us, um, come up with, uh, part.

And that was her keyword for, and it stuck, I mean, but we just, she could not. And so it was, it's hilarious, whatever it gets from there, right, exactly, you think you should see the picture, it's, it's so great, but it's just a great example of how individualizing and letting the student, you know, like a lot of times we, um, We draw, let them draw the picture and we've, some of them have come out really, um, hilarious, you know, like they draw the picture and you're like, what is that supposed to be?

And, um, they're, Oh, it's a monkey itching its butt. And you're like, Oh, okay. Okay. [00:46:00] Um, for that, I itchy. And so, yeah, so I think it's important. And then just going, you know, going back to morphology, same for that, you know, when you're working any vocabulary, really, what is like, what do they picture in their mind for that?

And that's, what's going to, that's, what's going to help because I mean, we can tell them things, but if it's not clicking for them, and that's another piece with those programs too, is they're very scripted, you know, and, and tutors and people that are trained in it are trained, you know, you do not go off the script.

And I understand that as far as like. for it. But what if it's not, what if it's not working? Like, what if those keywords that are in that program are not clicking with that student because they don't have the background knowledge for that, or, you know, whatever, it's not meaningful to them. Um, they need to be able to use what is going to be meaningful.

And I think us coming in as clinicians, we have that knowledge and Understand how important that is. So same goes back for that when you're just working on morphology too, and helping build that vocabulary. I just want to say that all 

Kate Grandbois: of the examples you're giving [00:47:00] make it feel so easy to address.

Literacy in what we're already doing. I'm just imagining a situation where you might have a student on your caseload that you maybe you're working on speech sounds and that's what your goals are related to. But then if you take that extra step to collaborate and find out if you know if they do have some sort of.

Services for literacy or need additional support for literacy, just tacking in those letters or putting in that extra step into your therapy program to tie it back to literacy. I, I. The way you're describing it makes it feel so accessible. Like it's not this whole extra thing you're doing. You're already doing it.

You just need to 

Heather Caska: tweak it a little bit. Yeah. I'm 

Karina Kadhi: glad you say that because that's our goal. 

Heather Caska: That is, um, and even if the, even if your student doesn't have goals for literacy, like it's gonna benefit everyone, you know, you're benefiting. Everyone's going to benefit from that. And that's the [00:48:00] thing is not only students, not only students with dyslexia are going to benefit from structured literacy.

All students benefit from structured literacy. So 

Karina Kadhi: I feel like that's going to funnel that can funnel us into executive function. Can we like jump to that? Yeah. He's really quick because what, what that no students going to We had a disadvantage from being exposed to this in their intervention, right? Because what we're doing is making it multimodal.

What we're doing is making it accessible to everyone and just incorporating another neural pathway that's going to make an association, you know? So no one's going to be at a disadvantage from us embedding phonological or phonemic awareness into our speech therapy. No student is going to be harmed in this therapy.

Right, but yeah, yeah, it's it can be something simple that we embed and hit on that. And so I talked a little [00:49:00] bit about, um, executive function. I know it's not a one of the formal six elements of structured literacy, but it's involved in everything. It's involved in, um, learn our students learning. So in a nutshell, uh, executive function skills are like, um, perception, awareness, attention, working memory, inhibition, initiation, self monitoring, retrieval, right? What Heather was talking about when, when that sound cue isn't working, it's not sticking. What's not sticking for me is I'm not able to like retrieve that information that I've learned and then apply it.

And that, that's an executive function skill, um, or several together. Um, and so we love to embed, um. supports for executive functioning into our speech and language therapy as well. And so, um, a few different ways we could do that is. Making things multimodal, giving them visuals of things, um, making things tactile, just making, individualizing it, and finding what works for them.

Um, and then probably the most valuable [00:50:00] tool that we can, oh, I say valuable in that we can do the easiest and reach the most students, um, without really having to, because EEF is a whole, can be a whole, Presentation on its own. Right. And so without having to dive too much into that, something that we really think that we could do to support this is called reflexive questioning.

And Tara Sumter is a SLP who specializes in executive functioning and she has a book and she's extremely knowledgeable in this and so we got this, this strategy, if you will, from her and so it's the idea that it. Thank you. Our words matter and the way that we word things can support our students so a reflexive questioning really remote promote self reflection and self awareness, which ultimately leads to that generalization right which is what we want, and it doesn't give or tell our student what to do, but rather guides and models [00:51:00] self talk and teaches problem solving for them so in our speech room, what that might look like when we're working on our coughing camel sound or.

And so maybe we are producing it and they make the instead of just nope try again that wasn't it. Some way we could use our words differently to put them into a reflexive question is where, where did you feel that working? Where should you feel it working? Because now we're forcing them to think and to kind of get some of those self talk patterns and self checking, self monitoring patterns in there.

Another way that that one other thing that could look like in our speech room is we have that kiddo that really can't sit still and it's doing all this and instead of sit still sit down, sit down, that we're just telling them what to do right there's no thinking involved for them. Where should your body be right now, what's your job right now, what should you be doing right now, because then what's that's going to force them to come back and be like, Oh, wait, what should I be.

And maybe they don't know, but then [00:52:00] that's an opportunity to, oh, so here's where we can, here you can ask. And, and so it's just great modeling, problem solving, making, um, our, our kiddos more independent and less reliant on those external cues. And more aware of their internal. 

Heather Caska: Yeah, I think and on top of that too.

And I remember Tara talking a lot about this as well as it's also just like they're confident. So if you say like, um, you know, where did you feel that your tongue working? Um, I felt it in the front. You're right. Yeah. So you're not. Like you're not, it's not like a, nope, you do it wrong. Do it again. Wrong.

Do it again. You know, where did you feel your tongue working in the front? You're right. Or should you feel it working in the back? You're right again. Can you show me that? Show me it working in the back so they can get the, and so I really like the independence and also just. That confidence to have like affirming.

Yes, they're doing, you know, they're doing the right thing instead of constantly. Nope. Do it again. Wrong. Do it again. Um, because then that can just be super discouraging as well.

Amy Wonkka: I think that those are such nice. And I think that's one of the big points to raise to [00:53:00] not only about shifting the student into a more reflective state, but also providing a more positive environment for them to be in when they're practicing like those strategies seem, I can't remember exactly what you said, Karina, but the best bang for your buck in terms of, you know, it's not a big change to your, to, to what you're actually doing, but I think it benefits the student and your relationship in multiple ways.

Totally. And similar to some of that. integrating the literacy concepts. I don't, I don't know that that would 

Karina Kadhi: be a bad approach for anybody. Yeah. Yeah. Yeah. Um, we can go, you want to go into semantics? Yeah. 

Heather Caska: So, um, the fifth element that we'll talk about as far as structured literacy, again, is very much in our wheelhouse.

So we won't spend too much time talking about it, but semantics or vocabulary. Um, again, I think the biggest takeaway for this, it goes back again to that orthographic piece and writing it out. Um, there's, uh, a podcast episode with Dr. Mary [00:54:00] Eltz, um, and Dr. Shelley Gray and Dr. Tiffany Hogan, um, on the See, Hear, Speak podcast.

And it just talks about working memory, um, and word learning, um, and it's. I've listened to the episode probably like five or six times because it's just, it's so good. But, um, Dr. Alt has this really great quote in there. Um, it says we don't always do a good job of identifying when students have both like oral and written language difficulties because what their research is showing is that kids that struggle both with oral and written language that there's, they, um, They do have a lot more difficulty learning words.

And so when it, and so they just say by writing, even kids with dyslexia, by giving that orthographic representation of a word. So even think about that with sounds. We keep talking about that when you're working on articulation. Match it with those orthographic cues too, that they're, they're, they're significantly better at learning those words when you have the [00:55:00] orthographic piece too.

So don't, don't forget about that. You know, when you're working on vocabulary development, write it out for all students, cause it's just going to really benefit them. Um, we have a really great resource, um, that we like front it's called from talking to writing. Um, it's a, it's a book that we really love.

And it, um, addresses a lot of vocabulary and syntax, um, and even written expression. So, um, it starts just, you know, vocabulary goes into basic sentences and then even into, like, um, multi paragraph essays, um, scaffolds it to wonderful curriculum. We use it and adapt it a ton with the students that we work with in our, in the school and privately.

Um, so just a, a really, um, useful resource. And then again, that just goes into syntax, something that we're probably already doing in our, in our speech and language rooms as well. Um, again, we love the book from talking to writing to support this, but just writing it out. So we do a lot of, um, [00:56:00] we start a lot kind of like bigger working on phrase.

There's like who phrase, what phrase, where phrase, when, and kind of building that way. And we literally cut out colored pieces of paper, who, what, where, when, um, we have a lot of examples of these on our Instagram. I know of videos of how we've used it and really just helping showing how we can build sentences.

And then we kind of break it down even smaller than into nouns and adjectives, like those parts of speech, but we start bigger, you know, with the, who phrase, who did it? The cat, what did the cat do? Ran? Where did the cat run? In the yard? The cat ran in the yard and just, and then, you know, then you can kind of go back and break it down into, okay, so what's your noun, what's your adjective, what's your verb.

Another way we've kind of helped support even spelling like that is we will have like, um, on the whiteboard and we make three columns, maybe like noun, adjective, verb, and then we give them a word, maybe like a, a specific target spelling, like phonogram that they're using. Um, and then we use it in a sentence and then they just, they spell the word like in that column, as far as like, what's that a [00:57:00] noun, what's that a verb, what's an adjective.

So just another way to just really support those syntax skills, but then also supporting. Um, their spelling as well, and just that sound symbol piece. So those are the six elements. So again, phonology, sound symbol, syllable, syntax, semantics, and morphology. Um, and four of those six well within our wheelhouse.

And then the other two, um, you know, sound symbols, I think we have a little bit more knowledge syllables and syllable division. Syllable types might be be a little bit more new. But again, we have a lot of resources to kind of help you understand that. And then the last piece we always are, um, encouraging or that we, what we do address or encourage you to support is reading comprehension and written expression.

So we've talked a lot about the reading comprehension already. Um, this really ties heavily into your executive function as well, as far as self monitoring really using, um, active reading strategies. building background knowledge, um, is going to be really [00:58:00] important for these students. Sometimes, you know, with some of our students, we've created these like active reading checklists, um, you know, for that visual support to kind of help them, you know, check in, um, you know, Review questions first.

So we talk about background knowledge. We kind of do a scan of what we're about to read, looking at pictures, headings, read pre read and in comprehension questions that we have. And then as we go through and we read whatever we're reading, we have check in points where we kind of stop and do some self reflection.

Okay. What did I picture for that? What am I reading? You know, and just using, and then kind of going. And then again for written expression, we use lots of visuals to kind of help as far as like the writing process and organizing your thoughts, a big thing we really encourage our students don't stop writing, you know, they'll start writing and they get stuck on spelling a word, and then the rest of their sentence is gone, you know, they completely lose their train of thought.

We have one little girl, one girl that we worked with for a while. And she was, I think it's seventh, eighth grade at [00:59:00] this time. And Karina was doing like a writing, um, task with her in, in their session. And she was, I don't remember what it was, but she wrote the cooks going to write instead of kitchen. And Karina was like the cook's room and she's all, well, the kitchen, but I didn't know how, how to spell it.

And so completely avoiding, you know, and changing their sentences. And it didn't sound as good, 

Karina Kadhi: right? That didn't, that wasn't as nice of a, of a sentence, um, for her. 

Heather Caska: Yeah. So really we're working on. Just add like teaching them, you know, it's okay, like just get it down and then we will come back and we'll edit later, you know, but it's hard because a lot of times kids with dyslexia, they're, they also tend to be perfectionist too.

So it's hard for them, you know, if they don't, if they're not getting it, you know, right. Or it's not exactly the way it should be. And, um, we had another, um, boy tell us one day, he's like, I have my thoughts here, like they're here, but then it's like, as it goes down and gets to my hand, it gets lost. And then he just like, can't get his [01:00:00] thoughts on paper.

And so like, just to have him be able to verbally express that was like really helpful for us, you know, like, what could we do to, to better support him then? Cause it's not like he doesn't have the ideas he has them, you know, but it's when he'd go to get it on paper, he loses it. And you hear that all the time with your students with dyslexia.

So, um, really supporting that written expression. Scribing for them so you can get it, you know, you can get it down. That's often a big support or an accommodation on their IEP as well. Um, but just really encouraging them not to not to worry about spelling. So, um, and I think that's it. We talked about executive function.

So, um, again, you're you're We're not saying that you now have to start adding all of these new students onto your caseload because I, we get that a lot to like new goals. Yeah, but just being aware of the students you have on your caseload, and how you can really support them with these structured literacy elements with the therapy that you're already [01:01:00] doing by just adding in some different elements or kind of tweaking your, your activities that you're doing with them.

Kate Grandbois: You all have shared so much with us today. I can't tell you how much more accessible this all feels now. And we're really, really grateful for you sharing it all. Do you have any additional last rec last set of recommendations or words of wisdom that you want to leave our listeners with? 

Karina Kadhi: Um, I, you know, I, I think it's just that I've really, and for myself personally too, is just that we're lifelong learners and sometimes it can feel like, oh, you're asking me to do what?

Because I remember learning these spelling words, rules at one point and I felt the same way. But, um, but, but to know that we have a bigger, look at the bigger picture and that we can, we can play a bigger role in the, um, with, with these students, um, in the, in our existing role. Um, and hopefully we spark some interest for some, um, speech therapists that really have a passion for [01:02:00] literacy.

Heather Caska: Yeah, and I think especially in your kindergartners, because again, they're the ones we are most often the first professional that comes into contact with these students that are going to have, you know, learning difficulties, specifically in reading and writing. And so really just being more aware in our younger students because we're the ones that can really make that impact.

Early on, um, because most likely they're not going to get tested or formally evaluated until later on. So especially in those younger students, just kind of come up with a good action plan of how you can better support them and be aware of them on your caseload. Thank you so much for 

Kate Grandbois: all of this. We're so grateful for your time.

For anyone listening, all of the references mentioned will be listed in the show notes. Thank you again so much for being here and we hope to welcome you back here again 

Karina Kadhi: sometime soon. Thank you. 

Kate Grandbois: Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA [01:03:00] CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study.

Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com

thank you so much for joining us and we hope to welcome you back here again soon.

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