Banter Speech & Language

Sydney speech pathologists helping adults and children speak for themselves.

David Kinnane

Beginning readers’ brains are not the same as skilled readers’ brains, so stop teaching beginners to read like they are adult experts

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Unlike speech and oral language (talking and listening), reading is biologically unnatural. Most (not all) people learn to understand and to speak their first language without much fuss. But everyone – in every generation, from every culture, in any language – needs to learn to read. As a species, we’ve only been doing it for a bit over 5000 years.

For some people, learning to read happens easily. For others – including people with dyslexia and reading comprehension problems – learning to read can be a lifelong struggle.

Learning to read changes the brain

Brain plasticity – also called ‘neuroplasticity’ – is the ability of the brain to modify its connections or to rewire itself. Without brain plasticity, the brain would not be able to develop from infancy to adulthood, or recover from brain damage (Banks, 2016).

At birth, we are not wired to read – there is no specialised “reading centre” in the brain. Instead, researchers think that most of us are able to ‘recycle’ evolutionary older brain circuits with similar underlying functions – e.g. general visual processing – to recognise written word forms. This is called the ‘neuronal recycling hypothesis’ (e.g. Dehaene & Cohen, 2007).

Many reading scientists think that learning to read consists of creating mappings (associations) between:

  • visual representations (letters and written words); 
  • phonological representations (speech sounds); and
  • semantic representations (word meanings).

These three-sided mappings are the focus of the ‘triangle model of reading’ (e.g. Seidenberg, 2005). This model suggests that learning to read requires us to:

  • look at written words, sentences and texts; and
  • convert them into oral (spoken) language, so that we can understand them (e.g. Dehaene & Cohen, 2007).

This model is consistent with the evidence-based ‘Simple View of Reading’, which you can read more about here and here and here. 

Learning to read: the print-speech convergence

To learn to read, we have to learn to integrate (combine into a useful whole):

  • auditory information (speech and oral language comprehension); with 
  • visual language information (recognising words). 

Learning to read results in a brain network that brings together speech, language and print recognition: an overlap in activation during reading tasks. Some researchers call this the ‘print-speech convergence’: a brain signature of successful literacy acquisition (Rueckl et al., 2015). 

The development of print-speech convergence can be seen in emerging readers, but not in pre-readers of the same ages. This suggests that learning to read induces (influences or causes) speech-print convergence (Chyl et al., 2018).

The dual-stream model of reading

The brain’s organisation for reading is different for beginners and for skilled readers. The brain changes as beginners learn to read (e.g. Dehaene et al., 2015; and Pugh et al., 2001). To understand what this means in a bit more detail, we need to understand some very basic brain anatomy and a theory called the ‘dual-stream model of reading’ (Marks et al., 2019; and Pugh et al., 2001):

Source: Selket, 2007.

This diagram shows a (very simplified) outline of the human brain visual system. There are two main streams to know about that are relevant for reading: 

  • the dorsal stream or system, which is marked in green; and
  • the ventral stream or system, which is marked in purple. 

For developing readers, the dorsal (green) system predominates at first. This stream is associated with analytic processing for learning to integrate the:

  • orthographic (letters/spelling); 
  • phonological (speech sound); and 
  • lexical-semantic (word comprehension/meaning) 

features of printed words. This stream is most involved in the slow, effortful learning that’s needed to build the foundations for reading. We have summarised some of the key research about how best to teach early reading skills here.

As beginners become more skilled, the ventral (purple) system plays an increasingly important role in the processing of reading, facilitating fast, fluent word recognition that does not require effortful decoding. To explore this almost magical process in more detail, you need to learn more about specific dual pathway models of reading, e.g. the DRC model (Coltheart et al., 2001), the Triangle Model (Harm & Seidenberg, 2004) and the CDP+ model (Perry et al., 2010), which are beyond the scope of this article. It’s also useful to learn about the Self-Teaching Hypothesis (e.g. Share, 1995), which we touch on here.

Growing evidence

Evidence for these ideas continues to mount. For example, recent research by He and colleagues on child beginners (aged 9-12 years) and skilled adult readers of Chinese (aged 20-21 years), using a Chinese word-sound matching tasks in speech and print, showed that:

  • skilled adult readers demonstrated greater speech-print convergence than children who were beginning to read;
  • consistent with the dual-stream model of reading, coactivation in the dorsal stream predominated for children, whereas coactivation in the ventral stream predominated in adults; and
  • greater visual-model specialisation was observed with development. 

In other words, the researchers found clear evidence of developmental changes in readers’ print-speech networks during word-sound matching processes. (The study is cited as our primary source below, with a link to the full paper.) These findings are consistent broadly with studies using alphabetic languages (e.g. Chyl et al., 2018; Marks et al., 2019; and Preston et al., 2016).* 

Bottom line

When we are teaching children and adults how to read, we must remember that:

  • reading is biologically unnatural: no one is wired to do it from birth;
  • the brain needs to rewire itself to become good at reading; and 
  • rewiring the brain to read takes lots of time and effort, and comes more easily to some, than to others.

We can help beginners learn to read by:

Beginners are not experts. Beginning artists can’t paint like Leonardo da Vinci or Jackson Pollock. Beginner composers can’t write music like Johann Sebastian Bach, John Williams, or Prince. Beginning readers can’t read like Maria Popova, James Clear, Mortimer Adler, Octavia E Butler, Warren Buffett,  Mahatma Gandhi  – or even just you or me.

Related articles:

Principal source: 

Yin He, Xin Liu, Jiali Hu, Emily S. Nichols, Chunming Lu & Li Liu (2021). Difference Between Children and Adults in the Print-speech Coactivated Network, Scientific Studies of Reading, DOI: 10.1080/10888438.2021.1965607 https://doi.org/10.1080/10888438.2021.1965607

An introduction to neuroplasticity: What is brain plasticity and why is it so important?

*In studies of alphabetic languages, there were some differences from the findings in He et al., 2021, including significant co-activation of the dorsal posterior temporal regions of the brain in beginning child readers. The researchers speculate that this may be due to the differences between alphabetic and non-alphabetic writing systems.

David

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

Back on track: How to produce better work, more often, to achieve worthwhile goals and to live a meaningful life – in spite of the pandemic

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As a speech pathologist, my job is to help clients achieve their goals. Most worthwhile goals demand intense, focused work over time. But, during lockdown, many people – including me – have been distracted and less productive than usual. Understandable, perhaps. But frustrating, too. 

Over the weekend, I’ve reflected on the last 10 weeks, recommitted to my professional, client, and personal goals for 2021, and set up some systems to get moving and to stay accountable. To spur myself into action, I’ve embraced the idea of “Deep Work”, a term coined by Professor Cal Newport in his popular book of the same name.  

Learning how to do Deep Work consistently – and how to filter out the noise and distractions of the news cycle, social media, email, and the busy workday – can radically improve the quality of your professional life and your creative output. 

Here are seven actionable ideas and tips I took away from the book:

  1. Many of us spend too much time on shallow work: non-demanding, logistical-style tasks, often performed while distracted. Shallow work includes most emails and messaging, administration tasks, and social media scrolling.
  2. To thrive professionally, you need to:
    • master hard things quickly; and
    • produce good quality work regularly, sometimes at speed.
  3. Both abilities require deep work: professional activities performed in a state of distraction-free concentration that push your cognitive abilities to the limit, create new value, and improve your skills.  
  4. Deep Work is:
    • a process of getting into a state of flow: when your body or mind is stretched to its limits in a voluntary effort to accomplish something difficult and worthwhile (Csikszentmihalyi);
    • about focusing on what matters most to you: Who you are, what you think, feel, and do, what you love – is the sum of what you focus on. We should live a focused life, because it is the best kind there is (Gallagher); and
    • about craftsmanship: finding a source of meaning outside yourself by cultivating a skill of finding meaning in what is already there. Seeing your work – whatever it is – as a craft encourages you to hone and apply your skills with respect and care: “We who cut mere stones must always be envisioning cathedrals” (Dreyfus & Kelly).
  5. Good intentions and willpower aren’t enough: 
    • Most of us can’t work like monks, and have to attend to shallow busywork at some point. But switching quickly between deep and shallow work doesn’t work. 
    • Create a habit, establish a deep workspace – somewhere you won’t be interrupted – devise work rituals, track streaks, and measure your hours of deep work. 
    • Time-block deep work into your calendar, e.g. a whole season, a couple of days a week, or even just a couple of hours a day. Build in additional blocks for when you are on a roll or if you are interrupted.
    • Follow a shutdown ritual at the end of each workday to combat the Zeigarnik effect – the ability of incomplete tasks to dominate our attention.
    • Become harder to reach. Use sender filters on your email that lower expectations for a reply, establish written FAQs, and require sender confirmations that they have checked the FAQs before emailing you.
    • Restore your attention, by taking breaks to walk outside in nature, talk with colleagues, friends and family, or to meditate. 
    • Increase your ability to focus for longer with memory training tasks, e.g. by memorising a pack of cards.
    • Put more thought into your leisure time. Replace mindless Internet surfing or social media scrolling with a challenging but engrossing hobby. Research and enjoy great books, movies, music and art. Exercise towards a specific goal like a half-marathon.
  6. Impose constraints on your work day to increase focus and intensity:
    • Think like an artist but work like an accountant (Brooks). 
    • Keep to a fixed work schedule, e.g. by finishing work at 5.30pm every day or a maximum number of hours per week. 
    • Add “Roosevelt dashes” into your day: ambitious deadlines for discrete tasks that force you to focus and work at maximum intensity.
    • Embrace boredom: Take breaks from focus, not distraction.
    • Block social media and email during deep work time: These tools can be professionally useful, but are designed to distract and to hold your attention, taking you away from deep work. Try a thirty day social media diet and see if it makes your life better, the same, or worse.  
  7. Execute: During deep work, focus on the ‘wildly important’. Track hours spent in deep work and important results. Keep a scorecard and review it weekly to hold yourself to account (Grove). High quality work produced = (Time spent) x (Intensity of Focus).

Over the next quarter, starting today, I’ll implement these ideas. I’ll be quieter on social media. I’ll turn down opportunities that aren’t related to goals for my staff, clients, practice or business. And, when I resurface, I hope to show you some nifty projects I’ve planned and – more importantly – executed for the benefit of my wonderful profession and our clients. 

If you’re intrigued by the idea of Deep Work, check out the book. If you decide to have a go at it, please let us know!

Principal source: Newport, C. (2016). Deep Work: Rules for Focused Success in a Distracted World. Piatkus, Little, Brown Book Group, London, UK. 

Further resources:

David

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

Banter BOOSTeR Lockdown Issue

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Banter BOOSTeR: Ideas, strategies, tips and resources for speech pathologists who manage other speech pathologists properly in private practice

Managing speech pathologists in private practice properly is hard work – especially during a pandemic. 

Need a boost?

Welcome to the third issue of Banter BOOSTeR, our free, short newsletter for time-poor speech pathologists who have the tough job of managing other speech pathologists properly in private practice while looking after their businesses and caseloads.  

BOOSTeR stands for:

In this month’s BOOSTeR, we share ideas and tools to:

  • get better client feedback about your services;
  • plan for a return to face-to-face therapy with a mask policy and scripts;
  • think about risk properly as we manage the COVID-19 pandemic;
  • manage remote teams better; 
  • reduce feelings of loneliness; and
  • manage complaints and feedback more effectively using a Plain English complaints resolution system.  

Quick, practical tips and resources from different disciplines that you can use to improve your skills and private practice. 

Let’s go!

Business: Five questions you should ask your clients to improve your practice 

We all want to get better at private practice. One of the best ways to do it is to ask for feedback from clients and then to act on it. 

During lockdown, we’ve found that we don’t get as much direct feedback from our clients because, via telehealth, we get less opportunity for small talk before and after sessions. So we need to ask for it.

As Jon Clark reports in this useful Forbes article, the feedback you get is only as good as the questions you ask. So which questions should we ask our time poor clients? Here are five suggestions, paraphrased from Clark’s advice:

  • How did you find out about us?
  • Why did you choose us, and not another speech pathologist? 
  • How would you rank your satisfaction with our service, and why?
  • What are your biggest challenges?
  • What can we do better to give you more value?

Honest feedback is key. But, if you want to improve, avoid too many questions, jargon, vague and leading questions and, most importantly, act on the feedback you get by making changes to your systems to address it.

Operations: Planning for the resumption of face-to-face services by having a clear mask policy

When the lockdown ends – and it will – we need to reopen safely to protect staff, clients and visitors. Amongst other things, we need a mask policy, and we need to be prepared to enforce it fairly and without favour. 

Some clients may not agree with our policies, and we need to be prepared to stand our ground and defend them.

So what should we do? Psychologist Vanessa Bohns in the Harvard Business Review, makes these suggestions:

  • Be prepared. Have a written policy and a sign on your entrance as a condition of entry. Prepare scripts for staff to use when confronted by a person who does not agree with your policy, refuses to wear a mask, or doesn’t wear a mask properly when required.
  • Ask in a way that allows the person to save face. Don‘t make the person feel rejected or morally judged as a ‘bad person’. Explain the policy in human terms, e.g.:
    • “We see lots of clients every day, and I don’t want you to get sick.”
    • “We work with lots of vulnerable clients who have health challenges, and we need to be careful.”
    • “We’re trying to be extra careful because some of our staff have health issues and are at risk.”
    • “My manager would kill me if I didn’t follow the mask policy.”
  • Be direct: Direct requests are more effective than beating around the bush. Follow up your explanations with a clear, direct request, e.g. “So please put on your mask”.

One additional suggestion: make sure your staff know when to escalate the discussion to management, and remind everyone that, although you welcome feedback, your practice has a Zero Tolerance Policy for abuse.

Opportunities & Risks: Controlling for bias when assessing business risks

As humans, we do a poor job at handling uncertainty over things we can’t control. So far, 2021 has been riddled with fear, uncertainty and doubt. We’ve all struggled to make choices involving risks, which is a big problem in private practice.

There are some established approaches to help make decisions rationally under risk, including Expected Utility Theory.

Paul Schoemaker, of Wharton’s Mack Institute, reminds us to think about the many ways our risk perceptions are biased when making decisions, including:

  • risk aversion in decisions involving gains;
  • overweighting low probabilities and underweighting high ones; 
  • looking at each risk in isolation, rather than adopting a portfolio risk management approach; and
  • preferring known risks over ambiguous ones.

If we want to achieve our purpose, and pursue our business strategies, we have to make risky decisions. Reading up on risk management biases and theories can help us to make better decisions, recognising that risk is inevitable in practice – even if we decide to not act.

Supervision: Tips for managing your team remotely

Many of us are managing teams remotely during lockdown. Regardless of your current service delivery model, private practices need a contingency plan for disruptions to face-to-face service delivery.  In this context, we all need to think more about managing teams remotely. Paul Yonatan, founder of GetVoIP, has some tips, including:

  • creating multiple communication channels and clear rules about how each will be used (we use different channels depending on the type of communication required and privacy and security levels);
  • including team chat and collaboration apps (we find these particularly useful for logistics);
  • hosting regular video meetings with a written agenda, screen sharing and whiteboard capabilities (we host a short daily Zoom call to enhance teamwork);
  • using  cloud and mobile phone solutions, including voicemail transcription, voice notes, and texting;
  • setting clear expectations and structure for work, including around hours of work;
  • weekly one-to-one meetings and check ins to seek feedback on work quality, quantity and satisfaction (we do this in supervision meetings); and
  • setting clear goals, and not micromanaging how each staff member achieves them.

Tip for practice: Working from home doesn’t need to be lonely!

Working from home can be lonely, even when you are seeing clients all day via telehealth. Benjamin Rojas has five tips to combat loneliness:

  • Proactively reach out to colleagues and friends, even when you don’t feel like it!
  • If permitted, work outside the house once a week, even if it’s just in a backyard, park or even with your head stuck out a window!
  • Focus on small, achievable goals: getting things done will improve your mood. Routines help, and, as Elizabeth King says, process can save you from the poverty of your intentions. 
  • Have a proper lunch break, ideally outside.
  • Make plans after work with friends or family, and draw clear lines between work and personal hours. 

Resource of the month: Complaints Management Policy

Do you need a new Plain English complaints management and resolution system to help comply with your NDIS, health law, and ethical obligations to clients? If so, we’ve got your back! 

 Consider yourself boosted!

If you found BOOSTeR useful, please sign up below to receive it each month, or help us spread the word by sharing it with a colleague or on social media!

David

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

Communication is everyone’s right: Speech Pathology Week 2021

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Communication is everyone’s right. But what does that mean?

For those of us in lockdown, and for everyone else dealing with the challenges of 2021, communication has never been more important for staying connected, informed, included, healthy, and safe. 

Happy Speech Pathology Week 2021 everyone!

David

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

Lockdown and oral language therapy: practical things we can do to make things better for everyone in these tough times

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Seven weeks of lockdown in Sydney – and counting – have given us ample time to reflect on our therapy systems and practices. To protect our clients and staff, we’ve had to close our physical clinic temporarily to clients and families. We’ve been operating 100% by telehealth, six days a week. We couldn’t be prouder of our talented team for being so adaptable. We are so grateful to our clients for sticking with us through thick and thin.

Despite all the service-delivery changes, some things have stayed the same. As with many speech pathologists, our waiting lists remain longer than we would like them to be.  

In these difficult times, children with developmental language disorders and other learning disorders are particularly at risk. We are all under pressure to improve our practices so we can:

  • help our clients and families to get the most from therapy in the shortest amount of time; 
  • help more children on our waitlists; and
  • avoid wasting anyone’s time on things that don’t work or aren’t efficient.

Recap: Key elements of providing good quality language therapy 

For years, we’ve read peer-reviewed studies to figure out how to improve language therapy outcomes for clients. We’ve learned a lot about:

  • language as a complex system with a social purpose;
  • the importance of joint attention and interaction;
  • how to deliver the right the amount (or dose) of therapy;
  • giving children the right kinds of feedback and rewards;
  • the benefits of targeting multiple goals and mixing up language activities;
  • the evidence for distributed or spaced practice;
  • building retrieval practice and self-explanations into every session; and
  • introducing facts about the real world into therapy.

We’ve learned to work with our clients and their families to choose:

  • language goals – rather than subskills like auditory processing or working memory – to improve language outcomes;
  • functional goals – things that matter most to families, and things that get in the way of the child following their interests and participating in the real world; and
  • complex goals that promote system-wide change to language skills, rather than simply following a developmental sequence or targeting isolated goals that don’t have a noticeable effect on language as a system.

We’ve realised that many evidence-based therapy techniques share common elements, including:

  • an explicit focus on the skill you are working on;
  • clear language models to reduce the noise and to increase the signal of the target for the client;
  • repetition and repeated opportunities for learning skills; and
  • responsiveness to the child’s attempts.

We’ve come to understand the importance of:

  • collaborating with families, educators, health professionals and others to support the whole child; and
  • including natural play, conversation, dialogic reading, and storytelling activities into therapy to encourage transfer of language skills to the real world.

You can read more about these elements of therapy and how we think about them in our therapy here. 

So what else can we do to make language therapy more effective? 

As waiting lists for services have increased, and as we’ve pivoted to telehealth, we’ve been looking for other ways to improve the efficiency of our language therapy further. Specifically, we’ve been looking at ways to improve the transfer of language gains in one area of language to other areas of language to give clients and their families more value for their time and money. 

Transfer of learning happens when one set of skills transfers to another set of skills. When looking at the evidence for transfer, it helps to be clear about what kind of transfer you mean:

  • Near transfer is transfer between skills that are very similar. For example, if you do working memory training, you can improve your performance on tests that resemble the tasks that have been trained.
  • Far transfer is transfer between domains that are rather different, e.g. chess to problem solving, or working memory to language and reading. 

Many researchers think that far transfer is rare, or question whether far transfer is even possible. Different studies of working memory training, music, and video games have found a lack of, or very limited, transfer from one domain to another. This is why we do not recommend working memory training for language disorders. 

Other researchers think that transfer is possible between tasks that are quite different in content if they share the same basic underlying structure, or if the tasks (and the skills underpinning them) are interconnected in the learner’s mind. 

Within the language domain, a group of researchers thinks that transfer can occur when a new word is related to similar words that are already known (e.g. “parched” and “thirsty”); and that learning new words improves the learner’s understanding of words they already know. Vocabulary studies typically show large gains for words that have been taught or trained, but limited gains for words that are not trained. 

In 2019, Dr Melby-Lervåg and colleagues looked at transfer within the domain of language in more detail and concluded that transfer is possible within the domain of language, although direct transfer – as measured by improvement in one specific task to another – is difficult to obtain (see citation below). 

Despite its rather intimidating title, the paper includes some very practical guidance for front line speech pathologists and others working with children with language disorders during lockdown. Here are some of the main things we learned from the paper, followed by some examples of how we are seeking to apply the research recommendations in our practice within the constraints imposed on us by lockdown:

(1) Focus therapy on expressive language goals

A review of the evidence suggests that most of the effects of language interventions are generated through expressive language measures. This means we should focus on complex expressive language skills in functional ways, such as having clients:

  • construct sentences;
  • retell stories; 
  • make up their own stories; and
  • finish stories already started.

(2) Smaller groups are better than big ones   

On the whole, small group language interventions are more effective than large group or whole-class interventions. This is probably because children have more opportunities to speak and practice their expressive language in smaller group settings.

(3) Target words should be presented in context

We should not work on new vocabulary in isolation, e.g. by teaching word lists with definitions. Instead, we should introduce and explain new vocabulary in sentences, in stories, as well as in other texts. The ways in which different words can be used in different contexts should also be emphasised.

(4) Therapy should focus on the procedures that are used to complete language tasks, not just the content of each task

We want children to become aware of the procedures they use when solving a task so it is more likely they will use them in other tasks. For example, rote learning the definition of a cactus is less useful to children than learning the process of describing a cactus by features like category, function, location, shape, size, colour and its parts – an approach that can be transferred to nouns, generally. 

(5) We should tell children what they are working on and why it matters

We should prime children with knowledge of what we are working on and why, and be specific about what we are trying to achieve. We should tell children that we are working on their language skills to make them more conscious of how they use language and the language that surrounds them. This may make it more likely that the effects of therapy will transfer out of the clinic and into the child’s “real world”.

Our efforts to date to translate research into practice when delivering therapy by telehealth 

In response to research, we have developed a range of language tools for our clients that are explicit in their goals, and focused on expressive language in context. We’ve also adapted some of our resources to make delivery by telehealth easier for clients. For example, we’ve written:

Having used these tools with clients, we are now much more conscious of the need to work on expressive language for social purposes as part of a complex system, and the importance of making sure we collaborate with children and their families through therapy planning and delivery so that we all understand what we are working on, and why.

Bottom line

Effective language therapy can increase children’s participation and success at home, at school, and in life. Regardless of all the other things going on in the world right now, speech pathologists and others working with children with language disorders should keep a close eye on research developments so that we can continue to improve our practices by focusing on therapy tasks that make a positive difference to clients and their families outside the clinic. 

Related articles:

Principal source: Melby-Lervåg, M., Mjelve Hagen, A., and Lervåg, A. (2020). Disentangling the far transfer of language comprehension gains using latent mediation models, Developmental Science. 23:e12929. See: https://doi.org/10.1111/desc.12929.

David

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

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