20Q: Preventing Reading Difficulties in Children with Language Disorders

From the Desk of Ann Kummer

Reading is such a fundamental skill for learning and success in life. Unfortunately, children with early verbal language problems tend to have additional difficulties when they begin learning written language. It is so important for speech-language pathologists to address the precursors to reading when working with children with early language disorders. Therefore, I am delighted that Laura Justice, PhD, CCC-SLP, an expert in language and reading disorders, has agreed to share her knowledge with us through this 20Q article!

Dr. Justice is the EHE Distinguished Professor of Educational Psychology at the Ohio State University. In 2017, she was also recognized as an OSU Distinguished Scholar. Dr. Justice is currently the Executive Director of the Crane Center for Early Childhood Research and Policy at OSU, which is a multidisciplinary research center focused on increasing the wellbeing of children through research, practice, and policy. Dr. Justice’s research primarily focuses on young children who exhibit developmental vulnerabilities in language and literacy acquisition. Much of her research considers the effects of teacher or parent implemented interventions on children’s learning, including the effective use of storybooks.

In this 20Q article, Dr. Justice discusses the evidence that shows the relationship between early language disorders and reading difficulties. She clarifies the difference between a reading difficulty, a reading disability, and dyslexia. Importantly, Dr. Justice describes the precursory (or early literacy) skills that are necessary for reading and methods to identify these skills. Finally, she provides information about tools that are available for children with language disorders who are at greatest risk for reading difficulties.

This 20Q article provides some key facts and useful information regarding this very important topic. It will be of great interest to all speech-language pathologists who work in pediatrics.

Now...read on, learn and enjoy!

Ann W. Kummer, PhD, CCC-SLP, FASHA
Contributing Editor 

20Q: Preventing Reading Difficulties in Children with Language Disorders

1. It has been suggested for some time that children with language disorders are at heightened risk for reading difficulties. Is this true?

 Yes, there is consistent evidence indicating that children with language disorders, such as those with developmental language disorders, are more likely to be affected by reading difficulties than typically developing children. A seminal work on this was conducted by Hugh Catts and his colleagues, which suggested that more than 50% of children with developmental language disorders had poor reading skills in the elementary grades (Catts, Fey, Tomblin, & Zhang, 2002).

2. I’ve heard that children with language disorders have problems with literacy development in preschool, but don’t these problems go away with time?

Unfortunately, it seems that the opposite might be true. A study by Paul Morgan and his colleagues examined the trajectory of reading development for children with language disorders compared to typically developing peers (Morgan, Farkas, & Wu, 2011). At kindergarten, children with LI performed about .4 SD lower than those without disabilities in reading achievement (Morgan et al., 2011). Over time, however, the gap between the two groups widened: by fifth grade, children with LI performed .8 SD lower than those without reading disabilities. Such work has led to great interest in determining how reading disabilities among children with LI can be prevented, potentially by enhancing children’s early-literacy skills prior to entrance to formal schooling and the rigors of reading instruction in kindergarten.

3. What is the difference between a reading difficulty and a reading disability?

I use the term ‘reading difficulty’ to reference children who are not reading at the level they should, given age, year in schooling, background, and so on. Data drawn from the National Assessment of Educational Progress indicate that about 36% of fourth graders are proficient readers; conversely, 64% are not (see www.nationsreportcard.gov/reading_math_2015/#reading?grade=4). Children who are not proficient readers can be viewed as having reading difficulties (i.e., struggling with reading). Many of these children are not proficient due to the effects of poverty and race on educational achievement in the United States; they may attend schools with limited focus on reading or that have chronic problems. In comparison, I use the term ‘reading disability’ to describe children who have unexplained problems in reading development, such as those with dyslexia.

4. Why is reading difficulty a concern for me, as a speech-language pathologist?

Language problems often lead to reading difficulties, for reasons I highlight shortly. I often argue that reading difficulties is the greatest ‘handicap’ to be faced by children with language disorders. If one cannot read, they are unlikely to succeed educationally and in other areas of life (social relations, post-secondary education, etc.)

5. Why is it that so many children struggle with reading achievement, including those with language problems, but others as well?

Reading development is extremely complicated. It is considered a multi-component skill that is developmentally complex. Reading growth is affected by numerous aspects of one’s environment as well as basic cognitive and affective facilities of the individual. It is, unfortunately, easy for progress in reading to stall; for instance, attending an elementary school that is very low in quality can have drastic consequences for students’ reading achievement. At the same time, having cognitive issues that affect the skills and processes upon which reading draws – such as the visual, linguistic, and auditory systems – can also compromise development.

6. I’ve always thought that children fail at reading because their parents don’t care about reading or don’t read regularly to their children.

There are parents who – for many reasons – don’t’ understand enough about early literacy development to provide their children crucial experiences with reading in the early years. However, when children struggle with reading, it’s not because of ‘one thing’ that happened, or failed to happen, in their lives. Usually, reading difficulties reflect a conglomeration of issues that raised to a threshold so as to circumvent the child’s reading development. For instance, it may be that a child is born with a significant intellectual disabilities, contributing to very little motivation to read or be read to. In turn, parents (and teachers and others) read less to that children and develop low expectations about the child’s future as a reader. As I mentioned previously, reading development and difficulty is an extremely complex phenomenon, and seldom is there every one cause or concern that lead to the child’s difficulties.

7. I don’t have much formal training in reading. Is there a prevailing theory or conceptual framework that I can use to understand more about reading?

I like the ‘simple view of reading’, or SVR (Gough & Tunmer, 1986), as a theoretical framework to conceptualize reading. SVR posits that reading (R) is the production of decoding (D) and linguistic comprehension (C), or R = D x C. Decoding is, simply put, one’s ability to apply the alphabetic principle to decode words, whereas linguistic comprehensive is, more or less, one’s language skills. We can therefore conceptualize a child with reading difficulties as having problems with decoding and/or linguistic comprehension, either of which can compromise reading ability.

8. What is dyslexia? I’ve heard a lot about it but don’t quite understand it.

Dyslexia is a particular group of struggling readers who have adequate C (linguistic comprehension) but very poor decoding skills. Thus, persons with dyslexia can understand complex texts that they hear, but cannot decode them. There is a disconnect between their linguistic comprehension skills and their decoding skills. A subset of children with language disorders have decoding problems and can be described as dyslexic.

9. I heard that dyslexia is caused by problems with phonology. If that’s true, can’t we treat the phonology problem to solve their reading difficulties?

I wish this were true. There is a strong link between dyslexia (decoding-specific reading problems) and phonological skills, such as phonological processing. Providing treatments to these children that address core phonological problems can improve their reading skills. However, because reading skill is complicated, this is not usually a ‘magic bullet.’ Oftentimes, children with dyslexia are not identified early enough to resolve their phonological problems and they may have lost precious instructional time in reading development and are quite far behind. Also, they may have motivational issues due to not being able to read grade-level texts. It’s important to not be fooled into believing that there is a single program or approach that can easily fix dyslexia. It’s often a life-long issue that needs ongoing, thorough attention.

10. Some children have good decoding skills (i.e., they are not dyslexic), but they don’t seem to understand what they read. What’s up with that?

These children are typically described as ‘poor comprehenders’ – these children have fine decoding skills (and phonological processing) but don’t understand what they read (L M Justice, Mashburn, & Petscher, 2013). These children tend to have poor underlying language skills, including issues with grammar and vocabulary that compromise their ability to comprehend what they read. Often, these children have ‘sub-clinical language problems’: language issues that are not significantly severe as to warrant professional intervention by a speech-language pathologist. Thus, it seems that poor comprehenders are in grave danger of falling through the cracks.

11. I’ve heard a lot about the importance of preventing reading difficulties. How do we prevent reading problems in children?

The key to preventing reading difficulties in young children is to address those issues that give rise to reading problems early in the child’s life. For many children, reading development formally begins in kindergarten or first grade when they are taught to read by their primary-grade teachers. However, there are precursory skills that this reading development and reading instruction will build upon. If we – parents, teachers, speech-language pathologists – help children arrive to reading development with these precursory skills in place, they are much more likely to respond to, and thrive in, beginning reading instruction.

12. What are some of the precursory skills?

The most prominently discussed precursory skills – often called early literacy skills – include vocabulary, grammar, narrative, phonological awareness, and print knowledge. The first three are conventional language domains likely familiar to speech-language pathologists. These skills are important precursors to the C (linguistic comprehension) in the SVR. The latter two – phonological awareness and print knowledge – are important precursors to the D (decoding) in the SVR. Phonological awareness represents the young children’s growing sensitivity to sound structures in spoken language, whereas print knowledge represents the young children’s growing knowledge about print forms and functions. All of these precursory skills have reliable, longitudinal associations to future reading achievement (Lonigan & Shanahan, 2009).

13. How do researchers identify precursory skills that are important to a child’s future reading achievement?

The most common approach used by researchers is longitudinal work. Researchers will sample a number of children prior to reading instruction, usually around 3 or 4 years of age, and administer them numerous early assessments representing possible candidate precursors of reading. The children are then followed through the early stages of reading development, and researchers can use various statistical approaches to identify those early skills that are the more consistent and reliable predictors of future reading achievement. This is how we know, for instance, that children who have sufficient knowledge about the alphabet at age 4 years tend to be better readers in their future and, conversely, are less likely to experience reading difficulties (Lonigan & Shanahan, 2009).

14. Aren’t reading problems the responsibility of the reading teacher?

First of all, there is no ‘reading teacher’ in the elementary grades. Children have a generalist educator who is responsible for all content area instruction, reading included. Second, teachers who serve as primary-grade generalists do have training in reading, typically several courses focused on the basics of reading development and methods to teach reading. However, they are likely not sufficiently skills in delivering the tailored assessments and interventions needed to identify how to address a given child’s issues. When children struggle with reading, providing a sufficient level of response to remediate these problems is oftentimes far more than the primary teacher can take on. For this reason, schools often have numerous specialists who can step in and provide additional supports, including school psychologists, special educators, and speech-language pathologists. So, no – reading problems are not the responsibility of the reading teacher. Reading difficulties are a serious issue for many students, and we need to have ‘all hands on deck’, so to speak, to identify and address these issues when they occur.

15. Can you help me understand why children with language disorders seem susceptible to reading problems?

There has been much work done on this issue, and the general evidence implies that the same underlying issues that contribute to diagnosis of a language disorder also are implicated in reading difficulties. This is because reading, at least the C part of reading (linguistic comprehension), IS language. However, this isn’t the entire story. There is some evidence suggesting that children with language disorders may be less motivated to participate in literacy activities (Kaderavek & Sulzby, 1998), which lead to lessened experience in the types of experiences that can promote reading growth. It is also true that language problems tend to run in families, thus children with language disorders may have parents who themselves have language problems and comorbid reading problems. In turn, such parents may provide a less robust home-literacy environment to their children. Finally, it is also possible that teachers and therapists might lower their expectations regarding reading achievement for children with language disorders. If this were to occur, they might provide fewer instructional opportunities that further hinders their reading growth.

16. Are there effective interventions for improving the early literacy skills of children with language disorders?

Yes! There has been considerable attention to this issue in the scientific literature over the last decade. Researchers have tested avenues for increasing phonological awareness among children with language disorders (L M Justice, Kaderavek, Bowles, & Grimm, 2005) as well as print knowledge (Lovelace & Stewart, 2007). Perhaps the greatest limitation of such work, however, is that there is little longitudinal evidence showing that early literacy interventions delivered to children with language disorders have long-term benefits to reading achievement. However, one recent study showed that children with language disorders who received a literacy intervention during preschool maintained their early growth in literacy to one-year post-intervention (Laura M Justice, Logan, & Kaderavek, 2017). More work like this will be instrumental in learning how we can improve the long-term reading outcomes for children with language disorders.

17. I’ve often heard that when parents read to their children, it can boost their reading achievement. Is this true?

There is evidence that home-based reading between parents and their children can be influential to their children’s early reading development (Mol, Bus, & de Jong, 2009). However, it is most certainly not a ‘magic bullet.’ At best, exposure to regular reading in the home boosts children’s early reading skills a modest amount, and getting parents to read daily to their children will not be sufficient to address significant reading difficulties. In such cases, professional intervention is most important.

18. I often work with children and adolescents with very significant communication challenges; for instance, some of the kids I work with are nonverbal. I don’t feel that expecting them to ever be able to read is realistic.

It is not irrational to focus on more basic needs for children with significant communication challenges than focusing on reading development. However, children with even quite severe communication and intellectual difficulties can develop some basic reading skills, and this can be crucial to their future vocational outcomes. For instance, developing some sight-word recognition can open the door to an individual having a job that requires such recognition. There is important work underway that is helping us re-focus on the literacy potential of individuals with severe disabilities (Erickson, 2017), including those with autism (Dynia, Brock, Justice, & Kaderavek, 2017), and I would suggest that it’s better to be overly optimistic than to over-estimate.

19. Are there tools available that could help me to identify early on those children with language disorders who might have problems with reading in their future?

Yes, there are several tools that are very simple to use and freely available. There is a phonological awareness screener in the appendix of an article by Catts and colleagues (Catts, Fey, Zhang, & Tomblin, 2001) that can help to identify children who have poor phonological awareness and might benefit from early intervention. We’ve also published a tool in the appendix of an article (L M Justice, Bowles, & Skibbe, 2006) that can be used to identify children who don’t have a sufficient grasp of print concepts prior to kindergarten. Even simply determining how many letters a child knows prior to kindergarten can be informative (Piasta, Petscher, & Justice, 2012). There are many such tools out there; what is key is that these are used to identify as early as possible children at risk for future reading problems so that preventive maneuvers can be put in place.

20. I work with a lot of school-aged children with high-functioning autism spectrum disorder. A lot of these kids seem just fine reading. This surprises me – what’s going on?

Children with high-functioning autism spectrum disorder (ASD) often have certain skills that help them in the area of word recognition, such as strong visual processing and memory systems. Thus, a child with ASD might be able to visually recognize words in texts more readily than their typically developing peers. Where kids with ASD tend to struggle, however, is the C part of reading, in that their language skills are often insufficiently developed to deal with high-level comprehension of texts, especially as texts become increasingly complex. For children with ASD who seem to be good readers, it’s important to ensure that their comprehension of texts is well developed as well.