Word Finding Difficulty (WFD) otherwise known as Dysnomia or Anomic Aphasia is difficulty recalling words correctly. In children it is more commonly part of a developmental difference rather than as a result of injury to the brain. WFD is most commonly identified as part of language based learning disabilities such as Specific Language Impairment and Dyslexia.
A person with WFD often has difficulty recalling the exact word they want to use in conversation. They may get around this by using less specific words like 'thing' or 'stuff', using umms, aahs and pauses or describing what they mean in a round about way. Sometimes the person is aware they can't think of the right word, and sometimes they just use the wrong word or mispronounce the word without realising, even when the correct word is part of their normal vocabulary.
In normal development, children build their vocabulary through lived experiences and what they hear and read. Not knowing the correct word for something is normal if we have not come across that word many times in life. For children with WFD, the difficulty can occur even with common everyday words, such as not remembering the name of their teacher, or saying 'mango' or 'lemon' instead of 'melon' by accident.
If your child seems to have difficulty using the correct words when talking about everyday things, or makes obvious errors on words they know, they would benefit from assessment by a Speech Pathologist.
Statistically every classroom in Australia has at least one child with Dyslexia, and yet Australian teachers are not provided with any standardised training to recognise Dyslexia or provide appropriate teaching for children with Dyslexia. Often, it is parents who are looking for answers to their child's learning difficulties, and find mixed messages about the causes and treatments for Dyslexia.
What is Dyslexia?
The International and Australian Dyslexia Associations' definition of Dyslexia:
“Dyslexia is a specific learning disability 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.”
Dyslexia is a genetic, life-long difference in the way the brain processes language. Dyslexia can be improved with appropriate intensive instruction in the core difficulties of reading and spelling.
But wouldn't it make life easier if you could put on a magic pair of glasses that enabled you to read and write like a non-dyslexic person?
The joint statement of the American Academy of Pediatrics, Section on Ophthalmology, Council on Children with Disabilities, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Association of Certified Orthoptists on Learning Disabilities, Dyslexia and Vision states that:
"Vision problems can interfere with the process of learning; however, vision problems are not the cause of primary dyslexia or learning disabilities."
The Royal Australian and New Zealand College of Ophthalmologists' statement on vision therapies for the treatment of specific learning disabilities such as Dyslexia is clear:
"Scientific evidence does not support the efficacy of eye exercises, behavioral vision therapy, or special tinted filters or lenses for improving the long-term educational performance in these complex pediatric neurocognitive conditions."
"There is no credible evidence to support claims for treatments such as vision training/therapy with or without combined neurodevelopmental training, Irlen tinted lenses and the Lawson anti-suppression device."
Speech Pathologists are qualified to diagnose and treat language development problems, including reading and writing difficulties. Educational Psychologists and Developmental Paediatricians also diagnose a variety of profiles of learning difficulties including ADHD and Dyslexia.
However, it is very important that any child with learning difficulties have their eyesight and hearing checked to make sure their eyes and ears are functioning optimally for learning.
Have you "researched" the psycho-neuro-cognitive-behavioural-braintraining methods? We've all heard and seen this jargon in marketing and popular media. "Researching" has come to mean looking something up on google (a far cry from conducting and evaluating actual academic research). Similarly, "Best Practice" has been used to describe well marketed or popular programs and methods that are widely accepted, whether or not they're effective or suitable to an individual. We also hear lots about "neuro...", "developmental...." and "cognitive...." et cetera. It seems the more jargon the higher the price tag, much like a designer logo.
The jargon was invented so academics and professionals in the field could efficiently communicate about specific concepts. It was not intended to replace Plain English and should not be used to impress, intimidate or persuade.
So, as parents, what can we do to cut through the marketing and the jargon, to find effective treatments for our children? How do we choose support services that will really make a difference for them?
Speech Pathology is an Applied Science, so we're trained to constantly question and measure whether what we do is effective. As a health service, we also have an ethical duty to use the most effective treatments based on the best scientific evidence available. This is what I call "best practice".
As a parent you are the expert on your child, their needs and what or who they respond well to. Ask as many questions as you need to find the right service for your child, then watch them and see for yourself whether the treatment is helpful.
Watch Speech Pathologists in action helping people like you and your family.
However, a small but increasing number of educators are accessing training about learning disabilities and the Disability Standards for Education. These teachers are recognising students' needs and increasingly seeking out the specialist support their students need.
Speech Pathology Australia is advocating for funding to be based on functional needs, rather than the individualised disability funding, from which most children with communication and learning disabilities are exempt.
For more information, check out Canberra University's guide to the Disability Standards for Education.
Hearing, listening, understanding what we hear and remembering what we hear is such an amazing process.
From hearing sounds to following complex instructions, there are many links in this chain.
When a child is not able to learn well from listening, they can miss the majority of teaching in a typical classroom.
One possible reason for this can be "Auditory Processing Disorder".
I was recently on a webchat about "Auditory Processing Disorders (APD)", with some experts from the American Speech and Hearing Association.
The label 'APD' is hotly debated in the research and amongst the allied health and medical practitioners who support children with learning disabilities. Many symptoms of APD overlap with disorders of language processing, sensory processing, behavioural and attention disorders, so a process of elimination is required for accurate diagnosis and effective treatment
Signs of APD:
What to do: Assessment
What to do: Strategies
ALL children learn better in a quiet classroom so...
ALL children learn best from doing, so for less talk more action...
What to do: Therapies
On the search to figure out what's going wrong with their child's learning, some parents find their child receives multiple diagnoses.
Symptoms of many learning disabilities overlap and multiple assessment perspectives can lead to multiple diagnoses.
Sometimes this happens when communication between parents, teachers and health professionals is not as clear and collaborative as it should be.
There's an old Indian parable about six blind men who each touch a different part of an elephant.
The man who touches the leg says the elephant is like a pillar.
The man who touches the tail says the elephant is like a rope.
The man who touches the ear says the elephant is like a fan.
You see where this is going.....
Receiving multiple diagnoses can be confusing and unhelpful to determining which therapies to prioritise.
Some aspects of development and learning are precursors to others. A delay or disorder in one area of development can affect therapy progress in other disciplines. So make sure the people assessing and treating your child have all the information they need from you and other professionals. That way you should get more wholistic advice.
Any service that is worth a parent's investment cannot work in isolation, or claim to be the only answer to your child's difficulties, especially if it sounds like a quick fix.
My advise is, when you receive multiple reports and opinions, ask yourself "what is the main area of functioning that is holding back my child's learning?", then prioritise one step at a time.
I am often asked what a Speech Pathologist does. Some people have come across Speech Pathology in hospitals or rehabilitation when their relatives suffer strokes, illnesses or injuries that affect their communication or swallowing. Some people think of a child they once knew whose speech was delayed, or someone they knew who had a stutter. Speech pathologists assess and treat anyone whose communication or swallowing is causing them difficulty in everyday life.
Communication skills include spoken and written communication. Spoken communication includes understanding and remembering what you hear and responding appropriately with clear speech that is easy for others to understand. Difficulties with understanding and expressing your thoughts can show up in reading and writing during the school years when these skills are developing and needed for academic learning.
The majority of learning difficulties that emerge in the school years are in part due to underlying problems with language processing, even in children who seem to understand and speak well enough. So, why a Speech Pathologist? Speech Pathology Australia's Literacy Factsheet explains how and why we play a crucial role in helping with literacy development.....
I was recently chatting with a teacher who made an interesting comment about one of her students, one of my clients; "If she would just apply that memory she uses in HSIE to her maths lessons, she could do much better in maths".
There are many reasons why a student may apply themselves better in one subject area than another, such as; interest in the subject, relationship with the teacher, whether the lessons fit their learning style, whether they are sitting next to their friend etc. etc.
This particular teacher is a master at accommodating these kinds of factors, to get the most from each student. However, in this case there was one interesting element missing from the analysis that came to light through her comment about the child's memory.
As I've mentioned in previous posts, some children with language difficulties also have difficulties with some parts of their memory but not others.
The most commonly known memory processes are "short term" and "long term" memory.
Short Term Memory holds small amounts of information for a short time, until distraction causes us to forget the information, or until the information moves into long term memory.
Long Term Memory holds large amounts of information from what we had for breakfast back to a movie we saw many years ago.
However, memory is a bit more complex and dynamic than just "short term / long term". Some memory processes require no conscious attention; images we don't consciously remember are captured by our "iconic store" and the "echoic store" briefly holds sounds we are not consciously listening to.
In the field of learning difficulties increasing attention has been given to a process known as "working memory", an essential skill in our busy school, work and home schedules.
Working Memory holds a limited amount of information, while we use that information to solve a problem, such as remembering an address, while we figure out the directions to get there. To do this we must be able to keep our conscious attention both on the address, and the problem solving process of figuring out the directions. Maintaining attention at this level can be very difficult for children with ADHD and for children with weak language or visual processing.
But back to the student who appeared to be applying her memory better to HSIE than to Maths. Another memory process that can be a struggle for children with certain learning difficulties is "procedural memory".
Procedural Memory is used to recall overlearned information such as reciting the alphabet or times tables and to perform automatic tasks such as driving a car. Getting information into our procedural memory requires sequencing and rehearsal. Contrasting with this process is "declarative memory".
Declarative Memory stores our personal experiences and general knowledge. Using this process we can store a piece of information in our long term memory just from a single experience, although even declarative memories can be strengthened by multiple exposures.
So, it became apparent the child in question was using her strong declarative memory in HSIE, but her weak procedural memory was holding her back in Maths. To improve her Maths, she needed to build her procedural memory through repetition and find ways of applying her strong declarative memory to Maths. Maths became as much fun as HSIE when she began using her declarative memory to relate maths problems to her daily experience with money, portions of cake etc and making up "Maths Stories" about taxes in imaginary kingdoms, and floating cars that travel at different heights to avoid crashing.
I love it when Speech Pathologists and Teachers put their heads together :)
Last month Australia had its first Gifted Awareness Week. What am I doing talking about gifted awareness week when I work with children with learning difficulties?
It was only about three years ago I discovered that amongst the most intellectually gifted students, about one in six also have a learning disability. This phenomenon was first recognised in the 1970's but an increasing body of research about gifted children with learning disabilities has emerged in the last decade. When identified, these children are most commonly given a diagnosis of "Gifted with Learning Disabilities (GLD)" or "Twice Exceptional (2e)".
However, many GLD children go undetected, either because their disability masks their potential, or their intellect masks their struggles. Either way, the cost to society and the individuals can be disruptive and destructive behaviours and mental health problems. On the flip side, when the GLD student is supported in their areas of interest and talent, they can be productive, engaged students who go on to enrich society through their areas of expertise.
Identifying the GLD child is the first step. Here are some signs to look out for:
• highly variable academic performance
• verbal language skills that far exceed their written work
• a sense of justice and fairness that does not translate to practical peer social skills
• better at individual work than team work
• low self esteem and/or academic self confidence
• poor organisation or time management skills
• classroom behaviour problems
• daydreaming in class and yet highly focussed in self-directed projects at home
• average or below average schoolwork with occasional flashes of creative insight
The definitive way to find out if this is why your child's school experience isn't working is to see an Educational Psychologist for an IQ assessment. Ideally this will be combined with information from their teachers, perhaps other health professionals and of course parents. For a diagnosis of "Gifted with Learning Disabilities" there will be a significant discrepancy between scale scores in different domains of the IQ test.
Meeting the educational needs of students with this profile is exceptionally challenging for the majority of schools that cater to the majority of students. It takes a dynamic team approach to really challenge and extend the GLD child in ways that also accommodate learning difficulties such as ADHD, sensory processing differences and dyslexia.
Unlike New Zealand, UK and USA, in Australia we do not yet have specialist schools for GLD students, so the onus is on parents and teachers to educate themselves in how to provide the best educational opportunities for these children. So here are some links to get you started:
And here are some famous faces of people who are Gifted with Learning Disabilities!
When a child is struggling with aspects of learning, many parents will turn to the internet for information, explanation and resources to help their child. If you have already been in this position you know what a minefield it is! Not only is the stream of information and opinion endless, but much of it is conflicting and sometimes confusing.
In Australia, the most common term used to describe these struggles is Learning Difficulties, but other common terms are Learning Disabilities, Learning Disorders, Learning Differences. There are valid explanations why each of these terms are used.
"Difficulty" may or may not be ongoing depending on the cause.
"Disability" implies a functional impairment.
"Disorder" typically implies a neurological condition.
"Difference" is a term sometimes used to avoid stigma.
A common acronym is LD - which covers all the basis, but is equally unclear.
Learning difficulties have many labels and even more treatment options. Figuring out whether any of these apply to your child is what professionals call a differential diagnosis. We must rule out what is not the cause of the difficulties and use sensitive assessment methods to determine an accurate diagnosis. This kind of thorough assessment means we can determine the most effective treatment for the specific needs of each child.
This is a complex process as many diagnoses overlap in their symptoms. The most common difficulties I assess in my practice involve listening, talking, reading, writing and memory. Obviously these all affect learning across all areas of the curriculum, and sometimes require diagnosis and treatment by more than one professional.
So how do you know who to turn to? Start with your primary concern, but be open to referrals across multiple professionals and be aware that aspects of our training and clinical practice do overlap.
Speech Pathologists assess and treat: language based difficulties affecting understanding, talking, reading and writing
Psychologists assess and treat: stress, anxiety, transitions at home or school, academic difficulties due to low or high IQ, attention, memory and behaviour
Occupational Therapists assess and treat: handwriting, sensory integration, organisation and planning that are important for functioning at school
Audiologists assess and treat: hearing and balance impairments and difficulties with understanding or listening due to auditory processing that can affect behaviour and academic progress
Optometrists assess and treat: difficulties reading or writing due to near or far sightedness or visual processing that may cause headaches and fatigue at school
Dietitians assess and treat: food allergies and sensitivities and nutritional deficiencies that may cause headaches and stomach aches or affect a students energy and ability to concentrate and learn
These professions are all bound by their code of ethics to diagnose and treat children only according to the best scientific evidence available.
Many treatments for learning difficulties that are well marketed through the internet and make sensational claims of cures and quick fixes are not thoroughly researched and their practitioners will not have the theoretical background to give you a differential diagnosis. So, before you hand over your hard earned dollars, ask whether the practitioner is qualified to provide a differential diagnosis, and whether their treatment methods are backed by independent scientific research.
"Spelling shmelling" I hear you mumble, "can't I just use spell-check?". Well, of course you can. But you may also want to improve your spelling. I quite often hear from people that spelling doesn't really matter as long as you can read. The thing is, that when I looked at the research on spelling, I found that reading and spelling really are two sides of the same coin. When we consistently spell a word accurately, we also read that word with greater speed and accuracy. To do this we need a really clear memory of the sequence of sounds and letters in the word.
Some children work their way through the reading levels with their peers but their spelling seems to lag behind, others struggle with reading and spelling from Kindergarten. Some students are functional readers, who do fine on their weekly spelling tests, but their creative writing is full of spelling errors and the speed or accuracy of their reading and writing may prevent them performing in tests and exams. Some researchers call this more hidden impairment "stealth dyslexia". All these children exert far more than the typical effort to complete reading and writing tasks, and far from being 'lazy' spellers, they are doing very well to keep up considering they are missing some of the basic skills normally developed along the path to fluent literacy.
So, what does good spelling instruction involve? Phonology, morphology and orthography are basics.
Phonological awareness is well established as a basic for reading instruction, but is also essential for spelling. It involves recognising the sounds and syllables in the word and sequencing them correctly for different words.
Morphology is often taught after reading and writing skills are established, but recent research shows that it is of benefit as early as Kindergarten to reading instruction, and it is also essential for spelling. It involves recognising the parts of words that change the meaning of a word. For example, the 's' on the end of "cats" means there must be more than one cat.
Orthography is the letters we use to represent the sounds of our language. English has a complex orthography, that is, many different ways to write a single sound, and often more than one sound for a particular letter. However, the majority of our orthography does follow predictable patterns or 'spelling rules' and parts that don't fit often become more logical once you know whether the word or part of the word came from Latin, Greek or Anglo-Saxon origins.
If your child is using 'read, cover, write, check', to memorise words for their weekly spelling test, but doesn't use phonology (the sounding out), morphology (the units of meaning in the word), and orthography (spelling 'rules') to inform their spelling choices, then they are probably getting letters in the wrong order or missing letters. These errors are affecting their reading too.
If your child is receiving good spelling instruction but still struggling with spelling and therefore reading too, there is probably an underlying difficulty that will benefit from specialist assessment. A good place to start is with a speech pathology assessment.
In Australia I'm called a Speech Pathologist, overseas we can be called Speech Therapists or Speech-Language Pathologists. Whatever the name, we provide assessments, diagnoses and therapy for more than just speech difficulties. Some 'speech therapy' is actually for language and literacy difficulties and even for swallowing and eating difficulties.
The 'who, where, when and how' of your therapy therefore depends very much on your needs. Traditionally, speech therapy was often a once a week appointment, mostly in a therapy room, sometimes with parents and teachers kept somewhat in the dark about the process.
In my practice I find I can make so much more of a difference to a child's language and literacy with the support of teachers and parents. It seems I'm not alone in my experience - the research clearly supports collaboration, and therapy that reaches into the child's daily life. So who is involved, where, when and how?
Who is involved? The research tells us that effective therapy is collaborative. When the therapist works closely with the parents and teachers who care for the child every day, that child has the support they need to practise their new skills daily.
Where does therapy happen? When therapy happens in a clinic room, the therapist has an extra job of working on how the child will transfer their new skills to their daily life at home and school. Gold standard programs such as the Lidcombe Program and the Hanen programs train parents and preschool teachers to do the 'therapy', because they are with the child in the places where he/she needs to communicate. For school age children, research shows the same principle applies - when specialist support is provided in the classroom, then skills are being taught and used right where they are needed. Some skills do need to be introduced in a quiet environment, sometimes in a group, sometimes individually, before they can be transferred to a busy classroom with background noise and other distractions.
When should therapy happen? Early intervention whenever possible gives the child the best chance of preventing difficulties from accumulating and providing strong building blocks for the next stage of development. The frequency of therapy is one of the keys to effective therapy and goes hand in hand with the 'who' and 'where'. Effective, evidence based programs are intense. They rely on daily practice, patience and motivation. When therapist, parents and teachers are consistent in their support of a struggling student then a child's skills and confidence can soar.
How is therapy done? Therapy can take the form of direct individual appointments, parent training, teacher training, group therapy, tele-therapy or any form that best meets the child's needs. Therapy goals are based on a thorough assessment of the child's needs. They are individualised to suit the strengths and weaknesses in the child's speech or language processing, which means no time or effort is wasted on tasks that do not affect improvement. Therapy is dynamic, even within one activity the therapist will shift the difficulty of the task to the correct challenge level for that moment, if something isn't working or could be more efficient, then changes are made accordingly. Motivation is key with any learning, so therapy tasks must be fun and achievable.
Speech Pathologists work in many different settings and specialise in different problems, so I recommend you consider the 'who, where, when and how' when deciding on the therapist that will best fit your needs. Finally, be sure to check your speech pathologist is registered with our professional body "Speech Pathology Australia" as a "Certified Practising Speech Pathologist" (CPSP). This means they are bound by our code of ethics and professional standards, and are using current evidence based methods in their practice.
If a child is struggling with writing then they need more practice with pen and paper, not more screen time, right? Well, that depends how they're using the screen time. There are new apps coming out all the time that can really be a great help to students who struggle with writing, by allowing them to record their ideas using text, voice and illustration all in one document. While this may not make their handwriting neater or their sentences more complex, it will help them record their ideas and share their knowledge. Isn't that what writing is really all about? So here are a couple of writing apps for iPad that I like:
Little Bird Tales for iPad
This app is a great creative tool for a child who likes to draw and tell stories. With a very simple layout and toolbox they can create a multi page book that can be shared by email.
Using the touchscreen they can draw and write straight onto the page, or upload and edit photos and draw or write on them, and type text onto the page. But best of all, they are not restricted to writing or typing because they can make a voice recording for each page.
The program can be used on a wide range of devices including desktop computer which is great for collaborative classroom work or homework, just go to www.littlebirdtales.com for all the options.
PaperPort Notes for iPad
Some students find that writing takes so much effort, they forget or mix up what they intended to say. That's when 'speech to text' or dictation software is a great assistant. This app stands out above others because it uses Dragon voice recognition software, so even if you don't have a newer iPad with a built in dictation function, your child can still use the 'speech to text' option to make a voice recording that will be converted to text on the page. This may seem like a soft option, but they will still need to read and edit this text when the iPad inevitably mishears a word or phrase. Just like many note-taking apps, you can also upload and edit documents or photos to annotate, highlight and illustrate. Just like "little bird tales" you can also make an audio recording for each page and print or share the whole document or individual pages via email, google drive, dropbox or box.
Thankfully our children grow out of many medical, developmental and behavioural concerns, but can the same be said of speech, language and literacy difficulties?
Many scholarly academics have asked the same question, so we have quite a body of research that tells us when a child is more or less likely to 'grow out of it'.
The variation in children's communication skills in the toddler and preschool stage is huge, and most children fall within the range of normal development. Speech errors are common in little children, but they should have resolved by the time they've completed their first year at school. Children who struggle with both speech and language development in the early years, especially those who struggle to understand what is said to them, are more likely to continue to fall behind their peers. These children benefit a great deal from early diagnosis and therapy. Likewise, children with relatives who had difficulty with language and learning are more likely to have persistent difficulties.
Once children hit school age, the normal range of speech and language ability within their agegroup becomes less varied. Children who were delayed in understanding longer words and sentences at preschool, or those with delays in both speech and language development, are more likely to struggle with learning to read, spell and write fluently. Some children with a family history of difficulties with reading, spelling and learning may only begin to fall behind their peers at this stage. These children may have kept up with their peers in the toddler and preschool years, but begin to struggle when reading and writing become the focus of learning at school. At this stage a child can suffer quite a hit in their self esteem without positive support from family, teachers and a therapist qualified to diagnose and treat their difficulties.
In short, the answer to "Will my child grow out of it?" won't be the same for every child. Early intervention is always best, before difficulties and expectations multiply or self esteem is affected. If you have concerns about your child's speech, language or literacy, just pick up the phone to a Certified Practising Speech Pathologist .
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