Many school systems today use the RTI (see Chapter 3 for definition and further discussion) model, particularly in the primary grades, to attempt to resolve learning problems within the regular education setting, by providing classroom modifications and accommodations that can prevent the need for special education or for labeling a student as having a special educational need. RTI approaches are most often seen in the area of literacy instruction in the primary grades (Fuchs & Fuchs, 2009), although their use in other curricular areas and age levels is expanding (see, for example, Ehren & Whitmire, 2009; Justice, McGinty, Guo, & Moore, 2009; Montgomery, 2008). As we saw in Chapter 3, RTI uses a three-tiered structure (National Joint Committee on Learning Disabilities, 2009):

Tier I: High quality, scientifically research-based classroom instruction for all students in general education, with ongoing, curriculum-based assessment and continuous progress monitoring.

Tier II: Students who lag behind peers receive small group, more specialized instruction to prevent failure within general education.

Tier III: For students who continue to struggle after provision of intensified, small group instruction in Tier II, individualized instruction may be provided; if adequate progress is not made, comprehensive evaluation is conducted by a multidisciplinary team to determine eligibility for special education and related services.

RTI, then, is aimed at prevention of reading disability.

Children who are found, through the monitoring process, to have difficulty with regular classroom instruction in this model, may be provided first with accommodations within the regular program, such as sitting closer to the teacher, or using an assistive listening device; alternatively, they may receive RTI Tier II (small group, intensified) instruction for a specified period of time. If ongoing assessment finds these strategies are adequate, students may return to Tier I instruction with ongoing follow-up consultation to the classroom teacher. If however, the accommodations fail to lead to adequate progress, students may be either placed in a Tier III (individualized, intensive) instructional setting, where progress will continue to be assessed, or referred directly for special educational evaluation. If Tier III support is provided without special education referral, progress will continue to be monitored and a formal referral for special educational assessment is made only if this high level of support fails to yield adequate progress after a specified period of time. By the time a child is referred for an evaluation for special education, though, the SLP may have already had a chance to get to know him or her through participation in RTI.

Implementation of RTI provides a number of important roles for SLPs. Ehren, Montgomery, Rudebusch, & Whitmire (2009) suggest that SLPs in RTI settings can make unique contributions by (1) participating, through their knowledge of the connections between oral language and literacy, in the design of Tier I instruction by planning and conducting professional development on the language basis of literacy, helping to select scientifically based literacy instruction programs, and choosing appropriate screening and progress-monitoring approaches; (2) collaborating with general education teachers in presenting Tier I instruction, assisting with ongoing progress monitoring, and helping teachers develop accommodations within Tier I for struggling students; and (3) serving students by providing small group and individual instruction at Tiers II and III, and using a range of assessments from tests to observational methods to identify struggling students and monitor progress. While RTI involves changes from the way SLPs have traditionally operated in school settings, it provides opportunities, as well: opportunities to use more pragmatic, authentic assessment procedures to identify children having difficulty, to work more closely with general education teachers on ways to enhance language and literacy skills not only for children with special educational needs, but for students for whom school failure can be prevented with just a little extra “boost” early in their school careers, and to allocate time for indirect services such as supporting classroom teachers and others who work with children before referrals for special education happen. All these opportunities give SLPs the chance to be a more highly visible, integrated member of the school success team.

Still, SLPs will continue to be responsible for the communication skills of all children in public schools, such as those with intellectual disability, autism spectrum disorder, hearing impairment, and severe speech impairments. As Ukrainetz (2006) pointed out, SLPs may find their services needed both by students with recognized special needs and by students needing support within an RTI model, as a preventive measure. SLPs in work in settings that demand these dual roles may need to make adjustments in the organization of their delivery of services. We’ll talk about some of these options in Chapter 12.

Determining eligibility

One responsibility of the school SLP is to decide whether a student referred for speech-language services meets district eligibility criteria. Eligibility criteria, though, vary not only from state to state but in some cases from school district to school district. Just as we learned in Chapter 1 that there is no universally accepted definition of language disorder, there is no universally accepted criterion of eligibility for communication services in schools. Some states require a test score that is two or more standard deviations below the mean; others require two test scores that are 1.5 standard deviations below the mean, some a combination of test performance and severity rating, and so on (Moore-Brown & Montgomery, 2001). In districts that employ RTI, a student may be required to be tried at all three RTI levels before a referral for special education can be made.

Moreover, IDEA requires that whatever impairment the child has must adversely affect academic performance if services are to be provided. This requirement is interpreted rather broadly, though. Whitmire and Dublinske (2003) show that, because many state standards for academic proficiency include speaking and listening skills, children who have language problems may qualify for special educational services, even if their academic achievement is not significantly depressed by their communicative disorder. For example, even though residual speech errors on late-developing sounds such as /s/, /r/, and /l/ do not to carry great risk for literacy problems (Bishop & Clarkson, 2003), the presence of “speech/language impairment” as one category of disability eligible for special education services suggests that SLPs may include children with residual errors on caseloads, particularly if the errors affect social opportunities and acceptance. SLPs need to become familiar with the eligibility requirements and local proficiency standards of the school districts in which they are employed and learn to use these standards to find ways to provide services for all children with communicative needs.

Documenting present level of educational performance

When a student is deemed eligible for special educational services, the IEP includes a summary of the assessment information gathered on the child. A variety of areas are assessed by the educational team; these include intellectual functioning; readiness or academic skills; communicative status; motor ability; sensory status; health and physical status; emotional, social, and behavioral development; and self-help skills. Not every area needs to be assessed for every student, however. If deficits are restricted to speech and language, for example, present level of performance may be given in communicative areas alone. The law requires that multiple instruments be used, so that children are not identified as having a disability on the basis of only one test. Informal, observational, parent or teacher interview, and language sampling measures, as well as standardized instruments, can be part of this assessment, and information from previous assessments can also be used. The assessment of performance must also include information on how the child’s disability affects participation and progress in academic and social environments. For schools that employ RTI models, much of this information may be gathered through the course of the child’s participation in the various levels of RTI, thus economizing the new information that needs to be collected at the time of referral.

Writing individualized educational plans

Once a child has been identified as having a special need in the area of communication, the next step is to establish goals and objectives to meet these needs, as identified in the assessment. These goals and objectives are incorporated into the IEP, which contains the components listed in Table 10-1.

TABLE 10-1

Required Components of the Individualized Educational Plans

Component	Description
Strengths & concerns	Parent concerns and priorities, as well as child’s areas of relative strength are listed.
Evaluation results	Assessment results are reported and interpreted.
Present level of educational performance	The effect of the student’s disability on participation and progress in the curriculum is reported.
Annual goals	Long-term goals related to meeting general educational curriculum or other educational needs that result from the disability are listed in each area of disability.
Short-term objective and benchmarks	Measurable, sequenced steps toward annual goals are detailed.
Amount of special education or related services	Projected beginning date, frequency and types of service, and an estimate of duration are given.
Supplementary aids and services	Describes how the regular educational program will be modified so that the child can participate, how services will contribute toward this participation in the general education curriculum, as well as in extracurricular activities. Also contains information about the types of related services needed (SLP, occupational therapy, etc.). These services may be direct, as in one-to-one therapy, or indirect, as in consultation to the classroom teacher by the SLP. Any assistive equipment the student might need to participate in the curriculum (such as a hearing aid or an AAC device) is also listed.
Participation in regular education environments (least restrictive environment; LRE)	The extent of the student’s participation with students without disabilities in both educational and extracurricular settings is given. Accommodations might be included, such as support staff to help the child succeed in the setting, modifications in transportation and equipment, and behavioral interventions to manage problem behaviors in the classroom.
Test modifications	Modifications needed to participate in district-wide assessments of student achievement are given.
Transition services	Interagency responsibilities and community links to help student move toward adult placement are listed.
Notification of transfer rights	Documentation that the student has been informed of his or her rights when maturity is reached.
Evaluation procedures and measurement methods	How and when student progress will be measured (progress must be reported as often as it is for general education students). Progress must be evaluated at least once every 3 years, although it can be done more often. Assessment may be relatively short and may use existing data or observational records. Parents also must be informed of how the child’s progress toward goals will be measured, and they must receive progress reports as least as often as children in regular education receive report cards. The reevaluation can have three possible outcomes: (1) continuation—if the student is moving toward goals as expected, the plan can be continued without changes; (2) modification—if small changes in the IEP are needed to maximize student progress but the changes are not significant enough to warrant another IEP meeting; or (3) revision—if the IEP must be rewritten with significant changes because of lack of or greater-than-expected progress that warrants the targeting of new goals or a reduction in services needed. Parents’ consent must be obtained for the program to be changed.
IEP team members	Signatures of all IEP members, including parents, general education teachers, special educators, and administrators are needed.

Adapted from Moore-Brown, B., Montgomery, J., Bielinski, H., & Shubin, J. (2005). Responsiveness to intervention: Teaching before testing helps avoid labeling. Topics in Language Disorders, 25(2), 148-167.

Delivering services within the curriculum

Under IDEA regulations, SLPs no longer work separately on a set of language goals and activities they develop on their own. Whether they work in individual “therapy” sessions, with a small group of students within a classroom activity, or alongside the classroom teacher in a collaborative model, language activities are drawn from the general education curriculum, and goals address helping the student progress through it, to whatever extent possible.

Inclusion

The 2004 regulations place a greater burden on local education agencies (LEAs) to justify any placement that is not full-time in a mainstream classroom. However, this does not mean that every child must be placed in the general classroom all the time. The law requires that there be a continuum of services to meet the needs of children who are not placed in the mainstream full time. Moreover, the only alternative to full inclusion need not be a completely segregated program. Instead, there can be levels of involvement between these two extremes. SLPs will be involved in determining the nature and extent of inclusion for their students, and in finding ways to provide appropriate services within the mainstream setting.

These issues will be addressed again at each of the developmental levels we will discuss for the school-aged student. But for now, let’s get back to Nick. How can we define and characterize the language needs of children like him? What is the SLP’s role in ameliorating their problems? We’ll take these questions one at a time.

Students with language learning disabilities

Definitions and characteristics

Before we start talking about what children with LLD are like, let’s make sure we understand the terms often used to discuss them. Learning disability (LD) is perhaps the most general. IDEA 2004 defines learning disability as

“. . . a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations, including conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.”

However, learning disabilities do not include, “. . . learning problems that are primarily the result of visual, hearing, or motor disabilities, of mental retardation, of emotional disturbance, or of environmental, cultural, or economic disadvantage” [34 Code of Federal Regulations §300.7(c)(10)].

A more colloquial definition would be that LDs involve an unexpected difficulty, relative to age and other abilities, in learning in school. Unexpected is usually taken to mean that there is no obvious explanation for the child’s difficulty. So, as the IDEA definition states, the child may or may not have a hearing impairment, intellectual disability, emotional disturbance, autistic disorder, motor deficit, or lack of opportunity or experience, but even if these are present, they would not be sufficient to explain the learning problem. Many definitions of LD have traditionally included a discrepancy criterion. That means that eligibility for the label involved a significant discrepancy (and we saw in Chapter 1 how hard that is to agree upon!) between potential (usually meaning IQ) and achievement (usually measured by a standardized test of school performance) or between areas of development, such as between verbal and nonverbal IQ. The discrepancy criterion has now fallen out of favor, for many of the reasons we talked about in Chapter 1. In fact, in the 2004 reauthorization of IDEA, the law specifically states that a discrepancy between test scores does not have to be the criterion for eligibility for LD. LEAs may, under the new law, choose a different criterion, such as lack of response to scientifically-based instruction. This provision of IDEA has opened the door for the use of RTI as a method both of preventing academic failure and as a means of identifying children with learning disabilities.

Not all LDs are language-based. A student could have a specific learning problem in, say, mathematics or graphomotor skills that might not be based on a language weakness. But the U.S. Department of Education estimated in 2002 that 80% of children with LD have their primary difficulties in the language-based skills of reading and writing/spelling. For most children with LD, then, if other academic areas are affected, it is because of the underlying deficit in literacy. These LDs that affect primarily reading, writing, and spelling are the ones we will call language-learning disorders. We use this term to emphasize the fact that reading, writing, and spelling are language-based skills that draw on a foundation of oral language abilities. Students with LLDs have underlying weaknesses in their oral language base, even when speech might sound OK to the “naked ear,” and they often have histories of delayed speech and/or language development. We can think of LLDs, then, as one type—probably the most common type—of LD.

Another term in common use for the disorders we are calling LLD is reading disorder, or RD. Catts and Kamhi (2005b) use this term to refer to a heterogeneous group of poor readers whose weak language skills play a causal role in their reading difficulty. The “simple view” of reading (Kahmi, 2009), the view most prevalent among reading researchers today, holds that these reading disorders can be divided into two basic classes, as depicted in Figure 10-1. There we can see that children are given the label dyslexia when they have a deficit that primarily affects their ability to decode, or to translate letters into their corresponding sounds and synthesize the sounds to form words. The National Institute of Child Health and Development adopted this definition of dyslexia (Lyon, Shaywitz, & Shaywitz, 2003):

Figure 10-1 Classification of RD based on the Simple View of Reading (Adapted from Catts, Adlof, & Weismer, [2006]. Language deficits in poor comprehenders: A case for the simple view of reading. *Journal of Speech, Language, and Hearing Research, 49,* 278-293.)

Dyslexia is a specific RD that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.

Contemporary summaries of the current state of research on dyslexia (Pennington & Bishop, 2009; Pennington & Lefly, 2001; for reviews, see Catts & Kamhi, 2005b; Goswami, 2009; Pennington & Bishop, 2008; Pugh & McCardle, 2009; Ramus & Szenkovits, 2009; Scarborough, 2003; Shaywitz & Shaywitz, 2005; Snow, Burns, & Griffin, 1998; Snowling, 1996; Snowling & Hayiou-Thomas, 2006; Snowling & Stackhouse, 1996; Vellutino et al., 2004; Vellutino, Fletcher, Snowling, & Scanlon, 2004) show that the root of this specific reading disorder has been quite firmly established as an inadequate ability in word identification due primarily to deficiencies in phonological skills, with the involvement of specific brain regions demonstrated through neuroimaging studies (see Frost et al., 2009; Noble & McCandliss, 2005; Shaywitz & Shaywitz, 2005 for review). Evidence for visual processing disorders as a cause of dyslexia is very weak; children with dyslexia don’t reverse words and letters visually, as has been thought in the past. Instead, their primary difficulty is in the phonological awareness, memory, and coding skills that allow children to do phonemic segmentation and synthesis tasks, and learn to use the alphabetic principle—the understanding that words can be broken down into sounds and that letters stand for sounds which can be combined to produce words—to decode print. Other deficiencies in word recognition and reading comprehension stem from this basic difficulty in cracking the alphabetic code. A wide range of studies (e.g., Bradley & Bryant, 1985; Gillon, 2005b; Liberman & Liberman, 1990; Mann & Liberman, 1984; Noble & McCandliss, 2005; Scarborough, 2003; Schuele & Boudreau, 2008; Snowling & Nation, 1997; Stackhouse & Wells, 1997) has shown that phonological awareness is highly correlated with reading ability, and that treatment for phonological awareness is associated with increases in decoding skill (e.g., Ehri et al., 2001; Gillon, 2005b; Schuele & Boudreau, 2008).

Specific comprehension deficits, on the other hand, are those seen in children who typically have long-standing delays in oral language acquisition that affect their ability to comprehend language in any form, whether oral or written. These children may learn to decode in the first few grades and may manage early classroom texts normally, when their language content is simple and the demands on comprehension limited. These students run into difficulty in middle grades, when their weak oral language skills are inadequate to support the more complex content they need to process in grade-level reading material. Of course, some children may have both kinds of difficulties, as Figure 10-1 suggests.

So what’s the difference between RD and dyslexia? Most current thinking, represented by Catts and Kamhi (2005a), Catts et al., (2006), Snowling (1996), Snowling and Hayiou-Thomas (2006), and Vellutino et al. (2004), holds that dyslexia is part of a continuum of language disorders. What differentiates dyslexia from a more general LLD or RD is that dyslexia involves a specific deficit in single-word decoding that is based in a weakness in the phonological domain of the oral language base and has only a secondary impact on reading comprehension. It is a disorder affecting just one aspect of the reading process: decoding. Children with LLD, on the other hand, can have problems with both single-word reading and comprehension, and not only of written language, but of oral language, as well. These comprehension problems are thought to stem from difficulties the child has not only in phonological processing but in other language domains, such as syntax and semantics. Children with more general LLDs often have a history of delayed speech and language development as preschoolers, whereas those with dyslexia often do not (Snowling, 1996). We can think of dyslexia as a specific subtype of RD, which is a common subtype of LLD.

Will all children who fail to make progress in RTI have LLD? Since use of RTI to prevent school failure is relatively new, we don’t have a lot of hard evidence to answer this question. Essentially, though, if the theory behind RTI is correct, children who do not make adequate progress given the supports provided at Tiers II and III would be considered to have a learning disability that qualifies them for special education, by definition, since the definition of LLD is a difficulty in learning literacy that is unexplained by other problems and is not the result of poor instruction. In this sense, RTI is used to identify learning disabilities (National Joint Committee on Learning Disabilities, 2005). What about the converse? Will all children with LLD fail to make adequate progress in RTI? Again, this is partly a matter of definitions. If RTI is designed to separate children who just need a bit of extra help from those with biologically based learning disabilities, we would expect that children who can keep up with grade expectations given only the limited support Tiers II and III provide would not have a bona fide learning disability. But we won’t know for sure, at least until these children are followed throughout their academic careers to determine whether problems continue to crop up after early school years. In any case, the good news is that RTI approaches give the SLP an opportunity to support not only those children with identified disabilities, but to use our knowledge of language across modalities to serve a broad range of children who struggle to learn to read for whatever reason, and to increase our contribution to their success in school.

What are the communicative characteristics that we’ll see in children who do have language-learning disorders? A great deal of research has been done in recent years to describe these characteristics. Let’s look at some of the typical problems seen in students with LLDs and talk about what they might mean for academic achievement.

Phonological characteristics

School-aged children with LLD do not necessarily have obvious errors in their speech production, and their speech is generally intelligible. A good deal of research has examined the relationship between preschool speech delay and later reading problems. Generally, findings suggest a higher prevalence of speech disorders in children with LLDs than in the general population, with about 25% of children with LLD showing delayed speech development at school age, whereas only 4% to 6% of the general population does (Kuder, 1997; Pennington & Bishop, 2009). Hesketh (2004) and Leitao and Fletcher (2004) reported that, although most children with speech delays during the preschool period make adequate progress in reading once they get to school, a small number of them develop phonological awareness and literacy delays. Snowling, Bishop, and Stothard (2000) reported that reading outcomes are poorest for children with the most severe phonological disorders. As it is for other children, phonological awareness appears to be the best predictor of literacy achievement in these speech-delayed students. Stackhouse (1996) reports that these speech difficulties primarily affect the acquisition of spelling. Still, it is important to know that both Pennington and Bishop (2009) and Peterson et al. (2009) found that reading difficulties in children with a history of speech disorders were better predicted by their language skills (speech and language difficulties often go together in young children) than by their speech.

Even though children with LLD do not have significant articulation errors, they often show difficulty with speech perception, phonological memory and phonological awareness (Pennington & Bishop, 2009), as well as with complex phonological production in difficult words (such as statistics) or phrases (“Fly free in the Air Force”; Catts, 1986), or in repeating phonologically complex non-words (such as /tribabli/). Tests involving phonologically complex, multisyllabic words (such as aluminum) and unfamiliar nonsense words can be useful in identifying these children. Rvachew (2006) and Rvachew and Grawburg (2006) reported that speech-delayed children who have poor speech perception and low receptive vocabulary were at greatest risk. Rvachew advocates assessing both speech perception and vocabulary in making decisions about whether to provide intervention to prevent literacy difficulties in speech-delayed preschoolers.

Children with LLD have consistently shown problems with short-term memory tasks (Catts, 1989; Snowling, 1996). Bishop (1997) and Liberman and Liberman (1990) reported, though, that these deficits are restricted to memory for verbal material. Students with LLD generally have no difficulty with memory tasks involving nonverbal stimuli or environmental sounds. Moreover, children with LLD show weaknesses in the ability to do rapid naming and in non-word repetition tasks. When asked, for example, to say all the days of the week or to repeat nonsense words, such as flipe or wid, children with LLD perform more poorly than those with normal school achievement (Larrivee & Catts, 1999; Snowling, 1996; Wesseling & Reitsma, 2001). These problems may not sound phonological at first, but researchers believe that the source of this difficulty is in establishing and retrieving accurate phonological representations (or segmenting the words into sounds, then storing sound-by-sound auditory images and retrieving these images as a template for production) of verbal material. These same problems also are thought to be related to the word retrieval difficulties so commonly seen in children with LLD.

We can point to two important factors to remember about phonological skills in youngsters with LLD. First, phonological production may sound adequate; problems with phonological processing, including memory, perception, and complex production, that appear to be related to literacy can only be tapped by specially designed tasks. These include imitation of complex sound sequences, and activities that tap phonological awareness including segmenting words into constituent phonemes, counting sounds in words, producing words with one sound left out (such as fun without the /f/ sound), sound manipulation (such as reversing sounds in words), and sound categorization (such as identifying words that have the same last sound, like men and dawn), as well as nonsense word imitation and rapid naming assessments. Several measures have been devised to tap these abilities. They include The Test of Phonological Awareness (Torgensen & Bryant, 2004), Test of Phonological Skills (Newcomer & Barenbaum, 2004), The Phonological Awareness Profile (Robertson & Salter, 1995), The Comprehensive Test of Phonological Processing (Wagner, Torgensen, & Rashotte, 1999), and The Lindamood Auditory Conceptualization Test (Lindamood & Lindamood, 2004), to name a few. Tasks that ask children to produce rapid sequences of names, such as naming the months of the year, or to imitate nonsense words also are useful in this regard. The Rapid Automatized Naming and Rapid Alternating Stimulus Tests (Wolf & Denckla, 2004), as well as subtests from language measures such as the Clinical Evaluation of Language Fundamentals (Wiig et al., 2003) can be helpful here. Second, the research on phonological skills in children with LLD suggests that some of the deficits that appear to be related to memory or semantic ability may actually stem from these “underground” phonological skills, particularly the ability to segment, store, and retrieve words from memory on the basis of their phonological properties. This finding tells us that as we think about remediating skills such as word retrieval, we need to add phonological components to the intervention program.