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In this article, the authors assist teachers who are working with young students at risk for reading disabilities by helping make sense of the large—but unwieldy—scientific knowledge base. They offer a conceptual framework for thinking about beginning reading instruction and intervention across three dimensions: the content of instruction (what to teach), the delivery of instruction (how to teach), and the timing of instruction (when to teach). The authors discuss each of these dimensions and describe how teachers can use them to help organize and make sense of what we know about beginning reading instruction for students experiencing reading difficulties.

Abstract The purpose of this study was to compare 2 methods for directly teaching word meanings to kindergarten students within storybook read‐alouds that varied in instructional time and depth of instruction along with a control condition that provided students with incidental exposure to target words. Embedded instruction introduces target word meanings during storybook readings in a time‐efficient manner. Extended instruction is more time intensive but provides multiple opportunities to interact with target words outside the context of the story. Participants included 42 kindergarten students who were taught 9 target words, 3 with each method. Target words were counterbalanced in a within‐subjects design. Findings indicated that extended instruction resulted in more full and refined word knowledge, while embedded instruction resulted in partial knowledge of target vocabulary. Implications are discussed in relation to the strengths and limitations of different approaches to direct vocabulary instruction in kindergarten and the trade‐offs between instruction that focuses on teaching for breadth versus depth.

This article examines the role of direct instruction in promoting listening and reading comprehension. Instructional examples from 2 programs of intervention research focused on improving comprehension; the Story Read Aloud Program and the Embedded Story Structure Routine are used to illustrate principles of direct instruction. An analysis of these 2 approaches suggests that direct instruction principles are effective in supporting students with varied achievement levels and that these principles can be used to enhance comprehension among students at very different points in reading development. These evidence-based approaches also illustrate that direct instruction can be designed to support complex learning and the development of higher order cognitive strategies.

The purpose of this prospective study was to determine if fiberoptic endoscopic evaluation of swallowing (FEES) maintains high intra- and interrater reliability in detecting pharyngeal dysphagia and aspiration without the addition of FD&C Blue No. 1 to food. Twenty consecutive adults referred for a swallow evaluation participated. Nine subjects received blue-dyed food and 11 subjects received regular nondyed food, i.e., yellow pudding and white skim milk. Four variables were rated: (1) the stage transition characterized by depth of bolus flow to at least the vallecula prior to the pharyngeal swallow; (2) evidence of bolus retention in the vallecula or pyriform sinuses after the pharyngeal swallow; (3) laryngeal penetration defined as material in the laryngeal vestibule but not passing below the level of the true vocal folds either before or after the pharyngeal swallow; and (4) tracheal aspiration defined as material below the level of the true vocal folds either before or after the pharyngeal swallow. Three speech–language pathologists experienced in interpreting FEES results independently and blindly reviewed the digitized videotape three times. Intrarater agreements for the four variables with blue-dyed and non-blue-dyed food trials were 100% and monochrome trials ranged from 95% to 100%. Average kappa values for interrater reliability ranged from moderate to excellent agreement (0.61–1.00) for all viewing conditions. Kappa values for blue-dyed trials versus monochrome trials were 0.83 and for non-blue-dyed trials versus monochrome trials were 0.88, indicative of excellent reliability under both viewing conditions. FEES maintains both high intra- and interrater reliability in detecting the critical features of pharyngeal dysphagia and aspiration using either blue-dyed or non-blue-dyed foods. The endoscopist, therefore, can be assured of reliable FEES results using regular, non-dyed food trials.

In the acute-care setting patients with altered mental status as a result of such diverse etiologies as stroke, traumatic brain injury, degenerative neurologic impairments, dementia, or alcohol/drug abuse are routinely referred for dysphagia testing. A protocol for dysphagia testing was developed that began with verbal stimuli to determine patient orientation status and ability to follow single-step verbal commands. Although unknown, it would be beneficial to ascertain if this information on mental status was predictive of aspiration risk. The purpose of this investigation was to determine if there was a difference in odds for aspiration based upon correctly answering specific orientation questions, i.e., 1. What is your name? 2. Where are you right now? and 3. What year is it?, and following specific single-step verbal commands, i.e., 1. Open your mouth. 2. Stick out your tongue. and 3. Smile. In a consecutive retrospective manner data from 4070 referred patients accrued between 1 December 1999 and 1 January 2007 were analyzed. The odds of liquid aspiration were 31% greater for patients not oriented to person, place, and time (odds ratio [OR] = 1.305, 95% CI = 1.134–1.501). The odds of liquid aspiration (OR = 1.566, 95% CI = 1.307–1.876), puree aspiration (OR = 1.484, 95% CI = 1.202–1.831), and being deemed unsafe for any oral intake (OR = 1.688, 95% CI = 1.387–2.054) were, respectively, 57, 48, and 69% greater for patients unable to follow single-step verbal commands. Being able to answer orientation questions and follow single-step verbal commands provides information on odds of aspiration for liquid and puree food consistencies as well as overall eating status prior todysphagia testing. Knowledge of potential increased odds of aspiration allows for individualization of dysphagia testing thereby optimizing swallowing success.

Purpose: To compare the amplitude, latency, morphology, and threshold of the auditory P300 using standard oddball and omitted paradigms. Research Design: P300 waveforms were measured from the Cz electrode site. Frequent stimuli for both paradigms were 1000 Hz tone bursts. Target stimuli for the standard oddball paradigm were 2000 Hz tone bursts and an omitted stimulus, or silent gap, for the omitted paradigm. Study Sample: Fifteen bilaterally normal-hearing young adults. Results: There were significantly lower amplitudes, poorer morphology, and higher thresholds for the P300 using an omitted paradigm compared to the standard oddball paradigm. Conclusion: These results suggest that the auditory P300 could have a larger exogenous component than traditionally thought.

Determining the relative efficacy of various intervention programs for auditory processing disorders (APD) is a major goal in the field of rehabilitative audiology. Currently, because of their widespread availability, the most commonly used measuring tools to assess the central auditory system have been behaviorally based. Such measures do have notable disadvantages in that they may be influenced by a number of extraneous variables that may impede, or at least influence, efficacy measures. Electrophysiologic measures offer unique advantages not available from the behavioral measures. A significant amount of research has been completed offering compelling evidence relative to the clinical utility of a number of these electrophysiologic measures, including the maximum length sequences-auditory brainstem response, the middle latency response, the obligatory long latency responses, and the MMN and P3 event-related potentials. This article will review the current research related to electrophyiologic measures and present a rationale for including them in the management program.

Background: There is an increasing recognition that the communication problems one observes in persons with aphasia extend beyond verbal deficits and that the myriad of symptoms observed are not solely due to a faulty linguistic system. Rather, there exists a coalition of causal elements resulting in a wide range of communicative deficits. There is some preliminary evidence suggesting that communicative success of clients with aphasia may depend on the integrity of executive function skills. Executive functions are called into play when an individual is involved in a complex, novel activity. They allow us to plan, sequence, organise, and monitor goal-directed activities in a flexible manner as demanded by situational and environmental changes. When linguistic skills are impaired, individuals need to rely on other cognitive skills in order to communicate. Aims: The purpose of this study was to explore executive functioning ability in persons with aphasia. Methods & procedures: A total of 15 individuals with aphasia and 12 healthy control subjects participated in this study. Three dimensions of performance were examined (accuracy, speed, and efficiency) in the context of neuropsychological tests designed to examine cognitive flexibility and goal-directed planning (Wisconsin Card Sorting Test, Porteus Maze Test, Tower of London, and Tower of Hanoi). Outcomes & results: Results indicated that the two groups performed with similar levels of accuracy on two of the four tests. However, significant differences were found on all speed and efficiency variables, suggesting decreased executive functioning skills in the group of individuals with aphasia. Conclusions: It is important to consider executive functioning ability in clients with aphasia and attempt to determine the influence of executive function skill on communicative performance. Understanding the cognitive abilities as well as the linguistic abilities of these clients may ultimately help clinicians determine which patients are better candidates for intervention as well as which treatment approaches would be most efficient and beneficial.

This study examined script knowledge in 20 subjects who sustained a stroke (10 with left hemisphere brain damage and aphasia and 10 with right hemisphere brain damage) and 10 neurologically normal subjects. Script knowledge was examined via performance on three tasks: procedural sequencing, procedure production, and procedural discourse. Neurologically normal subjects performed all tasks accurately, and all subjects in the stroke group completed at least one of the three tasks for each script accurately, suggesting that script knowledge was preserved in this mildly brain-damaged population. However, significant differences were obtained between the neurologically normal and stroke groups when overall performance was examined. These findings suggest that additional cognitive processes influence task performance. Implications of these findings are discussed.

Introduction Communication deficits are one of the core symptoms of autism spectrum disorders (ASDs). People with ASD can be slow to begin talking, or may not learn to talk at all; others may learn to produce words and sentences but have difficulty using them effectively to accomplish social interactive goals. In this chapter we will discuss the course of the development of communication in ASD and will outline how communication deficiencies in this population are identified and treated. Before we do, however, we should be clear about three important terms we will be using, which are illustrated in Figure 4.1. The term “communication” is the broadest of this trio. It refers to all forms of sending and receiving messages, not only with language, but in other ways, such as with gestures, body language, even the way we dress. Animals can also communicate by means of their vocalizations to alert others to danger, for example. That's why the largest circle in Figure 4.1 represents communication. Within the realm of communication, language represents a specific type, so it is enclosed within the larger circle of communication in the figure. Language involves the creation of a potentially infinite set of never-before-conveyed messages through the combination of words in rule-governed ways that allow the formation of sentences to express meaning to others. © Cambridge University Press, 2007 and 2009.

This study was designed to evaluate maximum length sequences-auditory brainstem responses (MLS-ABR) in children with auditory processing disorders and to compare these results with a normal control group matched for age, intelligence, and gender. Although each waveform was analyzed for the presence of waves I, III, and V, the primary focus was wave V. Although absolute latency measures for wave V were obtained from all subjects, waves I and III were not always identified. Although the results showed latency increases for all waveforms in both groups, the only significant difference noted was an increase in wave V latency for both the left and right ears in the clinical group. These results suggest that the MLS-ABR may be useful in the assessment of auditory processing disorders. Implications for the potential use of the MLS-ABR in management programs are discussed.

Research on receptive language development in typical children, especially as explicated in a classic paper by Robin Chapman, is reviewed. These findings raise three challenges for clinicians assessing comprehension in children with language disorders: (1) contrary to popular wisdom, comprehension does not always precede production in a simple step-by-step way; (2) comprehension is a private event; indicators of comprehension must be used to assess it, and these indicators can be misleading; and (3) children with subtle comprehension deficits may do well on standardized tests that are not sensitive to their difficulties with real-time discourse. Some strategies for addressing these challenges, as well as a framework for assessing comprehension, are offered.

A total of 240 speech-language pathologists responded to a questionnaire examining attitudes toward and use of research and evidence-based practice (EBP). Perceived barriers to EBP were also explored. Positive attitudes toward research and EBP were reported. Attitudes were predicted by exposure to research and EBP practice during graduate training and the clinical fellowship year (CFY). Clinical experience and opinions of colleagues were used to guide decision making more frequently than research studies or clinical practice guidelines. Only exposure to research and EBP during the CFY predicted use of evidence-based resources. Respondents reported a decline in exposure to research and EBP as they moved from graduate training into the CFY. A lack of time was perceived as a barrier to EBP.

Background: Because communication deficits caused by aphasia affect both persons with aphasia and their communication partners, most speech-language pathologists are aware of the importance of client and caregiver education. To maximise the effectiveness of their communicative interactions, training should be conducted for both the aphasic clients and their caregivers. Training conducted in group environments offers peer support through shared learning experiences and joint problem solving. Aims: The purpose of this study was to explore the benefits of a caregiver education and training programme in improving communication between caregivers and their aphasic partners using didactic and experiential approaches in a group setting. Methods & procedures: Ten caregivers and their aphasic partners, ranging from 4 to 130 months post-stroke, participated in a 12-week group training and education programme. Information about stroke and aphasia was provided in a didactic format, and facilitative communication strategies were discussed and practised using Kolb's (1984) experiential learning cycle model. The experiential learning cycle involved drawing on concrete experiences, engaging in reflective observation and abstract conceptualisation, and practising what was learned through active experimentation. Outcomes & results: Analysis of communicative performance on transactional and interactional tasks demonstrated increased communicative success. Responses on a questionnaire indicated that participants had a better understanding of aphasia and were more confident using facilitating strategies. Conclusions: Group education and training for caregivers and their aphasic partners can be beneficial, even after the couple has been living with aphasia for a number of years. Having an opportunity to practise, observe, and reflect on their performances facilitated participants' learning, and there were observed and reported positive alterations in interactions. © 2005 Psychology Press Ltd.

Speakers with autism spectrum disorders (ASD) show difficulties in suprasegmental aspects of speech production, or prosody, those aspects of speech that accompany words and sentences and create what is commonly called "tone of voice." However, little is known about the perception of prosody, or about the specific aspects of prosodic production that result in the perception of "oddness." The present study examined the perception and production of a range of specific prosodic elements in an experimental protocol involving natural speech among speakers with ASD between 14 and 21 years of age, in comparison with a typical control group. Results revealed ceiling effects limiting interpretation of findings for some aspects of prosody. However, there were significant between-group differences in aspects of stress perception and production. The implications of these findings for understanding prosodic deficits is speakers with autism spectrum disorders, and for future research in this area, are discussed.

Thirty-one Connecticut group home managers responded to a 23-statement survey adapted from the Communications Supports Checklist for Programs Serving Individuals with Severe Disabilities (CSC; McCarthy et al., 1998, Paul H. Brookes, Baltimore, MD.). Results indicated that group home managers had very favorable opinions about the implementation of communication quality indicators in their group homes, and the degree of a resident's intellectual disability was not a factor in communication supports implementation. Three communication quality indicators were rated especially high: program philosophy, protection of communication rights, and assessment. Environmental support for communication was rated less favorably. Follow-up interviews with seven group home managers found that they especially valued direct care staff who understood a resident's idiosyncratic communication (e.g., response sensitivity). Managers also relied on team process for referral for ongoing speech-language consultation. Results from the surveys and interviews indicated that augmentative communication applications occurred less often than other quality communication indicators.

OBJECTIVE: The purpose of the present study was to investigate the value of a new gap detection procedure called Gaps-In-Noise (GIN) for assessment of temporal resolution in a clinical population. DESIGN: The test consists of 0 to 3 silent intervals ranging from 2 to 20 msec embedded in 6-sec segments of white noise. The location, number, and duration of the gaps per noise segment vary throughout the test for a total of 60 gaps presented in each of four lists. The GIN procedure was administered to 50 normal-hearing listeners (group I) and 18 subjects with confirmed neurological involvement of the central auditory nervous system (group II). RESULTS: Results showed mean approximated gap detection thresholds of 4.8 msec for the left ear and 4.9 msec for the right ear for group I. In comparison, results for group II demonstrated a statistically significant increase in gap detection thresholds, with approximated thresholds of 7.8 msec and 8.5 msec being noted for the left and right ears, respectively. Significant mean differences were also observed in the overall performance scores (i.e., the identification of the presence of the gaps within the noise segments) of the two groups of subjects. Finally, psychometric functions, although similar for short and long duration gaps, were highly different for gaps in the 4- to 10-msec range for the two groups. CONCLUSIONS: A variety of psychoacoustic procedures are available to assess temporal resolution; however, the clinical use of these procedures is minimal at best. Results of the present study show that the GIN test holds promise as a clinically useful tool in the assessment of temporal resolution in the clinical arena. Copyright © 2005 by Lippincott Williams & Wilkins.