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Sydney speech pathologists helping adults and children speak for themselves.

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Late talkers: how I choose which words to work on first

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Choosing words to teach* late talkers is hard – for both parents and speech pathologists!  But there’s some great research out there to guide decision-making, if you know where to look.

As a Hanen-certified speech pathologist, I’ve just completed a very practical seminar on word choice for late talkers presented by Cindy Earle, the Program Director for Hanen’s Target Word program.

For the benefit of parents and others caring for late-talking children, I thought I’d share my key takeaways:

1. What do we mean by a “late talker”?

The research definition of a “late talker” is a child aged between 18 and 30 months who:

Hanen’s clinical definition is much the same, but includes children who have fewer than 100 words.  I prefer this definition because it captures more children who might be at risk and who might benefit from early intervention.

2. Why does late-talking matter? Should we be concerned about it?

To answer the second question first: yes.

We know that roughly half of late talkers “catch up” to their peers by the time they go to school.  But, unfortunately, we don’t yet know which ones!  For the “other half”, the late onset of language is a good predictor of long-term language problems – particularly with syntax, vocabulary, and verbal memory (Rice, 2008; Rescorla, 2009).

3. Known risk Factors

We discuss known red flags for language delays here.

4.  Predictors of change/improvement

This was my first big takeaway from Cindy’s talk.  Drawing on studies by Olswang and colleagues (1998) and Wetherby (2000), Earle identified the following factors as “predictors of change” for late talkers’ language development:

  • quietness/noisiness;
  • consonant repertoire (i.e. how many consonants the child can say);
  • pretend play skills;
  • comprehension;
  • gestures;
  • imitation;
  • the kinds of words the child uses (if any);
  • social skills; and
  • time.

5. Getting specific about language goals for late talkers

“Talking” is of course the main goal for parents and carers of late talkers.  But teaching children random words without a plan or goal is not the way to do it.  Knowing about the above “predictors of change” allows us to get more specific about what might help the child get there ASAP, based on where they are at at the time of assessment:

  • noisiness, e.g. the child will vocalise with each turn;
  • imitation, e.g. the child will copy single words;
  • single words, e.g. the child will use single words spontaneously; or
  • combinations e.g. the child will combine words.

6. So, here’s what I think about when choosing words for a late talker

At the outset of therapy, I like to discuss and agree 10-15 target words with the families of late talkers I work with.  To come up with the list, we consider the following six factors:

(a) Does the child understand the word?

There’s no point trying to teach a child to say a word he or she doesn’t understand.

(b) Does the word start with a sound the child can say?

The technical term for this is “in phonology“.  We know that children are more likely to experiment with words that start with a sound in their existing repertoire of speech sounds.  That’s why getting a speech sound sample is so important when we assess late talking children, even if they are only babbling and not saying any ‘true words’.

(c) Is the word motivating for the child to say (not just understand)

Some kids are very interested in a favourite bedtime toy, pet, TV character, etc. To maximise motivation for talking, I always try to include words that refer to the child’s “favourite things in the world” – even – eek! – if it involves the motion picture Frozen. (Let It Go, David!)

(d) Can we use gestures to supplement the word?

Gesture science can get a bit technical and jargon-laden: I plan to tackle this important topic in a future blog post (or two!).  But, for the purposes of this article, we know that certain gesture-speech combinations help some late talkers to combine words (McEachern & Haynes, 2004).

If we’re trying to help a late talker combine words, teaching him/her gestures that supplement (rather than just echo) his/her words can help.  For example, teaching a child to point at things and to say applicable words like “go” or “fast” or “big”, can provide children with a bridge to developing multi-word utterances (e.g. “car go”, “fast dog”, “big tree”).

(e) Verbs, verbs, verbs

We’ve covered this point before. But it bears repeating:

In English, you need at least one verb (action word) to make a complete sentence (e.g. “go” or “fish swim”).  So teaching children the names of things and people (e.g. “mama”, “car”) and positions (e.g. “up”) is not enough.  If we want to help late talkers combine words into sentences, we MUST include verbs.

For this reason, I always choose at least four “all purpose” verbs in my initial word list for late talkers:  e.g. go, do, play, make, come, get.  The fancy name for this practice is “verb-focused intervention” (e.g. Hadley & Olsen, 2005).

(f) Words that occur throughout the day

Just like with verbs, we don’t want to spend our time on words that won’t come up a lot during the day.  One trick is to look for things that the child loves to do a lot of during the day.  This varies from child to child.  Observe the child doing it, then come up with words that will give you plenty of time to use them several times a day.

Bottom line

Correct word choice is very important when helping a late talker.  Early intervention is the best strategy.

If you’re the parent or carer of a late talker – or potential late talker – we recommend you get in touch with a certified practising speech pathologist for a chat and, if warranted, to organise a language assessment.

Related articles:

Key source: Earle. C. (2015). Choosing Initial Vocabulary Targets for Children who are Late Talkers. A Hanen e-Seminar. Hanen Centre. (Attended by the writer on 13-17 July 2015.)

* For you fellow Chomsky/Pinker fans out there, please note that I’m using the word “teach” loosely here – I could have said “naturalistic indirect language stimulation based on principles of interactive communication” to make the point that we don’t actually teach language to children: we just help them help themselves.  But life’s too short!

Image: http://bit.ly/1JsaZWB

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).

How to help our secondary teachers support teenagers with language disorders at school

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To look at the way public speech pathology services are funded, you’d think language disorders happen to a small group of toddlers and pre-schoolers and then magically disappear when they go to school.

If only.

Yes, early intervention is best practice and is supported by reams of research.  But we know that:

  • language disorders – particularly in comprehending language – have a high persistence rate into adolescence (e.g. Clegg et al. 2005);
  • teenagers with language disorders are at risk of poor academic progress, bullying and behavioural problems, like acting out in class (e.g. Snow & Powell, 2004).  Lots of teenagers with language problems give up, drop out and end up in unskilled, poorly paid jobs.  And teenagers with language disorders are well over-represented in the youth justice system;
  • in places like New South Wales, Australia (where I work), teenagers don’t have meaningful access to public speech pathology services.  Unlike some other places, we don’t have speech pathologists in our public high schools;
  • most teenagers with language disorders are expected to cope with the mainstream curriculum – despite their well documented problems with oral and written comprehension, written expression, new word learning and understanding the so-called “hidden curriculum” – teacher expectations of how they should behave when listening to others and speaking in class; and
  • busy teachers have a whole class to teach, often with limited support from over-stretched and under-resourced special education staff.

So, given all these constraints (which are unlikely to change any time soon), what can we do to help teenagers with language disorders cope with the curriculum at school?

Answer: we can arm our secondary teachers with evidence-based strategies that have been proven to help teenagers with language disorders cope with the language demands of school.  For example:

1. Written language tips:

  • break down large amounts of information into smaller, visually distinct sections;
  • add graphics and icons – use technology like Google Images and smart boards to explain key concepts visually;
  • explain instructional vocabulary (like “devise”, “analyse”, etc.) in plain English that makes it easier for the student to identify what precisely is required of them (e.g. “write about”);
  • put questions on the same page as the text to make it easier for students to cross-reference and check their work; and
  • explicitly teach these 6 evidence-based reading comprehension strategies.

2. Oral language tips:

  • be explicit about instructions – don’t expect students to infer what you want them to do from the context;
  • make instructions short – break multi-step instructions into separate steps;
  • give students more time to process and answer verbally;
  • rephrase key information in plain English, and repeat it regularly; and
  • face the class when giving instructions.

3.  Tips to help students process information:

  • get the whole class involved in breaking down complex texts, e.g. with mind-maps that summarise key facts;
  • provide visual planners (like this one) to help show students how to structure tasks;
  • outline the sequence of tasks to be covered in the lesson with visual cues; and
  • involve the whole class in creating visual aids (charts, posters, etc) to assist information processing and retention.

4. Tips for vocabulary instruction:

  • choose, say, “10 key words” that are essential to understand the given topic and teach them directly;
  • embed vocabulary in activities such as creating visual symbols;
  • conduct whole-class interactive tasks to break key words into root words, prefixes and suffixes; and
  • use these tips to deepen comprehension of key words and aid retention.

Quality research tells us that teachers trained to adopt strategies just like those listed above can materially improve the written expression and listening comprehension of teenagers with language disorders, without needing to pull kids out of mainstream classes or recruit additional specialist resources to give them additional support.

Related articles:

Source: Starling, J., Munro, N., Togher, L., Arciuli, J. (2012). Training Secondary School Teachers in Instructional Language Modification Techniques to Support Adolescents With Language Impairment: a Randomised Controled Trial. Language, Speech, and Hearing Services in Schools, 43, 474-495.

Image: http://tinyurl.com/kynuv94

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).

Test Scores: What do they mean?

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Unless you have a background in statistics, interpreting your child’s language or speech test results can be a challenge. The purpose of this article is to explain what test scores mean in plain English.

To keep things simple, we’ve focused on the bare essentials. If you want to know more about important concepts like standard deviations, confidence levels and z-scores, we’ve included links to some good “statistics 101” videos and other resources at the end.

What’s a norm-referenced, standardised test?

Norm-referenced, standardised tests allow speech-language pathologists to compare your child’s performance on a particular day to that of other children of the same age. “Standardisation” means that the test was itself tested several times on lots of children in exactly the same way (i.e. a standard way), to ensure it works.

Norm-referenced tests allow us to report how a child performed compared to a population of other children the same age who have completed the test. Ideally, this involves the test being given to:

  • a high number of children at each age level being tested; and
  • a representative range of children of both genders, and a range of socioeconomic and ethnic backgrounds, and abilities.

Common norm-referenced, standardised tests include the CELF-4, the new CELF-5, and the PPVT for language, and the DEAP and Goldman-Fristoe for speech. Other tests are used to assess phonological awareness, reading, spelling and writing.

Norm-referenced, standardised tests: what they do (and what they don’t do)

Norm-referenced, standardised tests results tell us whether, on the day tested, your child differed significantly from other children of the same age on the test. Well-designed tests, like those mentioned above, are reliable and valid. This means they measure what they say they measure and produce consistent, stable results. For these reasons, government and non-government organisations often require standardised tests be conducted on children to determine eligibility for funding or other supported assistance.

Norm-referenced, standardised test results don’t tell us how your child functions in the real world or how communication problems may affect his or her quality of life and participation. Test scores can be affected by conditions like ADHD and anxiety disorders, and factors like how tired, shy, ill, or distracted the child was on the testing date. If English isn’t your child’s first language, or if your child has a disability, the test results need to be interpreted with extreme care.

Norm-referenced, standardised tests tell us nothing about your concerns, goals or priorities. For this reason, speech pathologists should never rely solely on test results to diagnose or treat your child. Other specialised tools, language/speech sampling, interviews and observations over time provide us with essential additional information for treatment.

The assessment results table

After your child has been tested, your speech pathologist should provide you with a report. Test scores are reported in the assessment results summary, which usually looks something like this:

Core and Index scores (and what they measure) Sum of Scaled Scores Standard Score Standard Score Confidence Interval (90% Level) Percentile rank What the score suggests
Core Language Score (CLS) (overall language development) 16 63 59 to 67 1 Severe disorder.
Receptive Language Index (RLI) (listening and comprehension) 14 66 59 to 73 1 Severe disorder.
Expressive Language Index (ELI) (expression using words and sentences) 13 65 60 to 70 1 Severe disorder.
Language Content Index (LCI) (vocabulary and semantics) 15 70 64 to 76 2 Severe disorder.
Language Structure Index (LSI) (morphology and syntax) 18 67 62 to 72 1 Severe disorder.
Working memory index (WMI) 10 71 62 to 80 3 Moderate delay.

Note: This table summarises a (fictional) child’s test results on the CELF-4. A standard score of 86-115 is within the normal range: the average standard score for each index is 100.

Rider 1

The shaded area represents the normal range.

This child’s assessment results suggest a severe receptive and expressive language disorder requiring urgent treatment.

What is a “confidence interval”?

Children can have an off day on the date of their assessment. So can speech pathologists. We all make mistakes. A good speech pathology report will include not just the scaled scores, but confidence intervals, too. A 90% confidence interval (like the one quoted in the table above) gives you the range of scores that you can be 90% sure contains the child’s “true” score. (That of course means there is a 10% chance, the true range is not within the range.)

Sub-test results

Behind the index results, it’s useful to look for patterns of strengths and weaknesses to help identify therapy priorities for children with communication disorders. Sub-test results provide more information about your child’s performance, and are often presented in a table like this:

Subtests Scaled Score* Scaled Score Confidence interval (90% Level) Percentile Rank Comment
Concepts & Following Directions 3 2 to 4 1 Below normal range
Word Structure 5 3 to 7 5 Below normal range
Recalling Sentences 3 2 to 4 1 Below normal range
Formulated Sentences 5 4 to 6 5 Below normal range
Word Classes 1 – Receptive 6 4 to 8 9 Below normal range
Word Classes 1 – Expressive 6 4 to 8 9 Below normal range
Sentence Structure 5 3 to 7 5 Below normal range
Expressive Vocabulary 6 4 to 8 9 Below normal range
Number repetition – forwards 4 2 to 6 2 Below normal range
Number repetition – backwards 6 4 to 8 9 Below normal range
Number repetition – total 3 1 to 5 1 Below normal range
Familiar sequences 1 7 5 to 9 16 Borderline

Note: This table summarises our fictional client’s results on each of the relevant subtests of the CELF-4. A scaled score of between 7 and 13 is within the normal range.

Rider 2

The shaded area represents the normal range.

This child scored below normal limits on almost all of the sub-tests, although she had areas of relative strength and weakness.

Your speech pathologist will give you information about what each of the subtests assesses. (This information is often presented in an Appendix to the assessment report.)

Scores and the normal curve

For most common norm-referenced, standardised tests, the number of people tested is so large that the scores of the people taking it form a bell-shaped or “normal” curve when plotted on a graph. This fact allows us to measure your child’s performance against children of the same age by taking your child’s raw scores and translating them into standard or scaled scores and percentiles.

A normal curve looks like this:

8984c6c71b3a5f3c0e5f4c94058e2549

Source: http://www.linguisystems.com/pdf/testingguide.pdf

What types of scores are usually reported and what do they mean?

Sometimes (we don’t know why), speech pathologists report raw scores. These are simply the number of items your child answered correctly on the test. They don’t mean anything.

To report something useful, speech pathologists convert your child’s raw scores into standard scores and percentiles. To get a standard score, we use a scale, usually in a table buried at the back of the test manual. The scale sets the average score (or mean) for the test at a round number. For example, in the table above, the Receptive Language Index is based on a scale where the average is 100. If a child achieves a standard score of less than 100, then the student is said to have performed below the average. If a child scores above 100, the student is said to have performed above the average (see the bottom line of the normal curve above.)

Using a similar process, speech pathologists convert your child’s standard scores into percentiles. Percentiles tell you the percentage of scores that were lower than your child’s score for children of the same age. For example, if your child obtains a percentile rank of 70, 70 per cent of children the same age tested scored below your child’s score (see the second bottom line of the normal curve above).

So which standard scores and percentiles are within “normal limits”?

Using a scale where the average standard score is 100 (as in the normal curve above), a standard score of anywhere between 86-115 is considered “within normal limits”. Scores within these ranges are considered “normal”. As you can see:

  • “normal” encompasses a wide range of scores; and
  • a standard score within normal limits does not necessarily mean your child achieved an average or higher than average score.

When do standard scores suggest an “impairment”?

Confusingly, different tests use different terms to describe levels or degrees of language or speech problems. As a rule of thumb, on a scale where 100 is the average (like the CELF-4):

  • a standard score of 70 or below suggests a severe impairment warranting urgent treatment;
  • a standard score of 70-77 suggests a moderate impairment;
  • a standard score of 78-85 suggests a mild impairment; and
  • a standard score of 86 or more suggests no impairment: treatment is not needed and should not be provided.

On the normal curve diagram (above), you can see the percentile range equivalent for each of these standard score ranges.

It’s your speech pathologist’s job to make sure you understand your child’s test results. If you don’t understand the results – or anything else in the report – just ask!

For some useful videos and information on standardised tests, normal curves and basic statistics, please check out the links below:

 

Statistics 101: A Tour of the Normal Distribution

Image: https://tinyurl.com/ya64f4zu

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).