Vol. 18 •Issue 40 • Page 5
Services for Students with LLD
One school's model
In the broadest sense the term language learning disabilities (LLDs) refers to difficulties with different facets of communication. The neurologically-based disorders affect the ability to understand or use spoken and/or written language. Students with LLDs may demonstrate deficits in age-appropriate spoken language, which is a prerequisite to literacy skills, as well as reading, writing and spelling skills. These deficits have negative repercussions for a child's ability to succeed in the school setting.
Individuals with language-based learning disabilities have average or above-average intelligence. While their disorder may be subtle or pervasive in its presentation, certain language characteristics frequently are observed. Challenges include difficulties with overall spoken language and language that is full of meaning, rather than fillers and non-specific words. There may be challenges with word retrieval, answering questions and following directions, especially those of increasing length and complexity.
Individuals with LLDs may have difficulty understanding stories and classroom information, remembering details, and understanding temporal and directional concepts and sequencing. Phonological awareness deficits also may be present. Each student is unique, with particular strengths and needs. It's important to understand the constellation of deficits students have in order to maximize their successes.
Speech-language pathologists in the school programs at Kennedy Krieger Institute, in Baltimore, MD, face the daily challenge of providing speech and language services to hundreds of children who require support for spoken and written language in order to succeed. Our special education school programs have nearly 650 students, ages 3-21. Many struggle with LLD characteristics, and even more struggle with language issues corresponding with neurological impairments such as autism spectrum disorders, traumatic brain injury, genetic and medical syndromes, and cognitive limitations.
We have developed a pyramid model that enhances the ability of students with LLD and others to succeed in an educational setting. At the base of the pyramid is classroom-based service delivery. This provides the solid, necessary support to enhance the language learning needs of students.
Speech-language pathologists work with special educators in the classroom to maximize every student's language abilities and academic access. They use the curriculum content as a basis for classroom-based oral language lessons. This reinforces the material being taught while allowing the speech-language pathologist to foster specific spoken and written language skills. Students derive additional benefit from a focus on functional language for peer and social interaction during the oral language sessions.
For example, Lydia Manni, MA, CCC-SLP, led students in being part of a PowerPoint presentation on the butterfly life cycle. Over the course of weeks, the students acted out the stages of the life of a butterfly. They used a multi-modal approach to learn essential science vocabulary, follow complex directions, sequence events, and learn directional and temporal concepts. The students burst through paper eggs, became caterpillars, crawled through their chrysalis, and emerged as butterflies.
The kinesthetic component of the lessons enhanced the language learning. Classroom-based language sessions such as these play a vital role in enabling students to learn and practice language skills in the most functional academic setting possible.
At the next level of the hierarchy are push-in services. In this classroom facilitation tier of the pyramid, students who require extra language support derive benefit from the proximity of the speech-language pathologist, who serves as an "in-house" facilitator to assist their access to and comprehension of classroom content. Techniques used to benefit students with LLD include visual supports, graphic organizers, pared-down language, rephrasing and comprehension checks. They receive the support in the location they most need it-the classroom.
The top level of the pyramid is comprised of traditional pull-out speech-language therapy. Students have the opportunity to focus on specific skills and strategies in a small, intimate setting. Pull-out therapy may be used successfully with these students to work on skills such as memory strategies, word-retrieval strategies, techniques for identifying key information, and other deficit areas. Adequate practice in this forum can increase their chance of successfully using techniques in the classroom setting.
Clinicians have reported a number of successes with students who have language impairments. One speech-language pathologist spoke about a child whose struggles included sentence formulation difficulties, understanding prepositions, and using irregular plurals. A pull-out dyad provided this student with the opportunity to learn and practice these discrete skills. As these skills continued to grow, he demonstrated improvement in applying them in the classroom setting. The additional support of the pull-out approach enhanced his ability to comprehend the academic information as well.
Another clinician discussed student successes in applying memory strategies to classroom work. When given three-step directions in class, for instance, a student was able to use verbal rehearsal to recall the directions accurately. Given the opportunity to learn and practice this skill in a supported therapeutic setting and push-in sessions, his ability to follow directions and retain academic information in the classroom was enhanced.
The "K-W-L" strategy has been used successfully with students. This structure helps students with LLD structure their thoughts and language in a way that allows classroom information to be more comprehensible. Students learn to ask, "What do I know? What do I want to learn? What did I learn?" This technique provides important language supports. Students apply the strategy to mastering curriculum content and to other life pursuits, such as making recipes and learning new games.
These examples illustrate how students with LLD benefit from accessing language support for spoken and written language at a variety of levels. A multi-tiered pyramid structure provides the basis for the ultimate goal of all students: improved access to curriculum content and enhanced social language for functional use. When combined with talented, creative clinicians and a thorough understanding of each child's language needs, a pyramid approach provides an effective and comprehensive service delivery model.
Patricia Laibstain is director of Speech-Language Services for School Programs at Kennedy Krieger Institute in Baltimore, MD. For more information, visit www.kennedykrieger.org.