1) Carol, the field of “learning disabilities” has been with us for many years. What do you feel are the current issues in identification?
The field of learning disabilities has made great progress over the years, including better assessments and the use of MRI brain imaging, allowing for earlier and more definitive identification of a child’s learning disabilities. Further, research into specific programs or therapeutic strategies for intervention, have greatly enhanced the ability to more closely match the learning profile of students, thus reducing the unnecessary and time consuming attempts to find the appropriate remediation tools.
However, as I see it, there is often a disconnect between educational and clinical assessments, diagnostic identification and qualifying for assistance. Since I live in California, I can be specific to my state, although most other states follow similar patterns.
First, in CA, in order to be considered as having a learning disability, there must be a processing disorder coupled with a discrepancy between the student’s measured cognitive skills and academic achievement. Secondly, even though many districts are employing the Response to Intervention model before moving to assessment, a process which can provide earlier needed research-based assistance, those services may not necessarily match the student’s learning skill pattern. Thirdly, the educational regulatory mandate for qualifying for special education services often takes precedent over understanding a student’s learning style. Thus, a rich and diversified team assessment may never be thoroughly utilized to provide teachers with the research-based classroom tools necessary to help a struggling student.
In the world of private practice, the laws and regulations that govern practitioners and providers often are not the same as in the public schools and practitioners working in both environments can be confused. Children who receive private assessments often get them from a sole service provider who is regulated to assess only in particular domains, although their scope of practice can typically be broader than in the public schools. Nevertheless, many private assessments are often lacking in their description of areas pertinent to learning. Unregulated tutoring businesses often use only the test which accompanies their program, never really assessing a student at all.
Lastly, although 80% of all learning disabilities are language based, it is still routinely the practice that many students never receive a full speech-language assessment, even in the private sector. Additionally, since the educational mandate is for qualifying a student, not necessarily identifying or diagnosing, many times the speech-language assessment, or other assessments, can be lacking the comprehensiveness necessary to fully describe a student’s learning skills.
2) Carol, I have trained diagnosticians and school psychologists and have also suggested that they administer the Peabody Picture Vocabulary Test AND and Expressive Language Test. Why are these two realms important?
As I stated initially, research has shown that 80% of all learning disabilities are language based with students first being referred for a speech-language problem in preschool or even earlier. Classrooms are linguistically based and language driven. The key features of language- phonology, semantics, syntax, morphology and pragmatics intertwine and interact with each other all day in every situation. Oral language is the foundation for written language and they have a reciprocal relationship to each other- we talk about what we read and write, and write about what we discuss. We communicate and become literate through this ever evolving process.
The US Department of Education Statistics in 2007-08 showed learning disabilities accounted for half of all documented disabilities, with speech-language disorder a close second. However, if the first identified problem was more often than not in speech-language, I believe that what is happening is that the qualifying criteria, or diagnostic name, is what changes, because the fundamental speech-language problem just doesn’t go away. Therefore, the student’s oral speech and language skills can outwardly improve, but the underlying language deficit remain.
To further complicate matters, the 2000 US Census indicated that we have 167 different languages spoken by 47 million of the 281.4 million people who live here, with the new census probably expanding on these statistics. In California, after English, the second most prevalent language is Spanish with over 64 other languages. The standard California Class C driver’s license examination is available in 32 different languages, but the street names and most signs are in English. These statistics underline the challenges which face many students when it comes to learning and further impact the students with underlying learning disabilities. We are no longer just testing native English speakers for learning problems.
A comprehensive Speech-Language evaluation should routinely be done on every student suspected of having a learning disability. Considering that most assessments for special education are in English only, the challenge is to document a language-learning disorder in both languages. When English is not the primary language, steps should be taken to utilize bilingual personnel and for the testing to be as complete as possible taking into account the dominant language of the student being assessed. Nonverbal, non-oral assessments must accompany the oral and verbal assessments.
3) Many teachers complain that students with learning disabilities seem to have low frustration tolerance and are impatient. How should this be addressed?
To me it makes perfect sense that low frustration tolerance often accompanies learning disabilities. If 80% of learning disabilities are language based and language drives a classroom, a student with LD is in a daily 6-hour situation where he or she must obtain information through their weakest modality. That student must process what is being said, remember what was presented, figure out what it means, translate that information to written material or the learning of basic skills, and do it all in a time sensitive and rapidly evolving environment. I think it is almost unreasonable that educators would expect the students not to be frustrated.
Allowing extra time, providing frequent check-ins with the student, providing many visual aides such having outlines or charts of presentations, calling on them last so they have peer models, and chunking down information is all crucial. However the single most important thing an educator can do for LD students, and really for all students, is to slow down their presentations, and for most that means their speech rate.
4) Are there students that have both a learning disability as well as a speech or articulation impediment? ( am I being politically correct here?)
For the purposes of discussing learning disabilities, it is important to provide a distinction between a Speech Disorder and a Language Disorder. A speech disorder typically refers to the mechanics of talking- voice, fluency and articulation. A language disorder typically refers to those more cognitive processes responsible for vocabulary, sentence structure, and pragmatics (eye gaze, turn-taking, and other non-verbal language skills). The difference is crucial because a student can seemingly improve in how they articulate sounds or use their voice, or become more fluent, however underlying cognitive language problems may be more subtle or at least not as noticeable, but are the weak areas that often make learning hard.
A student can have both a speech problem and a language problem, or can have one or the other. Making that diagnosis and distinction is important, particularly in the schools where the failure to develop speech and language skills normally can interfere with written language learning.
5) Let’s talk inner ear infection for a few minutes- is there any relationship between otitis media and otitis externa and learning disabilities or language disorders?
Otitis externa is an inflammation of the outer ear and otitis media is an inflammation of the inner ear. Both can cause discomfort and pain and both need to be treated medically. The more prevalent condition, otitis media has often been identified as the culprit in a student’s difficulty in learning or in late language development. What is very important to remember, but is often undocumented, and sometimes not even known, is that there can be fluid in the middle ear, sometimes for long periods, without any infection or even pain. The fluid in the middle ear can cause hearing loss. Often a student has allergies which lead to this condition.
Several long term meta studies over the course of the last few years show that the long term effect of otitis media do not impact a child’s language development and that there is a resolution by age 7. (Journal of Speech, Language, and Hearing Research, v53 n1 p34-43 Feb 2010) Another earlier review of literature on the relationship of otitis media and leaning disorders revealed that the incidence of otitis media was twice as common in learning disabled as non-LD students. (Journal of Learning Disabilities, v16 n5 p272-78 May 1983)
However, what is not as clear is what happens to a child who enters kindergarten with intermittent hearing loss because of the accumulation of middle ear fluid which may or may not result in an infection. I think middle ear fluid coupled with allergies may be a topic of interest to many who work with students with learning disabilities and language disorder.
6) How can speech therapists best work with students with learning disabilities?
I often think that the services of the Speech-Language Pathologist are often underutilized, particularly in the public schools where caseloads remain high and there is a tremendous need for more therapists. However, therapists must see language in its broader sense and how it impacts everything a student does all day. Speech and language evaluations must describe what a student can do as well as what a student cannot do, and particularly in the public school, not just test for qualifying purposes.
Above all, therapists must see themselves as vital consultants to teachers and parents on how best to communicate with learning disabled students and how to help them maneuver the language world of learning.
7) What do parents need to know about speech and language problems and their relationship to learning disabilities?
As has already been noted, 80% of learning disabilities are language based. Parents need to look closely at their child’s speech-language development. Even though children can be quite talkative, that does not mean that they use language effectively, that they understand at age appropriate levels, or that their language is successful in an educational setting. One of the most recent studied aspects of language development that has great impact on later academic achievement, particularly in the area of reading comprehension, is narrative ability.
Narrative skill or the ability to explain events in a logical, sequential manner, not just a listing, but in a more cause-effect mode, is the basis for reading comprehension. Beyond phonics and phonemic awareness of the sounds needed to acquire basic reading skills, an ability in narrative impacts a student’s learning to understand what he or she is reading, the very reason we learn to read in the first place.
Oral narrative language development is important because the very act of telling stories or relating experiences requires that a student use all of the language components, (semantics, pragmatics, syntax, and morphology) together to communicate a meaningful coherent explanation or sequence of events, whether to themselves or another about what is happening in class or what they have read. Narrative is much more than just telling stories.
Both the California English Language Arts Content Standards and the new Core Curriculum Standards adopted by most all of the states in the US, list narrative as a goal. Telling sequential stories or making explanations, is a standard starting in kindergarten, even for English language learners, that only expands as the student progresses through the grades. The Core Curriculum Standards website emphasizes the need for students with disabilities to be encouraged to meet those standards with the necessary guidance and support. (http://www.corestandards.org/the-standards)
8) What have I neglected to ask?
Thank you for this opportunity to talk about learning disabilities and the impact of speech-language disorders on learning. It has been my passion for forty years. I continue to be intrigued and excited about the ever changing landscape of research with the developing strategies and programs. I am hopeful that this interview will help parents and educators see speech and language in an academic world and help them understand the relationship between talking and learning in a broader context.
Carol Murphy, MA, CCC-SLP, is a licensed speech/language pathologist and board certified educational therapist. She was trained at the National Center for Equine Facilitated Therapy. Her business, Speech and Learning and Psychology Services, is located in Santa Cruz County for 23 years, with a division called Animal T.A.L.K., that uses horses for Equine Facilitated Therapy. Currently she is serving on the CA State Speech-Language Pathology, Audiology and Hearing Aid Disperser’s Licensing Board and supervises graduate Speech-Language Pathologists for California State University Northridge in Santa Cruz and Monterey counties. Carol can be reached by phoning 831.234.4181, or email her at firstname.lastname@example.org.