We are pleased to welcome Karole Howland, M.S., CCC-SLP as our
guest speaker for our SLP student chat tonight, Monday, March 25, 2002 at
9:00pm EST.  Ms. Howland will lead us in a chat about Reading & Literacy.  She
is a Clinical Assistant Professor in the Communication Disorders Department at Boston University
where she teaches Reading Disorders.  Ms. Howland also works at Children's Hospital in Boston, where
she evaluates and treats children with a variety of speech and language disorders. Her areas of
specialization include: language-based learning disabilities, central auditory processing disorders,
autism spectrum disorders, phonological disorders and verbal dyspraxia.

<Robin>  Welcome!!! Tonight we are chatting with Karole Howland, MS, CCC-SLP, about reading & literacy,
           and how it relates to speech-language pathology.
<Adrienne> Is anyone addressing reading/literacy with clients?
<Kerry>  Hello everyone
<Robin>  Kerry, can you give us some general information about this topic?
<Kerry>  SLP's are playing an increasing role in the assessment and treatment of children with
           reading disorders. A large body of recent research documents the relationship between
           spoken and written language.
<Kerry>  Research tells us that many children who have early language problems have later problems
           in learning to read . Children with reading disorders also have problems with aspects of
           spoken language.
<Kerry>  While we have previously thought of reading as a visual process, we now know that reading
           problems are more commonly based in auditory/language deficits.
<Kerry>  In fact, we now believe that the core deficit in dyslexia is a problem with phonological
           processing. This includes problems with storing, retrieving, and analyzing the phonological
           representations for words.
<Robin>  Kerry, have SLPs treated reading disorders in the past?
<Kerry>  Some, but not to the extent that they are today.
<Kerry>  Traditionally, that has been the role of the special ed. teacher.
<Adrienne>  In order for it to fall under our scope of practice, do we have to treat phonological processes?
<dragongirl>  I think I've always had in the back of my mind that reading problems were dealt with by the
           "reading teachers" and not the SLP's.
<Kerry>  Dragongirl, that has been the traditional way things have worked.
<Kerry>  Actually, ASHA describes our role as encompassing virtually all aspects of written language:
<Kerry>  Prevention . early identification of children at risk . assessment . intervention . education of
           professionals with regard to the auditory skills needed for reading.
<dragongirl>  I see where the phonological process training comes in to play though the elementary and
           high school I graduated from were still set in the traditional ways of doing things. College really
           opened my eyes to a lot.
<Kerry>  One critical part of our role is assessment.
<Adrienne>  What do reading teachers do that we don't, or visa versa, ... or is it not divided that way?
<dragongirl>  Good question Adrienne. I wondered the same thing.
<Kerry>  It varies a lot in different settings. At Children's Hospital, I do both reading and oral language
<Kerry>  In many settings, the reading specialist does that actual reading work, but SLPs handle the various
           aspects of phonological awareness.
<Adrienne>  I see
<dragongirl>  What Children's hospital do you work for, Kerry?
<Kerry>  Boston Children's
<Robin>  What tests do you use for assessment?
<Kerry>  For phonological processing, I will usually use the Phonological Awareness Test, and/or the CTOPP
           (Comprehensive Test of Phonological Processing).
<Kerry>  It goes beyond just phonological awareness to also look at phonological memory and rapid naming.
<tehogan>  At what age are you assessing phonological awareness?
<Kerry>  From kindergarten on
<dragongirl>  What kind of intervention do you do?
<Kerry>  In the earlier grades I do a lot of work on phonological awareness, and multisensory approaches to
           helping kids to associate letters and sounds for decoding.
<dragongirl>  What is your opinion to the cyclic approach to intervention? Do you think it's helpful?
<Kerry>  Dragongirl, are you referring to the cycles approach for phonological disorders?
<dragongirl>  yes
<Kerry>  That is more for the speech production end of phonology, but it is one approach that can
           be very effective in that area.
<Kerry>  Phonological processing for reading is a bit different from phonological process disorders for speech
<Kerry>  Confusing because the terminology is so similar.
<dragongirl>  yes
<Kerry>  But they are related, because kids with early speech production problems often have later problems with
           learning to read.
<Cie>  How do phonological processing disorders effect reading?
<Kerry>  To learn to read, children must learn that words are made up of sounds, and learn to separate words into sounds.
<Kerry>  Phonological processing includes 4 basic areas, analysis of sounds, storage of sound patterns, retrieval
           of sound patterns and production of sound patterns.
<Cie>  Where do you start?
<Kerry>  Working at the syllable level is easiest, so I would teach kids to segment words into syllables
        and to blend syllables to form words.
<Cie>  I see
<Kerry>  Then, kids learn to separate the first sound from the rest of the word e.g, c-at.
<dragongirl>  So you teach them to read the word first and then break the word down?
<Kerry>  I teach them to break the word down, and then map letters onto the sounds they have learned to segment.
<dragongirl>  o.k. I got ya
<Cie>  At what age do you start this type of treatment usually?
<Kerry>  By 5, children should be starting to segment words into syllables, and recognize the first sounds.
<Kerry>  If they are not, I would start then.
<Adrienne>  Kerry, can this apply to kids with other developmental disabilities (Downs/Autism)?
<Kerry>  Yes, in fact, recently, there has been discussion about taking the requirement for average cognitive skills
           out of the definition of dyslexia.
<dragongirl>  Could you also apply this to adults with head injuries such as aphasia or TBI?
<Kerry>  Just recently, literature has started to apply what we know about reading with dyslexic kids to adults with TBI.
<Adrienne>  I have an 18 year old client with Downs Syndrome- he can't read very well but he can recognize sounds
           across different words (always picks out "guh" sound).
<Kerry>  Adrienne, it sounds like he has the beginnings of phonological awareness.
<Kerry>  Can he rhyme?
<Adrienne> I'm not sure if he can rhyme... what would it mean if he could?
<Kerry>  That is one of the earlier phonological skills Adrienne, if he can rhyme he could learn at least some
           rudimentary decoding skills.
<Adrienne>  neat
<Cie>  Does this type of treatment help kids with dyslexia?
<Kerry>  Cie, yes, in fact it is essential to kids with dyslexia.
<Cie>  That is good to know, we often don't hear much about how to help kids with dyslexia in our studies.
<dragongirl>  What about people who can read, but can't comprehend it? Any good suggestions?
<Kerry>  Comprehension problems are usually based in either inefficient decodings (slow) or in
           problems with comprehension of complex language-- understanding complicated syntax, inferencing,
           other higher level skills.
<Kerry>  So, first do a thorough oral language eval to assess comprehension.
<dragongirl>  I have a client who loves to read, but can't remember or comprehend what he read once it's
           no longer in front of him.
<Kerry>  That sounds like someone who would benefit from things like graphic organizers.
<dragongirl> He does have problems with directions. They must be simplified several times before he understands
           what you expect of him.
<dragongirl>  We have him using an organizer for appointments and phone numbers.
<Kerry>  Dragongirl, that is great. Focus him on key words.  Work to get automatic retrieval.
<Cie>  I have an aphasia client who has great comprehension, but is a very slow reader and must piece together
      the words. any suggestions?
<Kerry>  Cie, we are just beginning to try out a multi-sensory decoding program for an aphasic adult who has
           the same issues.
<Cie>  How is it going? What exactly are you doing?
<Kerry>  We are just starting. We are going to take common word patterns, affixies like "tion" and esse.
<Kerry>  I don't know how it will work. It is very effective with dyslexic kids to use a multisensory approach
           to get the decoding skills automatic.
<Cie>  Thank you. My supervisor suggested giving him scrambled words and having him rearrange them. Do you think
      that would benefit him?
<dragongirl>  That sounds like it might be hard for him, Cie.
<Cie>  That's what I was thinking. He gets frustrated and I don't want to make it harder on him.
<Kerry>  Perhaps. I would be more inclined to present him with regular patterns and practice them over and over.
<dragongirl>  Especially if he has to piece regular words together just to read them, let alone trying to figure
           out a scrambled one.
<Kerry>  How is his decoding? Can he sound out words?
<Cie>  Yes, he does fine with that, he just gets frustrated when it takes him a while.
<Kerry>  So, what he has probably lost is automatic word recognition-- the words that were stored in his lexicon
           before the stroke.
<Cie>  I think so
<Kerry>  It is the same as other retrieval problems.
<Adrienne>  Is reading something he wants to work on? Can he carry a conversation otherwise?
<Cie> He used to enjoy reading. He can carry on a conversation, just word finding difficulties here and there.
          He doesn't do some things he used to do because of reading difficulty.
<Adrienne>  how sad
<dragongirl>  Is he married Cie?
<Cie>  yes
<Kerry>  This is the first time I have tried to apply what I know of developmental dyslexia to an aphasic
           patient, so we are really experimenting right now!
<dragongirl>  Is she involved in his therapy at all? Is she very supportive?
<Cie>  She doesn't come along to therapy. He is very self sufficient, but she helps him out at home. He does very
      well actually, he's just self conscious.
<dragongirl>  Maybe, once you come up with a strategy to teach him, you could have her come to a session.
      Teach her what you're teaching him and she can help him at home. At least that would give him some extra motivation.
<Robin>  Kerry, do you know of any good computer software programs for reading?
<Cie>  yes
<Kerry>  We often recommend the Earobics program to work on auditory analysis skills.
<Cie>  I believe I used that in student teaching, the kids really liked it if it's the one I'm thinking of.
<Robin>  Cie, there are software companies that have programs for adults.
<Robin>  We have had some chats about this topic....look in the chat archives for more info.
<Cie>  Thank you Robin, I'll have to look into that for him.
<Kerry>  It is fun and very effective.
<Cie>  Thank you everyone for your advice!
<Robin>  Kerry, do you use any software for reading/phonological awareness?
<Kerry>  I use Earobics for phonological awareness. With children who have documented temporal processing disorders
           we have occasionally recommended Fast ForWord.
<Robin>  ok
<dragongirl>  What is Fast ForWord?
<Kerry>  It is a computer program designed for children with auditory discrimination issues.
<Kerry>  It helps them to hear the subtle differences among sounds.
<Kerry>  It is expensive and a bit controversial.
<Kerry>  But, potentially helpful for kids with some very specific problems.
<dragongirl>  Does it use a human voice?
<Kerry>  Dragongirl, it uses computer synthesized speech which initially elongates the sounds in words to help kids hear them.
<dragongirl>  neat
<Adrienne>  Why controversial?
<Kerry>  Adrienne, the initial study was very positive, but it has become very commercial, and is applied to all sorts of
           kids other than the ones for whom it was designed.
<Adrienne>  ahh
<Robin>  Doesn't it require intensive therapy?
<Kerry>  Robin yes, several hours per day for about 6 weeks.
<dragongirl>  Can this software be used with bi/multi-lingual children?
<Kerry>  I have not heard of it being used with bilingual kids.
<Adrienne>  Is there a higher incidence of reading problems with bilingual kids because of the language difference?
<Kerry>  Reading can pose a challenge for kids whose first language is not English.
<Kerry>  Not because of a disorder, but imposing that level of metalinguistic awareness on a language that you are not
           fluent in is challenging.
<Adrienne>  That makes sense.
<Kerry>  It can be hard to differentiate a reading disorder from normal second language learning.
<Robin>  Good point
<Kerry>  One task that helps is nonsense word repetition, which has been found to be sensitive and not culturally biased...
        or less biased at any rate.
<Adrienne>  good idea
<Adienne> I have a question about reading and autism.
<Adrienne>  My 5 year old client can read sentences, and with some comprehension..
<Kerry>  Adrienne, it sounds like the five year old shouldn't have much problem with reading!
<Adrienne>  I've been told that's a good sign, but I'm not really sure what to do with it.
<Kerry>  What is the child being seen for?
<Adrienne>  He has autism, so I want to develop the reading because he does so well with visual supports.
<Kerry>  Ahhh! Hyperlexia is common in autistic kids. Yes, that can help him immensely with learning language.
<Adrienne>  He has a "cue card" that says "I want____" and he will then say "I want blue book please"
<Adrienne>  Last week he even said "A blue book" !!
<Kerry>  As he learns to read, you will be able to develop all sorts of language scripts through reading.
<Adrienne>  Any suggestions?
<Adrienne>  Do you mean like memorizing sequence of sentences?
<Kerry>  Carrier phrases, like you are using, can be incorporated throughout the day.
<Kerry>  Or conversational frames for making comments.
<Adrienne>  Can you give me an example?
<Kerry>  For instance, one child learned to comment on actions in play, because I would write out the action
           he was performing and he would read the card.
<Kerry>  Eventually, he started commenting on his own.
<Adrienne>  oooo, that's a good one!
<Adrienne>  We've working on learning verbs too!
<Kerry>  It's funny how kids who pay no attention to verbal language will become interested if it is written.
<Adrienne>  yeah, weird
<Adrienne>  He gets really nuts when you write "blu " and leave off the "e".
<Kerry>  lol Adrienne, I had a child who was driven crazy by his younger sister learning to read and using invented spelling.
<Adrienne>  LOL
<Kerry>  He also learned how to greet others by written scripts.
<Adrienne>  Would you gradually wean off the written cues then?
<Kerry>  Yes, I try to wean away the written cues.
<Adrienne>  ok
<Adrienne>  Thanks, I will try it!!
<Robin>  Kerry, thank you so much for your advice!
<Adrienne>  Yes, very useful, thank you!!
<Kerry>  Sure thing. Hope it was helpful
<Robin>  Thanks again!!!!! goodnight!