This is a transcript from our podcast episode published March 14th, 2022. The podcast episode is offered for .1 ASHA CEU (introductory level, professional area). This transcript is made available as a course accommodation for and is supplementary to this episode / course. This transcript is not intended to be used in place of the podcast episode with the exception of course accommodation. Please note: This transcript was created by robots. We do our best to proof read but there is always a chance we miss something. Find a typo? Email us anytime.
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[00:00:00] Kate Grandbois: Welcome to SLP Nerdcast. I’m Kate
[00:00:09] Amy Wonkka: and I’m Amy, and we appreciate you tuning in. In our podcast we review and provide commentary on resources, literature, and we discuss issues related to the field of speech, language pathology.
[00:00:20] Kate Grandbois: You can use this podcast for ASHA CEUs. Visit our website for other courses, including live courses, webinars, blog posts, and SLP masterclasses available for graduate level credit.
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Language dynamics group develops and disseminates evidence-based language and literacy assessments and interventions. They specialize in narrative language intervention for your caseload and for the whole school, check out their dynamic assessments and [00:02:00] visit languagedynamicsgroup.com to download a suite of language screening and progress monitoring tools for free. Language dynamics group did not participate in creating the contents of this episode.
We are really excited for today's episode. We have a lot to learn and we're very excited to welcome Tim DeLuca and Kate Radville. Welcome, Kate and Tim.
[00:02:22] Tim Deluca: Thank you. Thanks for having us. We're excited to be here.
Kate Radville: Yeah. Thank you
[00:02:27] Amy Wonkka: All right, Tim and Kate, you guys are here to discuss the relationship between developmental language disorder and dyslexia.
But before we get started, can you please tell us a little bit about yourselves?
[00:02:38] Kate Radville: Yeah. Thanks Amy. I'm Kate Radville. I am an educator, a speech language pathologist, and a literacy specialist. I actually began my career more than 15 years ago as a classroom teacher, primarily working in early childhood general ed classrooms.
Uh, since [00:03:00] then I have been a speech language pathologist in a variety of clinical settings, including with adults and children in healthcare and education. And most recently I spent several years as a clinical instructor at the MGH Institute of health professions in Boston, teaching graduate student clinicians to work with school aged children with reading and writing difficulty and currently, and this is my connection to Tim, I am a doctoral student at the MGH IHP, and I'm studying developmental language disorder and dyslexia with Dr. Tiffany Hogan in the sale lab.
[00:03:41] Tim Deluca: I am Tim DeLuca. I am also a speech language pathologist and a reading specialist.
I started my career working with medically complex children, children with autism who have limited verbal language. Uh, so a lot of AAC. And then over the years, I've [00:04:00] transitioned to working more with children with DLD and dyslexia comorbidities. Over the past number of years, I've continued working clinically, um, done some clinical supervision at universities, a little bit of teaching.
And like Kate said, now we are together spending a whole lot of time together, uh, studying DLD and dyslexia and Dr. Tiffany Hogans, speech and language literacy lab at the MGH.
[00:04:25] Kate Grandbois: I cannot wait to hear about all of these things. As our listeners know, this is an area that I know very little about Amy. You might know a little bit more than me, so we're very excited to learn from you both.
Before we get into the fun discussions, the powers that be require that I read our learning objectives and financial and nonfinancial disclosures. Sometimes people write in and ask me to skip this part. I can't ASHA makes me do it. So please bear with us while we get through it as quickly as possible. So our learning objectives for the day: learning objective number one, define DLD and dyslexia, understand how they are related and report on at [00:05:00] least five behavioral presentations across academic and social settings.
Learning objective number two, understand the SLPs role in assessing and treating both DLD and dyslexia as members of an interdisciplinary team across the lifespan. And learning objective number three, be able to locate at least five free resources to further explore both DLD and dyslexia and assessment and treatment options.
Disclosures. Tim DeLuca's financial disclosure is Tim is employed by private practice and university. Tim's nonfinancial disclosures. Tim is an ASHA member, a certified speech and language pathologist and reading specialist, a doctoral student at the MGH Institute of health professions and a member of the sall lab at the MGH at the Massachusetts Institute of health professions.
Kate Radville not me. Kate Radville financial disclosures. Kate does not have any financial relationships to disclose. Kate Rodville is non-financial disclosures. Kate is an ASHA member, a certified speech language pathologist, and doctoral student at the MGH Institute of health professions.
Kate Grandbois that's [00:06:00] me, my financial disclosures. I am the owner and founder of Grandbois Therapy and Consulting LLC, and co-founder of SLP nerd cast, my nonfinancial 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, Mass ABA, the association for behavior analysis international and the corresponding speech pathology and applied behavior analysis special interest group.
[00:06:25] Amy Wonkka: Amy that's me financial disclosures. I'm an employee of a public school system and I receive compensation as co-founder of SLP nerd cast. And my non-financial disclosures are that I am a member of ASHA SIG 12, and I serve on the AAC advisory group for Massachusetts advocates for children. All right.
We made it through the boring stuff is done onto the fun, Kate and Tim, why don't you start us off and start us off just by giving us some background and the definitions of DLD and dyslexia. What's the difference? And why is that important for a speech [00:07:00] language pathologist to know?
[00:07:01] Kate Radville: Yeah, absolutely. So, ah, big questions, Amy.
I think maybe I'll start by saying that I think, you know, being on the same page about definitions and we have this conversation as probably a theme that will come out throughout our conversation today. I hope it will. So just to kind of get everyone on the same page, let's kind of break things down and maybe start with DLD.
DLD stands for developmental language disorder and it is a neurodevelopmental condition. In other words, it, that means it's a brain difference and that children are born with it and just put most simply it's marked by difficulty learning, understanding, and or sort of any of the above, using spoken language.
And so we might see in a child with DLD difficulty with vocabulary, grammar, use, some or all of the above. And as you might expect, this can really make [00:08:00] communicating or listening and understanding really challenging.
[00:08:08] Kate Grandbois: I did not know that. So how is this different from dyslexia?
[00:08:10] Kate Radville: Yeah. To contrast that I guess, with dyslexia and we'll kind of, let's contrast things first.
And then I think we can get into this conversation of how DLD and dyslexia are, are related and what happens when they coexist. So dyslexia, you know, similarly it is also neuro-biological in origin. So children are born with it. It's a specific learning disability, but unlike DLD, which is really characterized by oral language difficulties, dyslexia, um, really involves difficulty with accurate or fluent word recognition.
So word reading. Usually this happens because children have a difficulty with the phonological component of language. So the piece [00:09:00] of language that has to do with speech sounds, their phonological system, and this usually happens, um, sort of in this unexpected way, given other cognitive abilities and given good instructions.
So really dyslexia is difficulty with word reading.
[00:09:20] Amy Wonkka: So let me ask you a question. It might be a silly question, but when I'm thinking about DLD, some of those examples that you gave challenges with word finding and some of those other pieces, how do I, how do I tell the difference between that and maybe just a receptive language delay or an expressive language delay?
How, how is that differentiated.
[00:09:39] Tim Deluca: That's a really good question. And I think one that is a challenge in our field, right. I think, depending on where you were trained, when you were trained, where you practice, um, you might see the same child and kind of classify that child's abilities in multiple different ways.
So it's almost like a [00:10:00] branding problem for our field, right? Because we're not using common language across different SLPs where not able to translate research into practice because what somebody in research is calling a certain type of presentation, somebody in practice is calling something very different.
If you're going from a private practice to a school, the child's going to be classified in different ways. So DLD actually became a term that became more widely adopted pretty recently, there was this really cool conference where all of the powers that be in the field of speech language pathology got together, worked together and, uh, kind of debated how we should classify language impairment.
So, um, that was called the catalyst convention and, uh, through a process that they use there, they kind of determined that DLD would be the most appropriate term for us to use to describe this whole body and different presentations of language impairments. And [00:11:00] then I think Kate was going to talk a little bit too about like other terms we might see with DLD.
[00:11:07] Kate Grandbois: That was going to be my question. And also that sounds like an, a very official, very official conference. Like it was like the UN or something like everybody got together and was like, because I've never heard, I went to graduate school 15 years ago. This was not a term that I was at all familiar with.
So it doesn't surprise me that as you know, over the last 10 years, as people have dripped into the field one year after another, there it's interesting that it's created this. I don't know, confusion with too many terms, but tell us about the terms. What other names might this go by?
[00:11:40] Kate Radville: Yeah. So, Tim, I love that you referred to this as a branding problem.
This is great. And this is why I said like, you know, I think framing this, um, from the beginning, just getting everyone on the same page, because we're saying DLD, but I hope that as we discuss this, people who work with children with oral language difficulty will be thinking like, oh yeah, [00:12:00] no, I work with kids with DLD.
We're just using so many different terms. So, you know, again, we just haven't been consistent defining disorders, but, um, a lot of clinicians may be using or may have heard the term specific language impairment up until recently. And it continues to be used. If you're reading research, you probably seen SLI. A lot of this depends on where you work.
You know, if you're in a hospital, maybe you're in an outpatient department, you might be coding this as an expressive or receptive language impairment. Mixed receptive, expressive language impairment. You're probably using the ICD 10, even under F 80.9 or the code that your parole using their whole range of sort of sub categories that you might be coding children's oral language difficulty as. Probably most common. I see SLI language delay, even developmental dysphasia. You know, that's probably the least [00:13:00] common, but really a range of terms. But all of this is really talking about more or less the same thing. You know, these children who struggle with receptive language, listening comprehension, expressive language, or both, and really to varying degrees.
No, I know Tim you've worked in the schools as an SLP a lot more than I have. Do you want to kind of talk about what you've some good insights about how this sort of works with IEPs and qualifying kids and what terms are used.
[00:13:32] Tim Deluca: Sure. And I actually, I worked in schools with Amy for a long time. So Amy feel free to jump in a few extra ideas here.
So in schools, we're, we're really our role in a school is not to provide a diagnosis, but rather to identify a category under which a child qualifies for services, right. That's what IDEA asks us to do. And there are 13 different categories that we're thinking from. So we might be, [00:14:00] uh, classifying children as having a specific learning disability or a language impairment under IDEA.
And I think that gets kind of tricky, right? Because in schools we want to give good information to families, but we also want to make sure that we are doing kind of what we're guided to do within our school system and kind of following the rules of our school system. So like we talked about with this branding problem and how we're all talking about the same disorders in different ways is so a family might come in for an IEP meeting and hear that their child either has a specific learning disability or a language impairment.
And then they're looking for resources. They're trying to figure out, okay, what else can I do to support my child? What is this going to look like for my child across the day inside of school, outside of school? And the families might not be able to find a lot of good support around this, because again, we're all looking for different terms and talking about the same thing in different ways.
So. I know that's something that I struggled with in, in schools is trying to [00:15:00] figure out how to best support families and be consistent with the language I'm using so that if this family is going and seeking services at a private practice, we're able to really communicate effectively with one another and coordinate our services so that the child's going to have the best chance at making the most progress.
[00:15:16] Kate Radville: Yeah. And to add, I'm glad you brought that up Tim. I just read this fabulous paper it's by Andrea Ash and what she did was, um, she has qualitative methods to actually find out what affects this poor branding problem, right? This lack of consistent terminology has on families. And they really did find that, um, these difficulties in sharing information, in part, there were other issues, but in part due to inconsistent use of terminology really did have lasting negative impacts on families.
They looked at mothers specifically, but mothers felt stressed and confused about their kids' diagnoses and less able to find [00:16:00] resources. Right? Like if you're not really sure what your child's diagnosis is, it's a lot harder to even find useful materials on the internet. You know, you get into this kind of like mess of Googling and not necessarily even the right terms.
So this definitely has impacts on both kids and families.
[00:16:18] Kate Grandbois: That was going to be my next, related to my next question, which was as the SLP, how much does the label matter? Because are you going to be treating it any differently based on the data that you find in your assessment, for example? So there are obviously, can you tell us a little bit about that?
Like why as SLPs, should we really care about having a deeper understanding related to the nomenclature around this?
[00:16:47] Tim Deluca: Yeah, I think you're right, right. Um, DLD is a broad term. It's it's like Kate said it could talk, um, it can refer to difficulties with vocabulary. So word level, sentence level, discourse level language.
So as you're assessing [00:17:00] a child, you're really going to be looking at like, okay, which level of language is impaired? Where do I need to put my time with intervention? That's where I'm going to provide my supports. So in that regard, you might say like, uh, why, why does my label matter? And that goes back to maybe you have a child that's presenting in a way, or, you know, their language presenting in a way that you've never worked with before.
How are you going to find information about what to do? Well you're going to go look at research, you're going to look at tools online probably. Right. That's how a lot of us are getting information these days, look for good podcasts. And if you're not aware of the kind of language that might be used to refer to this, uh, kind of uh, disability, right? Then you might not be able to find good information and good resources. And then as you're communicating these ideas to others, you might not be doing it justice. You might not be effectively communicating your ideas so that you can pass off care to [00:18:00] another provider effectively. And this might actually be a really good time to, to throw in a few of our resources around, um, how to learn more about DLD.
And we'll, we'll send links to these, um, as well, we talked a little bit earlier about the catalyst convention, which is that big kind of like SLP UN conference, where, where they came up with this, this, uh, or agreed upon this term. And there's a great podcast by actually mine and Kate's mentor, Dr. Tiffany Hogan, where she talks with Dr. Dorothy Bishop, and they talk all about that catalyst convention of what it looked like and how they came to the term DLD. The best term for us to use as a field moving forward. And then on top of that, there's a paper by Dr. Ray Paul of textbook fame. You know, I know Amy loves those textbooks. Yeah. Um, so that article is called what's in a name.
And Dr. Paul basically walks through the history of our field and how across the [00:19:00] years we've referred to language disorders and talks a little bit about why, how we refer to language disorders matters. So I think those will be two good resources to further explore why DLD should be used in our practice.
[00:19:14] Kate Grandbois: I just want to say for one second, how much I appreciated your answer. That was the most amazing answer because I'm imagining myself as a clinician working in the schools or working anywhere and saying, okay, my, I have this student or client or patient who's presenting with an expressive language delay.
Jeez. I'm looking for some treatment intervention. I'm going to go back to the literature, looking, doing a literature search and saying papers for SLI. Well, that doesn't apply to me because that's not the diagnosis that I'm working with. And how, how it really does limit your ability to seek additional information to support you as a clinician.
I think that is just such a good point. And we're going to link all of those resources and references in the show notes. I should just say, so if you're listening and you're jogging or you're [00:20:00] running or driving, whatever, all of those resources will be listed on the page. So thank you so much for those.
[00:20:06] Amy Wonkka: I do think this is such a persistent issue in our field.
This like having a consistent nomenclature for things, because Kate we've talked about this in sort of our area in our scope of practice focus with aided interventions, right? Those interventions are called like 15 different things in the literature and it serves the same challenges at the clinician level.
What am I really looking for? How do I find more resources? So I think, you know, it's, it can be hard to shift the way we do things, especially for those of us who are used to calling something one title. Um, but I think that there are a lot of reasons that using a common terminology makes so much sense for clinicians and clients and their families.
[00:20:49] Kate Radville: And I think just to add to that, DLD is really significantly under identified. And I think another negative [00:21:00] ramification of not using consistent terminology is that we don't find these kids. So we know that about 7% of kids have DLD, which is, I think like one or two in every classroom. And it's actually far more common, or I think it's like five times more prevalent than autism, for example, which we know has had a lot of really awesome press, right. Um, but despite that, you know, despite how common DLD is only about half of kids with DLD are identified. Um, so I think this limited public awareness is another sort of impetus to fix our branding problem.
[00:21:39] Tim Deluca: And that, that makes me think to Kate about how, um, because a lot of people are not necessarily thinking first about language impairment.
These children with DLD might be classified in different ways. So if we picture a child who's seven or eight years old in a classroom, and they're in a classroom where their teacher is [00:22:00] using some phenomenal language, modeling complex sentences all day, and this child has an unidentified language disorder.
What's the child going to look like in that classroom? They're probably going to be moving around a lot. They're probably going to look like they're not really paying attention. They might be trying to chat with a friend and trying to distract others. And that might look like, oh, the child has behavioral problem.
Or, oh, this child may have had, might have ADHD. And we know that our tools right now, depending on how we're using our tools might not be sensitive enough to tell us like, oh, this child definitely doesn't have ADHD. Let's look at something else. Um, a lot of, a lot of. Gold standard for an ADHD tool. Uh, Dr.
Shawn Redmond does a lot of work on this. This tool actually has a lot of questions that are more closely associated with language impairment rather than ADHD. So if, uh, that neuroscience or school educational psychologist is not privy to that, not aware that the child's [00:23:00] looking very significant on the set of questions that might actually be more closely associated with language disorder.
The child might be ending up getting a label of ADHD or getting a label of some sort of behavioral, social, emotional disorder when really the underlying impairment is language and we're not ever really addressing that.
[00:23:18] Amy Wonkka: And that right there is why the consistent labeling and looking is so important because it's not just about making sure that we check the right box.
It's about providing the appropriate treatment. And I think the example that you gave right there, Tim is one in which the strategies and approach that a team might take to support that student or that client could look really different depending upon the lens and the focus of everybody on the team and what they think is kind of the underlying challenge area.
[00:23:50] Kate Grandbois: This is all very interesting. So can you tell us a little bit more about, you know, we, we started this by [00:24:00] talking about the difference between DLD and dyslexia and how an SLP, so we've covered the difference between those two things, some resources and, um, labeling issues, name issues related to the two disorders.
But we have, I think, as a field, I'm just, I guess saying this for my own confirmation, the label of dyslexia is still very clear is that, is that right? So in other words, if you have a student who is, I'm getting some, I'm getting some funny faces from you, Tim. So there's more to the story here and I want you to tell us, um, you know, is there, um, is there more to the story for dyslexia as well?
[00:24:41] Tim Deluca: Of course, there is, that’s what so exciting. Well, well, I think I, I'm going to pass this one to Kate because Kate speaks about this so well, and it's really kind of an area of expertise for her. So i’ll pass this one.
[00:24:55] Kate Radville: Okay. Well, thank you, Tim. That's a, it's a lot to live up to, but okay. So, you know, we've [00:25:00] talked about DLD and DLD we can think, you know, not to over-simplify but difficulty with oral language, right? So range of kids, range of severity levels, difficulty with oral language. Dyslexia is really a difficulty with written language. So it is, I think what probably more people know about as compared to DLD it's reading difficulty.
Right. Um, and it, it really is word reading difficulty. It is certainly very related to language in that most children with dyslexia, like I said before, have this difficulty because of a deficit in the phonological component of language. So one thing we know is that early phonemic awareness, your awareness of the sounds and words and ability to manipulate them is very closely tied to early reading success.
In kids with dyslexia, we generally do see difficulty with decoding. So sounding out words, you know, in, in [00:26:00] early readers, we'll see them really struggle through a text. Um, not read as fluently as their peers who are really taking off and accelerating through learning how to read. Um, and later on, you know, if this continues to be a difficulty because they're not reading the words accurately, or as efficiently as we would expect, we start to see difficulty with reading comprehension, especially as that becomes more necessary, right?
Little kids start off reading very simple texts. It's not much to understand if they're struggling, we really see it. We're like, oh gosh, you're not reading the words on the page. Older students, um, who struggle, still struggle with reading. They might be able to read quite a bit, but it becomes even more obvious that they're not comprehending what they read because they're not reading accurately and efficiently.
[00:26:51] Kate Grandbois: Okay, that makes a lot of sense.
[00:26:51] Amy Wonkka: We've had a number of guests on this podcast, you know, I'm thinking of Trina and Doug who have talked just about that relationship [00:27:00] also between oral language and reading and how those two do affect one another and don't necessarily exist in a vacuum. Um, so I think again, being aware of potentially multiple issues that could be at play for your client is super important when you're planning your intervention.
[00:27:17] Kate Grandbois: And for those who are listening, who aren't sure who Trina and Doug are, they have, um, come onto the podcast with us, uh, 3, 4, 5 times. Um, there are researchers in this area. Um, so you can go look for those episodes. It's um, Dr. Trina Spencer and Dr. Doug Peterson. Um, I wonder if we could sort of merge into the second learning objective and start talking about assessment and treatment in these areas.
So we've talked about some of the overarching guiding principles, nomenclature, and those kinds of things. Tell us a little bit more about the assessment and treatment process across these two constructs.
[00:27:51] Kate Radville: I wonder if it might be useful. So we're thinking about DLD and we're thinking about dyslexia [00:28:00] and, you know, we do know there's about 30 to 50% comorbidity, so super high comorbidity between the two.
So about half of kids with DLD also have difficulty with word reading. So comorbid DLD, and dyslexia, most kids with DLD struggle with reading comprehension because of their oral language difficulty, right? Your oral language, underlies really what you're able to do in terms of understanding print. And you can read all the words you want, but if you don't, if your language system doesn't support it, you probably won't understand what you're reading.
So DLD, dyslexia, high comorbidity between the two, I think when talking about sort of assessment and teasing out the two and figuring out, you know, why. Is this child not successful with reading the simple view of reading. And I don't know if that's come up on this podcast, but this model called the simple view of reading is super useful [00:29:00] to think about.
Kate Grandbois:Tell us more about it. I don’t know anything
Kate Radville: Yes. It's sort of what it, you know, I I've often joked, I want to get a tattoo of the simple view of reading. Like I just think it's that useful. So, um, originally this model is not new. Um, I think it was same as in 1986, I think
[00:29:17] Tim Deluca: 86, 87, 88, around there
[00:29:19] Kate Radville: another great thing out of the eighties.
So I think researchers Duff and Tunmer in the eighties, and really, it says that we think the end goal of reading, right? The equal sign points to reading comprehension. That's what we all want to do. Like the point of reading is to understand what you read. Um, and it's just a simple math equation, listening comprehension, plus word reading equals reading comprehension
[00:29:45] Tim Deluca: times.
[00:29:46] Kate Radville: Times, sorry, times I used the wrong …So we have these two components, right? We have oral language or written language reading the words on the page equals you know, [00:30:00] basically successful reading
[00:30:01] Tim Deluca: and, and it being multiplication versus addition is important because if you have a zero for word reading zero times, even if your language comprehension is.
Your overall reading comprehension is still going to be a zero because you read any of the words and then you flip that as well. So that's why, that's why that multiplication sign is an important one there. And I think this is also a really useful way to communicate these ideas with parents and the rest of your team, right?
When you're working on an interdisciplinary team, especially like within a school, you're often, you might be an SLP working with a reading specialist, special educator, whomever else. This is a really great way to explain why your role on that team is really important because that oral language component is half of the equation.
[00:30:49] Kate Radville: And this is why it's important to assess both oral language and written language, right? Like picture your multiplication equation. We don't want a question mark on half of it. [00:31:00] Right? You can't do that math. We want information times information equaling a known product. So we want our number for word reading.
We want our number. This is making it seem incredibly simple, but we want our number for oral language. And then we want it to equal this known product of, you know, why are things breaking down for this child?
[00:31:23] Kate Grandbois: This equation is so simple, but so brilliant. It makes so much sense. It's the first and only time we've discussed math on this podcast and it is absolutely worth every, every minute of thinking about this.
And we will have the link to this article in the show notes as well. So tell us more, just tell us more about this assessment and treating lens that we need to think about.
[00:31:46] Tim Deluca: I I think, uh, Dr. Spencer and Dr. Peterson actually talked a little bit about this too.
[00:31:53] Kate Grandbois: We should probably call them that too, sorry, Doug and Trina, sorry.
[00:31:58] Tim Deluca: They spoke a lot [00:32:00] about screening and one phenomenal thing. That's come out of the past bunch of years of advocacy through groups that advocate on behalf of this, like Lexia, a treatment and support is that a lot of states are now adopting universal screening for dyslexia in kindergarten. Um, and now there's a push also growing for better universal screening of oral language as well, because we know both of those things are going to be really important for a child to be successful in school.
Um, Kate, I think you might know a little bit about this too, where right now, so we're in Massachusetts and right now in Massachusetts, the law says you need to do universal screening for dyslexia, but then it kind of stops there, right?
[00:32:45] Kate Radville: That's my understanding, Tim and I, we can post information with more specifics for the listeners, but yes.
So in Massachusetts, we need to screen for dyslexia in kindergarten. I think where things get tricky is that, you know, screening is [00:33:00] awesome. And we do know that intervening early is incredibly helpful. It's exponentially more efficient and effective to teach word reading when kids are younger, right in K and one and two, especially.
Um, but what often happens is we screen and then that's it. We don't really have a plan for following up. So good screening involves exactly that, you know, finding kids who are at risk and as your listeners know, you know, a screening is not an assessment. So we want to over identify and find all the kids who might be at risk, but then good screening really doesn't stop there.
Good screening also involves having a plan for how we're going to further assess, and then what we're going to do when we figure out like, oh, this group of children is at risk. Um, and I think that's the piece, that's probably the piece that's harder. Honestly.
[00:33:54] Amy Wonkka: I think that's such an important point. And we talk a fair amount about that on this podcast.
Just the need [00:34:00] for not just collecting the data, but actually reviewing the data and having a plan to do something about it. Um, because otherwise it's just kind of, so, okay. We screened everybody what happens next. Right. So part of that's an infrastructure piece too. I don't know if you guys have thoughts about how to work with organizations kind of on a bigger level in terms of maybe making some of that change or what you might suggest as those next steps?
[00:34:26] Kate Radville: Um, yeah. I ha I have, I have thoughts on this as both a clinician and a former classroom teacher. Um, and a lot of my thoughts, I'm sure I have a bias in the direction of sort of general ed and how we support educators, but I think a lot of this infrastructure issue comes back to really, really solid evidence-based classroom instruction because this all sort of breaks down if we're identifying kids who have difficulty or who are at risk, we'll say kids who are at risk for literacy [00:35:00] difficulty. Um, but then we also don't have a strong general ed curriculum, right? So it becomes even harder to tease out, you know, which kids just aren't getting good daily instruction and which have a disability.
Um, and we definitely know that diagnosis of dyslexia and early identification are much easier in the context of really good classroom instruction. So really good for those of you familiar with RTI, really good tier one instruction, right? If that's solidly in place, this whole process works better and we have less kids who kind of become at risk because they're just not getting what they need.
[00:35:41] Kate Grandbois: And if you're listening, um, RTI stands for response to intervention. And if you want to learn more about response to intervention and MTSS, we have several episodes published on that topic from Dr. Um, Dr. Trina Spencer and Dr. Doug Peterson, I will use their formal tables, um, and [00:36:00] we can link, um, we can link to those episodes in the show notes as well.
[00:36:05] Tim Deluca: So that, that first step is screening, right? And then we have all these kids coming into general education. We need really good tier one instruction. Like Kate said, sets that we're not kind of creating like human made disabilities, right. Does teach you where, where students are presenting as impaired in a certain way, but it's only because they're not getting good input.
Um, so in order to kind of make sure we're doing what we need to do as the professionals in the school after screening, we need to make sure that we're doing our progress monitoring throughout. Right? So a lot of schools have adopted really good progress monitoring for reading and word reading over time.
So I know a lot of schools use things like the DIBELS aims web, things like that. Uh, there's a great tool on the IES website that allows you to kind of look, to see which of these kinds of progress monitoring tools are most evidence-based for your purpose. So we can link to that [00:37:00] tool as well. Um, so if you're thinking about, oh, we're really not monitoring how kids are progressing and reading, this might be a good way for you to advocate for your school to monitor that a little more closely when we're thinking about progress monitoring as well, a lot of schools are using, uh, measures that are closely related to basal readers, right?
So Kate, you talked earlier about how early on text that’s really simple for children. There's not a lot to comprehend, uh, there, you know, so children. With these really early, early readers might look like really good comprehenders, but it's really just a matter of the picture kind of gives the answer or it's such a common progression of events that the child's background knowledge provides them with an answer.
And it looks like they're comprehending, but not necessarily comprehending. So using tools that you know are going to actually measure that oral language progress peace in that simple view of reading. Um, one of my favorite tools is actually the cube assessments that [00:38:00] Dr. Spencer and Dr. Peterson were on here talking about.
So another plug for them, obviously a big fan. I think that's a really nice way to continue to monitor children's oral language progress, make sure that we're doing what we need to do within tier one instruction. Um, and then a plug for Dr. Hogan as well. Um, the sale lab is also working on creating, um, a strong screening tool for oral and written language, um, within school.
So hopefully there'll be more and more information about that coming out in the next few years.
[00:38:29] Kate Grandbois: I want to also ask a question about sort of the second half of the second learning objective. So in terms of, you know, I know we're now sort of in the context, talking about a school environment with response to intervention, what does it mean to look at this issue through the lens of an interdisciplinary team.
[00:38:49] Tim Deluca: Now that's a, that's such a great question, such an important question. And I think one that both you, uh, Kate and Amy are going to be passionate about. So I know you both talk a lot [00:39:00] about advocating more for our field to have more time for a consultation.
Um, andYeah.
[00:39:09] Kate Grandbois: Yes! you heard our memo. I might as well have that tattooed on my forehead. I say it so often. I'm so glad someone was listening.
[00:39:13] Tim Deluca: I gotcha. I gotcha. So, um, I think that is a huge piece there, so, all right. Let's take a step back and let's talk about what Kate presented earlier, as far as what children with either DLD or dyslexia might look like within a classroom.
And if we think about how these children represented a classroom, we know that, uh, they might be having trouble with either all of the reading within a day. All of the oral language within a day or a combination of both. And we can all imagine if we are in a setting where things are hard all day, a whole number of things can happen from there.
Right. We could get frustrated. So it could look like we have, again like behavioral issues or presenting, like, you know, hyperactive, things like that. We could shut down, [00:40:00] right? Because things are difficult. We also might be having trouble making friends. I'm in a bad mood. I'm not going to be my most pleasant self.
I'm missing some of the social cues, some of the idiosyncrasies of language. I'm not keeping up with my peers as well. So I might be having trouble making friends. We also know that there's, you know, if, if you're having a lot of trouble with word reading early on, you might be getting less time where you're actually writing.
So you might be getting less of that good, fine motor practice, uh, with early writing, things like that. So. From all those presentations we just thought about, you can imagine that within a school system or even outside of a school system, we're going to need to consult with people, as SLPs we'll need to talk to people who have other areas of expertise that could mean reading specialists, moderate, special educators, occupational therapists, physical therapists, and then counselors, behavior specialists, educational psychologists, you know, a [00:41:00] whole variety of professionals because each of those people is going to have a little bit of, or is going to have a unique perspective and a level of expertise that they're bringing to address one aspect of how the child is presenting across their day.
So right now we know our systems are not set up in a way that makes that interprofessional collaboration easy. So what do we do about that? There's not a ton of research yet in the field of education, how we can create interprofessional collaboration successfully within our schools, where there is a lot of practice or a lot of research in this is it more in the medical field. So we know in the medical field, there's been a ton of research done where if I go into my primary care physician with a knee problem, and that primary care physician connects with me and the person, the doctor who handles knee problems, and we all communicate together, you know, that doctor has all my background information on the person actually experiencing the issue.
And then [00:42:00] that knee doctors, the specialist with knees, when we all communicate together, the outcomes are better. Right. Translate that to schools and think if all of us are communicating, working together collectively along with the child and the child's family, there are probably going to be better outcomes for that child.
One of the tools I really like to start getting us to think about this in schools is a tool that was developed. Um, I forget who was developed by, uh, it's called the working together continuum and it was, I think, first developed by doctors Hall and Accord in 2015 and adapted by Dr. Mitchell for SLPs in 2020.
And it's basically just this continuum where you consider all of the different tasks you engage in across your day and think, all right. Is this particular task falling closer to me, engaging in no interaction with others, or is it at the opposite end of the continuum where I'm engaging in shared creation with others?
Then if I think about this task, [00:43:00] is it appropriate for where it is on the spectrum? Like, do I need to consult more, consult less with others? So I need to collaborate more, collaborate less with others in order to achieve whatever goal I'm trying to achieve. And I think this helps us to start thinking about, okay, I know I have this role or this goal within my school system.
I need to be the one supporting oral language for children and also educating other professionals in the school about oral language so that, that tier one instruction looks great across the day. What am I doing currently to do that? To make that happen. Is there no interaction? Is there a lot of shared collaboration?
Does there need to be more, does there need to be less? And then I can start taking data on those kinds of things presented to my school system and say, Hey, I have data to show that our children are not doing well on these oral language progress monitoring tools. I think that I have this area of expertise right now, based on my roles and responsibilities in the school, I'm [00:44:00] not able to engage in shared creation collaboration. Here are some ideas of what I think we can do in order to reach that. And let's try it for a while and see how children start doing on these certain measures. Let's see if there is that distal outcome of improved language performance for children.
So that's kind of a very long-winded and kind of complicated response, but that the systems level work is, is really complicated. And we're not set up for it right now in many of our schools. So we need to start getting creative.
[00:44:32] Kate Radville: Yeah. And Tim, I'm so happy that you brought up healthcare because I think, you know, I've had, my career has spanned education and healthcare in terms of my work as a speech pathologist and working in healthcare was the time, you know, healthcare has its flaws and we know that there's work to be done.
That said when I worked in healthcare, the first 20 minutes of my day, which is not a ton of time was dedicated and we never deviate from this to interdisciplinary rounds. So [00:45:00] there was not a day that I entered the hospital when I was working in neuro rehabilitation without talking to physical therapists, occupational therapists, the medical team and social workers.
So there was this routine that was integrated and it didn't take, it was a tiny percentage of the work day, right? When you, when you think about it, but it was just known that this is how we structured our time. So I think even just. Short structured interactions are getting those routines in place. This is not, you know, we're not talking about spending entire school days meeting with other professionals.
Um, just making it more routine where you are, Tim, like you said, going from this continuum of, I don't talk to other people to, we interact frequently. Doesn't probably have to be that time consuming. It is so, so helpful.
[00:45:55] Amy Wonkka: Well, and I think to that point, something you just said was that it happened every [00:46:00] day.
So there's also this nice piece of, I think sometimes we trade these big chunks of less frequent time, because that's the only way we have a construct to carve it out. When in actuality, if you were able to build something into your system that is a frequent and ongoing thing, you would find that you have these chances to see everybody on an ongoing basis.
And your, I did have to Google the continuum cause they'd never heard of that. And that thing's awesome. We're going to plop it up on the website. Um, but you know, you, you really are kind of further down on that continuum of collaboration and sharing just by the nature of like your proximity to other people and it's happening all the time.Very cool.
[00:46:38] Kate Radville: And I do think, you know, this happens and I get why it happens because people are so busy, right. People in schools or no, caseload's tend to be big class sizes tend to be large, but we end up in our silos, right? We're in our offices and we're doing a million things separately. And then, you know, end of the school year, there's a day of PD.
So I [00:47:00] integrating this collaboration throughout the school year is just so helpful. And also I think backing up a step even before this, um, just making sure that professionals know what other professionals do. So I can tell you, you know, it was awhile ago, but as a classroom teacher, I did not deeply know what the speech language pathologist did.
I know, I couldn't have told you that if a child was struggling with early literacy, I should talk to the literacy specialists and the SLP. And I definitely wouldn't have said, oh, we should all have a conversation together. So you can see how, you know, It go. One of my interest is in teacher training, but going back to this piece of like, our training should involve these deep discussions of what other professionals do and where we overlap and where we don't.
And we don't all have to do all the things, but knowing sort of from the start of your career, [00:48:00] who you want to be talking with, I think is just a simple thing. Even walking away from this podcast and saying like, oh yeah, you know, now I sort of know who I would have a conversation with in my school, um, is a great first step.
[00:48:13] Kate Grandbois: I also think approaching that with a little bit of an open mind and curiosity is important because oftentimes particularly with professionals where we share, we might have a shared scope. We think, oh, they do this. I don't need to X, Y, and Z, or the PT, just us strikes. I don't need to do X, Y, and Z. You know, we categorize other professionals and either write them off, or we have decidedly, we have preconceived notions about what they do. And that is a barrier to trying to establish more robust, dynamic, collaborative relationships.
[00:48:49] Amy Wonkka: So getting back to treating. Again, kind of circling back to this and what the treatment. So we know the treatment involves ideally an [00:49:00] interdisciplinary team. We know that part of our assessment involves screening and then a plan for actual deeper assessment for folks who have been identified, which all kind of comes back to having a nice RTI MTSS system, you know, up in place and running.
Um, I know the focus of this talk isn't necessarily on treatment specifically, but how might those, how might your treatment approach look different or the same, um, for kind of the different groups of students who we've discussed. So we've got our students who are maybe presenting just with DLD. We have students who may present just with dyslexia.
We may have students, like you said, up to 50%, I think who may have kind of that overlap between the two. Does that look different for you as a treating speech language pathologist? Are there things that you would do differently for a student or a client on your caseload depending upon where they fall in those three groups?
Or is it sort of similar intervention?
[00:49:57] Kate Radville: Yeah, no, I think this goes back to this question of [00:50:00] like, let's say, for example, A new child and they're struggling with reading, you know, and maybe the classroom teacher says, why are they having difficulty with reading? I'm probably going to say, I don't know. And going back to the simple view of reading, I'm going to drill into both sides of that multiplication equation, right?
Like, let's take a look at oral language. Let's take a look at word reading and let's figure out if we need to intervene in both areas one or both.
[00:50:28] Tim Deluca: And I think a really important thing to remember there is based on where you are in the world, your roles and responsibilities might look different. So you might not be the one who is able to drill into both.
That might not be part of your scope of practice wherever you work. So you really need to engage in that collaborative practice with that.
[00:50:49] Kate Radville: Yes. And actually, Tim, I would say chances are, I don't know the numbers on this, but you are currently not doing both. I'd say by and large, right. [00:51:00] Unfortunately, and this is part of why these, this collaboration is so crucial is that most professionals are not intervening in both oral language and written language.
[00:51:12] Kate Grandbois: We published an episode, uh, with, uh, Jeanette Washington, who shared a resource, a website for us, where you can go to your state and look up what your state how, how your state has designated interventions for dyslexia. Um, so we will post, I can't remember the link off the top of my head at this very moment in time, but we will post that link as well.
Um, and I think just sort of piggybacking onto that thought, that's another vote for developing robust collaborative practices, because if you only quote “own” one side of that equation, but you know, it's a whole equation. You really do need to have time and skills to be able to work with another professional, to get the other side of the equation.
[00:51:57] Kate Radville: Yeah. And we'll take, let's just take a half the [00:52:00] equation, right? Since you asked about intervention, let's take the word reading part of the equation to start, right. This in many schools is the literacy specialist, but in most lots of schools is a special educator, right? So child who struggles with word reading, this is probably going to route to special education.
Um, the great thing is when we get the kid there, right to the right professional, because we've collaborated, um, we know that explicit word reading instruction with a focus in phonics, the focus in written morphology with explicit practice in spelling too, which we know reciprocally helps reading, kids can make a ton of progress, especially in the early grades.
But what we really need to be doing is being explicit and systematic with teaching word reading. Um, and that's the piece too, you know, it goes back to good classroom instruction where if we are also doing that in the classroom, it [00:53:00] helps all children, right. Practices that help kids with dyslexia learn to read are useful for all kids.
This does not harm anyone. It can be very efficient, it can be integrated into routines. And the kids who need extra support are then also benefiting from what's going on in the classroom. So really explicit, really clear, um, phonics-based early word reading instruction. So we have that half of the equation, right.
And we hope you found the right person because we've worked together.
[00:53:31] Tim Deluca: And then if we think about the other half of that equation, that's more likely to fall into the lap of the SLP right. Um, and I think we all end up getting good training. Throughout our graduate programs in what good intervention looks like. Um, but our intervention needs to be guided by good data, right?
So we need to know which areas of language specifically require our intervention, our skilled intervention. And we also need to think which areas of [00:54:00] language might be well supported in the classroom. If we're able to provide a little bit of collaboration, a little bit of coaching to that individual, who's providing that tier one instruction.
And then we also need to start thinking about dosage and frequency. So dosage, we can kind of think about like, if you're taking a five milligram or 10 milligram drug, right. That's your, that's your dosage? So translating that to SLP services, like, am I getting 10 repetitions of a skill versus 20 repetitions of a skill within my session?
And then a frequency is how many times per week, month am I providing this type of intervention? So a lot of our research or how this isn't great, but there's more and more research coming out around how to best support children with oral language impairment when considering dosage and frequency and what we're learning is, for word learning children with DLD probably are going to need three times more exposure [00:55:00] than, uh, their neurotypical counterparts when trying to learn new language. However, that doesn't mean that we need to be seeing them five times a week. I have sat in many an IEP meeting where a parent is like, you need to be seeing my kid every day.
And, um, I, we now have more data to support that that's not what needs to happen. We know that a really good dosage, like one time a week of really good therapy is just as good, if not better than seeing that kid three or four times a week for these types of supports. And then again, making sure their tier one instruction is looking the way it should look.
And there are classroom supports in place to make sure that if there are accommodations needed, those are, those are happening. That's what we can spend more of our time doing as well.
[00:55:46] Amy Wonkka: Well, and you make the point, Tim, about the frequency. And I think because we are talking about a pediatric population and we are talking about school-based services, you know, it's also an important thing to always [00:56:00] remember any of those services that we, as the speech language pathologists are providing that time is coming from something else.
So it's also always that balancing act. And I think, you know, back to our kind of quest for indirect service, but, you know, I think it's very likely that high quality, short frequency or reduced frequency of intervention with some type of consultative piece where you're able to help support the classroom teacher or whoever's in there.
It's probably better not only for your client, but you know, kind of to Kate Radville's point earlier, like beneficial for everybody, because it's just good instruction.
[00:56:37] Kate Radville: And I think too, you like picturing, you know, we've kind of described this child who might have DLD or dyslexia or both, and this impact in the classroom where maybe they're presenting as struggling with attention or having some behavioral difficulties or not engaging with peers.
This model too. In addition to freeing up time, we think about interprofessional collaboration is also [00:57:00] perhaps less detrimental to routines. So pulling this child out for services for one high-quality session might be significantly less disruptive and framing it in sort of the positive, let them participate in their school day with their class in a way more cohesive, stable way, which I have worked with a bunch of kids, especially recently where they're, you know, they're getting these pull out services all the time and they're out at this time, they're out at this time.
And then at this time, honestly, in my role, working with kids after school, they're exhausted and they can barely tell you, you know, what the routine of their school day was. And, you know, they're all over the place. So I think this is a less disruptive model as well.
[00:57:42] Tim Deluca: Yeah and I think that's such a nice way of also talking about it with families or, or stakeholders, right?
Because, um, stakeholders are probably coming in to a meeting where they're hearing about what's being decided about services for their child and, um, I think there's a lot [00:58:00] of kind of misinformation out there, um, around what parents should be looking for or what might happen within these kinds of meetings.
And I think it's on us as the, um, language professionals to be able to, uh, talk not only about the language, but also about how language affects the whole child and the way you put it as, you know, the child needs to be a part of your team needs to be a part of their classroom community. And, uh, if we can support them in that way, it's probably going to be really beneficial.
And that also might put those other stakeholders at ease. When we talk about it in this way, when we talk about thinking about the whole child, that stakeholder might buy in much more to the plan and be willing to collaborate on that treatment plan, moving forward, more, more willing to collaborate a bunch of and plan moving forward when they have that understanding.
[00:58:48] Kate Radville: Yeah. And I would even take it a step further and say that this extends to the home too. Right. You know, and this is, I'm a, I'm a parent of two young kids and from a parent's point of view, too, I mean, understanding how you can extend supporting the child to the home environment as [00:59:00] well, um, is just absolutely crucial.
So, you know, moving away from this siloed, we pull the kid out, we do our thing. We send them back in to collaborative practice where we're thinking, like Tim said, I love this phrase as an early childhood person originally this whole child. And thinking of them in this sort of developmentally appropriate holistic way is just so important.
[00:59:25] Kate Grandbois: This is such great information. And we have about five minutes left and I wondered if an hour you've already given us so many resources. I mean, you guys have every other sentence has been, you should read this, you should read that. It's been amazing in our last couple of minutes. I'm wondering if, um, there are other additional resources or recommendations that you would have for SLPs who are listening, who want to deepen their understanding of these topics.
[00:59:56] Kate Radville: Oh, I have one. I meant to mention this. I don't think this came up earlier, [01:00:00] but, um, the website DLDandme.org, um, Dr. Tiffany Hogan is a co-founder of that website and it's just a super caregiver and teacher and sort of other professional friendly, um, website for finding information about DLD. It has definitions resources, it's just, it's a really nice place to direct. I think it's useful for speech, language pathologists, but also really super accessible for people who don't know anything about DLD. Um, it's really easy to navigate, and it has quite a few papers written sort of like, you know, code switched for people who aren't in research,
[01:00:42] Amy Wonkka:
Taking a look at it right now. And this seems like a great stopping point for all sorts of different information. So thank you for that resource.
[01:00:50] Tim Deluca: Another interesting resource is actually a visual that I think is useful when trying to communicate your ideas with a variety of stakeholders. [01:01:00] Um, and it's a visual called I guess it's called the Snow model and it's from Dr. Snow who is down in Australia and it's, uh, a model of oral language competence and why oral language matters across the lifespan. And the visual is basically like a house. So this is kind of like simple view of reading, but like really, you know, expanded upon for oral language. Um, and it's basically a house that shows a solid ground of good social and emotional support.
And then on top of that there's oral language, uh, presented throughout the lifespan. The pillars are transitioning from written some from oral language to written language, and also go along with the development of interpersonal skills and showing how all of those go together to create social, emotional, behavioral wellbeing, social cognition skills.
And then the roof goes up to what that looks like as an adult, right. Um, if we have good input that whole way, then we have marketable employment skills, social and economic [01:02:00] engagement, uh, academic achievement. So I really like this visual because I think it's also, it's good to communicate your ideas with families as to kind of what area that you might be intervening in or what area you might be seeing some, uh, some extra need for support.
And then it also could be good for advocating for why your role matters within a team. Right? You could talk about how certain parts of this are really fall under the scope of an SLP and how we can support, uh, this skill so that this individual is going to have a, have a happy and healthy adult life.
[01:02:34] Kate Grandbois: These are incredible resources.
Thank you so much for sharing. Do you have any additional words of wisdom for any SLPs who are maybe feeling like this is an abyss of information anywhere you think people might benefit from starting or beginning their journey and learning more about this?
[01:02:53] Kate Radville: I'll give a shout out to. Awesome resource for literacy.
Um, the Florida center for reading [01:03:00] research website, which I think is FCRR.org. Is that correct? Yeah, we got we'll link to it too, but they are super hub in terms of not only helping with resources, for understanding dyslexia, but also directly linking you can go in sort of by age and grade and developmental stage.
And you can click on, for example, like I'm working with kindergartners and I know they struggle with phonemic awareness, right? Like going back, like absolutely integral for developing written language. Um, and they actually have. Very user-friendly structured activities you can use. It is all completely free and evidence-based totally vetted.
It's awesome.
[01:03:41] Amy Wonkka: And just taking a look at this website for the first time, cause I'd just found out about it. Um, it does also look like they have information kind of organized for educators and then also for families. So it seems like it's another place that you can go to sort of have information that is presented in a couple of different ways, depending upon kind of your [01:04:00] level of jargon
[01:04:01] Kate Radville: and yeah, actually that's into that point.
I often share those resources with families I work with whose children are having difficulty with word reading, um, and also the international dyslexia association or IDA. Their website is great and extensive, and they also can be really great for connecting families with resources about reading and writing difficulty, and also for connecting families with sort of local advocacy groups, you know, they'll link out and help families find other people locally who are going through similar things.
[01:04:35] Kate Grandbois: This has all been so incredibly helpful. Thank you guys so much for first of all, all of these resources, all of this information and all of the things you're contributing through your doctoral work. I'm sure it is it really hard, but so worth it. So thank you for taking the time to join us here. Um, anyone who is listening, who would like to use this episode for ASHA CEUs, you can do so [01:05:00] on our website.
There's also a link to do so in the show notes, all of the references and resources that we've listed are also listed in the show notes, um, and just a big fat thanks. Thanks for joining us guys.
[01:05:12] Kate Radville: Thank you. Thanks. This was so fun. It was my pleasure.
[01:05:17] Kate Grandbois: Thank you so much for joining us in today's episode. As always, you can use this episode for ASHA 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 for 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 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. Another big thank you to our corporate sponsor language dynamics group who helped make this episode [01:06:00] possible. Our corporate sponsors keep our CEU prices low and our program ad-free language dynamics, group develops and disseminates evidence-based language and literacy assessments and interventions.
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