Banter Speech & Language

Sydney speech pathologists helping adults and children speak for themselves.

David Kinnane

Too many children can’t read. We know what to do. But how should we do it?

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The goal is clear.

You wouldn’t know it from Twitter, but literacy researchers, teachers, speech-language pathologists, education psychologists, and reading tutors all want the same thing when working with someone who can’t read. 

We want them to be able to read. More specifically, we want them to understand what they read.

What we disagree about is how we should teach reading. 

The stakes are high

When we get it wrong, students suffer the most. But, actually, we all pay for it:

  • Illiteracy costs the global economy more than $1 trillion a year in direct costs.
  • Low literacy is a major contributor to inequality.
  • Low literacy increases the likelihood of workplace accidents, medication errors, involvement in crime  and welfare dependency (World Literacy Foundation, 2015).
  • Even in rich countries, around 20% of 15-year olds can’t read well enough to participate effectively in life (OECD, 2016).

Individually, and as a group, we can do better.

The science is solid. Gaps remain.

A growing body of peer-reviewed research evidence (sometimes called ‘the science of reading’) tells us a lot – but not everything –  about how we should teach reading. But, too often, ideological, political and professional differences distort or drown out the key ideas. Too often, teachers, speech pathologists, and others are not taught the science of reading in university or college. Too often, sunk costs and other biases, training gaps, and resource and time limitations get in the way of us putting the science to work. 

We can all get better at teaching reading. We need to be honest about what we know, and don’t know. We need to reflect on the limits of our own skills and resources and invest in reducing them. We need to listen to feedback. We need to read new research.  

It’s hard work. But we must do it. 

We owe it to our students. Our job is to:

  • know which approaches work best;
  • explain why they work to others, including students, teachers and parents;
  • know how to teach reading by working on the right things at the right time;
  • stay open and honest about the many things we don’t know;
  • keep questioning what we’re doing, keep learning, and be prepared to abandon practices no longer supported by evidence;
  • measure our results; and
  • keep improving our knowledge, systems, processes, techniques and resources to seek better results.

Teaching reading: how? 

We’ve written at length about what works. 

In this article, we outline how we go about translating reading science into practice – explaining what we do – recognising that we still have much to learn. That we all have much more to learn. We’ve tried to focus on evidence-based practices, rather than broad theories or ideologies, but we’ve referred to some of the key mental models we use when necessary to explain why we do (or don’t) do something.  

We organised our thoughts on this very important topic after reading a great paper by Professor Anne Castles and colleagues (a citation and link to the full text of the article appear below), and reflecting on our clinical experiences and changing practices over the years.

The basic recipe (with messy ingredients)

Let’s start at…the start. To read well, students need to learn:

To teach reading well, you need to know how these skills typically develop over time. You need at least some idea of how they interact with each other. You then need to apply that knowledge to the student in front of you.

We think our practices are supported by evidence. But we’re open to different views and criticism. We will – no doubt – abandon some practices and adopt others as we learn more. Where possible, we have linked to articles we have written summarising the evidence we rely on to support our practices.

How we support preschoolers to set the stage for later reading success 

(a) Oral language and speech development are essential for later reading success

We are hard wired to understand oral language and to speak it. Most (but not all) of us learn to do it without needing to be taught. Parents, early educators and others can play a big role in helping to stimulate early language development by using language stimulation strategies, and engaging activities like play and simply exploring the world. We written hundreds of articles about promoting oral language and speech development. (We’ve created quite the rabbit hole of information, if you have the time.)

(b) Early treatment of speech and language disorders is very important

A child’s oral language competencies (listening and talking) are highly predictive of school readiness and success. And many (but not all) preschoolers with unclear speech go on to have problems with reading. Early intervention is important for children with language disorders and speech sound disorders. But it’s never too late to seek help.

(c) Some phonemic awareness skills are important for later reading

Many preschoolers, including some children with speech and language disorders,  need extra help to figure out, for example, that the first sound in ‘pot’ is /p/, or that the last sound in ‘pot’ is /t/, and that the sounds /p/, /ɒ/ and /t/ can be blended together to make the word ‘pot’. These skills can be taught to preschoolers. For school-aged children, we do not teach phonemic awareness in isolation. Instead, we build phonemic awareness skills through letter-sound and early decoding exercises. In other words, we teach sounds with letters, and sound blending and segmenting skills with written words. Read more here.

(d) Letter knowledge is an important precursor to learning letter-sound links 

Here are some things you should know when teaching the alphabet to your child.

(e) Increasing print awareness can help preschoolers prepare for reading

Here is a summary of some of the research.

(f) Read quality picture books with preschoolers every day

Here’s how to do it. Here’s why you should do it. This practice should continue well into primary school.

(g) Read nonfiction to your preschoolers to build world knowledge

Read more non-fiction books to your preschoolers. Here’s why.

(h) Listen to audio books and high quality read-alouds with your child

We include some suggestions here. This practice should also continue into primary school, and we make some specific recommendations of audiobooks, with links, for school age children here (Kindergarten and Year 1) and here (Years 2-6).  

How we support school-aged students and adults

(1) Reading needs to be taught.

Unlike with talking and listening, we are not biologically primed to read. Everyone needs to be taught. But some children need more help than others.

(2) Use the ‘Simple View of Reading’.

When we look at a student’s reading strengths and challenges, we apply the ‘Simple View of Reading’. You can watch our short video summarising what we think about here. Or you can read a longer article we have written here. In summary, we see the ultimate goal – reading comprehension – as the product of two elements: Word Reading x Listening (language) Comprehension.

(3) Beginners are not experts. 

Beginning piano players can’t play Chopin’s Etude Op. 10 No 4. Beginning artists can’t paint The Lady with the Ermine. I’ve been reading, nerdishly, for more than 40 years. Why would we expect a beginning reader to read like we do: automatically and effortlessly, understanding what we read, as we read it? If you can’t read the words on the page, you can’t understand what you are reading, even with excellent oral language skills. So we have to start with the squiggles on the page.

(4) Unlike, say with Chinese or Japanese, English has an alphabetic writing system.

In alphabetic systems like English, the speech sounds (phonemes) of the language are represented by letters or groups of letters (graphemes). Most children need to be taught these letter-sound links because they don’t pick them up without being taught. Early in reading development, reading comprehension is highly constrained by decoding limitations. Poor decoding can be a bottleneck that stops students from understanding what they are reading about. 

(5) Systematic phonics instruction.

There is a strong scientific consensus on the effectiveness of systematic phonics instruction during the initial period of reading instruction (Castles et al., 2018).  

(6) Systematic phonics systems teach letter-sound links in an ordered way. 

In English, we have 26 letters that, in different combinations, are used to represent the roughly 44 phonemes (speech sounds) we use (depending on our dialect). There are many evidence-based letter-sound sequences around. In our clinic, we used to use the UK Letter-Sound sequence. But we have now adopted the Sounds-Write letter-sound Sequence because it is logical. This sequence teaches children the basic code first (including the sounds most commonly linked to the 26 letters of the alphabet), and then an extended code of frequent letter combinations and the sounds most commonly associated with them, e.g. <ai>, <oo>, <er>, <oy>, <ew>.

(7) One sound per letter to start with.  

In English, some letters and letter combinations are linked to more than one speech sound. For example, <c> is linked to /k/ in ‘kangaroo’ but /s/ in ‘city’; <g> is linked to /g/ in ‘get’ but /dʒ/  ‘giraffe’; <ch> is linked to /tʃ/ in ‘chicken’, /k/ in school, and /ʃ/ in ‘chef’); and, infamously, the letter combination ‘ough’ is linked to at least six different speech sounds (e.g. ‘though’, ‘through’, ‘rough’, ‘cough’, ‘thought’, ‘thou’). 

Before 2016, we followed the Spalding approach of explicitly teaching multiple sounds linked to letters and letter-sounds. But, since then we have opted – initially – to teach the sound most commonly associated with each letter or letter combination, and to later teach context-sensitive rules once children have mastered the basic mappings. 

For example, once beginning readers have mastered the basic mappings, we will teach them that <c> is linked to /s/ in words where the <c> is followed by <i>, <e> or <y> (as in ‘circle’, ‘ceiling’ or ‘cycle’), and that <oo> is linked to  /ʊ/ when followed by /d/, e.g. ‘hood’, ‘stood’, and ‘good’. We have found, clinically, that many children (including some children with working memory, speech or language disorders) have difficulty mapping different sounds to letters; and some children rote learn the multiple sounds, but cannot then apply them when decoding words. We have also found that starting out with a limited set of letter-sound links, puts many children on the path to independent reading earlier than if we dedicate too much time to teaching context-sensitive and less common links early. 

(8) We take a synthetic phonics approach to systematic phonics instruction.

I wish it had a better name. Synthetic doesn’t mean ‘fake’. It means that we teach children early to blend individual phonemes together to make words. Another word for blending is ‘synthesise’, which is where we get the term ‘synthetic phonics’.

Note: we don’t wait until children have mastered all their letter-sound links to start reading words. As soon as they have mapped the first five letter-sound links in our sequence (<a>, <i>, <m>, <s>, <t>), we practice blending the related sounds together in different combinations, so we can read words like ‘mat’ and ‘sat’ and ‘tim tam’). (There are other approaches to phonics instruction. One is called analytic phonics, which teaches children to break down whole words into parts. We’ve seen some evidence that synthetic phonics is better, e.g. Johnson & Watson, 2004, 2005, but I would love to see more evidence and am keeping an open mind.) 

(9) We consolidate early decoding skills with encoding (spelling) practice, following the same letter-sound sequence.

There’s good evidence it helps to improve phonological awareness skills, including letter-sound links and word reading skills, which you can see summarised here. We are big fans of the inexpensive Spelfabet resources to support this practice, although you can make your own.

(10) We focus on real words in reading instruction.

Nonword reading and writing tests are a great way to test a child’s phonological awareness, and to figure out if a child is learning to decode words phonically. That’s why we support the Phonics Check.

But, for most students, we focus on real words. Children with small vocabularies can find it hard to know whether a word is ‘real’ or not, and we’d rather spend the time helping them to build their vocabularies. One caveat: some children with excellent language skills are able to pretend they are decoding, when in fact they are guessing from context, from pictures or because they are reading predictable books (e.g. ‘I see a square. I see a circle. I see a triangle.’). For these children, we sometimes use non-words in instruction to help them to break the habit of guessing words. 

(11) We are not against supplementing early phonics with 100 or so high frequency ‘sight words’.

Most alphabetic writing systems have at least some degree of spelling-to-sound irregularity. English includes many high frequency words that are highly unusual. Teaching sight words is controversial, and some people think it confuses children. The evidence doesn’t support these concerns. There is a case for teaching children the pronunciations of a small number of high frequency sight words directly, including words like ‘the’, ‘come’, ‘have’, ‘said’. One study shows that teaching the 64 most common letter-sound mappings combined with 100 or so of the most frequent sight words allows children to read aloud 90% of the words in texts they typically encounter, again promoting independent reading (Solity & Vousden, 2009).

Many evidence-based reading programs, like MultiLit, include sight word lists. We think that sight word learning is likely to be most successful when children have basic letter knowledge.

(12) We think that there is a role in early reading for decodable books.

Decodable books are texts written for children that consist mostly of words that they can read correctly using the letter-sound links they have learned and some high frequency sight words like ‘the’ and ‘said’. These books give children an opportunity to practice what they have learned and to experience success in reading independently. 

We use decodable books while children are learning the basic and extended codes. Some of our favourites include the InitialLit, Moon Dogs, SPELD SA, and Talisman readers. We have also made our own without pictures, and mapped to the Sounds Write Sequence to check that children are reading (and not guessing from pictures). We’ve made them available for free.

Once children have acquired basic decoding skills, we fade out decodable books, and move on to books with a wider variety of vocabulary and knowledge, in part to support ongoing language development, and in part to keep children motivated to read about the things that interest them the most. 

(13) We supplement early reading lessons with access to high quality audio books and books. 

As noted above, during the early years of primary school, we should continue to expose children to high quality books to support oral language development and later reading skills. There is no reason why this can’t happen at the same time as early phonics instruction, and both practices are supported by evidence. 

(14) For skilled readers, we know word reading involves more than just alphabetic decoding (but you have to walk before you can run).

Although the focus on our reading work with beginner readers is on letter-sound links and blending speech sounds to make words, we know that skilled readers use more than just decoding. There are two key processes in word reading: one that involves effortful phonics-based decoding, and another that involves gaining access to meaning directly from the spelling.

In skilled readers, both processes are used: we use the (more efficient) direct access from spelling method for familiar words, and (effortful) decoding for new and unfamiliar words. For example, when reading the Castle et al., 2018 article, I was flying through, until I hit the word ‘pseudohomophone’. I had to pause and decode this word using both my knowledge of the extended code letter sound links (<ps> is sounded out as /s/, <ph>, as /f/) and my morphological awareness skills (e.g. knowing the meanings of pseudo-, homo- and -phone). More on morphological awareness in a minute.

(15) As children become skilled and get more reading practice, the need to decode word-by-word decreases.

When you see a young reader go from laborious word-by-word decoding, and start to read fluently, it seems like a miracle. Complex computational ‘dual pathway’ models far beyond my ken, like the DRC model (Coltheart et al., 2001), the Triangle Model (Harm & Seidenberg, 2004) and the CDP+ model (Perry et al., 2010) recognise that reading involves both knowledge of learned words and knowledge of the relationship between spelling and sounds. We all want kids to recognise words rapidly and automatically without having to decode them sound-by-sound. We all want kids to read independently as soon as possible.

The self-teaching hypothesis (e.g. Share, 1995) suggests that the act of decoding itself provides opportunities for children to become more familiar with the spelling of words. As children build mental representations of words, cognitive resources are freed up for comprehension. Through repeated exposure to words, a child develops word-recognition optimised for reading for meaning. 

What seems to matter most are increasing a child’s exposure to print, getting lots of experience reading, increasing the frequency of times a child reads particular words over time, and the diversity of contexts in which they read particular words. You can read more about the importance of reading fluency here.

(16) For some readers who have mastered the basic and at least some of the extended code, teaching morphological awareness can help to increase reading skills.

This includes explicitly teaching children things like the spellings of high frequency prefixes and suffixes, and Greek and Latin roots of words.  You can read more about morphological awareness here. Importantly, for beginning readers, we think it is better to prioritise letter-sound links and basic decoding skills. But some people disagree – the science is not settled – and we are keeping an open mind. We see an important role for early oral morphological awareness and explicit grammar instruction for many children, including many children with language disorders, including targeting Brown’s 14 morphemes.

(17) Do what it takes to motivate children to read! 

The most effective pathway to fluent word reading is print experience: children need to see as many words as possible, as frequently as possible in print. There are extreme variances here.

One older (pre-digital era) study of Year 5 children found that children at the 10th percentile read about 60,000 words a year; those at the 50th percentile read 900,000 words; and those at the 90th percentile read more than 4 million words a year (Anderson et al., 1988). This contributes to the Matthew Effect: where good readers keep getting better, and poor readers fall further behind over time (Stanovich, 1986). 

So how do we motivate children to read? We have written about reinforcements in detail here. Some behavioural scientists suggest external rewards can help (e.g. iPad time for doing enough reading), but other experts suggest that external rewards can in some circumstances reduce the intrinsic (internal) motivation to do the activity (here reading) for its own sake (e.g. Deci et al. 1999). Effective practical strategies suggested by Willingham (1997) and others include to: 

  • increase availability of reading matter about topics of personal interest, e.g. comics, car manuals, sports magazines, movie tie in novels, movie scripts, YouTube scripts, reading movies from subtitles (with no sound), DIY books, etc;
  • make reading materials highly visible and easy to pick up. This is why we have piles of books scattered throughout our clinic, free to borrow, including reception areas and clinic rooms; and
  • allow you child to go on ‘library sprees’ where the student can borrow any book they want (within reason and subject to parent discretion!).

For more strategies, read this.

(18) The better students become at reading, the more they want to read.

This seems obvious. But children are motivated to read more when they know they are good at it (e.g. Willingham, 2017). Ideally, we want students to see themselves as readers.

(19) Reading comprehension is really complex. It is not a single idea and cannot be explained by one model. 

To understand what you are reading, you need a whole host of skills:

(20) Don’t forget to keep working on higher level language and other language skills

These include academic vocabulary and evidence-based study skills.  

In skilled readers, the correlation between oral language and reading comprehension is almost perfect, meaning oral language limitations will limit reading comprehension (and vice-versa). 

(21) Some people with reading difficulties benefit from compensatory strategies.

For some people, e.g. with severe dyslexia or otherwise protracted and severe reading difficulties, consider compensatory strategies like text-to-speech and speech-to text tools and, of course, audiobooks. Read more about these strategies here. 

Clinical bottom line

To help children and adults to read, we should:

  • foster oral language development, including of vocabulary, semantics, phonology, word forms, sentence level syntax, narratives and nonfiction books in the preschool and school years; 
  • start reading instruction by understanding that the English writing system is alphabetic: letter-sound links and the ability to blend speech sounds to form words are crucial to develop more advanced reading skills;
  • recognise that early decoding problems can be a major bottleneck in the early reading comprehension, and that even modest improvements in decoding can make a big difference to a student’s understanding;
  • encourage children to read as much and as widely as possible to increase fluent, automatic word-reading;
  • recognise that reading comprehension – the ultimate goal of learning to read – is very complex. Reading comprehension problems can be caused by decoding problems, oral language problems, or both;
  • carefully assess people with reading difficulties, so that we know where the breakdowns are happening and can develop evidence-based plan to address them; and
  • keep up-to-date with the research evidence, and apply it – even when it means abandoning long-standing practices.   

Principal source: Castles, A., Rastle, K., Nation, K. (2018). Ending the reading wars: reading acquisition from novice to expert. Psychological Science in the Public Interest, 19(1), 5-51.  

This is one of the most influential, practical papers I have read in the last couple of years.  Even better, it’s available for free via Sage Journals. In my view, this paper should be required reading for all reading professionals. (Note that any errors of interpretation above are mine and mine alone.)

Related articles:

Once upon a… ‘who’?

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Just in case you need a laugh, here’s me being a bit silly on a free oral language video resource. Back in the late ’90s, I would not have imagined spending my Saturday night this way. Strange times!

If you think you can do a better soundtrack than me, the PDF is available to download here.

Also, part of our Once Upon a… series, is our Once upon a…where? resource.

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.

I want to help my late talker to speak, but I’m stuck at home. What can I do?

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Which words should I choose? How should I target them? How many times should I say them?

Are you at home with a 2-3 year old who doesn’t speak or speaks only in single words? Here are five evidence-based suggestions to help encourage your late talker to start talking:

1. Follow your child’s natural interests and take an active interest in what they are looking at and doing 

2. Copy everything your late talker does, including any speech sounds, and add sound effects!

3. Use lots of gestures, especially pointing

language stimulation tip of the week more pointing

4. Make a list of words to work on: here’s how!

Make an initial list of 10-15 words that you would like your late talker to say. There is no formula for choosing words, but the evidence tells us we should choose a variety of words, including words that:

  • you are confident your late talker understands but is not yet attempting (e.g. names of household items, animals);
  • start with a sound that your child can make. You can read more about the order in which most kids learn their consonants here. For many children, first sounds include vowels, and consonants like /m/ and /b/, like:
    • ‘milk’, ‘moo’, ‘more’, ‘mama’; and
    • ‘bath’, ‘bear’, ‘bottle’, ‘ball’, ‘bird’, ‘bubbles’, ‘book’; ‘balloon’, ‘baby’;
  • are motivating for the child to say (e.g. the name of a loved toy);
  • are important to you (e.g. ‘mama’ or ‘dad’);
  • can be used with natural gestures (e.g. ‘up’, ‘open’);
  • include at least a few ‘all-purpose’ verbs to help with word-combining (e.g. ‘open’, ‘put’, ‘go’, ‘make’, ‘do’); 
  • include some social and commenting words, (e.g. ‘hi’, ‘bye’, ‘nigh nigh’, ‘uh-oh’, ‘owie’); 
  • include some describing words (e.g. ‘big’, ‘hot’, ‘dirty’);
  • include some protesting words (e.g. ‘no’);
  • include some ‘sound-effect’ friendly words (e.g. ‘grr’, ‘choo choo’, ‘woof woof’, ‘vroom’, ‘baa-baa’, ‘moo’, ‘baa-baa’); and/or
  • will be relevant to many daily routines that happen during the day (e.g. when getting dressed, at bath time, when eating, bed time, or when playing).

5. Choose 3 or 6 words to work on at a time

While playing face-to-face with your child, say each of the words you have chosen many times in short, grammatically correct sentences.

This kind of approach – where the parent provides all the input – has been found to improve expressive language skills in late-talking toddlers (e.g. Alt et al., 2014; Alt et al., 2020). 

How many words should you work on at a time? How many times should you say each word? How long should each play “session” go for?

These are really important questions to be answered if you are trying to help your late talker. The research (and common sense) tells us that:

  • you don’t want to try too many words at the same time, so start with 3 or 6 words to target;  
  • late talkers benefit from lots of repetitions; and
  • play sessions shouldn’t go for too long, so start with a target of around 30 minutes.

What recent research tells us

A recently published study looked at two different ‘dose’ formats for a 30 minute play session run by a speech pathologist:

  • 3 different words, each said 90 times; or
  • 6 different words, each said 45 times.

In both cases, that’s a total of 270 ‘doses’ in 30 minutes, or 9 ‘doses’ a minute – one target word every 6.7 seconds in a short grammatical sentence, while playing!  That’s a lot of repetitions!

The program went for around 8 weeks, with two 30-minute sessions a week. Speech pathologists worked with families to choose 10 target words. These words were words that the families wanted their children to say, and included words from different classes (e.g. nouns, verbs, adjectives) but there was no formula for choosing the word classes. 

Toys and activities were pre-planned to make it easier for the speech pathologists to use the targets many times. For example, if a target words were ‘milk’, ‘mum’ and ‘go’, the speech pathologist would use grocery shopping activities or preparing cereal, and use a range of objects, e.g. play milk bottles, real milk, pictures of milk, a colouring page of a milk carton, and a children’s book featuring milk.

Target words were addressed in treatment until the toddler attempted the word at least one time per session across three sessions. Some of the kids heard the same 3 words across all treatment sessions, and some heard all 10 of their words in sessions.

The program was tested on 24 mainly-monolingual English-speaking late-talkers, aged between 25-41 months. None of the children had autism, hearing loss or any other diagnosis other than being a late talker.

Over the roughly 8-week treatment period, most (15/24) of the children began producing targeted words; and at least a third of the children appeared to ‘learn how to learn’ words, gaining, on average more that 13 new words per week. Interestingly, there was no significant difference in the outcomes achieved by the toddlers who received 3 target words a session and those who received 6 target words a session. 

6. What can I do when my child starts talking?

Big topic, and one worthy of its own article. But if I had to choose two of my favourite techniques, they would be build-ups and breakdowns, and recasting:

You can read a bit more about recasting here.

Clinical bottom line

Speech pathologists are trained to train parents and carers in a variety of techniques to help late talkers, including focused stimulation. But you are the expert on your child, and probably the centre of his or her world. 

We hope this article has given you some practical tips for choosing words and helping your late talker to use them. Evidence-based techniques, like those summarised in this article, are safe and can be fun for you and your child in natural play activities and routines – even if you can’t quite manage 270 repetitions in 30 minutes! 

Related articles:

Principal source: Alt, M., Mettler, H.M., Erikson, J.A., Figueroa, C.R., Etters-Thomas, S.E., Arizmendi, G.D., Oglivie, T. (2020). Exploring Input Parameters in an Expressive Vocabulary Treatment with Late Talkers, Journal of Speech, Language, and Hearing Research, 63, 216-233.

Technical resource for speech pathologists looking to help parents choose first words: Wordbank, an open database of children’s vocabulary development: http://wordbank.stanford.edu/.

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.

Vroom through your Zooms with another free Banter Speech Blank’s resource

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Telehealth fatigue is a definitely a thing. 

For those of you on the front line, our speech pathology team have whipped up another free resource to help stay the course. 

Combining interesting pictures with scripted Blank’s Level 3 and 4 questions, this resource is designed to be used for a variety of speech and language goals, including understanding of questions, complex sentence formulation, verbal reasoning, and speech sounds at the sentence level, and speech fluency.

free Blank’s level 3 and 4 picture resource

If you find this resource useful in your practice, please let us know in the comments!

For more Blanks resources, check out our:

You can also read about the benefits of Blank’s language levels framework in our blog here.

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.

Preposition “On”: A No-Prep Preposition Pack with Animated Examples

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Teaching prepositions without movement is really hard, especially when you’re doing it by telehealth.

Here’s our solution for the preposition “On”.

Our new Powerpoint resource with animated examples is now available from our store:

Preposition “On”: no-prep pack with animated examples

Check out our video for more information:

We have had good success using this resource via telehealth in our speech pathology clinic. We hope you do, too.

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.

“There is a time for many words, and there is also a time for sleep.”* Why enough sleep is essential for speech and language learning

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When assessing and treating children and adults with communication disorders, speech pathologists need to ask more questions about sleep.

Why?

Sleep is critical for mental and physical health. Both sleep quality and quantity are important for memory and learning (Antony & Paller, 2017). Memory and learning ability are, in turn, essential for speech-language therapy to work (Morrow & Duff, 2020).

Sleep supports memory

To remember and use something you have learned, you need to:

  • encode it: convert the information into a new memory or mental representation that can be stored by the brain;
  • consolidate it: strengthen and stable the memory in the neocortex; and
  • retrieve it: access the memory.

Sleep may play a role in all these phases of memory, but it seems to be particularly important to the consolidation of newly learned information (e.g. Anthony & Paller, 2017; Stickgold, 2005). 

Sleep disturbances affect learning

Sleep disturbances of any kind have been linked to brain changes and associated disturbances in functional cognition. People with even mild sleep problems or poor sleep habits may have problems with cognition. For example, sleep quality and quality have been linked to student learning capacity and academic performance across settings and age groups (e.g. Curcio et al., 2006; Eliasson et al., 2002; Sadeh et al., 2000; and Trockel et al., 2000).

Memory supports language learning

Some researchers think that language learning depends on two learning and memory systems, which have been co-opted for language:

  • declarative memory, associated with explicit learning and knowledge that is available to conscious awareness, underlying knowledge about words (semantic memory) and events (episodic memory); and
  • procedural memory: associated with implicit, unconscious learning and processing of a wide range of perceptual, motor and cognitive skills and tasks (e.g. Kamhi, 2020, and Ullman, 2016). 

There is a growing body of research suggesting that developmental language disorders in children may be caused by a deficient procedural memory system. This would explain, for example, some of the difficulties many children with language disorders have understanding and applying the rules that comprise syntax, morphology, and the phonology of a language (e.g. Ullman & Pierpont, 2005).

However, the two systems interact with each other in complex and, as yet, not well understood ways, and some researchers do not agree with the procedural-declarative memory account of developmental language disorders (e.g. Goffman & Gerken, 2020).

In any event, research suggests that sleep supports nearly every type of memory, including:

  • declarative memories and language learning (e.g. Antony & Paller, 2017; Batterink & Paller, 2017; Cousins & Fernandez, 2019); and
  • procedural memories (e.g. Huber et al., 2004; Tamaki et al., 2008).

Taken together, this evidence suggests that undisturbed sleep plays a critical role in speech-language therapy success, including learning and retaining new vocabulary (e.g. Dumay & Gaskell, 2007) and complex language tasks, like full narratives (e.g. Antony & Paller, 2017).

Sleep disturbances and communication disorders often co-occur

Although there is good research linking sleep and learning in typically developing individuals, more studies are needed looking at the effects of sleep disturbances on people with communication disorders. 

We know that individuals with impaired development and/or brain injuries are at an increased risk for sleep disturbance. Sleep disturbance frequently co-occurs with:

  • Developmental Language Disorder (e.g. McGregor, 2014; McGregor & Alper, 2015);
  • Autism Spectrum Disorder (e.g. Liu et al., 2006; Schreck et al., 2004);
  • Down Syndrome (e.g. Carter et al., 2009);
  • Parkinson’s Disease (e.g. Chaudhuri et al., 2006; Kumar et al., 2002); and
  • Neurogenic disorder such as:
    • dementia with Lewy bodies (e.g. Murray et al., 2013);
    • traumatic brain injury (TBI), with up to 50% of TBI patients having a sleep disturbance (e.g. Dachtyl & Morales, 2017; Lundine et al., 2019; Mathias & Alvaro, 2012); and
    • stroke (e.g. Hermann et al., 2008).

Speech therapy is dependent on memory and learning ability. As such, sleep disturbance can interfere with our clients’ ability to participate in therapy.

What should we ask more about? Clinical symptoms of possible sleep disturbance

When assessing and treating clients, speech pathologists should ask more questions to probe whether the client exhibits any of the following symptoms of a possible sleep disturbance:

  • Difficulty falling or staying asleep.
  • Daytime somnolence (excessive tiredness or falling asleep during the day).
  • Shortness of breath or headaches on waking.
  • Irregular sleep and wake cycles.
  • Anxiety or irritability.
  • Difficulties concentrating.

(Mayo Clinic, 2019; Goel et al., 2009).

Common types of sleep disorders

Speech pathologists should be aware of the main categories of sleep disturbances:

  • Insomnias, an inability to fall asleep.
  • Hypersomnias, excessive sleepiness, falling asleep at inappropriate times.
  • Sleep-related breathing disorders, e.g. difficulties breathing during sleep, such as obstructive sleep apnoea.
  • Circardian rhythm sleep-wake disorders, meaning misaligned sleep schedules, e.g. where people do not sleep regular hours.
  • Parasomnias, being unwanted events or experiences that occur while falling asleep, sleeping or waking up.
  • Sleep movement disorders, being movements during or prior to sleep that make it difficult to fall asleep, stay asleep or get a restful sleep.

Clinical bottom line

Speech pathologists don’t treat sleep disturbances. But we need to know the signs and symptoms of possible sleep disturbances so that we can refer clients with suspected sleep difficulties to the right professionals to get the right help. 

Untreated sleep disturbances can get in the way of our clients achieving their speech therapy goals. Speech pathologists should:

  • ask about sleep as part of their clinical protocol, consider its clinical effects, and refer clients for medical follow-up as warranted (McGregor & Alper, 2015); and
  • help to educate clients, families and the general public about how sleep disturbances may affect memory and learning (including speech and language learning) (Morrow & Duff, 2020).

Related articles

Principal sources

Morrow, E.L, & Duff, M.C. (2020). Sleep Supports Memory and Learning: Implications for Clinical Practice in Speech-Language Pathology.  Am J Speech Lang Pathol. 2020 Mar 23:1-9. doi: 10.1044/2019_AJSLP-19-00125.

Kamhi, A.G. (2019). Speech-language development as proceduralization and skill learning: Implications for assessment and treatment. Journal of Communication Disorders 82, 105918. doi: https://doi.org/10.1016/j.jcomdis.2019.105918. Epub 2019 Jul 6.

More information

* “There is a time for many words, and there is also a time for sleep.” – Homer, The Odyssey

Related quotation: “It is a common experience that a problem difficult at night is resolved in the morning after the committee of sleep has worked on it.” – John Steinbeck

Image: https://tinyurl.com/rlt65v7

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.