Exceptional Reading: Speech-Language Pathologists Can Make an Impact
Speech-language pathologists (SLPs) working in schools, private practices, medical settings, or higher education are likely to encounter the question: “Do you work with reading and writing issues?” The answer is a resounding “Yes!” (Apel, 2009). Language is language, whether it is spoken and heard or written and read, and SLPs have the training and expertise to address language differences regardless of the modality in which they occur. Here are six specific examples of reading and writing differences that SLPs can assess and treat.
Readers with Intellectual or Developmental Disabilities
The population of individuals with intellectual or developmental disabilities (IDD) includes children and adults with genetic syndromes such as Down syndrome, Williams syndrome, or Fragile X syndrome; individuals who have experienced a traumatic brain injury or pre- or post-natal birth complications; individuals who have experienced adverse environmental conditions; and in some cases, individuals with autism spectrum disorder. The needs of individuals with IDD with respect to reading and writing vary across the lifespan. A young child with IDD may find it difficult to identify letters and link them to specific sounds, or to perform tasks requiring phonemic awareness such as rhyming or counting syllables. The motor act of writing may also pose challenges, including gripping the pen or pencil, pressing it to the page, and forming letters. It is the task of the SLP to collaborate with other members of the multidisciplinary team, including occupational, physical, and developmental therapists, social workers, school psychologists, and family to support early literacy development.
Adults with IDD may experience a unique set of literacy challenges. There is a dearth of appropriate reading materials for these individuals. It is often the case that, if a book’s content is interesting to an adult, it is likely to be too difficult for them to read independently at word and sentence levels. In contrast, if the book is written at an accessible reading level, it is likely to revolve around topics that are immature and uninteresting (Saletta & Winberg, 2018). How, then, are adults with IDD able to find suitable materials for leisure reading? One solution is to point them towards leveled books: texts that bridge this gap by exploring adult-level topics in accessible language (Fry, 2002; Spadorcia, 2005). Clinicians can purchase commercially-available leveled books or create their own. If they decide on the latter course, it is important to keep in mind that it is not always ideal to include extensive illustrations. Not only would this practice represent a significant difference from books enjoyed by adults with typical development, but the evidence is also equivocal as to whether or not illustrations actually help adults with IDD to comprehend (Saletta et al., 2019; Saletta Fitzgibbons et al., in review).
Readers with Developmental Dyslexia
The National Reading Panel (2000) identified five essential components of reading: vocabulary, comprehension strategies, phonemic awareness, phonics, and oral reading fluency. Individuals with dyslexia often demonstrate great strengths in the first two areas and significant challenges in the latter three. Proponents of the classic theoretical framework known as the Simple View of Reading (Catts, 2018; Gough & Tunmer, 1986; Hoover & Gough, 1990; Lonigan et al., 2018) state that in order to understand what one reads, one must be able to both decode the written text and to comprehend spoken/written language. Reading cannot occur by either on its own (Nation, 2019). Readers with dyslexia may or may not struggle to comprehend language (Adlof & Hogan, 2018), but they do experience the hallmark characteristic of this reading difference: difficulty in automatically decoding the written word. Dyslexia is also associated with brain-level differences, including reductions in functional activation, gray matter, and strengths of left hemisphere white matter tracts (D’Mello & Gabrieli, 2018). Thus, when SLPs work with readers with dyslexia, our interventions should correspond to what we know about brain plasticity, including alternating intense training with sleep, and engaging the reader’s attention, motivation, and pleasure networks (Dehaene, 2009). It is also important for SLPs and other team members to avoid lowering their expectations of students with dyslexia in an attempt to guide them towards a less challenging, but ultimately less rewarding, career path (Shaywitz & Shaywitz, 2020).
Readers with Poor Comprehension or Hyperlexia
In direct contrast to the profile of developmental dyslexia described above, some readers are proficient decoders who read accurately, fluently, at a proper rate, and with suitable prosody, but experience (sometimes significant) difficulty in understanding what they read. These individuals with poor comprehension may also encounter challenges in receptive vocabulary, semantic processing, morphosyntax, and higher-level language processing (Cain & Towse, 2008; Cain et al., 2004; Catts et al., 2006; Hogan et al., 2014; Nation et al., 2007), and their difficulties often become more pronounced as they proceed through school (Kelso et al., 2020). Like individuals with poor comprehension, readers with hyperlexia can decode fluently but without necessarily understanding what they are reading. Some children with hyperlexia learn to decode at the age of two or three, and seem to take exceptional enjoyment from their reading. Unlike poor comprehension, hyperlexia is associated with clinical implications; specifically, it is often associated with the diagnosis of a neurodevelopmental difference such as autism spectrum disorder (Ostroklenk et al., 2017), Down syndrome (Cossu et al., 1993), or Turner syndrome (Temple & Carney, 1996). Clinicians working with readers with hyperlexia can use their affinity with text as an advantage. When reading and typing phrases, many children show gains in their adaptive behaviors, intellectual functioning, and receptive and expressive language (Burd & Kerbeshian, 1985; Craig & Telfer, 2005; Jensen, 2005; Talero-Gutierrez, 2006).
Readers with Acquired Alexia
Damage to an adult’s central nervous system caused by a stroke, traumatic brain injury, tumor, or degenerative disease can cause a previously literate individual to become unable to recognize and/or comprehend the printed word. Some types of alexia (the central alexias) involve reading difficulties which are precipitated by impairments that are central to language function, whereas other types of alexia (the peripheral alexias) are caused by impairments in visually perceiving the written word (Aguilar et al., 2018; Kemmerer, 2015; Leff & Starrfelt, 2014; Riley et al., 2011). Leff and Starrfelt (2014) offer three suggestions for SLPs who work with clients with central alexia. First, it is important to evaluate carefully reading impairments and cognitive skills before planning therapy. Second, it is valuable to focus on both building upon the client’s strengths and targeting his/her/their weaknesses. Third, helping the client to relearn rules rather than individual items will promote generalization. For clients with peripheral alexia, these authors recommend visual restoration and eye-movement strategies, tactile-kinesthetic training, and errorless learning, as well as specific intervention programs such as the multiple oral reading (MOR) technique (Moyer, 1979) and the Oral Reading in Language for Aphasia (ORLA) program (Cherney, 2010; Riley et al., 2011).
Readers with Cultural and Linguistic Diversity
In 2020, authors of the Nation’s Report Card revealed inequalities between children of color and white children on reading tests, grade point averages, graduation rates, and college attendance (Horton, 2021). Reading achievement is sometimes associated with dialect differences (Charity et al., 2004). SLPs must carefully consider the distinction between a true reading disorder and a difference when working with children who are bilingual or multilingual, or who use a dialect other than School English. Hyter and Salas-Provance (2019) recommend testing the child in their native language whenever possible. Specific cultural differences may be apparent in storytelling (Spencer & Petersen, 2020). Black children may use a call-response interaction in which the narrator creates a story with interspersed calls from the listener (Smitherman, 1977). Similarly, Hawaiian children may tell stories together with peers’ overlapping contributions (McCabe, 1997). Children of First Nation peoples may produce stories that focus on setting information (Worth & Adair, 1972). Whereas the number three appears frequently in Western cultures’ storytelling (three pigs, three bears …), the number four appears frequently in First Nation children’s storytelling (four seasons, four compass directions…; McCabe, 1996; Westby, 2001). Mexican-American families may produce accounts during family gatherings and food preparation (Heath, 1986; Westby, 2001). Chinese-American families may emphasize storytelling as a way to teach values rather than emphasizing imaginative stories (Heath, 1986; Westby, 2001). Japanese children may produce brief and minimalistic stories (Minami, 2002) which are influenced by Buddhism (Matsuyama, 1983; Westby, 2001).
Whether working with children, adolescents, or adults with IDD, developmental dyslexia, poor comprehension, hyperlexia, acquired alexia, cultural and linguistic diversity, or other ways in which reading and writing can be exceptional, SLPs can make an impact on their clients’ literacy skills. Assessing and treating these skills requires patience, creativity, and going beyond the simple administration of a standardized test. It is important for practicing clinicians, as well as students studying speech-language pathology, to ensure that they have the proper training and experience to enable them to work together with this diverse group of individuals.
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