Banter Speech & Language

Sydney speech pathologists helping adults and children speak for themselves.

Receptive Language

“Huh?!” The many benefits of using Blank’s Language Levels framework to help your kids to understand language for school

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Some researchers think that up to 15% of young school kids don’t have the language comprehension skills to cope fully with the demands of school (Hart & Fielding-Barnsley, 2009). Many of these kids struggle – some for their whole lives.

For most kids, home life plays a big role in helping to understand and use language (Morgan & Goldstein, 2004; Nation, 2005). So what can families and others do to help kids improve their understanding of language?

General advice is sometimes not enough

It’s easy to feel overwhelmed when your child is struggling with language. Advice like “put down the devices and talk with your child more”, or “encourage your child to speak in full sentences”, or “read books with your child every day” can seem a bit general to be of practical help on a day-to-day basis – especially if you are doing all of these things and your child is still struggling.

Yes, children need to hear lots of language: quantity is important. But kids also need quality, real interactions with their parents, siblings, and others they care about, about topics of shared interest. For example, this is one reason evidence-based, shared reading practice can improve kids’ language skills.

Getting practical: tackling the mystery of language comprehension with a framework

Oral language comprehension – also called listening comprehension or receptive language – is deeply mysterious for the simple reason that we can’t know exactly what goes on inside someone else’s head. It can also seem very abstract to non-experts – language comprehension includes comprehension of language content (vocabulary and semantic knowledge), language forms (e.g. phonology, morphology, and syntax), and use (pragmatics).

So where to begin?

Well, it helps to have a plan. And good plans are based on tried and tested frameworks.

For language comprehension, one of the most influential frameworks was developed way back in the late 1970s by Dr Marion Blank, a developmental psychologist. Despite its vintage, we use Dr Blank’s model almost every day in our clinic to inform our approach to the assessment and treatment of children, teenagers and adults with language difficulties. And we’re not alone – many researchers have reported that Blank’s framework provides a good mechanism for child educators and others to enhance children’s learning (e.g. Elias et al., 2006; Hay et al., 2010). And lots of other speech pathologists use the framework, too.

I wish more parents, early educators and teachers knew about Blank’s wonderful work. (Hence this article!)

Blank’s Levels of Questioning

Dr Blank’s framework is based on the simple idea that young children’s early language and reasoning skills – while separate things – develop interactively to their mutual benefit. As a child’s understanding of words and the meanings of words improves, so does their ability to think and reason in words, which then further enhances their ability to understand and use words in more complex situations. In other words, stimulating language development can improve verbal reasoning, which, in turn can help more advanced language development: a virtuous cycle.

Dr Blank proposed that children learn language through social interaction, including through the way they listen to and speak with others while engaged in activities together. She thought that parents, early child educators, speech pathologists and others can improve preschoolers’ language and reasoning skills by changing the way they interact with kids, and, in particular, the way in which they ask kids questions, and respond to their answers.

The model is based on the idea that language exists on a “continuum of perceptual-language distance”. Kids first learn to understand and use language in very concrete ways based on what they see, hear and touch, etc.. As they develop, kids learn to use language to understand and express more abstract ideas (e.g. to make predictions, draw inferences, and to explain ideas and events that you can’t see, smell or touch).

Dr Blank proposed four levels of abstraction, from least to most abstract:

LevelLanguage complexityGoalExamples of activitiesExamples of questions or statements adults can use at the level [example items in square brackets]
1Directly supplied information
(Matching perception) 		Children map language directly onto what they see, hear and touch. They use directly supplied information.Tasks where children match pictures, sounds, or sights, and label objects. Show me what you touched.
Show me what you heard.
Show me a [dog].
What's this called?
What did you touch?
What did you hear?
Can you find one like this?
Say this: [tree].
What is this?
2Classification (Selective analysis of perception)Children respond selectively to different aspects, attributes or features of the situation.Tasks where children comment on the colour, size, shape, function and other features of objects that they can see, hear or touch. What is she doing?
Find the one that is [big] and [green].
Tell me its [shape, colour, size].
How are these two different?
Finish this: [e.g. I like to...I want to....].
Where?
Who?
What things [e.g. swim, fly, run fast]?
Find the one that can [dig, jump, cut].
What is happening?
3Reorganisation (Reordering perception).

Language no longer mapped onto what they see.		Children look beyond what they see and rework the experience in accord with the language demands of the task. Tasks where children must summarise, predict, explain, or retell the information they have been presented with.Which one is not [an animal, tree, vegetable]?
Do this, then this...
Tell the story [e.g. about process like a bath being filled up, or a suitcase being packed].
What happened to all of these?
Tell me how [e.g. to fill a water pistol, or make a cake].
How are these the same [when they don't look the same, e.g. scissors and a knife, or a mug and a glass]?
What could she say?
How does he feel?
What else [grows, flies, sleeps]?
What will happen next?
What is a [car, hammer, frog]? (Answer to include attributes like function, location, category, colour, shape, etc.)
4Abstraction and inferences (Reasoning about perception)Child thinks about what may, might, could or would happen to materials, including why questions. Tasks where children must discern relationships among objects and events and explain the reasons for the relationships.What could we use [to fix, paint, climb]?
What could you do if [the house was on fire]?
Why can't we [fly, eat glass]?
What could he do [to dry himself]?
How can we tell [it's about to rain]?
What made it happen?
Why wouldn't [the boy sleep, the mouse come out]?
Why will [the girl go home, the firefighters come]?
Where will [the girl on the slide go, the ball go]?
What will happen if?

Note that many Level 3 and 4 tasks require children to make inferences – ideally skills we want kids to have or to be developing when they start school and start learning to read.

Using Blank’s framework to spot kids at risk

Blank’s Levels provide a quick way of identifying young preschoolers and school-age kids at risk. Most (although not all) kids start school with an ability to complete Level 1 tasks. But many kids struggle with Level 2, including many kids with developmental language disorders and kids who have had disadvantaged childhoods. For example, Blank’s studies show about 50%-65% of 5 year-old kids from well off households with educated parents can answer Level 3 questions – but only about 10% from disadvantaged backgrounds, including kids with average intelligence.

Many children with autism spectrum disorder or social language disorders have significant difficulties answering Level 3 and 4 questions.

How we use the Blank’s Levels in practice

When we assess a child’s language, we include Levels 1, 2, 3 and 4 Blank’s questions. This can be done with a formal assessment tool, or informally using a book and pre-prepared questions of different levels of abstraction. We keep a close eye on answers that are incomplete, vague, irrelevant and of course incorrect to determine where the child’s current skill-set sits in the context of Blank’s model. This, along with all the other assessment data we collect (e.g. through standardised testing and narrative/conversation samples, etc.), gives us a good idea of where to start language therapy, which we can refine as we get to know the child better.

When working to help children with language difficulties, we usually aim to target questions at the child’s current level for about 70% of the session, and at the next level for about 30% of the time. This helps the client build confidence and gain mastery at their current level while challenging them to develop skills at the next level.

Can you use Blank’s Levels with older children, teenagers and adults?

Absolutely.

Blank’s Levels are a useful framework for helping older children and others to develop their language skills in any school, vocational, or university subject, and for any functional work task. It can also provide a useful framework to help improving writing skills.

For example, if working with a Year 6 student on an assignment about natural disasters, you could work through the Levels, as follows:

Level 1 (looking at a map of natural disasters):
Show me the brown crosses (showing recent earthquakes)
Show me the blue circles (showing tsunamis)
Point to the red triangles (showing volcanoes)
Say: tectonic plate.

What is this? [the Pacific Ocean]

Level 2:
What do all the different colours [on the map] mean?
Where are most of the disasters located?
What things erupt?
What things flood?
Find one that can destroy buildings.

What does the Richter magnitude scale measure?

Level 3:
Tell my the story of the Mt Etna eruption of 1669.
How was the Japanese tsunami of 2011 different from the Indonesian tsunami of 2004?
Other than tsunamis, what else can causes major flooding events in populated areas?
When do experts think the next big earthquake will hit California?

What is a bushfire?

Level 4:
What could you do if you lived near Mt Agung in Bali and saw it erupt?
Why did Australian tourists have to cancel their flights when Mt Agung erupted?
Why are earthquakes inevitable?
Why should nuclear energy reactors not be built near coasts at risk of tsunamis?
How can we tell that bushfires are becoming more frequent in South Australia during El Nino years?

How can we reduce risks to human life caused by natural disasters?

Here’s another example, targeting even more abstract language levels. If working with a Year 12 student to improve her essay responses about The Long Song of J. Alfred Prufrock by T.S. Elliot in Advanced English, you could analyse the poem, working through the levels, e.g.:

Level 1:
Identify the people and objects mentioned in the poem by sight, sound, and touch.

What do you see when you look at the poem [e.g. length, number of stanzas].

Level 2:
What happens in the poem?
Who is the poem about?
Describe the objects mentioned in the poem by attributes, including category, size, shape, texture, function, location, parts.
Compare the key objects by attribute. How do they differ?
Where is the poem set?

In terms of structure, how is the poem different to [the other poems being studied, e.g. a Shakespearean sonnet]?

Level 3:
Sequence the events of the poem – retell it in your own words.
Take on the role of the narrator and role play how you feel.
Retell the life story of T.S. Elliot.
What would you do if you were the main character?
Immediately after the events described in the poem, what do you think would happen next?
How is the poem the same as some of the poet’s other poems?

Tell me how the poem is structured.

Level 4:
Why did the author write the poem?
Why does the author use [specific imagery] and [specific language] in the poem; and what does it convey to you?
How do you know that the author isn’t optimistic about the effects of industrialisation on the human condition?
How can we tell the author is concerned about urban alienation?

Evaluate whether and, if so, to what extent, the poet succeeds in conveying the character’s anxieties about his life and future in the modern world.

What about late talkers and toddlers?

A note of caution here. For young kids and others who are still learning the basics of joint attention and turn-taking, and for kids who are not yet speaking in word combinations or short sentences, asking too many questions – especially in a row – can turn interactions into interrogations, and shut down conversations.

Consistent with Hanen training principles, with early language users and late talkers, we seek to balance questions with lots of comments to keep the conversation going. For example, instead of asking “What’s that?” repeatedly when looking at a book about animals, we might follow the child’s lead, see that she is looking at a tiger and say: “I see a stripy tiger!”, then wait for a response from the child, and then praise her response.

Clinical bottom line

Marion Blank’s framework is a very useful tool to spot and help people of all ages with language difficulties to understand and to use language. It can also help parents, educators, and others working with young people – including people with or at risk for communication disorders – to pitch their questions and statements in conversations at the levels most likely to help young people to develop their communication skills.

Related resources:

To view our Blanks resources, visit our Teachers Pay Teachers Speechies in Business store for:

Related articles:

Principal sources:

Hay, I., & Fielding-Barnsley, R. (2012). Social Learning, Language and Literacy. Australasian Journal of Early Childhood, 37(1)24-29.

Westby, C. (2017). Marion Blank’s Levels of Language Abstraction. Word of Mouth 29:1, 12-15.

Blank, M., Rose, S.A., & Berlin, L.J. (1978) The language of learning: The preschool years. New York, NY: Grune & Stratton.

Image: https://tinyurl.com/ydbdvk56

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Concord West, North Strathfield, Rhodes, and Strathfield, and all other suburbs of Sydney.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the PreLit early literacy preparation program by MultiLit, the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP). David is a part-time Associate Lecturer at the University of Technology Sydney’s Graduate School of Health. David sits on Speech Pathology Australia’s Ethics Board and Professional Standards Advisory Committee.

Following instructions: why so many of us struggle with more than one step

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‘Pick up the yellow pencil and put it into the green pencil case.’
‘If there is a green square on the top row, touch the orange square.’
‘Go the office and ask Mrs Lee for the portable projector, then go to Mr William’s room and pick up the power cord.’
‘Don’t go out to recess until you’ve finished your writing.’
‘Put your homework on the round table, your reader in the orange folders, put your pencils away, then come and sit on the carpet.’
‘Sit on the floor, cross-legged, and point to the picture at the top of page 6, then copy it twice in your workbook.’
‘To get to Martin Place Station from North Strathfield by 8.30am, you to need to catch the 8.01am train from Platform One. You need to change trains at Strathfield, Redfern or Central. Before you leave, remember to take your Opal card and $20 – take your velcro wallet with the chain attached to your bag so you don’t lose it. Ask your dad to give you the money. He’s either outside trimming the hedge or in his mancave having a nap.’

1. Following instructions: why it matters

The ability to follow instructions like those above is a big advantage. It helps to carry out learning activities and to succeed in tests. It can make you seem more diligent and responsible (especially to teachers, workmates and peers). And it can help you to navigate to new places and to deal with new situations (e.g. high school, or jobs).

Many children and adults struggle to follow multi-step instructions, including many people with developmental language disorders.

Why?

Here are two likely candidates, which often – but not always – occur together:

(a) Too long! (Working memory limits)

Many people with low working memories fail to complete long, multi-step instructions. In particular, children with low working memory abilities struggle to follow instructions in everyday classroom situations (Gathercole et al., 2006).

In the classroom, kids with low working memory:

  • often complete the first one or two parts of the instruction (e.g. putting their homework on the table and their readers in the folder) before giving up;
  • sometimes, complete only the last step (e.g. sitting on the floor); and
  • learn (over time) to compensate, e.g. by watching and copying what the other kids are doing, or doing what you normally do with the objects mentioned. Strategies like these can sometimes mask kids who have problems understanding instructions.

Verbal working memory is closely linked with the ability to follow multi-step instructions. Following long instructions (e.g. ‘First, touch the red one, then the blue one, then the orange one, and then draw a circle around them all’) requires you to hold all the detailed content of the sequence while monitoring yourself carrying them out at the same time. This capacity to maintain information while engaged in other activities requiring the brain is a key feature of working memory (e.g. Baddely, 2012).

Working memory supports the retention of activity-specific and classroom management instructions at school (Gathercole & Alloway, 2006). Working memory is closely linked with children’s abilities to perform task instructions such as ‘Pick up the red pen and then touch the blue folder’ (e.g. Gathercole et al., 2008).

It’s even harder for people to remember instructions when you have to remember the later steps for several minutes while you attend to earlier steps (e.g. ‘First, finish your maths questions, and then I want you to write me a story about what you did on holidays.’). When the time needed to complete the instructions exceeds the duration of your working memory (usually somewhere between 2 and 18 seconds), you have to actively maintain the instructions in your working memory, e.g. by rehearsal (retelling yourself the instruction out loud or ‘in your head’, over and over) (e.g. Camos et al., 2009).

(b) Oral language difficulties and disorders

(i) Vocabulary and semantic problems:

Obviously:

  • if you don’t know the names of colours, you will have difficulty following instructions that ask you to ‘Point to the blue one, then the red one’; and
  • if you don’t know your basic position words (prepositions), you may struggle to follow instructions that ask you to ‘Put your hat on the table, and your bag under your chair.’. (This is the kind of instruction where kids with difficulties will look at what others are doing.)

Many kids who are learning English as a second language, and kids with developmental language disorders, do not understand language concepts that many of us take for granted, e.g. words many of use in every day instructions, like ‘first’, ‘then’, ‘before‘, ‘after‘, ‘if’, ‘except‘, ‘when’, ‘unless’, ‘until’, and ‘while’. (As an aside, this is one reason, I prioritise words like these for preschoolers and young school age children with developmental language disorders.)

(ii) Complex syntax problems

Many people who are learning English as a second language and people with developmental language disorders have difficulty processing complex sentences. For example, consider these sentences, using the language concepts ‘before’ and ‘after’:

Before you eat your lunch, clean up your desk.
Clean up your desk before you eat your lunch.
After you clean up your desk, go and eat your lunch.

Go and eat your lunch after you’ve cleaned up your desk.

All four of these sentences mean exactly the same thing! No wonder many kids – and adults – get confused!

In practice, many kids with language disorders will do things in the order they hear the steps, which can lead to errors when the word order doesn’t match the order or tasks (e.g. ‘Go and eat your lunch after you’ve cleaned up your desk’).

Here’s another example:

‘Go and ask that boy who was chased by Mark to come and see me in the Principal’s office.’

This sentence uses complicated syntax, which is hard for many kids to process and understand. Many kids with language difficulties will dutifully go off and get Mark, rather than the boy who was chased by Mark.

2. Practical tips to help people who have difficulties with multi-step instructions

In language therapy, we help by:

  • working on language concepts frequently used in instructions; and
  • practising using items and instructions based on those used in the client’s real world (e.g. in the classroom, workplace).

To date, working memory training has had some success in boosting kids’ performance on tasks similar to those practised. But there is (as yet) little reliable evidence that it enhances performance on more practical everyday tasks (Jaroslawska, et al., 2016).

Teachers, family members, bosses, and others can adopt a few, common sense suggestions to make life easier for people who have difficulties following instructions:

  • Speak slowly and clearly when giving instructions. Avoid too much background noise.
  • Break multi-step instructions into single steps, e.g ‘Please clean your desk. Now go to lunch’.
  • Use the ‘When…then’ technique to replace complex instructions with simpler ones (e.g. instead of ‘Before you go to lunch, clean up your desks’, say ‘WHEN you finish cleaning your desk, THEN you can have lunch.’).
  • Use actions, modelling, pictures and/or videos to support everyday routine instructions. For example:
    1. Use actions to accompany your instructions.
    2. Show students how to complete the task by doing it yourself in front of them.
    3. Draw simple (e.g. stick figure) comics showing each step of the instruction.
    4. Make short videos of you carrying out the steps, e.g. on your smart phone, iPad or smartboard.
  • If students can read, provide written notes summarising the steps.
  • Repeat instructions, using actions words (verbs) as the person is about to carry out the step.

For a longer list of practical tips to help students with language difficulties at school, go here.

Related articles and resources:

Principal sources:

Jaroslawska, A. J., Gathercole, S.E., Logie, M.R., Holmes, J. (2016). Following instructions in a virtual school: Does working memory play a role? Memory Cognition, 44:580-589.

Gathercole, S.E., Durling, E., Evans, M., Jeffcock, S., & Stone, S. (2008). Working Memory Abilities and Children’s Performance in Laboratory Analogues of Classroom Activities, Applied Cognitive Psychology, 1019-1037.

Image: https://tinyurl.com/y7gorc92

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Concord West, North Strathfield, Rhodes, and Strathfield, and all other suburbs of Sydney.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the PreLit early literacy preparation program by MultiLit, the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP). David is a part-time Associate Lecturer at the University of Technology Sydney’s Graduate School of Health. David sits on Speech Pathology Australia’s Ethics Board and Professional Standards Advisory Committee.

How to improve exam results: 9 free evidence-based DIY strategies

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I can’t cook, read blueprints, or dress with style. But I’m good at exams. Not because I’m special or gifted. My “secret” is boring and simple:

As a young adult, I learned how to study properly.

For more than 100 years, education and health academics have been researching study techniques to figure out which ones work the best. Unfortunately, they haven’t been very good at sharing their findings with teachers, therapists or the general public. The people who tend to read the research closely are those making lots of money running tutoring “academies”.

We’ve talked about evidence-based reading comprehension strategies here and here. But, in practice, many of us use a variety of reading comprehension and study skills together when preparing for exams (e.g. see Hock & Mellard, 2005).

A. Information about effective studying strategies should be free!

In this article, I want to share 9 evidence-based techniques I use to learn things for exams. They’ve helped me succeed in more exams, tests and quizzes than I’d care to remember over the years, including for my (ancient) Higher School Certificate and three University degrees.

They work.

I’ve chosen strategies that can be put into action by students without much outside help and without cost. And I’ve based my choices on things that:

  • have worked for me; and
  • are supported by peer-reviewed research.

I’ve sorted the strategies from most useful to least useful based on the evidence and my experiences. For evidence summaries, I’ve drawn from the excellent 55-page monograph by Professor John Dunlosky and colleagues published in 2013 (citation below, errors of interpretation are my own).

Note: These tips work best for tests of knowledge/content/subjects (e.g. Maths, English, Anatomy), rather than tests of intelligence or personality (e.g. psychometric IQ tests) or motor skills (e.g. piano-playing or speech).

B. 9 effective, evidence-based study strategies

1: Do practice tests

What is it? Practice testing is low- or no-stakes practice doing “tests” outside of class. It includes doing mock tests and activities where you practice recalling information, e.g. answering questions at the end of text-book chapters or using real or virtual flashcards to “test” your recall of knowledge.

Why does it work? No-one likes doing tests and people tend to avoid them where ever possible. This is a real shame because we’ve known for a long time that testing improves learning (e.g. Abbott, 1909). Practice testing helps you remember things (e.g. Rawson & Dunlosky, 2011). We think testing has two effects:

  • direct: improving the retention of information by triggering “elaborative retrieval processes”. In other words, testing yourself forces you to search your long-term memory, which activates related information, and forms an association between the information you are attempting to retrieve and information already in your long-term memory (e.g. Carpenter, 2009); and
  • indirect: forming connections between the cue (question) and the response (answer) when you re-study, which helps you to remember the answer when asked the question in the real test (Pyc & Rawson, 2010).

How to do it? If possible, get your hands on practice tests that are similar to the exam you will be taking. Look for publicly available/free versions before spending money. You can also create your own flashcards with questions on one side and answers on the other (there are lots of free and low-cost options to create virtual flashcards online, e.g. Anki, which also uses the next strategy). Or you can adopt the Cornell note-taking method, which involves leaving a blank column when taking notes in class and entering key terms or questions in it shortly after taking notes to use for self-testing when reviewing notes at a later time (e.g. Pauk & Ross, 2010).

With any system or method, you want clear feedback on whether your answers are right or wrong, so make sure you write the complete correct answers on the back of the flashcards and look for model answers to go with practice exams.

Real world examples: When studying for my Hong Kong conveyancing exam, I did five practice tests, carefully comparing my responses to the model answers. The exam has a notoriously high failure rate (at the time reported to be about 70%) and my studying was interrupted by a burst appendix. I managed to pass the exam – mainly due to all the practice tests I’d done. Another example: when learning phonetics, short “no-stakes” practice tests in class every day shocked me into improving my transcription skills from zero to semi-competence in six weeks.

Usefulness: High. Studies show that practice testing is more effective than concept mapping, note-taking, imagery use, and re-reading.

2: Space out your study (distributed practice)

What is it? Distributed practice is a fancy way of saying “spread out your study over time”.

Why does it work? We all procrastinate, which means we all cram to some degree. And cramming works better than not studying at all. But distributing learning over time helps you to remember things more than by cramming sessions together. There’s a few theories about why distributed practice works. One argues that our processing of information in a second session suffers when it is in close to time to the original session, basically because we don’t have to work hard during the second session, which makes us think we remember more than we do (Bahrick & Hall, 2005).

How to do it? There is no one size fits all answer. But there is some evidence that the lag time should be about 10-20% of the desired retention interval. For example, to remember something for one week, study sessions should be spaced about one or two days apart. To remember something for 5 years, you should revise it every 6 to 12 months (Cepeda et al., 2008). For big exams (e.g. the Higher School Certificate), intervals of a month or even more may be ideal for studying core content that needs to be retained, especially where the exam is testing knowledge gained across several years of education.

Real world example: When I was studying speech pathology, there were a number of key principles of assessment and intervention that applied to different subjects. By revising these principles once a month or so, I found them easy to recall at will during exams. I still recall and use them in practice.

Usefulness: High. It’s been shown to work with students of different ages with a wide variety of subjects. It’s easy to put into practice once you know how to do it.

3: Channel your inner 3-year old and ask “why, why, why?” (elaborate interrogation)

What is it? Asking “why?” about what you’re reading.

How to do it? For example, read this sentence: “The hungry man got in the car”.

Now ask yourself: “Why did the hungry man get in the car?”

If, like me, you answered the questions with something like: “So he could go to the restaurant”, or “So he could go through drive thru”, congratulations, you’ve successfully used the technique. Easy, right?

(Across different studies, there are a few variations of the basic question we ask ourselves. It can be “Why?”, “Why does it make sense that…”, or “Why is this true?”. I prefer to just ask “Why?”)

Why does it work? The most credible explanation is that asking “why” forces us to integrate new information with existing prior knowledge. We took the new information (“The hungry man got in the car”) and combined it with what we know about hungry people who get in cars. In a study, over 70% of people who used this technique were able to recall that the man got in the car, compared to about 40% of people who were told the man got in the car to go the restaurant and 40% of people who simply read the sentence (Pressley et al., 1987).

Real world example: I must confess, I don’t use this strategy as much as I should. As a thought-experiment, I used it to review the Dunlosky paper, and found I could remember many of his key findings without needing to re-read the paper. I’m going to try it out more often.

Usefulness: Moderate. It doesn’t require much training, if any. It’s most useful when dealing with lists of factual sentences. It’s not as useful when dealing with more complex texts, e.g. about a process or system. For the strategy to work, you need to use it frequently. One prompt per page or two is not enough.

4: Explain it to yourself in Plain English (self-explanation)

What is it? Explaining how new information is related to known information, or explaining steps taken during problem solving.

How to do it? Simply pause after reading a sentence or paragraph and ask yourself questions like “Explain what that sentence/paragraph means to you?”, “What new information does this sentence give you?” or “How does it relate to what you already know?” Alternatively, explain the steps you are taking to solve a problem as you solve it.

Why does it work? As with asking yourself “Why?”, we think self-explanation helps integrate new knowledge with existing knowledge to aid learning and recall (e.g. Berry, 1983).

Real world example: I use this technique when preparing to answer case-based questions. It’s particularly useful for tasks where you are asked to explain technical, jargon laden concepts/results in Plain English with no pointless long words. If you can’t explain what you’ve read to yourself, you have no hope of explaining it to someone else, especially when under exam pressure.

Usefulness: Moderate. The strategy has been shown to work across lots of different types of texts and tasks. But we don’t know how long the learning lasts. And it can take a long time to do well, which reduces its usefulness when you are pressed for time or in an exam.

5: Mix and match study problems (interleaved practice)

What is it? Mixing different kinds of problems or materials within a single study session.

How to do it? For example, you might practice trigonometry, geometry and calculus problems in a single session. Or you might tackle three or four kinds of legal problems focusing on different rights and remedies.

Why does it work? We’ve known for a while that mixing activities can improve motor learning in some conditions (e.g. Wulf & Shea, 2002). There’s growing evidence that it might also work on cognitive tasks like learning for exams. One theory is that mixing up different kinds of problems with a single session helps students distinguish between different kinds of problems so they can apply the right strategies for each in a test (e.g. Rohrer & Taylor, 2007).

Mixed practice may promote organisational processing because it allows students to compare different kinds of problems more readily. It’s also possible that mixed practice creates distributed learning conditions, which help students retain information and learn more effectively (see strategy 2, above). Mixed practice is also more akin to true test conditions than working sequentially through kinds of problems, which may create results like practice testing (see strategy 1, above).

Real world example: When studying for an anatomy exam, I shuffled my head, neck, hearing and lung-related notes/cards to randomise the key kinds of questions I was asking myself based on the format of previous exams. This enabled me to use strategies 1, 2 and 5 together.

Usefulness: Moderate. Results to date suggest that mixed practice may have dramatic results on learning maths skills. In a study comparing students doing one type of problem versus children doing four kinds of problems per session, children working on one kind of problem at a time tended to do better during practice. But this reversed dramatically when the skills were tested later, with the “mixed problem” students outperforming the “single problem” students by more than 40% (Rohrer & Taylor, 2007). But the research base is fairly limited to date, and we don’t know how much practice of a particular skill is required before mixed practice will help. In my example, I was already fairly comfortable with the content of the topics to be examined before I randomised the questions.

6: Link words to vivid images to help cue and remember the answers (key-word mnemonics)

What is it? Using key-words and mental imagery to associate words and concepts. This is an “oldie but a goodie”, dating back at least to the Ancient Greeks (Yates, 1966).

How to do it? For example, just say you are trying to learn the French word for tooth (la dent). You would develop a vivid mental image of the English key-word (tooth) somehow interacting with the French translation (la dent). For example, you could imagine a lady dentist pulling out a tooth and giving it a big dent with a big red ladle, to make a la-dent in the tooth.  The more vivid and silly (and hence memorable) the image, the better!

Why it works? The power of this technique lies in its use of interactive images – images that link the cue with the target. The technique has been shown to work with foreign-language vocabulary, definitions of scientific terms, state capital memorisation, elements of the periodic table (e.g. Jitendra et al., 2004).

Real world examples: I have used the technique successfully to memorise several lists of words and concepts over the years, from case names lists for law exams, to the capitals of countries (for a trivia competition), to cranial nerve pathways (for a speech pathology exam), to Bahasa Indonesian vocabulary (for something to do while stuck in transit on a business trip). As per the studies quoted above, I have found the technique quite time and labour intensive, and less useful for abstract, dynamic or complex topics. I have also found that long-term retention requires upkeep/practice – if you lose the image, you can lose the cue and target, too. Don’t ask me anything in Bahasa Indonesian, for example!

Usefulness: High for memorising word lists for short periods; low generally: For “key-word friendly targets” like the examples above, it can be very useful. e.g. for learning lists of concrete nouns quickly. But it takes lots of time to learn to do it well, and some evidence suggests it does not lead to long-term retention of information (e.g. Fritz et al., 2007).

7: Imagery for text learning

What is it? Attempting to form mental images of text materials when reading or listening.

How to do it? As you listen or read, e.g. to a story, consciously create a mental image of what’s happening. Try to imagine the sights, sounds, smells, and textures of the “world” around you.

Why it works? Developing images about what you are hearing/reading can improve your mental organisation and integration of the text (e.g. Hunt, 2006). Using prior knowledge of the world to generate a picture of a story may also improve your understanding (e.g. Leutner et al., 2009). This technique may work better for listening tasks than for reading tasks (Brooks, 1968). But it’s one thing to tell yourself to visualise something; it’s another to actually do it (Anderson & Kulhavy, 1972).

Real world examples: I tend to use this when reading fiction for pleasure to enhance my comprehension of the details (otherwise I find myself skimming!). I used it for English exams back when I was in high school. It takes some practice to learn to “see”, “hear”, “smell” and “feel” what the characters are feeling. And, because I’m not particularly good at manipulating images in my head, I tend to use other strategies when under pressure in exams.

Usefulness: Low. The strategy seems to have a wider scope of potential use than key-word mnemonics. However, the benefits of the technique are limited to image-friendly materials and, like key-word mnemonics, may fade over time without upkeep.

8:  Summarising

What is it? Writing summaries of texts.

How to do it? Read the text, identify the main points, discard the less important information, and capture the gist (Brown et al., 1981). Sounds easy in principle!

Why it works? We think summarising boosts learning and retention because it involves paying attention to what you are reading and extracting the higher-level meaning and gist of the material (Bretzing & Kulhavy, 1979). It also boosts organisational processing because it makes us connect the ideas in a text to each other. Writing about the important points in your own words produces a benefit over and above simply selecting the important information (e.g. Chi, 2009).

Real life example: When studying for my closed book law exams, I often prepared one paragraph summaries of each case on my case list, usually following a set format (e.g. case/parties names, year, judge, key issues/why memorable, main decision). I would then prepare a summary of the summary, e.g. “Donoghue v Stevenson – 1932 – Lord Atkin, House of Lords – Snail in the Bottle Case – negligence – duty of care/neighbour principle.”

Usefulness: Low. Even though making summaries sounds sensible, and is a well-known reading comprehension technique, the usefulness of the strategy for exam preparation depends on how well you can summarise. If you summarise the wrong things, the strategy can backfire. Many learners need training to summarise well, which makes the strategy less accessible than some of the others mentioned above. We’ll tackle the fine art of summarising in a future post.

9:  Highlighting/underlining

What is it? A favourite of students!

How to do it? with a highlighter or pen, mark potentially important parts of the text when reading.

Why it works? Researchers cite the isolation effect (e.g. Hunt, 1995). For instance, if you are given this list: “goat, pig, table, chicken, cow”, you will be more likely to recall “table” than if you had been asked to remember it in a list of furniture. By analogy, highlighting or underlining text causes it to “pop out” from the rest of the text, making it easier to remember (e.g. Lorch, 1989). Another theory is that the effort of actively selecting information should benefit memory more than simply reading it (e.g. Faw & Waller, 1976), which seems a better explanation to me.

Real life examples: I’m an habitual highlighter! Despite its relatively low-level of evidence, I can’t help it and now find it difficult to absorb technical information without highlighting the key points. I used to highlight way too much and have taught myself to focus on main points, and to asterix points requiring follow-up or further thought.

Usefulness: Low. In many studies, highlighting has been shown to do little to boost performance. The quality of the highlighting is crucial to whether it helps students learn (e.g. Wollen et al., 1985); and many students mark too much or too little (e.g. Idstein & Jenkins, 1972). Training students to highlight more effectively (e.g. looking for main ideas before highlighting, and underlining as little as possible) may help (e.g. Hayati & Shariatifar, 2009), but this reduces the accessibility of the strategy without special training. Disturbingly, there is some evidence that highlighting may actually hurt performance on high level tasks like reading between the lines (i.e. inferencing) (e.g. Peterson, 1992).

C. Clinical bottom line

Learning to use effective studying techniques can help students improve their test results. But lots of students aren’t taught which strategies work, and may end up using techniques with a low-level of evidence, e.g. highlighting indiscriminately or simply re-reading texts they are meant to learn. Most of the study strategies summarised in this article are easy to put into action – even for students in upper primary school. If used properly, these techniques can help students accomplish their academic, work and life goals.

Key source: Dunlosky, J., Rawson, K.A., Marsh, E.J., Nathan, M.J., & Willingham, D.T. (2013). Improving Students’ Learning with Effective Learning Techniques: Promising Directions from Cognitive and Educational Psychology. Psychological Science in the Public Interest, 14(1) 4-58. This is an excellent read and contains lots of useful details that I couldn’t capture in an article like this.

Images: http://tinyurl.com/z4zttut, http://tinyurl.com/zm7ae9d, http://tinyurl.com/gs3fo43 and http://tinyurl.com/gogaw2p.

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Rhodes, Strathfield and all other suburbs of Sydney’s Inner West.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).

Helping older students with their reading comprehension. What should we teach and how?

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We know a lot about teaching reading comprehension skills to older children with language, reading and learning difficulties.  One of my favourite researchers, Dr Teresa Urkrainetz, has just published a wonderful article summarising the evidence.

Here’s my summary of her summary!

What’s needed for effective teaching?

In 2000, the US National Reading Panel identified seven teaching procedures that help children’s reading comprehension:

  1. Co-operative learning.
  2. Answering teacher questions.
  3. Using graphic organisers like this one.
  4. Story structure analysis.
  5. Active comprehension monitoring.
  6. Question generation.
  7. Summarising.

In 2008, Kamil and colleagues systematically looked at the evidence for strategies that help students in 8th grade and above and identified four important elements of teaching children about reading comprehension:

  1. Explicit vocabulary instruction.
  2. Direct and explicit comprehension strategies.
  3. Opportunities for extended discussion about the meaning and interpretation of what they read.
  4. Increasing student motivation and engagement in learning to read.

Three kinds of comprehension reading strategies

By strategies, we are talking about rules of thumb that help children actively focus on, and think about, what they’re reading.  Ideally, we want children to use these strategies independently – not just in class with teacher support.  This can be challenging!

Researchers call the things we read – e.g. stories, reports, essays, instructions, etc – “texts”.  Reading comprehension strategies can be grouped into three categories:

(a) Pre-reading strategies: thinking about what is already known about the topic, predicting the content and coming up with a plan to read the text.

(b) During-reading strategies: maintaining the reading purpose, noting important information, paraphrasing ideas, integrating new information with things already known, and staying alert to lapses in understanding.

(c) After-reading strategies: recalling the most important ideas, reviewing what has been learned, and re-reading to fill in comprehension gaps.

Which strategies should we teach?

The strategies with a strong scientific basis include:

  • comprehension monitoring;
  • question generation;
  • summarising;
  • paraphrasing; and
  • vocabulary/word-learning.

Other strategies supported by moderate evidence include giving children specific prompts about text ideas and text structure.  Examples of these questions include:

  • What is the main idea of this paragraph?
  • What is the difference between this idea and the idea in the previous paragraph?
  • What was the problem in the story?
  • Where in the story was the problem solved? How?

Teaching children multiple strategies is more useful than just one strategy.  What matters most is that students get into the habit of asking themselves “What did that part say?” and responding with “I’m not sure. I’d better re-read that part”.

How should we teach the strategies?

Research tells us that we should teach children about reading comprehension with:

(a) explicit modelling – we should tell them how we do it as we do it;
(b) lots of practice, with our feedback;
(c) enough support to keep the student motivated; and

(d) tasks that keep children interested and engaged, knowing why they are reading the text.

Three things are vital:

(1) making sure texts are at the right reading level so decoding problems don’t get in the way;
(2) using small, interactive groups; and

(3) having students use a specified language or format for strategy questions.

Other considerations include:

  • using texts appropriate for the strategies being taught, e.g. using non-fiction texts to teach a “main idea” strategy; or stories to teach the strategy of identifying characters or “the problem”; and
  • engaging students with things that interest them – especially when first teaching strategies, e.g. video game or other product reviews that appeal to the children being taught.

How should we teach older children with language, reading and learning delays?

Strategically. To learn, students with communication or learning challenges need what Dr Ukrainetz calls sufficient “RISE”, meaning:

  • Repeated opportunities;
  • Intensity of practice;
  • Systematic scaffolding (support); and
  • Explicit instruction.

This means we need to choose a small number of goals for which we have the time and resources to provide sufficient RISE to obtain noticeable, functional change and help students to become more competent and independent learners.

For teenagers, in particular, we also need students to buy-in to the process.  For this to happen, students need to have confidence in their skills, interest in the topic and texts and of course knowledge of the right strategies.

Three examples

Text preview strategy

This pre-reading strategy is useful for information texts.  It starts with the student and teacher identifying the type of thing being read – e.g. a story chapter or a research report.  Then the student identifies the purpose for reading the material (e.g. entertainment, information about a topic).  The student is then guided to travel through the text to get a sense for what it covers, the organisation, how important points are indicated and where summaries are located.  For example, a student’s attention might be drawn to chapter titles, section headings, abstracts, opening paragraphs, conclusions with “takeaway” messages, and glossaries and indexes.

Look-back strategy

This after-reading strategy is also useful for information texts.  It involves raising a student’s awareness that he or she has a gap in understanding and that it is permissible to look back at the text to find the answer.  The teacher models asking a question about something not understood, and then skims the text to find the most likely place to find it, with comments on why the other sections are not good candidates.  Children should be taught that good readers use look-backs – many students think that looking back is not allowed or even cheating!

Finding the main idea strategy

There are a few ways to teach this – from teaching children ways of identifying topics and supporting sentences in paragraphs and how information texts are usually structured.  It’s best to start with texts that have strong first or “topic” sentences at the start of each paragraph.  Graphical organisers can be used to identify and then to summarise the gist or main idea of what the paragraph is about.

Bottom line

Poor readers need to be taught strategies and given support to improve their reading comprehension.  Ukrainetz’s excellent article provides examples of several practical, evidence-based things we can do at school and in speech therapy to help.

Source: Ukrainetz, T.A. (2015). Improving Text Comprehension: Scaffold Adolescents into Strategic Reading. Seminars in Speech and Language, 36(1), 17-30.

Image: http://bit.ly/1FMPlgN

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Rhodes, Strathfield and all other suburbs of Sydney’s Inner West.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).

FAQ: Auditory Processing Disorder

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At least once a month, I get asked about auditory processing disorder (APD), which is also known as central auditory processing disorder.

APD is a controversial topic in Australia and overseas, and I write this post with some trepidation.  While some studies suggest something like 2-5% of school-age kids meet the criteria for a diagnosis of APD (e.g. Bellis & Anzalone, 2008), the correct diagnosis is often hotly debated, with some researchers questioning whether it is over-diagnosed; others questioning whether it exists as a reliable diagnosis (see, e.g. Levy & Parkin, 2003) and yet others suggesting it might be a “twentieth century unicorn” (Kamhi and Beasley, 1985).

The purpose of this article is to address some basic questions about the disorder based on recent evidence, recognising that the experts have yet to reach a consensus on differentially diagnosing APD from other disorders or how best to treat it.

1. What is APD?

Auditory processing disorder is defined as a difficulty in the efficiency and effectiveness by which the central nervous system uses auditory information (e.g. ASHA, 2005).

What does this mean?  It means that an individual has normal sensitivity to sounds (i.e. they can hear) but has trouble making sense of the sounds.  One researcher likens APD’s features to being able to hear, “but acting as if hearing impaired” (Lovett, 2011).

2. What are its symptoms?

According to the American Academy of Audiology (2010), the most common effects of APD include problems following directions, understanding speech, responding in noisy environments, singing or appreciating music and determining where a sound came from.

At school, red flags for APD are said to include problems participating in class, understanding stories, responding to questions and taking good notes (e.g. Geffen, 2007).

3. What causes it?

APD is thought to be caused by dysfunction in the central auditory system, although there is not a lot of direct evidence that it is caused by an impairment in a particular part or parts of the brain (one reason why the word “central” has been dropped by many researchers investigating APD).

4. Who diagnoses APD and how?

Qualified audiologists diagnose APD in Australia, the US and the UK.

APD cannot be properly diagnosed unless the person has undergone specialised hearing tests using special equipment measuring the person’s ability to locate sounds, discriminate between different sounds, discriminate between similar sounds, detect small differences in the timing of sounds, the order of sounds and sound patterns, and respond to sounds that are “degraded” (e.g. by having some of their auditory information “masked”).

To receive a diagnosis, the person being tested must score at least 2 standard deviations below the average on at least two auditory processing tasks (ASHA, 2005).

5. So why the controversy?

Diagnosing APD is not as simple as it sounds (no pun intended):

  • APD is a collection of symptoms that usually co-occurs with other neuro-developmental disorders (British Society of Audiology, 2011);
  • Many of the symptoms and red flags for APD overlap with those seen in other disorders, including receptive language disorders (diagnosed by speech pathologists), attention deficit disorders (diagnosed by psychologists and psychiatrists), autism spectrum disorders and general developmental and cognitive delays (usually diagnosed by a multi-disciplinary team, including a paediatrician);
  • Some of the hearing tests used to diagnose APD are considered unreliable for children under seven; with some considered unreliable for children under 10 years of age (Lovett, 2011). Audiologists investigating APD recognise the urgent need for more appropriate, objective tests of auditory function to serve as a “gold standard” for APD assessment (e.g. British Society of Audiology, 2011);
  • Many children perform inconsistently on APD tests, and it is hard to tell whether their poor performance is caused by difficulty in transmitting sound from the ear to the brain, difficulty interpreting the sounds once they get to the brain, simply not paying attention to the sounds, not being motivated to try hard enough to make the distinctions required, or a combination of these factors (Paul, 2008);
  • Receptive language delays (comprehension problems) are likely to impact adversely on a child’s performance on some of the hearing tests – particularly those that require a child to repeat words presented with background noise;
  • counter-intuitively, there is no correlation between performance on auditory processing tasks and standardised measures of academic performance (e.g. Watson & Kid, 2009); and
  • As the British Society of Audiology states: “There is clearly no consensus here but, rather, a list of problems that may be due to one or several causes”.

6. Is APD the same thing as a receptive language disorder?

No, though, again, there is a considerable overlap in many of the red flags and symptoms of each disorder.

In theory, the key difference is that children with APD are thought to have problems processing both speech and non-speech sounds (British Society of Audiology, 2011).  Children with receptive language disorders, on the other hand, should not have problems on tests involving non-speech sounds (such as determining whether two tones are the same or different, or whether there was a gap between two different tones).

Audiologists diagnose APD only after they have tested the person’s ability to process speech and non-speech sounds.  But, because of problems with the reliability of some of the APD tests (including the effects of attention and motivation on test performance), the distinction is not as neat in practice as it sounds in theory.

7. How is APD treated?

There are a few types of treatment for APD:

  • Making environmental changes aimed at increasing the signal-to-noise ratio (increasing important sounds and decreasing irrelevant sounds).  These treatments include preferential seating, closing windows, adding carpeting, and padding the bottom of chair legs to decrease noise.  They also include amplifying important sounds (e.g. the teacher’s voice).  Classroom acoustic research shows that these changes can benefit all students (including children with APD and other information processing disorders) (e.g. Crandall et al, 2005).
  • Special accommodations for students with APD: these include providing students with APD with written notes and “listening breaks”, as well as extra time during tests, and testing in a separate room (to minimise noise).  There doesn’t seem to be much research supporting these measures, but they are increasingly popular (in part, because they are easy and cheap to implement).
  • Auditory processing skills training: the idea behind these treatments (which are often computer-based) is that giving students lots of practice with auditory processing tasks will, over time, increase their listening skills and generalise to the real world.  To date, research shows that, although children get better at doing the exercises, there are very limited changes in their functional listening behaviour in real world environments.  For example, in 2011, Fey and colleagues conducted a systematic review of the evidence for auditory processing interventions and concluded that there is only limited evidence supporting the use of auditory processing treatments to improve spoken or written language functioning.  It should be noted that Fey’s conclusions have been challenged by other researchers, and that research continues on the effectiveness of auditory processing training.

8. Bottom line

To date, there is no consensus on a diagnostic rule detailed enough for clinicians to reliably distinguish APD from other information processing disorders, especially when other disorders such as attention deficit hyperactivity disorder and receptive language problems must be ruled out as causes of poor performance on auditory processing tests.

Having reviewed the evidence to date, I can see the clear benefit in making environmental changes in the classroom to help children diagnosed with APD (and other information processing disorders).  I also agree with Rhea Paul (2008) who, in the context of talking about children diagnosed with APD and autism, concluded that it makes most sense to spend intervention time on functional activities teaching children to pay attention to speech, to learn to comprehend words and sentences, and respond appropriately to the language they hear.  But we also need to keep an open mind and close eye on developments in this important space as more research is published about the effectiveness of listening treatments for APD and, in particular, their effects on real world outcomes.

Key sources:

Lovett, B.J. (2011) Auditory Processing Disorder: School Psychologists Beware. Psychology in the Schools, 48(8), 855-867.

Key, M.E., Richard, G.J., Geffner, D., Kamhi, A.G., Medwetsky, L., Paul, D., Ross-Swain, D., Wallach, G.P., Frymark, T., & Scooling, T. (2011). Auditory Processing Disorder and Auditory/Language Interventions: An Evidence-Based Systematic Review. Language, Speech, and Hearing Services in Schools, 42, 246-264.

Paul, R. (2008). Auditory Processing Disorder, J Autism Dev Disord, 38:208-209.

American Speech-Language Hearing Association Working Group on Auditory Processing Disorders. (2005). Technical Report: (Central) Auditory Processing Disorders, retrieved on 18 April 2015 from here.

British Society of Audiology (2011). Position Statement and Practice Guidance Auditory Processing Disorder (APD), retrieved on 17 March 2019 from here.

Image: http://tinyurl.com/q9rf7us

Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Rhodes, Strathfield and all other suburbs of Sydney’s Inner West.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).