After all, don't speech pathologists only work on stutters and lisps?
This is a common misconception. Speech pathologists not only work on speech, but on communication as a whole.
We have 9 main areas of specialty:
Speech sound production, when someone says 'tat' instead of 'cat';
Stutters, when someone says 'm-m-m-m-my dog is funny';
Receptive language (Comprehension), when someone doesn't know what words mean or can't follow what people are saying;
Expressive language, when people use really simple sentences, say 'thingy' or 'stuff' a lot, get their words mixed up or make grammatical errors;
Social skills, when people don't know how to start and maintain conversations;
Voice problems, when people speak in a raspy or hoarse voice and might have damaged their vocal folds;
Eating and swallowing problems, when a person can't close off the windpipe when swallowing, so food and drink go into the lungs instead of the stomach;
Augmentative and Alternative Communication (AAC) which involves using symbols, pictures, voice output devices or signs to replace or supplement spoken language;
And of course, the topic for today......LITERACY!
That is, Reading and Writing.
Reading
When we read, what do we have to do? Let's use the word 'jumped' in the sentence 'The cat was jumped on by a dog', for example:
Identify letters and the sounds they make, e.g. j says "j" (Phonics and Visual Processing);
Blend those sounds together and form a word, e.g. 'j..u..m..p..ed' = "jumped" (Phonological Awareness);
Recognise and understand the word, e.g. know that 'to jump' means to launch off a surface into the air (Receptive Language - Vocabulary/Semantics);
Recognise any word forms applied to that word and how they change the meaning, e.g. the -ed added to the end of the word means that the animal has already jumped, rather than it being about to jump (Receptive Language - Morphology);
Understand the grammar in the whole sentence, e.g. in the passive structure above, the dog did the jumping, not the cat. In fact the dog jumped on the cat, not next to it or over it (Receptive Language - Syntax).
Writing
To write the word 'jumped' in the same sentence above, we need to do the following:
Choose the correct words from our vocabulary (Expressive language - Vocabulary/Word-Finding);
Form the sentence in our mind and remember it (Expressive language - Syntax and Language Memory);
Sound out the word, e.g. 'jumped' = "j..u..m..p..t" (Phonological Awareness - Segmentation);
Hold those sounds in our mind and match them to letters (Phonics and Working Memory);
Remember the visual form and write the letters (Visual Processing and Fine Motor Skills);
Use our knowledge of word forms to know that the 't' sound on the end is actually the past tense 'ed' ending and add that (Expressive Language - Morphology).
OK so there is a lot of communication involved in reading and writing, I can see why it's relevant to Speech Pathologists.
So are my child's literacy problems related to their earlier speech and language delays?
To answer this we need to look at speech disorders and language disorders separately, as they impact differently.
Language Disorders - the children who have difficulty understanding what people say and/or have difficulty expressing themselves using complete sentences:
A 2002 study* found that language-impaired children have at least a 50% chance of reading difficulty in the 2nd and 4th year of schooling. This is 6 times higher than children with typical language development.
Simply put, if a child has difficulty understanding what they hear, they will also have difficulty understanding what they read, even if they can read all of the words correctly.
If a child says "Him eated all the mouses", they will also write the sentence that way.
If a child has a poor vocabulary, they will have difficulty understanding what they read and will use simple or incorrect words in their writing.
These students may appear to progress well with their early reading and spelling skills in Prep and grade 1 but will struggle more as the content becomes more complex and the expectations of written language increase.
Speech Disorders - the children who have difficulty using correct speech sounds and are hard to understand:
Between 30% and 77% of children with speech sound disorders struggle with reading.**
When we hear words we store information about them in our brains. Some of this information is to do with the sounds in the words. This is called the phonological representation. The more times that we hear the same word pronounced the same way, the stronger that information becomes. As children with speech disorders pronounce words differently, their phonological representations are weak and varied. This puts them at a disadvantage when they try to draw on that information for reading and spelling.
Sometimes there are residual speech errors at age 9 or beyond, such as using F instead of TH (e.g thumb = "fum"), W instead of R (e.g. ring = "wing") or difficulty pronouncing multisyllabic words like hospital and fire extinguisher.
Children who have a speech disorder (or a history of one) may have difficulties blending sounds together to form words. For example, if they hear 'p..l..u..s' they might say that they make the word 'puss', 'luss, 'sup' or 'pass'. This skills is needed when reading.
They may also have difficulty segmenting words into their sounds, for example if they hear the word 'plant' they might say that the sounds are 'p...en...t'. This skill is essential for spelling.
Additional skills such as discriminating between sounds and manipulating sounds in words are also important for reading and spelling, but these are difficult for children who have a speech disorder.
These children may appear smart in other ways. When the words are spoken they have no difficulty understanding them. They might have normal intelligence or even be more intelligent than their peers. They may struggle from the very beginning of literacy learning, or a little later as more vowel sounds and spelling patterns are introduced.
Initially these children only have difficulty 'breaking the code' for reading and spelling. Once they have read a sentence, they usually know what it means. Unfortunately, because reading becomes such a chore they may not be exposed to texts at an age-appropriate level and their learning may not advance as it should. This is when we see the gap widening between them and their peers.
It is these children who are sometimes diagnosed as having dyslexia. If there is a family history of dyslexia it is important to treat early.
As speech pathologists are speech and language specialists we are ideally-placed to provide support to children with reading and writing difficulties, including dyslexia.
If you have a child who has learning difficulties, contact a speech pathologist today.
*Catts, H.W., Fey, M.E., Tomblin, J.B., & Zhang, X. (2002) A longitudinal investigation of reading outcomes in children with language impairments. Journal of Speech, Language and Hearing Research, 45(6), 1142-1157.
**Anthony, J.L., Aghara, R.G., Dunkelberger, M.J., Anthony, T.I., Williams, J.M & Zhang, Z. (2011) Risk Factors in Speech Sound Disorders. American Journal of Speech-Language Pathology, 20, 146–160.
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