Marisha

Sequencing Shouldn’t Be Targeted in Isolation

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This is a guest blog post by Monica, a school-based SLP, all about the importance of sequencing in narrative therapy and why it shouldn’t be targeted in isolation!

The Importance of Sequencing

I want to expand on how sequencing shouldn’t be targeted in isolation, but in the context of narrative therapy.

I hope that this post will also help give you some language for explaining your goals to parents during IEP meetings and why it’s important to work on them. I’ve found that I strengthen relationships with my student’s families when I give them a lot of information and explain my next steps because it shows that I’m always planning for their student’s future.

Therapy Ideas

If you want to jump straight to therapy ideas, head over to this blog post, How To Target Sequencing. I talked about ways to target sequencing in therapy sessions (and possible goals!). Keep in mind that sequencing is just one part of the overall literacy-based therapy framework! 

Sequencing and Narratives

First things first, I’m going to clarify what I’m talking about when I say sequencing. The term “sequencing” gets thrown around a lot and can refer to sequencing steps to follow a direction or sequencing to retell a story.

If you’re looking for following directions resources, I’m going to direct you to these excellent blog posts:

Following Simple Directions: Speech Therapy Activities & Worksheets

Teaching How to Follow 2 – and 3 – Step Sequential Directions

In those posts, you’ll find that there may be many things that you want to target, like executive functioning (hello working memory!), vocabulary, and grammar. It’s also vital for therapy and materials to be contextualized (think real-life situations) instead of using a deck of cards because it’s convenient.

I know, I know! Sometimes it is just easier to use something we’re used to, but the research is pointing towards decontextualized therapy being more like working on making the leaves of a tree grow instead of the roots and trunk (which would be contextualized therapy).

To give us some context, let’s review where your students should be developmentally with telling stories. We’ll keep in mind that the population these studies were focused on probably does not match a population that needs more support, so take it with a grain of salt if your population isn’t a homogenous group.

Screen Shot 2021 10 22 at 11.26.44 AM
Click here to access the SLP Now Sequencing Cheat Sheet!

From ages five and up, we can also use Common Core State Standards as a developmental framework for what would be expected of a student at that age.

When we look at the developmental profile and common core standards, basic sequencing should be developed around 3-4 years old, and 4-5 year olds should be able to sequence/retell basic stories.

Kamhi (2014) talked about how sequencing shouldn’t be targeted in isolation and that working in the contexts of narratives is the perfect way to make it relevant to a student’s life.

This article talks about working on sequencing with contextualized narrative intervention and that clinicians have wrongly assumed that you need to work on sequencing on its own because sequencing is tested as its own in subtests on formal assessments. Narratives do encompass a large part of a student’s day, whether academic or their ability to communicate with others.

The article also states that “correctly recalling the sequence of events thus depends solely on attention and memory processes”. We can reduce the memory demands of retelling a story using macrostructure or “the logical, conceptually coherent order of events” (Kamhi, 2014). We know that macrostructure = story grammar parts and that microstructure (ex: temporal/causal words and grammar) is also an important part of narratives.

Sequencing and Working Memory

I also reviewed three articles (Singer & Bashir, 2018 ; Montgomery, Magimairaj & Finney, 2010; Boudreau & Contanza-Smith, 2010) that talked about how when we’re working on sequencing, we really want to target working memory. If we are only working on having a student listen to directions and do them, it’s targeting short-term memory skills that won’t generalize. By working on sequencing with narratives, you’re targeting a more complex system that will help with later comprehension. When we use narrative therapy, we’re teaching students to create a schema in their minds with story grammar.

We’re giving them a way to organize information and to know what to grab on to. This frees up their working memory to shift through the information given in a story to retell it and answer comprehension questions.

References

Boudreau, D., & Costanza-Smith, A. (2011). Assessment and treatment of working memory deficits in school-age children: The role of the speech-language pathologist. Language, Speech, and Hearing Services in Schools, 42(2), 152–166.

Kamhi, A. G. (2014). Improving Clinical Practices for Children With Language and Learning Disorders. Language, Speech, and Hearing Services in Schools, 45(2), 92–103.

Montgomery, J. W., Magimairaj, B. M., & Finney, M. C. (2010). Working Memory and Specific Language Impairment: An Update on the Relation and Perspectives on Assessment and Treatment. American Journal of Speech-Language Pathology, 19(1), 78–94.

Singer, B. D., & Bashir, A. S. (2018). Wait…What??? Guiding Intervention Principles for Students With Verbal Working Memory Limitations. Language, Speech, and Hearing Services in Schools, 49(3), 449–462.

FAQ

Why shouldn't sequencing be targeted in isolation?

Sequencing skills are often assessed as their own standalone subtest, which has led clinicians to assume they should be treated the same way in therapy. Kamhi (2014) argues that working on sequencing within the context of narratives is more meaningful and relevant to a student's actual life than isolated sequencing drills.

How does sequencing connect to working memory?

Retelling a story in the correct order relies heavily on attention and memory. Teaching narrative macrostructure (the logical, conceptually coherent order of events using story grammar) gives students a mental framework to organize information, which frees up working memory rather than relying only on rote recall.

At what age should sequencing and narrative retelling typically develop?

Basic sequencing skills are generally expected to develop around 3-4 years old, with most 4-5 year olds able to sequence or retell basic stories, though this can vary depending on a student's individual profile.

What's the difference between macrostructure and microstructure in narratives?

Macrostructure refers to the story grammar elements, the overall logical, coherent order of events. Microstructure refers to the finer-grain language details within the story, like temporal and causal words and grammar.

Speech Sound Development Chart for Speech Therapy [Free Download]

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At What Age Should Children Master Each Speech Sound?

Most children produce early sounds like /p/, /b/, /m/, /n/, /t/, and /d/ by age 3, and later sounds like /r/ and “th” by around age 6. A 2020 review by Crowe and McLeod found children acquire most English consonants by age 5, earlier than older charts suggested.

This is a guest blog post by Monica, a school-based SLP, all about speech sound development. We also share a cheat sheet that you can download for free! 

Speech Sound Development (By Age of Acquisition)

If you’re looking for a speech sound development chart to help you determine where to start with your speech articulation goals, it’s right here! 

The chart has been updated with the results from McLeod & Crowe’s (2016) study.

The study compiled 60 articles with 64 studies in 27 languages.

They found that “children produced at least 93% of consonants correctly” by 5;0. 

When looking at these norms, the age listed is when most children have acquired that sound–not that children have up until that age to acquire that sound.

For example, a child may develop the /r/ sound at age three but not master it until five, which would be typical development (Hogan, Storkel & Farquharson, 2019).

Articulation Cheat Sheet

Click Here to download the FREE Speech Sound Development Articulation Cheat Sheet!


What Does Speech Sound Development Mean for SLPs?

Spoiler Alert: The answer isn’t simple! 

We shouldn’t just be relying on speech sound norms when considering eligibility or to make a diagnosis. Helping SLPs with their high workload is why Marisha started SLP Now! Considering the impacts on our caseloads, this also means we need lower workloads and more advocacy.

Kelly also linked to two podcasts that are definitely worth your time:

1. Speech Norms, Eligibility for Speech Treatment, and Advocacy with Holly Storkel and Kelly Farquharson (Tiffany P. Hogan’s podcast episode 3)

2. We Have Been Interpreting the Articulation Norms All Wrong (SLP Toolkit’s podcast episode 19): They talk about things for SLPs to think about when providing services to students with speech sound disorders and the McLeod & Crowe article.

If you’re tackling burnout, here’s a link to a recent article by Lessa Merante and Kelly Farquarson for school SLPs. It’s a great read! They give lots of a lot of strategies for switching things up. Some are doable on a small scale (e.g., changing your service delivery model) and some require changes on a larger scale (e.g., RtI and advocacy). 

Reduce Your Workload with Ready-To-Go Articulation Materials

Since we were just talking about reducing workloads, I’m going to leave a preview of just SOME of the SLP Now materials available for speech sound disorders. New materials are added regularly. As a school SLP, I know that we love quick and easy resources! These resources plan everything out for you with very little prep required. Right now, there are hundreds of pages of speech sound disorder materials! 

Here’s a peek at a few of them:

📒 175 picture book and 45 non-fiction units with word lists by sounds

Articulation Later Sounds

📒 Silly sentences for articulation practice

Silly Sentences for Articulation

📒 Practice sheets for articulation, phonology, and complexity

Articulation Cards

📒 Articulation stickers (with placement cues and pictures for words by sound)

Articulation Stickers

📒 Smart Decks for articulation, phonology, and complexity

Articulation Smart Deck

Just to name a few!

Need these materials in your life? Sign up for a free SLP Now trial (no credit card required) to check out the entire library. 

References 

DeVeney, S. L., Cabbage, K., & Mourey, T. (2020). Target Selection Considerations for Speech Sound Disorder Intervention in Schools. Perspectives of the ASHA Special Interest Groups, 5(6), 1722–1734. 

Hogan, T. (2019). Episode 3. Speech Norms, Eligibility for Speech Treatment, and Advocacy with Holly Storkel and Kelly Farquharson [Podcast]. Retrieved 8 October 2021, from https://www.seehearspeakpodcast.com/episode-3/episode-3-speech-norms-eligibility-for-speech-treatment-and-advocacy-with-holly-storkel-and-kelly-farquharson.

Krueger, B. I. (2019). Eligibility and Speech Sound Disorders: Assessment of Social Impact. Perspectives of the ASHA Special Interest Groups, 4(1), 85–90. 

Marante, L., & Farquharson, K. (2021). Tackling Burnout in the School Setting: Practical Tips for School-Based Speech-Language Pathologists. Perspectives of the ASHA Special Interest Groups, 6(3), 665–675. 

McLeod, S., & Crowe, K. (2018). Children’s Consonant Acquisition in 27 Languages: A Cross-Linguistic Review. American Journal of Speech-Language Pathology, 27(4), 1546–1571. 

 

What We’ve Learned About Phonological Awareness for SLPs

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Phonological awareness work doesn’t need to be a separate add-on to therapy, it’s most effective embedded directly into existing speech and language goals using relevant target sounds and structures. Research shows it not only supports reading development but can improve speech articulation too, and three easy starting points are trying a free assessment with the next speech-only referral, targeting initial and final sound identification in sessions, and checking in with the classroom teacher about reading benchmark results.

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This Week’s Episode: What We’ve Learned About Phonological Awareness

Today we will wrap up our Phonological Awareness series with a quick review of all that we’ve learned. So far in this series, we’ve done a quick review of phonological awareness and why is it is so important. We shared phonological assessment resources and phonological awareness goal examples. And last week Monica shared some of her favorite treatment ideas and examples on how to use them in the therapy room.

We are excited for you to take all that we’ve learned and start embedding the practice into your therapy! Let us know what worked and what didn’t. We love to hear from you!

Let’s get to it!

Phonological Awareness Review

– Phonological awareness is your ability to “identify and manipulate units of oral language: words, syllables, onsets (beginning sound c in cat) & rimes (end sounds -at in cat)”.

– Phonological and Phonemic Awareness

– Free Phonological Awareness Assessment: The PAST Test Screener: David A. Kilpatrickby + Two Peas In A Pod (TPT): Free PA Assessment

–  Phonological Activities: University of Florida Literacy Institute (Multi-Sensory) + Phonemic awareness activities: from Children’s Learning Insitute at University of Texas (UT)

– Goal Examples:

When given a CVC word orally as a prompt and asked to identify which position a particular sound (initial. medial, final) in the word is in (example: “Say the word tap. What is the medial sound in “tap”?”), STUDENT will identify the sound being requested for each prompt with 80% accuracy in 2 out of 2 trials as measured by teacher-made assessment.

 When given the onset and rime (/b/ + /at/ , /h/+/ot/) for 10 different 3-letter short vowel words (CVC words), STUDENT will blend those sounds (onset and rimes) into words with 100% accuracy in 2 out of 2 trials as measured by teacher-made assessment.

–When given 3 phonemes as a prompt (example: /c/ /a/ /t/ or /p/ /i/ /g/), STUDENT will orally blend those phonemes into words with 80% accuracy in 2 out of 2 consecutive trials as measured by teacher made assessments.

Links Mentioned and Additional Research

– Kelly Farquharson, PhD, CCC-SLP Instagram: @classlab_fsu
– ASHA Evidence Map: Systematic Review: Effectiveness of Early Phonological Awareness Interventions for Students with Speech or Language Impairments
– ASHA Evidence Map: Early Childhood Education Interventions for Children With Disabilities Intervention Report: Phonological Awareness Training
–Article: Al Otaiba, S., Puranik, C., et al. (2009). Across the eight studies investigating the effects of phonological awareness training in students with speech impairments, all studies indicated improvement of the trained phonological skills.
– Ukrainetz Pearson EBP brief
–EBP brief on phonemic awareness efficacy
–Do Phonemic Awareness Interventions Improve Speech in Preschool Children with Speech Sound Disorders?
– Cabbage Et al article (Decision Tree + Sample Assessment Checklist)
– Test for multisyllabic words! Can they blend them together?
– “Hesketh (2009) says, “My intervention principle is to incorporate PA-type activities in support of speech change using stimuli relevant to the child’s target processes, syllable structures, contrasts or sounds, rather than seeing PA skills as a target in their own right. A typical intervention session will involve the child in listening to, thinking about and producing sounds but the balance between these three elements varies enormously across children and across sessions.”
–Gillion, 2000:
Compared traditional articulation to phonological awareness intervention (check out the article for the full details, but we’ll share some of the activities today). The children who received phonological awareness intervention made significantly more gains in their phonological awareness ability and reading development than the children receiving the other types of speech and language intervention. The phonological awareness intervention also improved the children’s speech articulation.

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Thanks so much!

Transcript

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Marisha: Hello there and welcome to the SLP Now podcast, where we share practical therapy tips and ideas for busy speech-language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode. Hey there SLP, this month, Monica and I are diving into all things phonological awareness. So in episode 98, we did a quick review of what phonological awareness is. And we're going to spend the rest of the month talking about assessment, goals, treatment ideas, all sorts of good stuff. So, without further ado, let's dive into this week's episode. Now, let's wrap it all up. So what are some last thoughts or things that you think SLPs should be thinking about or considering when they're implementing this?

Monica: I think probably one area of caution would be with students who have apraxia, just to be really cognizant that you don't want to be doing these phonological awareness things if you're doing that practice. Because it involves a lot of segmenting the sounds and you're teaching a motor plan. Just to be very intentional about your teaching and bringing phonological awareness. Then from where you're really practicing those sounds and to make sure the student knows... This is not the way that we're saying it, we're just working on being able to hear these sounds, being able to rhyme them, or whatever it is. Because it's still important to practice with that population, but just to be kind of intentional about that practice part.

Monica: I think also to know that this isn't a magic wand situation. Just because we work on phonological awareness that they're not necessarily going to be a successful reader. This is not just for us, this is for the classroom as well, and everyone who's working on it. That it's going to help them improve those skills, but maybe if you're talking to parents that... We still might expect that they have some difficulty later on, but that it's definitely going to help with future spoken language impairments and reading. And, of course, all of those things that are related... Writing, spelling, comprehension, kind of all of those things. So that's, I think, important to note. There's no like end to that. No, it's not like a speech sound disorder where you do that and then they're dismissed from it. It might be something that's kind of ongoing. That's where the literacy supports come in, too. The people who have done a lot more professional development and who really specialize in that... There's tons of different approaches out there.

Marisha: Awesome. Any other tips or words of advice or anything we need to consider?

Monica: No, I don't think so. I think that it's just, in the end, there's that little bit of assessment piece that you can add on that wouldn't take very long. It might be 10, 15 minutes. And then just incorporating things into your sessions using materials and target [inaudible 00:03:16] that you already use where... It sounds like a lot. It sounds like you're doing a lot more, but I think it really isn't a lot more. But the trade-off for doing this little bit of incorporating, I think, it's such a huge, huge trade-off with being able to be there. And making sure the kids get the right intervention and being able to incorporate the phonological skills with those kids who have speech sound disorders or don't have speech disorders. For all of the kids to get that exposure that are in your groups, the payoff is potentially really big.

Marisha: Yeah, absolutely. And you have a really interesting quote from Hesketh in 2009 about their intervention principle. Can we talk about that a little bit?

Monica: So I'm just going to quote from that article. It says, "My intervention principle is to incorporate phonological awareness type activities in support of speech change using stimuli relevant to the child's target processes, syllable structures, contrast or sounds, rather than seeing phonological skills as a target in their own right. And a typical intervention session will involve the child in listening to, thinking about, and producing sounds, but the balance between these three elements vary enormously across children and across sessions." So I think it just kind of mirrors what we've been talking about. That you're incorporating it into your sessions as you're going along, and its not necessarily its own separate thing. That it's very much so embedded and should be embedded in practice.

Marisha: Yeah, that's super helpful. And that's what we've been talking about. All of that, but I thought that was a really nice way to wrap things up and put it all together. So just a super quick recap of what we've talked about. We've been talking about phonological awareness. Then we're working on identifying and manipulating words, syllables, [inaudible 00:05:22], and rhymes. And underneath that we've got the phonemic awareness. Then we went through all of the different types of activities that fall under phonological awareness, as well. And we talked about tons of really cool research studies that look at how phonological awareness does have a really significant impact on, or it can have a really significant impact on, reading development and just improving those skills. And then super interesting from a speech language perspective is that targeting phonological awareness can also improve speech production, which is super interesting.

Marisha: Also just emphasizing, Dr. [inaudible 00:06:06] does amazing, amazing work, and her Instagram that you shared is so incredibly helpful. But I think this discussion brought up the idea that a lot of our students... We might think of them as speech only, but how often are they really speech only? And I thought this was a really cool way to start thinking about that a little bit more and maybe adding a few tools to our toolbox if we haven't been using those yet. And just considering that when we are fighting through that assessment.

Monica: And I think that's helpful for SLPs that are trained to fight for full assessments for their speech sound kids. Sometimes you'll get a little bit of pushback... Like we don't have time... But it's either you do it now or they struggle years and years later. So I think all of these articles are great to have for everyone out there that's trying to push for that. I know I talk to my friends a lot in other districts. And then also when you're looking for ways to make those improvements faster and get the kids out faster... We're always looking at LRE and being able to work with the classroom teacher and collaborate and be able to get them out sooner.

Marisha: Yeah. If we can support their progress with their speech sounds and help them make more progress there, plus get the added bonus of that boost with the reading, that's pretty awesome. That's a huge win. And I loved how you found different tools that we can use if we don't have that support. If for some reason, the team isn't assessing that phonological awareness, we've got some really cool assessments that we can pull like the [inaudible 00:07:51] test. And then the [inaudible 00:07:53] article has some really cool tools that we can use as well in assessment. The Gillen 2000 article that I mentioned at the very beginning also talks about the treatment procedure. So some really, really awesome resources in the show notes if you're wanting to learn more. We'll put some goals in there too, if you need a recap of that. And I really liked how we were able to go through... If you have a bunch of different treatment strategies and get some really nice examples of what that would look like and how we can implement that into our therapy.

Marisha: So I'm curious, if someone is listening now... There's an SLP who hasn't been incorporating phonological awareness... Let's see if we can think of three things that they could potentially do. Three easy steps and they could choose any one of them to get started. One that I would pick is to check out some of those assessments if your team isn't looking into that. So the next time you get a speech sound referral or a speech only referral, going through that I think that's a really good introduction. Just to get to know, oh, so these are the types of skills that they're looking at. And then just to see how a student does with that. I think that'd be a huge first step and not too hard. It's just downloading and printing a thing and running through it with a student for a few minutes. So what about you, Monica? What would you do? Maybe we can share a quick strategy that they can use in therapy?

Monica: I think the first one I would probably do is identifying the initial and the final sounds. Just because if the students can do that, you're really working on auditory discrimination and then you can shoo them back to get that self-awareness. Like, oh, wait, what was that fun sound? Or what was the final sound? I feel like that is probably going to make the biggest difference out of those. And it's not too far away, probably, from what everyone's used to doing. And then the third one would probably be checking in with the classroom teacher and asking if they'd been struggling on a benchmark test like the DIBELS or with their reading. Just you check in with that and it might be a really super, quick, easy way to get insight on where that student's doing.

Marisha: I love that. That's a great strategy. They can support in getting started, too. Awesome, so many great tips. Thank you, Monica, for breaking that down for us.

Monica: You're so welcome. This has been fun.

Marisha: [inaudible 00:10:35] next time. Thanks for listening to the SLP Now podcast. This podcast is part of a course offered for continuing education through SpeechTherapyPD. So yes, you can earn ASHA CEUs for listening to this podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episodes sent directly to you. See you next time.

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Phonological Awareness: Treatment Ideas for Mixed Groups

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Phonological awareness treatment ideas can be embedded directly into existing speech sound work rather than added as a separate activity. Options range from syllable clapping and rhyme awareness to initial/final sound segmentation and blending and segmenting sounds, all using target words already in a session, and doubling as a low-frustration way to keep working on a sound when direct production practice becomes too hard.

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Phonological Awareness: Treatment Ideas

We are chugging along on this PA train!

So far in this series, we’ve done a quick review of phonological awareness and why is it is so important. Last week we shared phonological assessment resources and phonological awareness goal examples.

This week we get to dive into treatment ideas. Are you excited? Because I know I am! Monica will share some of her favorite treatment ideas and tips on how to get the student engaged with the activity while still focusing on those PA targets!

Let’s get to it!

Phonological Awareness Activities

– The University of Florida Literacy Institute has a list of phonological awareness activities (some are multisensory and include movement)

– The Children’s Learning Insitute at University of Texas (UT) has some phonemic awareness activities.

– I do activities that are embedded in SSD practice, I just need a whiteboard *bolded are the ones I usually do in sessions

Syllable awareness
Example: Clap out how many syllables there are
How many syllables did you hear? You clap this one out, how many are there?

Rhyme awareness and production
Example: Minimal pairs/any kind of pairs

Alliteration
Example: Look for words that start with the same sound. What sound do you hear? What else starts with that sound.

Onset-rime segmentation
Example: What’s the beginning of cat? /k/ what’s the end /at/ -> put it together

Initial and final sound segmentation
Example: What’s the first sound? In tab? /t/ what’s the final sounds or end sound /b/

Blending sounds into words
Example: If I say /s/ /n/ /o/ what word is that?

Segmenting words into sounds
Example: Break down snow into sounds /s/ /n/ /o/

Deleting and manipulating sounds
Example: Say /nail/ now add and /s/ and say /snail/

Use the target words you already have. Most likely you’re doing these things already.

Links Mentioned and Additional Research

– Gillion, 2000:
Compared traditional articulation to phonological awareness intervention (check out the article for the full details, but we’ll share some of the activities today).

The children who received phonological awareness intervention made significantly more gains in their phonological awareness ability and reading development than the children receiving the other types of speech and language intervention.

The phonological awareness intervention also improved the children’s speech articulation.


– “Hesketh (2009) says, “My intervention principle is to incorporate PA-type activities in support of speech change using stimuli relevant to the child’s target processes, syllable structures, contrasts or sounds, rather than seeing PA skills as a target in their own right. A typical intervention session will involve the child in listening to, thinking about and producing sounds but the balance between these three elements varies enormously across children and across sessions.”

Subscribe & Review in iTunes

Are you subscribed to the podcast? If you’re not, subscribe today to get the latest episodes sent directly to you! Click here to make your listening experience auto-magic and as easy as possible.

Bonus points if you leave us a review over on iTunes → Those reviews help other SLPs find the podcast, and I love reading your feedback! Just click here to review, select “Ratings and Reviews,” “Write a Review,” and let me know what your favorite part of the podcast is.

Thanks so much!

Transcript

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Marisha: Hello there and welcome to the SLP Now podcast, where we share practical therapy tips and ideas for busy speech-language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode.

Marisha: Hey there SLP. This month, Monica and I are diving into all things, phonological awareness. So in episode 98, we did a quick review of what phonological awareness is, and we're going to spend the rest of the month talking about assessment, goals, treatment ideas...all sorts of good stuff.

Marisha: So without further ado, let's dive in to this week's episode.

Marisha: Now let's dive into some treatment strategies and what this could look like. You shared some ideas already, but do you have any other thoughts on what we can do in terms of treatment strategies?

Monica: Yeah. So the way that I usually incorporate phonological awareness is right when I'm first introducing that sound. And I think it helps to do a couple of these to see what helps them. So a lot of times, I'll just have a dry erase board, or they might have crayons or markers, or whatever they think is fun. You can do it with paint. I've seen teachers do it with shaving cream on the table, that's really fun. And then a nice way to shake up doing the usual, 100 trials too, and just to work it into teaching, and then to also to work it into when they're having a hard time saying that, and then you want extra strategies for it.

Monica: So it's a really good, not backup, but a really good place to revisit if they're having a really hard time with that. With my younger students, we work on a lot of phonemic awareness stuff. So, what is the very first sound? So identifying the first sound and the last sound. Or , "Can you tell me which words all start with your target sound?". So, especially for those kids that are really frustrated, we've all been working on eliciting a "K" sound, they can look for all of the words that have that "K" sound. So you can still be working on them having that auditory discrimination for that sound, especially if they're getting really, really frustrated. And they're really, really aware of that error, you can back up into doing some of these phonological awareness activities. So you're still working on it, and still working on those skills, but they need a little bit of a break from trying to work on doing that sound because that frustration level is ramping up. So that's where I'll work it in for that.

Marisha: And it's super interesting too, because the Gillon study that I shared at the beginning, that's all that they did. They didn't do a ton of production stuff, the actual production of sound improved. So it feels like a break to them, for sure. And it's a way to increase their success and reduce their level of frustration, but we're still doing work when we're doing that. It's super cool how that ends up. It's fascinating how the brain works.

Monica: I recently had a student who we were working on the "K" sound, and he was already in kindergarten and was so painfully aware of these sounds with sound error and was so motivated to do it. And we worked on so much auditory discrimination, identifying those sounds, doing rhyming words. Do you hear it in the beginning of the sound, do you hear at the end of that sound?

Monica: And so we could do that for all of the different positions. And once he actually was able to do that sound, it generalized to almost sentences very quickly. And I was very shocked. We didn't have this sound two months ago, but we had been working on all of those skills for a couple months before he was making that sound, like I probably shouldn't have been as surprised because we had been working on it that whole time, but you're with there with that student, with their frustration of not being able to make it. But I think that definitely is a case where it really, really helped all of those different phonological awareness things. The teacher noticed as well. I think that happened a lot faster than when you were trying to teach some of the other kids.

Marisha: Yeah, that's awesome. I love that you had like a super concrete example to drive that home too. Super helpful.

Marisha: So what else do we have?

Monica: I could probably just go through some of the activities down the list of the different type of phonological awareness things, and then some resources, there's one from university of Florida's Literacy Institute, I think. And it's just a full list. It goes from, they're just phonological awareness activities. So a word list, a syllable level list, onset rhyme activities, phoneme level activities. And a lot of these too are multi-sensory. So children hopping once for each syllable, being able to count out the syllables using bead strings, being able to toss a beanbag for onset and rhyme. So it's got a lot of these like little fun activities that could get them up and moving, rhyming bingo, sound detectives. So all the students have to listen for which word and the sound for the word, then the list that contains that sound.

Monica: So I'll do that with books a lot. So it would be, you are the detective for the "T" sound. You're the detective for the "ch" sound. And so that's fun for them too. I-spy, definitely got a lot of different ideas. And then there is also one from the Children's Learning Institute at the University of Texas. And it's just a long list of, I think they're just worksheets for all the different types of phonological awareness. If you don't know where to start and you just want a big resource for it. So that one was really neat, and they're free.

Marisha: That is so cool.

Marisha: They gave different instructions. They even have little cards and stuff that you can use.

Monica: Some of the ones that I do during speech sound practice, which is also really good to do during mixed groups too.

Monica: If you have someone working on vocabulary, they can do these things with the vocabulary word that you're maybe working on describing that day or something. So for syllable awareness, we'll just clap out how many syllables there are. And then I do try to check in with the teacher to see what specific movement they do in class to do some of these. So some teachers, they count down their arm or they bend a certain way. So I do try to do the same thing, but I mean, I've been working with the same teachers for six years now. So it's a little bit easier for me, but maybe if you're a new, what a site. It's a good, easy way to get a conversation going about different ways to collaborate, because that can be a really tricky relationship sometimes to navigate with collaborating with certain teachers.

Monica: Rhyme awareness and production - We have so many minimal pairs, right? All of the minimal pairs, or multiple oppositions, maximal oppositions, all of those are going to be different rhyming pairs. So you don't have to have extra materials. You're just using the ones that you have. You're just adding maybe a little bit of an extra verbal instruction. Like, "did you hear those two? How are they the same? How are they different?" And then just pointing out that awareness for the alliteration, kind of what we were talking about to be able to, "We're going to put all of these out on the table. I want you guys to find all the ones that start with the T sound" or whatever they're doing. So the kids feel like it's a game, and it's super fun, but we're working on phonological awareness.

Monica: Onset and rhyme - I don't necessarily work on this all the time in speech sessions, but it's just breaking it down into the beginning part and the end part. So, what's the beginning of "cat". It's "c". What's the end sound, it's "at". Then putting it together would be the blending it back in.

Monica: Initial and final sound segmentation - What's the first sound, and what's the final sound. If kids are in the trains, which so many of them are, that helps too as a visual... "Where's the front of this one, with the engine, where is the caboose of the sound." So kids have a lot, but if you're also prompting too, for kids, "Oh, what was that first sound supposed to be? What did we talk about?" And just work in that way too, helps with that independence, and then being able to self reflect on what it is. And then, so much of that auditory discrimination is happening with that. So that one, I feel like I do the most.

Monica: So if we're going over our target words for that session, then I'll ask, "What is the first sound in that one? What is the last sound?" Especially for kids who are fronting and they tend to switch sounds up a lot, that helps a lot for that, I feel like. Maybe just because I had a couple of fronting kids this year, so that's really at the front of my mind, but that helped a lot.

Monica: Blending sounds into words - I don't do that as much... Or segmenting words into sounds. So blending sounds would be, if I say, "S-n-ow, what word is that?" And then have to say "snow", or segmenting would be the opposite of that. I do a lot of deleting and manipulating sounds. So, "If I say s-nail and you have to add your S sound, what does that make?" And they would have to say "snail", and then we might incorporate different ones. You don't have to work on one of these at a time. Then it would be, "Oh, what was that front sound? That was your S sound. Right?" And then you can use these to give really specific feedback as well. Instead of "good sound", it's, "Oh, you put on your front sound", "You put on your S", or "You put all of those sounds together really nicely. You blended those together to make snail." That's definitely something else that I use it for is just to give that really specific feedback as well.

Marisha: And you touched on this a little bit already, but you just listed a bunch of different activities that we could possibly be doing. So can you give a couple examples of which of these you would incorporate, like with your student or one of your students who was fronting, would you do syllable awareness and rhyme awareness and initial and find out, would you put it into a certain hierarchy and only work on a couple?

Marisha: Or how do you navigate that?

Monica: I am sure there is probably a specific hierarchy, but I've just worked it in the way that's worked over the years. What's the easiest. So I think I'll just do an example. So say we're going to work on the word cab and this one, they are fronting to tab. So then I'll be like, "okay, let's write the word". And then if we have a contrasting picture between cab and tab, that works even better. If they can't write it, I'll write it first and then they'll trace it. So as we do that, "okay, what's the front sound? Oh, this one, the front sound is a T can you make that sound? Right? What is your tongue do? So I hear tab, right? What's the second part is that AB now this one is cab, what's the front sound for this one.

Monica: It's, a K. And where do we make that sound in our throat, right? And then what is your tongue do? Does your tongue go up for cab? No, it doesn't, it stays down. So that's something that happens that's different". [inaudible 00:12:11] our K sound and our T sound, then we do the rhyme. "So, can you hear it? Tab cab? That end sound is the same, but our front sounds are different, right? Our T goes up, our tongue goes up behind our teeth and for cab, right, our sound is in our throat and our tongue does not go up like that". So that might be something that different parts of that I come back to that they have a hard time with, if they have a hard time with their tongue. We can work that in and then we can talk about how that makes a different front sound.

Monica: But that's generally how it sounds like. So being able to go through and list out specifically how I do some of this stuff it was just one of those things, you do it and you get so used to just doing all of those, breaking it down and explaining it was really interesting to do.

Marisha: Yeah, absolutely. But that was really helpful. And just getting one example of what that could look like and how it could be incorporated. We definitely want to check with our scope of practice and what makes sense. But a lot of the articles, like I know the Gillon one that I mentioned at the very beginning, they kind of described their intervention and a lot of the different resources that we shared describe how they implemented that. So we can definitely get some more inspiration from there, that was super helpful.

Marisha: And just again, emphasizing that we can use whatever words we're already working on, and then we can get feedback from the teacher or the reading specialist or the RTI, whoever is working on that with the student, I'm sure they would have recommendations and they can help us figure out that hierarchy or what they need the most support in and really leaning on their expertise to, okay, we really need to work on some syllables before we can do that deletion or whatever it may be.

Marisha: I think that's super helpful. So I feel like we've got some really good strategies and activity ideas that we can use in therapy.

Marisha: Thanks for listening to the SLP. Now podcast, this podcast is part of a course offered for continuing education through speech therapy PD. So yes, you can earn ASHA CEUs use for listening to this podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episodes sent directly to you. See you next time.

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Phonological Awareness: Assessment + Goals

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Assessing phonological awareness doesn’t always require a formal test or a dedicated goal. Free screeners like the PAST Test can quickly identify where a student stands, and much of the work can happen informally, collaborating with a reading specialist or classroom teacher who may already have relevant data, and embedding phonological awareness practice directly into an existing speech sound goal rather than writing a separate one.

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This month, Monica and I are talking about phonological awareness. 🎉

Last week we did a quick review of phonological awareness and why is it is so important. We learned PA is very important for future reading skills and all students can benefit from phonological awareness intervention.

This week we will focus on PA assessment and how to create goals to target PA.

Phonological awareness is your ability to “identify and manipulate units of oral language: words, syllables, onsets (beginning sound c in cat) & rimes (end sounds -at in cat)”. 

Let’s get to it!

Assessments and Tips discussed

– You can find screeners on PTP to see where students are with PA
– If a teacher or RTI instructed has already done a screener, collaborate with them and review their notes. Work smarter not harder!
– Reach out to parents to see if they have any concerns

Example Goals Discussed

– When given a CVC word orally as a prompt and asked to identify which position a particular sound (initial. medial, final) in the word is in (example: “Say the word tap. What is the medial sound in “tap”?”), STUDENT will identify the sound being requested for each prompt with 80% accuracy in 2 out of 2 trials as measured by teacher-made assessment.

– When given the onset and rime (/b/ + /at/ , /h/+/ot/) for 10 different 3-letter short vowel words (CVC words), STUDENT will blend those sounds (onset and rimes) into words with 100% accuracy in 2 out of 2 trials as measured by teacher-made assessment.

– When given 3 phonemes as a prompt (example: /c/ /a/ /t/ or /p/ /i/ /g/), STUDENT will orally blend those phonemes into words with 80% accuracy in 2 out of 2 consecutive trials as measured by teacher made assessments.

Links Mentioned and Additional Research

–  FREE: The PAST Test Screener : David A. Kilpatrickby
Basic Syllable
Onset-Rime
Basic Phoneme
Advanced Phoneme
–  Hello Two Peas In A Pod (TPT): Free PA Assessment
– Cabbage Et al article (Decision Tree + Sample Assessment Checklist)
– Test for multisyllabic words! Can they blend them together?

 

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Transcript

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Marisha: Hello there, and welcome to the SLP Now podcast, where we share practical therapy tips and ideas for busy speech-language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode.

Marisha: Hey, there SLP. This month, Monica and I are diving into all things phonological awareness. So in Episode 98, we did a quick review of what phonological awareness is. We're going to spend the rest of the month talking about assessment, goals, treatment ideas, all sorts of good stuff. So, without further ado, let's dive in to this week's episode.

Marisha: Let's spend a little bit of time talking about assessment and goals and what that might look like. Like you said, in California, things are a little bit different. So can you tell us a little bit about what that looks like for you?

Monica: Yeah. So, specifically in my district, SLPs don't really do the formal assessment or write the goals or provide the services because we have either reading specialists for RTI, or our classroom teachers who provide that specialized academic support do that. Either pulling from the gen-ed classroom, or for students who are either in our co-teach classes or separate classrooms, they all do that. So, I do a lot of collaborating.

Monica: But, we do have a state dyslexia guideline and it says that SLPs can play a role in the dyslexia intervention. So, they have a description of what SLPs can do, and then ASHA also says that we have a major role and responsibility to play in this, to support spoken language skills and written language skills as well. But I feel like that probably also if you are going to become a dyslexia specialist, you have a full lot of different CPU's to do, I feel like to specialize. But I feel like, there are a lot of things that we already do in speech-sound disorder intervention, that we just can add a couple of things in to be able to target that.

Monica: But for right now, my role in my particular school is really just to make sure I screen those speech-only students, kind of looks like checking back with the teacher, checking to make sure if they're getting RTI for reading, to make sure I'm talking to that teacher, asking the parents if they have any concerns for that. And then, I just do a little bit of informal assessment with it. And then during intervention I include a little bit of phonological awareness in that. I'm not doing that whole long list, I'm not hitting every single one of those, I just do the ones that are really easy to incorporate. And then if the teacher or the RTI person, or whoever it is that's working with that student, they'll email me and say, "They're having a really hard time with this specific area." Maybe the carry over from blending their words, or something isn't happening over in the classroom, so they'll give me a couple words. They'll say, "They're having a really hard time with these sounds." And so that's what role I play within my school.

Monica: And, I think that I probably also focus on it a little bit more because I have mainly kindergarten to second grade. So, it's really those grades where they're focusing on it, so I might be focusing on it more so than another SLP.

Marisha: That makes a lot of sense because every state will have a different setup, but especially in California where they have those specialists, and it sounds like your district has awesome RTI supports and everything too, but just keeping an eye out for things. So, like if we get that speech-only student, maybe we can run through a quick screener. There's a bunch of screeners available on Teachers Pay Teachers, or if you just search Phonological Awareness, basically just need to run through the activities and see where students are with that. And then just collaborating with the team to see, we'll use their expertise and do the legwork and just do what we can to support. I think that's a really awesome approach.

Marisha: And then if we happen to do a quick screening and that student, for some reason, isn't getting RTI yet, we could also refer out and help with that identification so students don't get missed.

Monica: For sure. And then we'll have linked, it's called the PAST test. This is by David Kilpatrick, and then it's a free screener. And on there is basic syllable, onset-rhyme, basic phoneme, and then advanced phoneme, if you just want something that's free and already put together.

Monica: And then the Cabbage et al. article has a sample assessment checklist in the appendix of their article as well, for things that you could include in your assessment if you just want a more in depth guideline to go through, if you really, really think that this is an area that you want to focus on for that student. Their article also has a decision tree for referral for your Student Support Teams or extra intervention, if this is something that you would like a decision tree for, and a little bit of extra support with that.

Marisha: That's some really good resources, definitely have to highlight those in the show notes.

Monica: For sure.

Monica: But, I think similar to what you were talking about, I definitely pull from the classroom teacher or RTI instruction, like our classroom teachers do the DIBELS. And so there's a lot of information in there, so a lot of times you don't have to do extra screening. I'll just take from whatever they do in the classroom. And then if we're doing a full evaluation, the psychologist or the academic specialist, they're usually doing a lot of phonological awareness testing, and so then I'll just pull from that and then I don't have to do my own.

Marisha: Yes, work smarter, not harder. Awesome.

Marisha: We talked about some different informal assessment options. Was there anything else that you wanted to point out?

Monica: So in that Cabbage article for the effectiveness of early phonological awareness interventions, they talked about different articles and different research for where you could focus your testing on. And then they showed that rhyming, blending, and segmentation tasks, especially rhyming and the ability to identify phonemes, were the most important meta-phonological skills for preschoolers to have that predicted reading and spelling abilities in first graders.

Monica: And then they talked about including receptive tasks for children who can't respond verbally. And so for students who might have a more severe phonological disorder, to be able to see if they, you know, if you want to know if they have some sort of knowledge for clusters, to have "Which one is spoon?" It has the sp- blend and then have three different pictures. And then to test for multi-syllabic words to see if they can blend them together, have non-word repetition tasks to test for phonological awareness, and then to do it for your initials as well as exiting, just to make sure. And not necessarily to keep them, you could be exiting a student, but then just to make sure that you refer them to the appropriate services.

Marisha: Awesome. Is that our list of informal assessment?

Monica: Yeah, I think that pretty much covers it.

Marisha: This is always a super common question, but what about goals?

Monica: Yeah.

Marisha: I know it's a little different with what you're working on in California.

Monica: It for sure is. So, I'm never specifically on those goals, just because ed code doesn't list out reading for SLPs, but it could be different for your state. You could be in private practice. I have some example goals, but also, I don't think that you need a goal to work on this. You just need to incorporate it into speech-sound disorder treatment, which we can talk about in a little bit. But one example goal is when given a CVC word, they'll be able to identify which position a particular sound is in the word. So initial, medial, or final. So, if you have to say the word tap, what's the medial sound? What's the middle sound? Or if given the onset and rhyme for 10 different CVC words, that they'll blend the onset and rhyme. So it's like, "What word is this? B-at." And they have to say bat.

Monica: Or another one could be the almost opposite of that. So if I say, "C-at, what word is that?" And for them to blend it. Or you can have the opposite, "what are the three sounds?" So they have to segment it as well.

Marisha: And we'll put some example goals in the show notes, if you're looking for some inspiration.

Marisha: I love what you were saying, because we might not have an actual phonological awareness goal, but if we have a goal for a student to reduce cluster reduction or to reduce fronting, or if they're learning a specific sound, we can incorporate this approach as a means to get towards that goal. Because there's plenty of evidence to show that that works. I like that perspective, that's helpful. Anything else you wanted to talk about when it comes to goals?

Monica: No, I don't think so. This is definitely where I end up working with the reading specialists, we call them RSP teachers in my district. But we'll share materials, or if there's a student with a severe phonological disorder, they'll be like, "Where can I start working first? What sound are you working on? So that I can make sure that I'm targeting that extra." Or they'll say, "This student says this phrase a lot in my classroom and I can't understand them when they're saying this." So, I can pull that and make some of those the target words, and then do phonological awareness with that, because sometimes they'll have a book or sight words or something that they're testing all the time. And it's something that the student has to do frequently. That's a good way. I feel like for me, that's worked to be able to work together with them.

Marisha: Awesome. So I think that's a wrap on our mini list through assessment and goals. So yeah, that was super helpful, and hopefully everyone feels like they've got a good grasp on where they can get started with that.

Marisha: Thanks for listening to the SLP Now podcast, this podcast is part of a course offered for continuing education through speech therapy PD. So yes, you can earn ASHA CEU's for listening to this podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episodes sent directly to you. See you next time.

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A Quick Review of Phonological Awareness

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Phonological awareness is the ability to identify and manipulate units of oral language, like words, syllables, and onset-rime, with phonemic awareness (individual sounds) as a subset underneath it. It matters because children with a history of speech or language impairment are 4-5 times more likely to have reading difficulties, and research shows that targeting phonological awareness alongside speech sound work can improve articulation too, not just reading and writing skills.

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This month, Monica and I are talking about phonological awareness. 🎉

It’s something that a lot of SLP Now members have been asking about and what it would look like in therapy.  Thank you for your requests!  Today we will discuss a brief overview of Phonological Awareness, what is it and what is it so important?

The rest of the month we will dive in deeper with episodes 99, 100, and 101 and discuss goals and therapy ideas for PA. 🤓

The first thing is first, what is phonological awareness and why is it important?

Phonological awareness is your ability to “identify and manipulate units of oral language: words, syllables, onsets (beginning sound c in cat) & rimes (end sounds -at in cat)”.

PA is very important for future reading skills and all students can benefit from phonological awareness intervention. Research shows that all students may not need small group intervention, but students who struggle will have positive outcomes from targeted practice. Some research we looked at showed that students with learning disabilities in early education settings and students with speech impairments would benefit. You can start as early as a preschool with phonemic tasks. 

And guess who is the perfect person to do a quick assessment of phonological awareness and to incorporate simple strategies in your intervention? That’s right. You are, my friend! 

Let’s get to it!

Strategies + Tips Discussed:

–Gillon, 2000. This study compared traditional articulation to phonological awareness intervention. The children who received phonological awareness intervention made significantly more gains in their phonological awareness ability and reading development than the children receiving the other types of speech and language intervention. The phonological awareness intervention also improved the children’s speech articulation.

– Phonological and Phonemic Awareness

Screen Shot 2021 09 13 at 1.58.26 PM

A Quick Review of the Parts of Phonological Awareness

Syllable awareness
Rhyme awareness and production
Alliteration
Onset-rime segmentation
Initial and final sound segmentation
Blending sounds into words
Segmenting words into sounds
Deleting and manipulating sounds

Links Mentioned and Additional Research

– Kelly Farquharson, PhD, CCC-SLP Instagram: @classlab_fsu
– ASHA Evidence Map: Systematic Review: Effectiveness of Early Phonological Awareness Interventions for Students with Speech or Language Impairments
– ASHA Evidence Map: Early Childhood Education Interventions for Children With Disabilities Intervention Report: Phonological Awareness Training
–Article: Al Otaiba, S., Puranik, C., et al. (2009). Across the eight studies investigating the effects of phonological awareness training in students with speech impairments, all studies indicated improvement of the trained phonological skills.
– Ukrainetz Pearson EBP brief
–EBP brief on phonemic awareness efficacy
–Do Phonemic Awareness Interventions Improve Speech in Preschool Children with Speech Sound Disorders?

 

Subscribe & Review in iTunes

Are you subscribed to the podcast? If you’re not, subscribe today to get the latest episodes sent directly to you! Click here to make your listening experience auto-magic and as easy as possible.

Bonus points if you leave us a review over on iTunes → Those reviews help other SLPs find the podcast, and I love reading your feedback! Just click here to review, select “Ratings and Reviews,” “Write a Review,” and let me know what your favorite part of the podcast is.

Thanks so much!

Transcript

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Marisha: Hello there, and welcome to the SLP Now podcast where we share practical therapy tips and ideas for busy speech language pathologists.

Marisha: Grab your favorite beverage and sit back as we dive into this week's episode.

Marisha: Hello there, and welcome to the SLP Now podcast. This month, Monica and I are talking about phonological awareness. It's something that a lot of SLP Now members have been asking about. They've been requesting activities and just asking about what that would look like in therapy.

Marisha: And then I also had a little experience that I wanted to share real quick before we dive into all of the nitty-gritty details that Monica did a fabulous job digging up and putting together for us. And so my first experience with phonological awareness was when I was working at a school and there was a student, he had a couple speech errors. We just had articulation goals. It was a student that I inherited, so I just started down that route. But after communicating with the teacher, I realized that there was a lot more going on. The student was really struggling with reading, among other things.

Marisha: So I started digging through the research, trying to figure out what my role would be and what I could do to better support. And there was one article that really stood out and got me excited, and it just made a lot of sense for this student. And this is just one article that I'm pulling out that just stood out to me, but we will go through a lot of different types of articles and research that has a higher quality of evidence, but this is just what got me started.

Marisha: But it was Guillen 2000. The article compared traditional articulation therapy to a phonological awareness intervention. Check out the article for the full details on their approach. But we will share some of the activities throughout the podcast today, just some ideas. What was really interesting was that these children with SLI who received phonological awareness intervention made significantly more gains in their phonological awareness ability and reading development, which makes sense because that's what they're targeting and they saw improvement, but it also improved the children's speech articulation.

Marisha: So they weren't doing direct speech activities. They were doing all of this phonological awareness, but they also saw an improvement in the speech articulation which was really interesting to me. And I was able to implement some of these approaches with this student, and I saw some similar approaches.

Marisha: But that was just my intro to it, and I'm really curious, Monica, to hear about what your experience was like because your school or district sets things up a little bit differently. [inaudible 00:03:03] you started with it and what have you seen?

Monica: I had preschool to junior high at one point, so I was kind of seeing the different spectrum of it.

Monica: So for my preschool students, we were just really using it a lot for that contrast for them to even hear the sound and do that auditory discrimination. And I was like, "This is really making a difference," so then I really looked into it, and I was like, "There is so much research behind this" because it's just one of those things where you're fresh out of grad school, and they might've touched on it, but then you look into it on your own and you're like, "Wow. I need to like really digest this."

Monica: So I started incorporating it and with my preschoolers because even if we weren't at a really high level, they could still do it receptively, so I feel like that was really great for them, and they felt great because they could be successful with something.

Monica: And then for my elementary students, it was a great way to be able to collaborate with the teachers. And so it was just kind of a natural way to do that, so that was really nice. And they were all just really happy that I was doing something with reading and speech as well because they saw the results. So I was like, "Well, if it's generalizing, there's a big light bulb right there."

Monica: And then for my junior high students, the ones that still kind of had residual speech sound errors, I found that doing those things really helped them, and it wasn't necessarily something that they had done, but just doing a lot of that and concentrating on that because they also were struggling readers as well. They were still going to get help with reading. So it was kind of like, "Maybe that's the missing piece for them to do that in speech as well."

Monica: So for one kid, he didn't have his R in, I think, it was seventh grade, but he had the motivation and he was like, "You know what? I want to get this." And I was like, "Well, we're going to get it" and building in some of those really helped him. I think it just felt like a new way for him to do speech because he had done speech for so long that I think it was just different, and so I got a little bit more buy-in.

Marisha: That is so interesting. I loved your range of experience with that too, and I think that'll resonate with people listening because we have SLPs working with all sorts of age groups, so that's awesome.

Marisha: And so what is phonological awareness, actually, because we've been sharing all of these cool little stories, but what is it? Phonological awareness is just your ability to, and I'm quoting, "identify and manipulate units of oral language," so words, syllables and onset and rime. so rimes is R-I-M-E-S, not like rhyming words. So the onset would be the beginning sound and then the rime would be the end sound.

Marisha: And then under that is also phonemic awareness. So that's your ability to manipulate individual sounds and words, and I feel like a lot of SLPs are probably doing a lot of phonological awareness, but you're just not calling it phonological awareness.

Monica: That's super interesting. And so what are some of the types of activities that we might be doing that fit under phonological overtness?

Monica: So some of the things could be syllable awareness, rime awareness and production, alliteration, onset and rime segmentation, initial and final sound segmentation, blending sounds into words, segmenting words into sounds, and then deleting and manipulating sounds.

Monica: And so we can do a quick example, so syllable awareness would be saying, "How many syllables are in awareness" and then they would get to clap them out.

Monica: Then rime awareness is that, "Do cat and dog rime," or for rime production, it would be, "What rimes with cat?"

Monica: And then for alliteration, it would just be saying words that start with the same sound.

Monica: Then onset rime segmentation would be splitting those words from the beginning sound and the end sound.

Monica: Initial and final sound segmentation is what it sounds like, is being able to segment those. All of that segmentation [inaudible 00:07:19].

Monica: And then blending sounds into words. So that's when we say, "C, A, T. What does that make?"

Monica: And it's so interesting. It feels like I've done some phonological awareness testing, and it's always fascinating that some of our students can't put that together. It seems like, "I'm giving you the answer," but, no. It's super interesting how that works.

Monica: And then the reverse of segmenting words into sounds like, "Tell me the sounds in 'cat' and then the student would have to do that."

Monica: And then the higher level with that is also deleting and manipulating sounds so, "Say 'cat' without the c-." That's how that works.

Monica: So why is all of this important? Why would we be targeting this with our students?

Marisha: It's important at every level, but I feel like maybe the most important is that early intervention where we can really make the biggest difference, especially with some kids who might come to us first just for speech because we all know that is definitely the case sometimes. But when I highlight how important it is for future reading skills and that we can incorporate it into things that we're already doing because I feel like sometimes, we hear like, "You need to do this. You need to do this. You need to do this," but you can incorporate it pretty quickly into something that you're already doing. So a quick phonological awareness check during an assessment and then when you're doing intervention with speech sound disorders, you can kind of put these into things that you're already doing.

Marisha: The kids who are at risk for dyslexia, we have so much overlap with kids who have speech sound disorders. So we're almost like the frontline of catching that and to be able to help with that intervention.

Monica: And it's not hard to incorporate. If we're doing articulation practice, we can do some of those. We can identify the syllables. We can identify the initial sound, the final sound. It's just a matter of knowing which questions to ask and could even have a little cheat sheet of like, "We're going to try this." And so it doesn't involve a lot of extra materials. We're just using words. And then we'll talk a little bit more about activities later, but I love that you pointed that out.

Marisha: I think that's important too is that it's you don't need extra materials or extra supplies. You can just kind of use what you already have.

Monica: Do we want to talk about who could benefit from this, or did you want to talk a little bit more about the importance?

Marisha: There are a couple articles that I looked at. So there was one by [inaudible 00:09:55] et al., and it said that children with a history of speech language impairment are four to five times more likely to have reading difficulties than children from the general education population, so that one definitely stood out to me.

Marisha: And then there is an article that I pulled a lot of this from. So it's from [inaudible 00:10:16] et al. which also includes Kelly Farquharson who is on Instagram, and she's classlab_FSU, and she has a lot on all sorts of things. But this article was exploring the overlap between dyslexia and speech sound disorder, speech sound production deficits. In that article, they just said one-quarter of kids with speech sound disorders who are receiving school-based speech therapy have decoding deficit. So I think she just really wanted to go over the importance that SLPs could play with the role they could play in schools and the best intervention is early.

Marisha: And then it kind of touched on that. It's our speech-only kids. They come in, and you think it's just a speech sound disorder, but I think we're now starting to realize that it's not ever just a speech sound disorder.

Marisha: And in our district, we're really trying to push for full assessments when they have that because you might have a kid who just has a lisp once in a blue moon, but most of the time, they're going to have a lot of other things that go along with that, and I think it's just the importance of also working with other members of the team, just to make sure things are covered. And if I get interns or CS and they'll be like, "Well, this kid just has a speech sound disorder. Do I need to do language testing too?" And I'm like, "Well, here's the thing" and then we kind of go into the importance of you have the opportunity to chat. You might as well just do it. If it's an extra hour or so of testing, you could make a difference in this kid's life for them to be able to get early intervention and to prevent reading difficulties that they have later on.

Monica: No, that can have a huge impact. If it's not super apparent right away, it will become very apparent. And if we lose that time, then that one hour, is it really that bad if we avoid that impact.

Marisha: And then in California, I think we'll talk about it a little bit later too, but in California, it's kind of a tricky area with our ED code. SLPs aren't covering reading skills. That's our other reading specialists, and we have RTI for that too in some districts. But a lot of times, they can't get that intervention until they're 1.5 standard deviations or 2 grade levels below or whatever the qualifier is. So that student might not get intervention until first or second grade which is too late. It's just kind of looking at the big picture sometimes helps to sacrifice that extra little bit of testing.

Monica: So who can benefit from this approach?

Marisha: Going through the research, all students can benefit. So I think all classrooms have it, but if we're looking at who needs that really targeted practice, it's the students that have these phonological awareness difficulties. That's really going to be some of the first indicators that they're going to have difficulty with future reading skills.

Monica: So it's students who have learning disabilities can benefit, students in early education settings, students with speech impairments would all benefit. There was even an article specifically mentioning apraxia. So it's all these different students can benefit it, and you can start as early as preschool.

Marisha: Did you want me to go through some of the articles that I found?

Monica: Maybe you pick one or two to talk about, and we can link in the show notes to the rest of the articles if people want to dig in more, but these are super interesting.

Marisha: Yeah. I, of course, went to the ASHA Evidence maps. It's the easiest place to go if you want a really good quality article. So I'm going to go over two more systematic review type ones.

Marisha: So the first one is a systematic review, and it's called, "The Effectiveness of Early Phonological Awareness Interventions for Students with Speech or Language Impairments." This one is by Otaiba et al. It's 2009. And so across eight studies, they just showed that phonological awareness training showed improvement in phonological skills kind of across the board. So that was awesome to see.

Marisha: And then the other one was [inaudible 00:14:42], and it was a Pearson EBP brief. And this one talked about how you can start as early as preschool and in those early years that you don't have to start with the super easy tasks where it's like, "Which one is a dog barking? Which one is a bell? Put sunset into sunset." You can start with the phoneme deletion. You can start with segmenting. You can start with blending. And that might not necessarily be for every student that we have. We [inaudible 00:15:12] different levels of support that we need to provide for students, but if they're able to and that seems like a good fit for your student, that you can start those as early as preschool.

Monica: That's awesome.

Monica: We have some additional articles that we'll share in the show notes related to the impact on articulation, but that was so cool how we can target, and it makes so much sense that targeting phonological awareness can impact articulation as well. Even if we don't do actual articulation practice, that's so interesting.

Monica: [inaudible 00:15:45] phonological patterns? What does the research show on that?

Marisha: We all know that if there is a phonological pattern in there, that there is going to be a weakness in their whole phonological system. So the research shows that if you do not target phonological awareness, it's not going to generalize to reading and writing skills.

Marisha: Also, if you don't dismiss the kids until you check for those phonological awareness skills because just because the speech sound errors are gone, it doesn't mean necessarily that their whole phonological system is intact. So that Guillen article that you were talking about, as well as the [inaudible 00:16:29] one, was just talking about how this phonological awareness training definitely improves their reading skills, but children who were in the control group... so it's children who received this controlled treatment made significant improvement, but made remarkably little progress in their phonological awareness and written language skills development over time.

Marisha: So I think it just kind of is highlighting the importance again of being able to just include those phonological awareness skills during the treatment.

Monica: That's super interesting, and the progress wasn't significantly slower by adding in the phonological awareness, just in terms of the progress on articulation. So there's not a huge... but we really want them to get their sounds and be able to graduate and all of that. Just targeting that helps the progress towards that, plus it looks at the whole child perspective. So I think I'm convinced.

Marisha: And we have all of the articles in the show notes if you want to dive in more.

Marisha: Thanks for listening to the SLP Now podcast. This podcast is part of a course offered for continuing education through Speech Therapy PD. So yes, you can earn ASHA CEUs for listening to this podcast.

Marisha: If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episodes sent directly to you. See you next time.

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Neurodiversity-Affirming Practices: How to Support Sensory Needs

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This is a guest blog post by Monica, a school-based SLP, all about how to support Sensory Needs.

Part of being neurodiversity affirming is recognizing that students who have sensory needs may not be able to regulate themselves or identify what their sensory needs are. What may have been traditionally seen as “noncompliance” can now be viewed through this lens. We can help support our students instead of requiring them to mask their needs. One thing to keep in mind is that students don’t know what they don’t know. It’s one of my favorite phrases that I learned from a fellow SLP. Students may not be aware that they have sensory preferences or how to advocate for themselves. They may not know that they are dysregulated or what would help. Even as adults, we have a hard time listening to our bodies, for example, sometimes remembering to eat or drink. I can’t imagine how hard it is for a neurodivergent child!

It is crucial to create an environment where students can be themselves and get their needs met. Masking and unmet support needs are highly correlated with higher rates of suicide and later mental health issues (Cassidy et al., 2018).

Jessie Ginsburg on Instagram is an excellent resource for what to look out for and tips for working with our students.

When talking about sensory needs and stimming, it’s easier to explain to others as if you were the student. Think about the itchiest bug bite you’ve ever had and how much you felt like you needed to scratch it. You can’t think about anything else because it’s so itchy. Sometimes that’s what having a sensory need feels like, and itching it would be stimming. When you ask students not to stim, or don’t give them an alternative, what you’re asking them to do is listen to you and follow your directions while all they can think about is how uncomfortable they feel. Just like how scratching a bug bite is the only thing that would make you feel better, the way a student prefers to stim may be the only thing that would help them self-regulate. Keep that in mind when alternatives to stimming are suggested. Listening to my students and their sensory needs is essential to building trust because most of my caseload is autistic or has sensory needs.

Quick Ways to Adjust Your Sessions

Give students a choice to sit or stand, as long as they are being safe.

Put a band on the chair legs so that they can move their legs while they sit.

Have an inflated wobble cushion.

Give movement breaks if they are sitting for a long time. Have them stretch in place or give themselves a hug.

Movement breaks with a preferred activity. A lot of my students love dancing to songs. I keep in mind what may be too much sensory input.

Practicing asking for accommodations during a session is a great way to practice self-advocacy skills as well! I start by experimenting with the different supports, then give them a choice of 2-3, tell them they need to ask, then wait for them to ask independently.

Other Things to Keep in Mind

Smells: If I could suggest one easy thing, it would be to not have any strong scents in the classroom and speech room.

Lighting: Is your speech space too bright? Some students may do better without bright overhead lighting. Try turning the lights off (if you can!) or adjusting the lighting to see if it makes a difference.

Sounds: I ask students if the music is too loud, and we adjust as needed. It’s also a great opportunity to practice self-advocacy.

References

Cassidy, S., Bradley, L., Shaw, R., & Baron-Cohen, S. (2018). Risk markers for suicidality in autistic adults. Molecular Autism, 9, 42.

Neurodiversity-Affirming Practices: How to Support Executive Functioning

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This is a guest blog post by Monica, a school-based SLP, all about how to support Executive Functioning. 

I always tell my interns that the SLP is sometimes going to function as a student’s executive functioning outside of their body until they can do it themselves. Realizing that many of our students struggle with executive functioning is a great way of problem-solving and collaborating with teachers.

Carie Ebert is a great overall resource for early intervention therapy and working with autistic students.

Tera Sumpter has great posts on executive functioning as well. Lots of students struggle with executive functioning, not just students with ADHD or that are autistic.

Here’s a great example of the executive functioning skills involved in a neurotypical conversation. This would be a great resource for talking about how neurotypical and neurodivergent communication styles are different.

 

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A post shared by Tera Sumpter, SLP (@terasumpter_slp)

Let’s dive into a few examples!

1. The student doesn’t “listen” to directions.

This student may be overwhelmed by multi-step directions and has difficulty with working memory.

Recommended Support

Give one step at a time and show the student visually how it is done. Having an example of what the finished task looks like and having clear steps about the task helps. Having the student imagine what each step looks like will help them towards independence with future tasks.

2. The student is impulsive in class.

This student may struggle with executive functioning and may not prioritize or start more challenging tasks. They may only want to do tasks that feel easy to them, but to others, it looks like they are off task and impulsively doing only preferred tasks.

Recommended Support

Helping the student estimate how much time the task will take and how to start it often helps with how overwhelming it can feel to start and finish tasks.

This post in the ASHA Leader, by Scott Prath, summarizes the SLPs role with executive functioning.

References

Prath, S. (2019). Helping Students With Executive Functions—What Is Our Role as SLPs? The ASHA Leader; American Speech-Language-Hearing Association.

Building Relationships with Students: How to Incorporate Trauma-Informed Practices

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This is a guest blog post by Monica, a school-based SLP, all about how to incorporate trauma-informed practices while building relationships with students.

This post by The Informed SLP talks about the effects of trauma on language development, and if you haven’t read it, you should! They, of course, go over a lot of research, including a 40-year meta-analysis by Sylvestre et al. (2015) that highlights that abuse and neglect lead to delayed language skills. Their post also provides many resources and a reminder that you are almost always a mandated reporter.

I will be honest and say that I take a trauma-informed approach with all of my students. I don’t want to assume that they have not experienced trauma because there may not be outward signs of it. Sometimes we find out later that our students are in foster care or have a difficult family situation. I would rather take a universal approach and have students feel safe rather than find out later that one of my students needed extra support. Here are some supports that I have found to be helpful:

1. Don’t use hand over hand. 

If students need extra support, they can put their hand on top of yours, but ask for consent first.

2. Tell students the plan for your lesson. 

I tell my students what the plan is each time we have a session. If we are going to have a change in our regular routine, I’ll also let them know in advance.

I also do my best to tell students what goal they are working on that day, and we occasionally review why it’s important to work on that goal. Knowing what they’re working on also gets a lot of buy-in from students at any age.

For younger students, I ask them if (their goal area) is really hard to do. They typically say yes, and I tell them that I will be working with them to make it easier. I talk about related activities and how they’ll be easier after we work on them. I also talk about how there will be times when they feel frustrated working on their goals and talk about how they can self-advocate for themselves.

The more reluctant students are typically older. With these students, we work together to choose goals, and we also talk about what it would take to be in speech for less time or to possibly exit.

Overall, these strategies help students feel like their voices are being heard.

3. Be predictable.

My students are the most comfortable when my expectations are very clear, and the consequences are very predictable. Allow time for transitions and give ample warning time for when an activity is going to end.

4. Don’t base your rules on compliance.

I only have a couple of true “rules” in speech. We need to stay safe, and we need to be kind to each other. If I ask a student to change their behavior, I will relate to safety or kindness. For example, if a student is leaning back on their chair, I will say, “We need to be safe. You can either sit all the way in your chair or stand if you need to move around. I don’t want you to get hurt.” That way, I have recognized that they aren’t intentionally breaking “rules”. They may just need movement to keep regulated, and they are having a hard time sitting in their chair.

5. Recognize emotions and feel emotions.

Don’t be quick to have students quickly recover from strong emotions to continue the session. You can work with the school counselor to see what would be appropriate to work on. Autistic students may also have alexithymia and have difficulty recognizing and labeling their emotions (Poquérusse et al., 2018).

6. Be flexible.

Sometimes you won’t get the activity that you planned done if a student is having a rough day. Communicating how they are feeling and working on a less structured activity still works on a student’s access to the school environment/curriculum and their ability to succeed at school. It only takes one adult at school that has the time to listen to them to make a difference.

If your student has a behavior that breaks a “rule” that you have, but you weren’t clear about your expectation for that rule and the consequences, then you have to be flexible about what happens. Admit that adults make mistakes too and that now that we know what the expectation is, we are going to enforce what the consequences are.

Rachel “The PTSD SLP” also shares some great content on Instagram.

References

Poquérusse, J., Pastore, L., Dellantonio, S., & Esposito, G. (2018). Alexithymia and Autism Spectrum Disorder: A Complex Relationship. Frontiers in Psychology, 9, 1196.

Sylvestre, A., Bussières, È.-L., & Bouchard, C. (2016). Language Problems Among Abused and Neglected Children: A Meta-Analytic Review. Child Maltreatment, 21(1), 47–58.

Building Relationships with Students: Anxiety and Other Mental Health Needs

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This is a guest blog post by Monica, a school-based SLP, all about how to build relationships with students while taking into consideration anxiety and other mental health needs!

When our students have anxiety or other mental health needs, we can collaborate with the school psychologist or counselor on goals. We can ask them about how to best support our students.

Another option is to work with the classroom teacher! The SLP is often the best person to collaborate with the classroom teacher if the student doesn’t have academic support services. Being able to suggest accommodations in the classroom could improve a student’s quality of life at school.

Examples of Accommodations

– To be able to present alone and not in front of the class for a student that stutters.
– To be able to ask a teacher to explain directions on a test if they are unclear without fear of being told no.
– To have a discrete signal with the teacher to communicate that they need help.
– To be referred to a peer mentor for classes they are struggling with.
– To have graphic organizers to help them plan assignments.

Push-In Lesson Ideas

– Talk about different styles of communication with neurotypical and neurodivergent students, also known as the double empathy problem (Mitchell et al., 2021).
– Talk about recognizing feelings and dysregulation in your body and have students try out different coping mechanisms to see what works for them.
– Talk about different ways to self-advocate when you are not feeling regulated. (Working in the classroom is also a great way to model for teachers and collaborate without adding it to your workload.)

My favorite Instagram account for school counseling resources and information is WholeHearted School Counseling.

Rachel Dorsey is an autistic SLP that is also one of my favorite accounts. She has a lot of amazing posts on working with autistic clients. I love this post on not labeling autistic student’s emotions:

 

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A post shared by Rachel Dorsey (@rdorseyslp)

References

Mitchell, P., Sheppard, E., & Cassidy, S. (2021). Autism and the double empathy problem: Implications for development and mental health. British Journal of Developmental Psychology, 39(1), 1–18.

How to Use Neurodiversity-Affirming Practices to Build Relationships with Students

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This is a guest blog post by Monica, a school-based SLP, all about how to use neurodiversity-affirming practices to build relationships with students!

If you’ve ever wondered how to build a relationship during speech sessions, I’m here to help! I’ve been using neurodiversity-affirming practices for a long time and am constantly shifting and changing. I’ll outline my approach and share what I’ve learned from autistic adults and other essential voices in the disability community. There will also be a lot of links to resources.

As a person of color and a neurodivergent SLP, my therapy approach has always been different. With more people talking about the neurodiversity-affirming movement, I have words to label what I’ve been doing. I have a neurodiversity-affirming, trauma-informed, and culturally responsive approach. It’s a mouthful, but I think it works wonders! I acknowledge that it is a unique time, where there are a lot of shifts happening in society which can be really overwhelming! Providing support communicates to our students that they are welcome as they are, and we will provide the tools to help them succeed. We’ll dig into some basic principles with some real-life examples, and by the end, I’m hoping that you’ll feel comfortable enough to incorporate some of them into your own practice.

First things first, a straightforward way to define a neurodiversity-affirming approach is to think of it as modifying the environment and providing supports, instead of expecting children to change themselves.

Ross Greene (2019) states that children do well when they can and that behind every challenging behavior is an unsolved problem or lagging skill.

In the article Collaborative & Proactive Solutions (CPS): A Review of Research Findings in Families, Schools, and Treatment Facilities, the CPS model is outlined, and a checklist of “lagging skills” to lead discussions for “unsolved problems” is included (Green and Winkler, 2019). In this list are executive functioning needs, sensory/motor difficulties, difficulties with transitions, and mental health needs–just to name a few. This article would be great when discussing making changes with other team members and administration.

This website by AutisticSLT (Emily Lees) in the UK is a fantastic resource on a neurodiversity-affirming approach.

We owe it to our students to learn about self-regulation skills and how to modify environments to help them succeed. By providing support to our students, we build trust and a relationship with them by communicating that we see their struggles and will help shape their environment, rather than putting the burden on them to change. I’ll go over a couple of different support areas for you to individualize for your students, keep in mind that this is not an exhaustive list.

If you want to learn more, check out these blog posts:

– How to Support Sensory Needs

– How to Support Executive Functioning

– How to Support Anxiety and Other Mental Health Needs

– How to Incorporate Trauma-Informed Practices

– How to Be Culturally Responsive

References

Greene, R., & Winkler, J. (2019). Collaborative & Proactive Solutions (CPS): A Review of Research Findings in Families, Schools, and Treatment Facilities. Clinical Child and Family Psychology Review, 22(4).

Building Relationships with Students: How to Be Culturally Responsive

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This is a guest blog post by Monica, a school-based SLP, all about how to be culturally responsive and why it matters!

Representation matters!

An easy way to keep that trust going with students is to have them feel like they are included and represented.

The account Books for Diversity on Instagram is an easy way to find culturally diverse books.

I love this ASHA post, “Why Use Literary Interventions for Diverse Populations” by Phuong Palafox (2018), as well as her Instagram for information about cultural responsiveness.

In her post, Phuong talks about “three ways to incorporate literacy to support the diverse needs of your students and clients”. They are: connect to experience, represent diverse narratives, and value home language. It’s a great way to build rapport and trust when your students’ culture is respected and included in your sessions.

I also love JRC the SLP and her anti-racism work.

Want more information on diversifying your therapy materials? Check out this SLP Now podcast with Liliana from The Bilingual Speechie.

Nina and Scott from Stuttering Therapy Resources also have so much great information on how stuttering is verbal diversity. They also talk about different paradigm shifts around thinking about stuttering in another way.

Here’s a great post about how we should use the word “stuttering” and drop the word “fluency”, as fluency should not be the end goal of therapy.

Keep in mind that it took me years to include all of this in my sessions! It may take some time if you choose to adopt any of these in your sessions and some shifts in thinking, but they are some of the most significant changes that you can make in your therapy room.