Literacy (Reading, Writing, Spelling)
While isolated difficulty with the printed word is often referred to as dyslexia, under current ICD-10 diagnostic codes, a child with these difficulties may receive the diagnoses of specific reading disorder, disorder of written expression, and/or specific spelling disorder. Many children and adults with language disorders have difficulty with one or more aspects of literacy.
An individual may have difficulty with phonology, or the rules of the sound system. Literacy requires phonological awareness, or awareness of the individual component sounds within words. In order to read and spell effectively, we must be able to identify, segment, blend, and manipulate these individual sounds. This is a necessary underlying skill in order to break down words so that they can be spelled or read correctly.
Difficulty with additional underlying reading and spelling skills may also be impacted, such as discriminating sounds within words, learning sound-symbol spelling patterns (i.e., the sounds associated with letters/groups of letters), and word attack skills (e.g., breaking down multisyllabic words).
Beyond these word-level reading and writing skills, contextual reading fluency skills may be weak, such as using visual memory and sentence context to read words automatically and/or identify reading errors.
Reading comprehension difficulties may be caused by a variety of underlying weaknesses depending upon the individual, and should be addressed differently depending on where these difficulties lie. For example, reading comprehension difficulties may be due to issues with visualization, sequential thinking/memory, working memory, understanding complex sentence structures, receptive vocabulary, and/or understanding of contextual language organization (e.g., the structure of a narrative story).
Many individuals with language disorders have difficulties with written language due to the extensive linguistic demands involved. In order to produce contextual written language, we must, among other things, understand the topic (often involving a complex writing prompt), identify and work through the multi-step writing process, generate relevant ideas, organize our ideas, put our ideas into meaningful grammatically-correct sentences, spell the words correctly, apply mechanics (e.g., capitalization, punctuation), and evaluate the correctness and cohesiveness of our writing. Many facets of the writing process may be targeted by a speech-language pathologist, such as learning underlying skills and applying strategies for: interpreting prompts, brainstorming relevant ideas, organizing ideas, structuring paragraph-level or multi-paragraph level writing, using compound or complex sentences, using transitions words/phrases/sentences, increasing word choice specificity, and editing/revising written work.
Difficulty with any of these literacy skills can significantly impact the ability to function academically, social, or professionally. For students, keeping up with reading and writing assignments may be difficult, and the completed work may not accurately reflect their capabilities or understanding of the material. Day-to-day activities may also be more difficult, such as writing emails or reading anything from street signs to the newspaper. At Language & Learning, our speech-language pathologists have training and experience with a variety of programmatic approaches to literacy skills, but we also believe in individualizing the therapy approach to each client, integrating elements of these programs as well as other approaches as necessary to target each client’s specific areas of weakness.
Auditory processing of linguistic information is a complex skill that involves an individual’s ability to attend to, separate out, and interpret relevant auditory information. While processing auditory information necessarily involves additional skills such as cognitive abilities and proper functioning of the auditory system, individuals may also have difficulty with the linguistic skill of identifying, interpreting, and using auditory information effectively.
It is important to differentiate difficulty processing verbal language from an auditory processing disorder. While the term “auditory processing” is used interchangeably to describe the disorder as well as the previously mentioned linguistic skills, auditory processing disorders signify that the individual’s programmed response to auditory information is faulty. Although the observable behaviors may be the same as those exhibited by someone who has trouble attending to and/or understanding language, the root cause for these behaviors is different; therefore, the diagnosis and therapy approach differ as well. If an auditory processing disorder is suspected, you should begin this process by inquiring with a trained audiologist.
Linguistic auditory processing involves identifying, interpreting, and using both single-word and contextual information, and is a skill that must continually develop in order to meet academic and social demands as they increase with age. While demands increase developmentally, as a whole, auditory processing is an important underlying skill for individuals to learn new information and interact with others in social, academic, and professional environments. For example, a young child may have difficulty building vocabulary through the primarily auditory channels relied upon at a young age; a school-aged child may struggle to identify, remember, and use the important information necessary to follow simple or multi-step verbal directions in the classroom; and an adolescent may struggle during a lecture to differentiate between topics, subtopics, and details, or identify linguistic concepts to predict, organize, and differentiate pieces of auditory information.
If linguistic auditory processing difficulties are suspected, a speech-language pathologist at Language & Learning will assess the client’s specific processing difficulties to develop a therapy approach that will target to their individual needs. Therapy typically involves multiple aspects. One element is targeting underlying skills that the client needs in order to process information effectively. While many people learn these underlying skills without direct instruction, others require them to be taught in a structured, repetitive, and interactive way. There are a variety of potential goals focused on targeting underlying processing skills, such as analyzing various text structures, learning the concept of “key words”, understanding relevant linguistic concepts, or differentiating between topics, subtopics, and details in context. Training compensatory strategies such as visualization, subvocalization, “chunking” phrases/steps, or note-taking may also play a large role in therapy targeting linguistic auditory processing. Finally, as an important element in targeting many communicative areas, the client’s understanding of their own strengths and weaknesses is essential to motivate improvement of skills and guide when and how to implement compensatory strategies to best suit their needs. For individuals with difficulty processing linguistic information verbally, visual supports and interactive tasks are necessary to circumvent their auditory processing weaknesses and ensure more rapid and complete understanding of the skills and strategies being implemented in therapy.
Social skills may also be referred to as pragmatics or social pragmatics. These skills involve understanding the rules that dictate how we interact with the world around us. Pragmatics relies on a set of underlying rules about what behaviors are expected and unexpected in various communicative situations. Difficulties with pragmatics may be a part of a broader diagnosis such as autistic disorder, but many have difficulties with only select aspects of pragmatics, which are only a portion of their overall linguistic weaknesses. An individual who has difficulties with pragmatics may struggle to:
- Use communication skills socially (e.g., greetings, closings, and politeness markers may be absent when communicating with others)
- Modify their communication depending on the listener or environment
- Develop higher-level or nonliteral comprehension skills (e.g., difficulty demonstrating inferential thinking or understanding idioms and humor in social and academic contexts)
- Follow conversational rules (e.g., difficulty taking conversational turns or maintaining topics appropriately)
- Understand and use nonverbal communication (e.g., difficulty with eye contact, body positioning, or facial expressions)
- Understand and use suprasegmentals, including tone, volume, and prosody
- Take others’ perspectives (e.g., difficulty thinking flexibly about situations, or understanding others’ emotions, social intent, actions, or expectations)
Among the many daily impacts of these weaknesses on the quality of life of individuals with pragmatic weaknesses, it may be difficult to learn and function within a group setting, create or maintain social relationships, or make their thoughts and ideas known to others in both social and nonsocial contexts. These daily struggles often have wide-ranging emotional, social, educational, and professional impacts.
If pragmatics are an area of concern, a speech-language pathologist at Language & Learning will evaluate specific areas of need and provide therapy to teach these often implicit, underlying skills in structured therapy activities. By making these social rules clear and providing specific instruction and strategies to navigate social situations effectively in a variety of communicative contexts, speech-language therapy can help improve the quality of life for an individual with pragmatic weaknesses.
Executive Functioning and Other Cognitive-Linguistic Skills
Cognitive-linguistic skills such as executive functioning, memory, and problem solving play a large role in our ability to effectively communicate and function throughout the day beginning in early elementary school. Executive functioning consists of the over-arching skills involved in managing tasks, such as identifying necessary steps, planning, organizing, thinking strategically, attending to specifics, monitoring progress, and self-evaluating. The frontal lobe, which is heavily involved in these skills, continues to develop into adulthood, so these skills progress throughout our development; however, difficulties with these skills can emerge beginning in early childhood, and intervention can help improve social, academic, and professional achievement. Particularly in early adolescence when children are required to complete increasingly complex academic work in greater amounts and with more independence, these issues become evermore apparent. An individual with executive functioning weaknesses may have trouble with daily activities and requirements such as:
- Completing assignments effectively or in a timely manner, including understanding the assignment, identifying steps, making/following/modifying plans, and monitoring progress
- Learning new information
- Following directions
- Managing time
- Organizing their workspace, living space, materials, or assignments
- Completing writing assignments
- Functioning and adapting in dynamic communicative situations
- Remembering and completing routines
- Transitioning or dealing with changes in expectations
- Communicating effectively, particularly in terms of sequencing, organizing, and speaking clearly and concisely
- Initiating tasks
- Generating ideas
- Being aware of the presence and severity of their own strengths and weaknesses
- Managing personal, academic, or professional circumstances
In addition to executive functioning, individuals with language disorders may also have difficulty with related cognitive-linguistic skills such as memory and problem-solving. Memory weaknesses typically involve difficultly efficiently storing and retrieving various types of information for immediate, short-term, or long-term use. Working memory specifically involves the ability to retain, manipulate, and use information in the present moment. While some individuals have difficulty with all aspects of memory, some may have difficulty with only select aspects. For example, learning many discrete facts about a topic of interest may be easy, while remembering a lengthy direction may be difficult. Individuals with memory weaknesses often have trouble during daily activities requiring them to learn and/or use new information or complete multi-step tasks, such as completing daily routines/activities, managing multiple tasks simultaneously, or following verbal directions.
Problem solving weaknesses may involve difficulty identifying specific problems, analyzing/thinking flexibly about problems, generating potential solutions, and selecting/implementing appropriate solutions. Individual with these weaknesses may struggle to function in their daily life due to difficulty anticipating problems or consequences of their decisions, judging situations, and reacting in an expected way to problematic situations.
Since these cognitive-linguistic skills are underlying processes relied upon constantly in our daily lives, weaknesses in these areas may have significant social, academic, and professional impacts. If cognitive-linguistic weaknesses are a concern, a speech-language pathologist at Language & Learning will evaluate specific areas of weakness and determine an approach to improve skills, implement strategies, and develop self-awareness of areas of difficulty. Particularly due to the metacognitive processes involved in this area, discussion and self-analysis play a significant role in improving executive and cognitive-linguistic functioning. Strategy and support implementation also plays a important role. For example, visual methods for breaking down, organizing, and monitoring progress through completion of tasks, or techniques to enhance memory such as visualization and subvocalization are often a helpful. Targeting underlying skills in structured, isolated contexts may be beneficial as well (e.g., visually charting problems and solutions for hypothetical situations, or learning the steps involved in common tasks).
Expressive/Receptive Language (Morphology, Syntax, Semantics)
Expressive and receptive language involve the ability to understand and convey verbal and written information. These skills are necessary in order to understand information in the world around you as well as express thoughts and information. As a result, receptive and expressive language play an integral role in our daily lives. For example, they are necessary when interacting with friends and family so that you can formulate sentences, tell stories, answer questions, and communicate knowledge, needs, and thoughts. Additionally, learning in a classroom, demonstrating knowledge to a teacher, reasoning with information, learning language rules and vocabulary, collaborating or contributing during a meeting, carrying out errands and routines, giving and following directions, and completing writing tasks rely heavily on expressive and receptive language. As children progress in school, expressive and receptive demands increase and build upon each other; therefore, impacts of weaknesses evident at a young age may increase as a child progresses throughout the curriculum.
Weaknesses in expressive or receptive language may involve any combination of semantic, morphologic, or syntactic difficulties. Each of these may be impacted with varying degrees of severity and at varying levels, ranging from the word level to the contextual level.
Semantics include the aspects of language involving meaning. This may include lexical semantics (word meaning) or lengthier meaning (i.e., phrases, sentences, or text). An individual with semantic weaknesses may have difficulty with a wide range of semantic skills or only isolated, specific areas. Areas of semantics that may be impacted include vocabulary comprehension, depth and breadth of word meaning, relationships between word meanings, definition skills, meaning ambiguity (e.g., multiple meaning words, idioms, metaphors), and word retrieval. These weaknesses may be apparent in tasks of varying levels of integration and complexity. For example, an individual may have trouble learning a new vocabulary word, associating new concepts with learned concepts in a class, providing a complete definition, understanding idioms in conversation, identifying nonliteral language in literature, or interpreting nonliteral language once it is identified.
The ability to recall specific words, or word retrieval, typically implicates inefficient ability to store and locate specific words. As a result, the individual with word retrieval difficulties, who may have varying levels of awareness of this weakness, might use vague vocabulary, talk around a specific word, or make incorrect word choices.
Poor semantic skills make it difficult to understand and express ideas effectively. For example, comprehension of printed materials (e.g., literature, textbooks, newspaper), learning new concepts/information, understanding directions, participating in a conversation, using specific words to express an idea clearly, relating concepts, or thinking more deeply about literature may be a struggle for the individual with semantic weaknesses. If semantic weaknesses are a concern, a speech-language pathologist at Language & Learning will determine specific areas of semantic difficulty, target isolated skills (e.g., using word parts to build vocabulary), and teach compensatory strategies (e.g., learning semantic attributes to enhance word retrieval) to help improve communicative functioning.
Morphology involves the smallest units of meaning working together to form a word. These individual meaningful elements (known as morphemes) can impact semantic and/or syntactic elements of the word. Grammatical morphemes, often found at the ends of words (e.g., -ed, -ing, -s, -es) require knowledge of subject-verb agreement and syntactic structure rules. Roots, prefixes, and suffixes also carry meaning and can be added on, substituted, removed, or combined to create words with different meanings and grammatical functions. In reading, writing, speaking, and listening tasks, morphological weaknesses may be apparent at varying levels of communicative complexity.
Syntax incorporates grammatical aspects of morphology, and involves the rules for assembling words and phrases to create grammatically correct sentences. While these skills improve throughout childhood and adolescence, developed syntactic skills involve understanding and creating sentences with grammatical structures of varying complexity. Syntactic weaknesses in spoken or written language may result in errors such as words being out of order, sentence fragments, run-ons, poor grammatical agreement, overly simplistic sentences, comma splices, or limited understanding/use of various types of phrases and clauses. Either receptive or expressive syntactic difficulties may have far-reaching impacts, including difficulty understanding directions, books, questions, or lectures, and formulating clear descriptions, explanations, or questions when speaking and writing.
For those with morphological and syntactic weaknesses, understanding and expressing themselves clearly may be difficult, impacting their social interactions as well as their academic or professional performance and perception. For these individuals, following analysis of specific areas of need by a speech-language pathologist at Language & Learning, therapy may involve structured instruction regarding morphological and syntactic rules/structures, beginning in isolation and increasing to functional contexts. Repetitive, targeted practice as well as interactive, innovative, and creative methods are important in making these rules more salient and easier to retain for individuals with syntactic weaknesses. For example, incorporating songs, mnemonics, visual supports, and movement-oriented activities may help clients understand and retain concepts that they have been struggling with. Following speech-language therapy, even persisting difficulties with these skills can be improved to enhance understanding and expression.