Response to Intervention (RTI) is a U.S. based reform effort designed to systematically add more regular education intervention to struggling kids prior to the use of special education. From what I understand, it actually is possible to effectively use RTI to shore up the cracks of language delay that are frequently so hard for professionals to fill. I am skeptical, however. I’ve heard and read many glowing recommendations of the theoretical underpinnings of RTI, usually along these lines:
All kids start at level one – basically a regular education classroom, where general education teachers provide differentiated instruction. Progress is frequently monitored with kids deemed not making enough of it then being moved to level two. Level two students receive supplemental instruction with lower student-teacher ratios and more progress monitoring. Kids not making enough progress at level two then are considered for level three, which is special education. A pyramid figure generally symbolizes the number of kids that are supposed to be at each level, with the most at level one, proceeding geometrically to level two, and ending up at the smallest, top part of the pyramid – where very few kids are supposed to be at level three.
So how can RTI be used to improve language services? Well, under RTI, educators are supposed to constantly monitor the progress of all kids. One of the things about language is how difficult this is. It is easy to miss a problem spot because of the complexity of language, and kids with language problems often compensate by using less of it. Kids with language deficits – and critically, not just kids with IQ/language discrepancies – then must be given good language “support.” As there is currently no research supported language intervention that has been validated for use with kids of higher functioning than the severely autistic kids receiving ABA therapy, it seems likely that this support would mirror the often subjective methods SLPs currently use to provide language therapy.
Conventional wisdom in education once held that only some children could be genuinely helped by their educators. The others were pretty much doomed by their circumstances. But then along came Benjamin Bloom, who in 1956 published his widely influential, Taxonomy of Educational Objectives. Bloom’s work helped lead an educational renaissance over the next several decades resulting in such things as Head Start and the Individuals with Disabilities Education Act.
Starting in the 1950s, research exploded exploring the hows and whys of using structure, individualized attention, and feedback, to give educators the tools to help all children maximize their potential. Bloom contributed his list of cognitive processes that organized thinking and learning from the simplest (recall) to the most complex (judging or evaluating). The point was to use the understanding of exactly where a person’s specific knowledge of a topic is to guide further teaching on that topic. After acquiring recall knowledge of an objective, learning proceeded hierarchically from comprehension, to application, to analysis and synthesis, before ending up at the top step – evaluation.
Of course the taxonomy wasn’t perfect. Since that time, educational researchers and cognitive psychologists have learned a great deal more about learning, especially concerning the impact of feelings and beliefs, as well as social and cultural influences. Bloom’s hierarchy came to be seen as too rigidly denying these external factors, while oversimplifying the progression from one step to another, and too strictly separating specific areas of knowledge. Other researchers, such as Marzano and Anderson have since made their own contributions, helping increase the taxonomy’s relevance and accuracy. In particular, the skill of creativity has been added to the top level. Creating specifically involves combining skills needed to generate, plan, and produce things, which are hopefully useful.
Other useful classifications often accompanying the taxonomy include procedural and declarative knowledge, and meta-cognitive knowledge. Procedural knowledge can be thought of as “know how” knowledge. An example would be knowing how to tie shoes. This kind of knowledge, which is greatly helped by actually doing the task, is often seen as the most difficult to teach. Declarative, or conceptual knowledge, is the “know what” type of knowledge. This usually involves facts and/or linguistic representations. This would involve, for example, the verbal instructions of what you do when you tie shoes (First you grab one lace in each hand, then…). Meta-cognitive knowledge is the “know why,” of knowledge. Why do we need to learn to tie shoes? “Meta” knowledge can also be very difficult to teach and to learn.
Okay, this is going to be a controversial post with the potential to make a lot of people a lot of mad. But, after much contemplation, fueled by relentless personal experience, I feel very strongly that this is the right thing to do. Today, on Autism Awareness day, I’m going to assert the following position: our society is too aware of autism. And way too often, autism is used to shield parents from what’s actually going on with their children. So, before I get into the controversial part, let me get the facts out of the way. Autism is a real and serious public health issue. While we seem to be getting some better guesses, its causes are still pretty much completely unknown. The best way to treat autism is intense and personally tailored therapy. Autism diagnosis has grown rapidly over the last couple of decades, and more rapidly over the past couple of years. Some of this seems to be due to increased awareness. Some seems due to a yet to be discovered cause. It is not due to cold and non-responsive mothering, which was an early and long ago repudiated suspect. But something else is no doubt going on, contributing insidiously to this recent rise. It keeps happening to me over and over again, and I’m done with merely grumbling to those around me each successive time.
I assess hundreds of children each year, many with multiple types of language delays, and many with concerns of autism. I get several very valid autism referrals each year. I also get several referrals from more borderline cases. What makes identification of all of these autistic kids more difficult, however, is the fact that I also get multiple referrals from parents and professionals alike – and I’m carefully choosing to put this bluntly – who want these children to get the label. Yes, this happens. And inevitably, it hurts all of these children.
The kids vary. Sometimes it’s just kids who are a little “weird.” Sometimes it’s kids with families with a history of known or suspected abuse. Other times diagnosticians will get referrals from parents or family members of a child with a different diagnosis who think that autism is somehow less severe. Sometimes no one knows exactly what’s going on, and so the finding of any label at all satisfies the human need to know. Additionally, I have seen, over my many years, parents emulating the actions of seeking the joining of a friendly and supportive community, not only of parents with autism, but also of community members who give extra care and compassion toward parents of disabled children. I’m sorry, but it happens. Continue reading →
As a speech and language diagnostician, I’ve tested a lot of kids. I’ve seen many, many patterns of language deficits, and while admittedly, my evidence for my upcoming assertion will be entirely anecdotal, often anecdotal evidence does accurately reflect reality. My assertion: when determining goals, language therapists should (usually) not separate receptive and expressive language. It’s usually much more effective to separate goals by morpho-syntax, semantics, and pragmatics.
Why? The bottom line is that most kids don’t have major differences between receptive language and expressive. It is just extremely difficult to produce something that you can’t understand. In this way, receptive language can be thought of as foundational, or a precursor for similar expressive language. Usually, the converse is true too – a kid can’t understand something that he can’t produce (with some exceptions). If you have a deficit in an area – pronouns for example – the majority of the time this deficit exists in both receptive and expressive language. So, since this is usually the case, and since it is usually the case that with most people there are not major differences between scores (and abilities) in receptive language and expressive language, it stands to reason that the deficits themselves can be more effectively addressed by shifting the focus.
Looking at reception as a foundation for expression also gives us a means of structuring our goals to more accurately reflect deficits. What a lot of people accept as difficulties with understanding, or following directions, really are problems with understanding (and producing) specific structures. Verb tense, prepositions, pronouns, negatives, clauses, etc. – these are the typical culprits of comprehension problems. And when kids have problems understanding a certain structure, they nearly always have problems producing that structure. Importantly, the pattern of these deficits vary from kid to kid. This means that goals for following directions usually cast too wide a net, and miss a kid’s uniquely specific problems. (Here’s another post for more on following directions.)
This post comes from this link. I didn’t have anything to add; I just wanted to point it out.
Pew Research Center recently asked a national sample of adults to select among a list of 10 skills: “Regardless of whether or not you think these skills are good to have, which ones do you think are most important for children to get ahead in the world today?”
The answer was clear. Across the board, more respondents said communication skills were most important, followed by reading, math, teamwork, writing and logic. Science fell somewhere in the middle, with more than half of Americans saying it was important.
Rounding out the bottom were skills more associated with kids’ extracurricular activities: art, music (sorry, right-brained people) and athletics. There was virtually no difference in the responses based on whether the person was a parent of a child aged 18 and younger or not.
Earlier I described why there’s a need for making language therapy more objective. Now I’ll specifically describe how this can be done.
- Check the deficits on the present levels and goals/objectives – They should be the same as from the most recent evaluation minus goals achieved since that evaluation.
- Keep referring to those deficits/goals – Make a list to put at the top of each data page, or the inside of speech folder – IEP goals can be copied, but make sure they reflect the present levels
- Take good notes – good notes help you as much as anyone else
- Be objective not subjective with your notes – Objective language data must have 3 things:
- Level of words – There are big time differences developmentally within classes of words. You may work on basic words or later developing words, but not at the same time with the same kid. For example, for a kid working on conjunctions, and and or should not be worked on at the same time as although and unless. You probably need a comprehensive list.
- Task type – Some tasks are easier; some are harder. To differentiate tasks, I use ID/Label/Use (ID is easiest, Use is hardest).
- ID tasks – Often involve pictures or objects and/or choices with foils – Easier tasks have fewer foils generally, with more foils making it harder with IDing objects in environment or in scenes being the most difficult, as they have tons of possible incorrect answers. Other tasks: “Wrong or Right,” and “Find It”
- Label – Can be spontaneous labeling (The kid just labels something as soon as he sees it); direct elicitation (What is ____?); choices (Is this a _____ or ______?); or fill in the blank (The giraffe is ____.), labeling from attributes, labeling category members
- Use – Can be using in a sentence (Use the word “fell” in a sentence); repair (Fix this sentence: “He are running.”), finishing sentence (Finish this sentence with the word “not:” “He did _____.”); describing; sentence repetition
- Cueing – Be consistent. This system seems prevalent: min (cueing required some of the time, generally less than 25%); mod (cueing required approximately half of the time or about 25 to 75%); and max (cueing required most or all of the time or greater than about 75%).
- Tons of great activities combine task types. Tons of great activities can’t be measured – Books, play activities, theme based activities, crafts, etc. These are all great to do, especially considering the tremendous motivational value from varying teaching techniques. However, you can’t perform objective measurements with combined tasks. Not all therapy should be objective, though – we know that best practice is to do baselines, and criterion referenced short “quizzes” to measure progress, and then devote much of therapy time to teaching, or activities that reinforce or integrate different skills.
The following scenario is completely made up, but in a way that should be familiar to a lot of speech-language pathologists (SLPs). Miraka has been working on time concepts for, well, a long time. You, as the therapist, have worked on asking her questions like what she did yesterday, when she eats lunch, and maybe even differentiating between hours and minutes. Perhaps you’ve worked with staff implementing routines and visual cues so that Miraka can anticipate what’s coming next in her school day. You seem to be doing some good stuff, but you’re just not sure Miraka’s making progress, and you’re not even sure exactly how to tell when her goal’s been met. People ask how Miraka’s doing, and we say things like, “She’s working hard. It seems like you can understand her better,” or “Her sentences seem better.” Inside we squirm because we can’t be more precise.
I’ll just state it bluntly: a lot of SLPs do not like language therapy. It’s just not as neat and straightforward as, say, articulation therapy, where you know exactly where the kid’s at, and exactly where the kid’s supposed to be going. The practice of language therapy has often been messy, or more of an art than science. And though we don’t like to admit it, we tend to measure language progress more from the gut than from any chart. We go almost entirely by subjective measures, such as how we feel, and what others are reporting. We can’t quantify Miraka’s progress, and this makes us uneasy.
In my many years of assessing many kids, so many of whom were three or under, I’ve often noted how different kids are in their abilities to play. I’ve also been motivated by the Preschool Language Scale’s differentiation of play, generally into functional and relational play – though I feel this great start can be expanded.
How a child plays tells us so much about that child, especially with children that are difficult to assess in traditional manners, because of compliance or a low level of function. Not only that, but an accurate assessment of what level a child is playing at can help guide intervention and suggestions for caregivers. Play can be an excellent method for developing other communication skills, such as initiation, imitation, and turn taking. I came up with a list of these levels that I’ve started using in my own assessment, and thought it would be helpful to share that here. It generally goes from a lower developmental level to higher, although there is much overlap.
1) Shaking/banging objects in play
2) Smiling or laughing at or along with others
3) Attending to others who are singing, dancing, or reading
4) Examining novel objects
3) Anticipation – Does the child demonstrate sensing when something is going to happen, such as an object about to fall off a table, block tower about to fall, or a pretend plane taking off?
4) Functional play – Does the child use play objects appropriately, such as bouncing balls, driving cars, etc.?
5) Relational play – Involves using two objects together, such as pretending to pour juice for a play picnic, or having a figure ride in a car or on a horse.
6) Other directed play – Does the child watch others for reactions, or imitate play behaviors, with some basic turn taking?
7) Representative play – Involves pretending like something is something else, such as pretending a pencil is a rocket, or a block is an ice cube.
One reason why describing language as a third reality can be helpful, is that it can reduce linguistic confusion. A lack of realization of belief’s influence on language frequently leads to confusion. Whenever you comprehend the words of another you are always doing so through the filter of their beliefs. You can never remove this filter, though you can take steps to remove the distortions of its influence.
A gap seems to exist between our understanding of language and our potential to understand language, particularly for large swathes of people isolated and intimidated by the manner in which language is currently explained. Additionally, a greater realization that language is a way of depicting our beliefs rather than reality itself seems to lend itself to a potential of resolution of conflicts more due to differing definitions and concepts than people currently realize. My choice in words is not affected by truth as much as I would like to believe, but rather by my belief in the words’ correspondence to reality.
Perhaps the lesser-haired man was wanting to climb the mountain, but after hearing of it’s description, he changed his mind. Some obvious means exist of clearing this confusion, such as the asking for more detail, and the seeking out of other sources. There are other ways too, but they all share the quality of first realizing the risk of equating words with reality rather than belief.
Concepts could be thought of as being utilitarian by nature. They are also subject to a sort of natural selection. These concepts exist, and ultimately persist or fade, based upon how well they serve us. Democracy, as one example, is nothing more than an idea, melded together of other ideas, such as, that leaders should be chosen based upon the will of the people those leaders serve. This one concept, though, draws upon, and lends characteristics to a multitude of other beliefs and concepts. That people vote is only one of a vast number of these potential characteristics. As is how they vote, and who exactly gets to do so – and what is an election, and a campaign, and how does campaign finance reform play into this? And what are the characteristics of a dual party system versus a multi-party system? You could list examples of good democracies, and you could even list examples of bad monarchies which led to revolutions, which led to the good democracies. Why doesn’t everybody automatically advocate democracy? What is the role of the media? What is a hanging chad? Continue reading →