Case Study 1: Milo
Milo, age 6, is struggling with first-grade reading. His native and only language is English, and he has an unremarkable history of sensory, motor, neurological, physiological, and social-emotional problems, with no previous language difficulties. He does not have an individualized education program, but his teacher is concerned about his struggle to learn to read and meet the demands of the grade-level curriculum objectives.
At the beginning of the school year, Milo demonstrated grade/age appropriate phonemic awareness skills on the first-grade screening tasks. He successfully blended orally produced single-syllable CVC phonemes (consonant phoneme → vowel phoneme → consonant phoneme) into CVC words (for example, c-a-t → cat) and segmented orally produced single-syllable words into their individual properly sequenced phoneme segments (for example, cat → c/a/t).
- He received curricula-based reading instruction in a whole-class setting, which focused on the development of phonics and word-recognition skills.
- Based on his classroom performance and results of regularly administered progress monitoring tasks, Milo did not demonstrate expected progress during the first two months of reading instruction in several instructional areas including: (1) sounding out common consonant digraphs; (2) decoding regularly spelled one-syllable words; and (3) decoding common two-syllable words. The assessment data clearly indicated that Milo required further instructional support to attain this foundational reading standard. Milo was placed in a small group with students who displayed similar needs and received additional instruction to supplement the whole-class format.
- The teacher and SLP developed a uniform set of recommendations for this additional instruction, which occurred daily in the classroom for 20 minutes: Make instruction more explicit and systematic; increase opportunities for practice; track Milo's mastery of the targeted skills, re-teaching as necessary, slowing the pace of instruction; and provide specific positive and corrective feedback following each response.
- Both the teacher and SLP provided the small-group instruction, alternating days according to their schedules. This collaborative effort resulted in a consistent instructional program that could be implemented with a high degree of fidelity. It also enabled meaningful communication between the educators with expertise in learning and the language of learning.
- Examples of specific teaching strategies included (1) sounding out words along with the teacher; (2) identifying examples and non-examples of correct pronunciation; (3) using visual cues (underline or color-code each syllable/chunk; use blocks to show word parts); and (4) providing extra practice opportunities by pairing students to work together to practice each of the instructional objectives.
- The outcome of this supplemental instruction was positive: Within eight weeks, Milo demonstrated substantial improvement in all three areas of reading, but continued to struggle in one area (did not attain the criterion level for skill mastery): decoding two-syllable words.
- On further review of the assessment data, Milo's difficulty seemed to be twofold: (1) he did not consistently divide words according to their syllable boundaries, and (2) he frequently pronounced words with misplaced stress patterns.
- Based on these performance data and his recent gains in other areas of reading, the teacher and SLP agreed that Milo would likely benefit from a higher level of differentiated instruction.
- Their plan included providing additional supplemental instruction with increased frequency, and large amounts of practice over time until Milo demonstrated the ability to apply these skills automatically when reading words and sentences.
- With this increased level of support, the teacher implemented several instructional strategies: (1) begin decoding instruction with two-syllable compound words, where each syllable stands alone as a real word to simplify the task; (2) use a small set of words for instruction along with repeated practice to concentrate Milo's focus on fewer exemplars; and (3) add additional words, including non-compound words, following mastery of the initial set, so that Milo could apply his own knowledge to new material.
- Prior to winter break, the teacher administered progress-monitoring measures, and Milo demonstrated criterion-level performance for decoding two-syllable words, as well as maintaining his gains in the two other areas of difficulty.
Following winter break, the teacher will reassess Milo's reading performance to determine the level of support services needed, as well as continually follow Milo's rate and degree of progress toward mastery of this Grade 1 reading standard.
Grade 1: Reading: Foundational Skills Standard 3
- Know and apply grade-level phonics and word analysis skills in decoding words.
- Know the spelling-sound correspondences for common consonant digraphs.
- Decode regularly spelled one-syllable words.
- Know final -e and common vowel team conventions for representing long vowel sounds.
- Use knowledge that every syllable must have a vowel sound to determine the number of syllables in a printed word.
- Decode two-syllable words following basic patterns by breaking the words into syllables.
- Read words with inflectional endings.
- Recognize and read grade-appropriate irregularly spelled words.
Some examples of whole-class instructional activities are:
Recognizing and Reading Digraphs. Select a digraph such as "sh" and write or find a paragraph or series of sentences beginning with "sh" words (such as ship, shout, sheep, shop, shark, shell). After writing the paragraph on the board, read it aloud to the class. Then go back and point out two or three of the "sh" digraphs. Read the paragraph again and ask students to clap each time they hear a word that has the "sh" sound. Then ask students to brainstorm other words that start with "sh" and write these words on the board. Distribute magazines, and instruct students to find pictures of objects that start with the "sh" digraph. Have them cut out two or three pictures. Create a "sh" poster and have each student pick one of his or her pictures to place on the poster. As students attach their pictures, instruct them to say the word aloud, and have class repeat the name of the picture. Write the name of the object underneath, highlighting the digraph. After completing this instructional sequence for two additional digraphs (e.g., "ch" and "th"), ask students to sort pictures into separate groups by letter combination. Have students say aloud the name of each picture as they sort it.
Decoding Regularly Spelled One-Syllable Words. Focus on CVC words, using a three-step approach: "Look for parts you know, sound it out, and check it" (Denton & Hocker, 2006) with three small blocks to represent each sound. After listing several unfamiliar or difficult single-syllable words on the board (e.g., can, got, had, fox, tell, him, dog, goes), ask students to look for and say the parts they know such as h-ad , h-a-d, or -ot, while pointing to the corresponding blocks. Then ask students to sound out each word, trying to blend the smaller parts into the larger part (the word). Finally, instruct students to "check" their word by putting it into a sentence to see if it makes sense. If the words were selected from a book or other text materials, have students read the sentence in the text in which the word occurred.
Decoding Two-Syllable Words by Breaking Words into Syllables. Write a list of common two-syllable words on the board and explain that these words are made up of "chunks." (Example words can include: teacher, under, because, happy, about, seven, person, purple, zebra, butter, lion). Model the first word explaining that "teacher" is made up of two chunks: teach-er, pausing one second between the two syllables, and placing a slash mark (/) between the syllables. Repeat the chunks and ask the class to say the number of chunks in the word "teacher." Then explain that when we read the word, we blend the chunks together to make the word "teacher." Have students read aloud each word on the list and tell you where to place the slash mark, providing corrective scaffolding as needed.
Case Study 2: Tyler
Tyler is an 8-year-old boy with autism described by Sturm (in press) as a limited communicator and emergent writer who requires extensive, individualized supports to benefit from communication and writing instruction. In addition to autism, Tyler has an intellectual developmental disability that affects his learning across multiple developmental domains. During baseline observations, Tyler touched his pencil to the page and made some scribbles. When offered pictures to stimulate topics for writing, he invariably showed a preference for a single photo, choosing a school bus image for his preferred topic for more than a year. When others commented on Tyler's writing, he did not make eye contact. In general, he did not initiate conversation, vocalize, make eye contact, or point to communicate. Because of his level of sensory sensitivity, Tyler generally stayed inside his "sensory suit" (a loose-fitting, stretchy body-size sack with a zipper). Although he would occasionally reach outside of the suit to make a comment, he immediately closed his suit, became agitated, and needed a break in the classroom's "sensory area."
Tyler is placed in a special education classroom for students with moderate intellectual developmental disabilities, ranging in age from 8 through 13. Although Tyler's chronological age is consistent with third-grade level placement, based on the complexity of his disability and his current level of performance, his Individual Education Program (IEP) team decided to select kindergarten-level curriculum standards to emphasize access to curricular learning with special supports. This would retain the rigor and high expectations of the CCSS and provide a stepping stone to more age-appropriate standards.
This decision was consistent with the paper on "Application to Students with Disabilities" (accessed on the website for the Common Core State Standards Initiative), which indicates the following:
"Some students with the most significant cognitive disabilities will require substantial supports and accommodations to have meaningful access to certain standards in both instruction and assessment, based on their communication and academic needs. These supports and accommodations should ensure that students receive access to multiple means of learning and opportunities to demonstrate knowledge, but retain the rigor and high expectations of the Common Core State Standards" (p. 2).
The standard in Writing (kindergarten level) selected for relevance to Tyler's curricular learning was to: "Use a combination of drawing, dictating, and writing to compose informative/explanatory texts in which they name what they are writing about and supply some information about the topic."
The standard in Speaking and Listening (kindergarten level) selected for relevance to Tyler's curricular learning was to: "Participate in collaborative conversations with diverse partners about kindergarten topics and texts with peers and adults in small and larger groups. a) Follow agreed-upon rules for discussions (e.g., listening to others and taking turns speaking about the topics and texts under discussion), and b) Continue a conversation through multiple exchanges."
Example IEP goals to address the Writing standard for Tyler include:
- When presented with two different personal photo choices that support informative topics (e.g., all about...) Tyler will choose a topic other than his two usual favorite topics (school bus and Thomas the Train) during four to five writing session probes.
- When given single word descriptive binary choices, Tyler will choose a word that will name (e.g., cat) and describe (e.g., little) what he/she is writing about during four to five writing session probes (adult scribes response).
Example IEP goals to address the Speaking and Listening standard for Tyler:
- Tyler will use emotions to "vote" on the quality of a communication partner's eye contact following a communication partner exchange modeled in a mini-lesson activity targeting use of good eye contact (four to five opportunities).
- Tyler will point to a photo image to "vote" on which photo should be used as the writing topic for the mini-lesson (four to five opportunities).
- Tyler will give a yes or no response when the class is asked, "Who else in this classroom likes the _____ topic that _____ wrote about today?" (four to five opportunities).
Instruction & Intervention Strategies
Tyler's special education teacher was working with Sturm (in press) to pilot an enriched writer's workshop approach to provide high-quality differentiated writing instruction for a range of learners. Sturm, an SLP, designed the workshop to align with the CCSS so that students with complex disabilities would have access to rigorous writing content standards. The approach uses many elements of writers' workshops that are familiar to general education teachers, with additional supports through adult scaffolding; specially tailored mini-lessons; and technological accommodations for cognitive, sensory, and motor impairments. A primary purpose of the program is to help students with disabilities learn to write across content areas and use multiple genres to do so, as targeted by the CCSS. Sturm is still gathering empirical evidence on the effectiveness of the program. Qualitative evidence regarding the meaningfulness of this approach to special education teachers struggling to redefine their roles in relationship to the CCSS was offered by one teacher responding to an evaluation questionnaire:
"We've been told that we should be doing writing based on the general education curriculum and to show progress in our students, but we didn't have any way to do it. Up until this year, my students, who are high-school age, have been copying and tracing and writing their name and address. We need guidance to give us a way to provide differentiated writing instruction to our students that allows them to be authors and to share their writing with us and with their peers" (to appear in Sturm, in press).
Tyler was provided with individualized supports for topic selection in the form of verbal cues and physical assistance to locate materials in his "Author Toolkit"; use his "places to get topics" tools and communication board to choose a writing topic; choose a photo image for his writing topic; and "use your letters to tell what you want to share today." He also received verbal reminders that he could make a comment, and, when taking a turn, he was provided with the talking stick and a digitized device that allowed him to review a range of comments and make an independent choice.
For writing, Tyler used traditional and assistive writing tools including a pencil or marker, a laminated alphabet board, a dry-erase board with word choice pairs presented by the adult, and a word processor. For support in communication, Tyler was assisted with multi-item choices, yes/no questions, emoticons, photo images, a Big Mack switch to ask, "Any questions or comments?" after his writing is shared, digitized AAC devices that offered choices to praise a student writer (e.g., awesome or cool) and make comments about an author's writing (e.g., "I liked your picture" or "I liked your words"); and a microphone for use during Author's Chair.
One of the challenges of documenting progress for students with severe disabilities is that most assessment tools are not designed to detect the small but important advances in their learning. One way SLPs may be able to contribute to meaningful implementation of the CCSS with students with disabilities is to develop sensitive assessment tools for measuring these advances. Tyler's progress was detectable using a new "Developmental Writing Scale" proposed by Sturm and Nelson (in press), which is showing promise as a reliable measure valid for capturing evidence of emergent writing. Tyler advanced from Level 2 (scribbling) to Level 3 (random letter patterns). Whereas he only touched his pencil to the page and produced some scribbles during baseline observations, he scribbled using circular motions and repeatedly wrote the letter "t" across his paper at the end of the school year.
He also chose letters using an alphabet board and using a computer keyboard, showing motivation to work on the computer by pointing to the computer, smiling, bouncing up and down and moving quickly to the chair in front of the computer, and staying and working independently at it for 15–20 minutes. During this 37-week period of instruction, in which he participated with classmates in the enriched writers' workshop approach, he also moved from selecting only school bus pictures for his topic to selecting 11 different topic pictures out of 37 opportunities. At the end of the observation period, Tyler was able to vocalize before and after his work was read and make eye contact with his audience.
Case Study 3: Charles
Charles is a 15-year-old boy in 10th grade who is struggling with performance in academic classes. He is an outgoing, personable young man who excels in sports. He has many friends and engages in activities typical of adolescents. He is has a history of language learning disabilities and is currently receiving services from a learning disabilities (LD) teacher, not from an SLP. According to school records his measured IQ (nonverbal) is well above average. District test results indicate that reading and writing skills are both at a fifth-grade level, with math skills at grade level. His parents are becoming increasingly concerned that he is not making the kind of progress in mastering high school curriculum standards that will result in his receiving a standard diploma.
Common Core State Standards
If Charles is to earn a standard diploma he will have to master all of the English/Language Arts standards, which will include specific literacy requirements in history/social studies, science and technical subjects, and mathematics standards in the CCSS. Given his reading and writing status, it is reasonable to assume that he will have difficulty with all the 9–10 standards. At this level it is difficult to separate standards, as they involve increased interconnectedness.
Although his school records indicate that his math performance is at grade level, one has to question this measure. Given his reading and writing levels and his history of LLD it would be reasonable to suspect that higher-level math may be problematic for him and deserving of more in-depth investigation.
At the outset, it is essential that the SLP investigate the continued role of language difficulties in Charles' performance, because ample evidence suggests that children diagnosed with language impairment at early ages continue to have language problems as they get older, although the symptomatology may change. After working with Charles' teachers to identify the specific successes and challenges he is experiencing in the classroom and after analyzing work samples, the school SLP conducted two, two-hour evaluation using the following instruments/procedures: Test of Adolescent and Adult Language-Fourth Edition (TOAL-4; Hammill, Brown, Larsen, & Wiederholt, 2007); Test of Language Competence-Expanded Edition (TLC-Expanded; Wiig & Secord, 1988); informal oral language sample; informal writing sample. Based on Charles' performance on the TLC-Expanded and considering the problems described by his teachers, the SLP also conducted an informal diagnostic teaching session on inference.
Results of the TOAL-4 showed that relatively simple written language tasks are an area of comparative strength for Charles. However, based on analysis of his written language sample, his writing is well below expectations for a 10th-grader and is more consistent with fifth-grade-level production. The TOAL-4 also showed that his spoken language is significantly below normal limits.
Results of the TLC-Expanded corroborated his difficulty with spoken language. On that test, Charles struggled with the metalinguistic skills needed to interpret and utilize complex language, such as figurative language and ambiguous sentence constructions. As a result, we would expect difficulties with both processing and production of language to have a significant negative impact on the performance of the complex academic tasks required of adolescents.
Results of an oral language sample confirm Charles' difficulty expressing himself orally, even in conversation. Specifically, his ability to convey intent and communicate his thoughts is impaired. He exhibits many linguistic dysfluencies, including repetitions and fillers. These dysfluencies should not be considered speech dysfluencies or stuttering. On a positive note, in a diagnostic teaching session Charles responded well to explicit instruction in inferences, demonstrating a good prognosis for therapeutic intervention. Specifically, targeted explanations and practice with inferences resulted in improved understanding and performance in tasks centered on this skill. The SLP also made arrangements to work with Charles' math teacher to corroborate grade level performance and investigate any possible language interference factors.
Diagnostic Teaching Session
An informal diagnostic teaching session was conducted based on the results of the inferences section of the TLC-Expanded. The purpose of this session was to introduce Charles to some helpful techniques that would address his difficulties with inferences and to further investigate underlying factors. Charles was first taught what an inference was and how a person learns how to infer from background knowledge. When asked to explain an inference, Charles responded that he couldn't give a definition. After more explanation, Charles was able to come to a correct conclusion that an inference is a "good guess." Charles went through five examples and identified multiple inferences for each statement. He was then administered five more statements with multiple-choice answers. Charles correctly chose the answer for each question, but showed difficulty when explaining his reasoning for his choice. When asked why he chose an answer, Charles responded by listing the other choices and saying that those were not the answers.
When probed further, by selecting each answer and asking why he did not choose that one, Charles responded with a more accurate response than just repeating the incorrect choices. Following the questions, Charles was asked again to explain an inference. With some encouragement, he was again able to reach the conclusion that an inference is a "good guess."
Based on the results of the evaluation, it is recommended that Charles receive more intensive intervention in the language underpinnings of listening, speaking, reading and writing to facilitate his academic learning with intervention, focusing on the following areas:
- Construct different forms of words (word derivations; e.g., democracy/democratic).
- Use complex clause patterns to express complex thoughts.
- Interpret ambiguous sentences and making inferences in academic texts.
- Formulate a coherent sequence of thoughts (fluency of ideas).
These areas should be addressed in both spoken and written language in the context of the curriculum he is encountering in school. Specifically the words, clauses, sentences, and discourse structures targeted for the work above should come from the textbooks and primary source materials teachers are using in content classes. Further, specific attention should be paid to the variations in language encountered in different disciplines.
It is important to note that the targeted areas for intervention noted above will play a role in all of the 9–10 CCSS in English/Language Arts (and perhaps Mathematics). Therefore, the SLP will need to work closely with classroom teachers to integrate all the components that compose these complex standards at the high school level. It is not a simple matter of choosing one or two standards to target. All these standards will be germane, with the SLP focusing on the language underpinnings foundational to them all. For example, the standard "Analyze in detail a series of events described in a text; determine whether earlier events caused later ones or simply preceded them" (Reading Standards for Literacy in History/Social Studies Grade 9-10, Key Ideas and Details) would require competence in all of the targeted areas noted. The same would be true of the following standard:
Write arguments focused on discipline-specific content.
- Introduce precise claim(s), distinguish the claim(s) from alternate or opposing claims, and create an organization that establishes clear relationships among the claim(s), counterclaims, reasons, and evidence.
- Develop claim(s) and counterclaims fairly, supplying data and evidence for each while pointing out the strengths and limitations of both claim(s) and counterclaims in a discipline-appropriate form and in a manner that anticipates the audience's knowledge level and concerns.
- Use words, phrases, and clauses to link and clarify the relationships between claim(s) and reasons, between reasons and evidence, and between claim(s) and counterclaims.
- Establish and maintain a formal style and objective tone while attending to the norms and conventions of the discipline in which they are writing.
- Provide a concluding statement or section that follows from or supports the argument presented.
(Writing Standards for Literacy in History/Social Studies, Science, and Technical Subjects Grade 9-10).
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