140: SLP Live: Get Ready! How to Diagnose and Assess Dyslexia

This episode is part of a digital conference event called SLP Live. Listening to this episode does not automatically guarantee ASHA CEUs. If you want to earn .1 ASHA CEUs, download the playbook, join the Facebook community, and grab the other courses materials for this episode, please register for the conference, SLP Live, using this link: Tasseltogether.com/courses/slp-live-2022

TRANSCRIPT

[00:00:00] Venita Litvack: Hi, everyone. Thank you so much for coming. We are super excited to discuss this topic. It is called get ready, how to diagnose and assessed dyslexia, which we've had a lot of requests to do more pod courses on dyslexia. And if you're not familiar with me, my name is Benita lip back, and I have a passion for AAC, assistive technology and literacy.

I've had the opportunity to deliver poster presentations related to AAC, Asher, and coauthor. The knows what to do. Books series published by voice sound press. I'm also the host of the speechie situp podcast and a newish mom to a 14 month old daughter. And I'm super thrilled to have this guest on today.

Heather Caska. Thank you so much for coming. I'll let you go ahead and introduce. 

[00:00:53] Heather Caska: Great. Thanks so much. Um, I'm Heather Caska. I am a speech language pathologist, and I've been practicing [00:01:00] for just about 10 years, maybe a little over 10 years now. So I am the owner of HBC language and literacy. It's a, I'm a new business owner.

I started, um, in the midst of a pandemic, believe it or not just decided that I was, um, ready to kind of do my own thing. I had just had my second baby and, um, going back to work after that was just really hard and I just knew I wanted to do something different. So, um, that summer I decided to, uh, leave my position as a clinic director at, uh, a really well-known and great clinic here in the valley, um, in Arizona and decided to start my own business.

So it's been, definitely been an experience, but, um, it's been really fun. Uh, I have a variety of experience of working with a variety of communication disorders. So I've been working with pediatrics, uh, for. Eight or nine years, my first year and a half, I was in a skilled nursing facility, but knew that just wasn't for me.

Um, but very quickly I became very passionate about working with kids with dyslexia. I was first [00:02:00] introduced, um, to dyslexia and undergrad at the university of Arizona. I had, uh, Dr. Tiffany Hogan, who's very well known in our field for her work in dyslexia and reading disorders. Um, and I had her for my pediatric disorders course, and I remember doing, um, reading some research articles about it, and it was just so fascinating to me.

And then as I started working in the field a little bit more, I kept running into these, um, students and these parents who just had these concerns and I just wasn't quite sure what to do with them. And so I just started doing more research and had some guidance from some other SLPs and, um, just started doing a ton of training and education, um, to, to learn more about dyslexia.

Um, like I said, I live here in Arizona in a small suburb of Phoenix called queen Creek, uh, with my husband and I have two kids Kaysen who just turned five and Jamie who just turned two. Oh, 

[00:02:52] Venita Litvack: well, congratulations on your little one and your new business. That's pretty amazing, um, that you [00:03:00] started it in the midst of the pandemic, but it seems like it's going well.

So that's great. And that's also amazing that you, you know, worked with Dr. Tiffany Hogan. You know, I've also heard about her, so I'm just really excited to learn more about dyslexia from you today. So, Here's the agenda. We are doing our introductions and backgrounds now, and then we'll get into a discussion about the early signs of dyslexia.

Then we'll talk about different areas that you need to assess and the role of the SLP and dyslexia assessment, as well as a discussion of different assessment protocols to consider. And then we'll wrap up with a live Q and a at the end and briefly my relevant financial disclosures include that I have ownership interest in speechie situp LLC and tassel, LLC.

And I received royalties from the Lunas, what to do book series. I am also a member of [00:04:00] ASHA's special interest group 12. Uh, Heather, I'll let you go ahead and share your, uh, financial disclosures as well. 

[00:04:07] Heather Caska: Uh, I am as mentioned earlier, the owner of HDC language and literacy, and also the co-founder of early birds learning specialists.

Um, I'm also being offered a stipend for the podcast interview today. Uh, I also am the past chair of the, um, chair of the professional development committee for the Arizona speech language hearing association, uh, and the current president of the Arizona chapter of the international dyslexia association.

Um, and then I do also have family members that have been affected by dyslexia. Oh, wow. 

[00:04:37] Venita Litvack: Yeah. Thank you for sharing that. So by the end of this podcast, we hope that you'll be able to identify three signs of dyslexia, three areas to assess for dyslexia, define the role of the SLP in diagnosing dyslexia and identify two assessments to consider for a dyslexia evaluation.

All right, let's get into [00:05:00] it. Heather, what are the early signs of dyslexia that SLPs and professionals should be looking 

[00:05:06] Heather Caska: for? Um, I think this is such a great question because this is one area. I think that I'm the most passionate about when it comes to our roles as SLPs for dyslexia. Um, I, and again, how I kind of started, we are, um, the first professionals that come in contact with these students in most cases.

Um, so some of those, if you look at those early signs that are listed there, it all has to do with speech and language. So. Something I've found in my experience, um, and working and working with these early kids. Um, and then even having parents come back a couple of years later and say, Pam, they're really struggling in school.

Now. It just kept, um, again, making me want to know more and learn more. So one of the biggest signs that you can look for, we know that dyslexia is genetic. And so I always always ask about family history of [00:06:00] dyslexia. Um, but I learned very quickly not to ask specifically about dyslexia because eight times out of 10, I would get no, you know, no one in our family has dyslexia, but the more we talk to the family or the more we ask questions, we ask the parent, you know, we would hear, well, I really struggled in school.

Um, you know, I, or dad, you know, dad got special help in school or so-and-so dropped out of school because it was really hard. So that right there, um, is, is a big red, uh, big. That, um, that there is, you know, probably an undiagnosed reading disorder that runs in the family. Um, we know that it's very common for dyslexia to be undiagnosed.

Uh, so just getting more information, a very detailed family history about, um, speech language and, and any literacy disorders. Um, so some of those other earlier signs are just delayed language skills, delayed speech skills. I think one important thing that we talked about too with, um, delayed speech skills is.

The child [00:07:00] doesn't necessarily have to have a diagnosed speech sound disorder for it to be an early indicator of dyslexia. Um, there's a difference when we, when we think of, you know, those speech sound disorders, or even a practice childhood apraxia speech, um, we think very common, like typical patterns, right?

We think those one logical processes, final consonant, deletion stopping. Those are a big, um, early indicator, but also we often have these, these, um, kids that we see where maybe it's a teacher or the parent, you know, depending how well they are, who are just, you know, they have concerns about their speech.

You know, they just don't say words. Right. But then when we give them an articulation test, nothing, nothing comes up. Um, so these are those kids that really just have more phrase specific, or even words, specific errors. Um, very common ones we hear all the time are like the spaghetti for spaghetti, where they're transposing sounds within.

Um, my, my son, he's very into [00:08:00] superheroes Avengers. And so he always says bow Avengers. Um, and he just, when you have specific words that you hear errors on, and so those students often aren't picked up on just like a speech assessment. Uh, so that's just another early indicator and, and to watch out for, so if, if someone's referring them for a concern, but even though you give them a test and they score with an average, or you don't see anything, make sure we're doing, um, speech samples or ask for exact, um, or specific samples of errors that they're seeing specific words, because those are patterns that we also want to be on the lookout.

Um, these are students that also have a really hard time learning colors, numbers, days of the week and letters. Um, I recently about evaluated a little girl and mom told me that, um, she's so smart, but she just, every day when they pick her up from preschool, she could not for the life of her. Remember like the letters that she [00:09:00] learned that day, or the sounds that they need.

And so that was just another, um, early sign that there was something going on because they just couldn't figure out why of all things. That was the one thing that she couldn't remember. Um, Those wrote a memo, rightly you know, days of the week, months of the year. Very difficult with that. Again, difficulty pronouncing words that kind of goes back to that speech, those speech skills that I was talking about, learning new vocabulary, or even just word-finding difficulties.

Uh, this is, um, another thing that I've noticed a lot in my own son is he has a really hard time remembering the names of things. Um, even if it's something that he's been familiar with for a long time, he'll just get stuck and he'll be like, oh, I can't remember that word. Um, so, so just difficulty word finding in general and then those early phonological awareness sounds so rhyming identifying sounds in words.

Um, so if you have a student that just can't seem to, um, make that connection, that's [00:10:00] definitely an early indicator that there might be something else. 

[00:10:04] Venita Litvack: Okay, thanks for sharing those. I found the, the fact that like, they aren't necessarily picked up on like an articulation test to be really interesting.

Why is it that some children with dyslexia have trouble with the rope memory piece? 

[00:10:20] Heather Caska: That's a great question. Um, I think a lot of it goes back into, so when we talk about like the underlying deficits of, um, dyslexia, the number one deficit is a phonological deficit and then research is showing that the second one is working memory.

Um, and I think it's just that ability to process that information, um, and, and hold it long enough, you know, to, to do something with it. So it's just one of those complicated networks that I think makes it really difficult for, for kids to remember something that is so. Familiar and automatic. And I think that's the thing that makes it hard too, is every, just like [00:11:00] any other disorder, every child with dyslexia is different and there's going to be different profiles for each kid.

Um, and so you won't see that all the time, but that is definitely something that you're going to, that's not uncommon for you to see. Okay. 

[00:11:16] Venita Litvack: Very helpful. Thank you for sharing that. And I know we'll get into different assessments and screeners that we'll probably look at some of these areas. So I'm excited to learn more about that too.

Anything else that you wanted to talk about in terms of early signs 

[00:11:28] Heather Caska: of before we move on? No, I think again, just really hitting home and understanding that we are often, you know, those for that, the first professionals. And so I think it's really important that we understand our job as an SLP is to really advocate.

So not necessarily saying that if you get a four year old or a three-year-old on your caseload are referred to you. That you need to be, you know, assessing for dyslexia right away. But knowing that these are very common, common patterns. And if you know, there's a family history, if you [00:12:00] know, they have an older brother in school, that's already getting special education services or struggling in school or the parents did, we need to be educating the family on how to advocate for this child and just advocating.

Um, and working on some of those, you know, lots of prevention is, is under our scope of practice. So working a lot on those phonological awareness skills, we're getting things in place to help them, um, with any potential learning difficulties. They may have a lot of these students also, you're gonna see very, um, they have difficult executive function, difficulty regulation is going to be a big issue.

Um, so just kind of working with the family and working with other professionals, whether you're in a private sector or you're in the schools and collaborating with, you know, the OT and the teachers, um, special education teachers. So, um, we're, we're often just going to be those first ones to identify them early on.

And that early intervention for dyslexia is key. Um, oftentimes we think early intervention by kindergarten and first grade, [00:13:00] but we know that it can be identified as early as five. Um, and oftentimes those students are still in preschool at that time. So I think it's just really important to recognize how.

Vital our role is in that early identification. 

[00:13:15] Venita Litvack: Yeah. Thank you for sharing that. So what areas should be evaluated for dyslexia? 

[00:13:23] Heather Caska: So, um, on, it just depends again, on the age of the child. So kind of sticking with that early intervention model first and identifying those students. So obviously we want to look at those speech sounds, um, productions, uh, through, you know, you can do it through formal testing.

Again, lots of specific examples from parents, language samples. So making sure you're looking at how their phonological system is set up, um, that phonological processing, um, phonological awareness and logical memory, even rapid automatic naming tests is really helpful, obviously for our younger students.

Um, they may not know the names of letters and numbers, and again, we know that that's [00:14:00] often a difficult task for these students. So. Um, you can use colors or pictures of objects, and also just a very comprehensive look at their oral language skills. So, um, you ha you can have students where they have strong oral language skills, you know, an early identification of dyslexia, but research has shown that students that are diagnosed with dyslexia, even if they have typical oral language skills are at risk of developing language difficulties.

Um, so I'll obviously just always looking at, um, expressive, receptive language skills. I already mentioned the rapid automatic naming working memory again. Um, like I had said previously is another big component in these students with dyslexia. Um, the speech sound productions, written language, um, when we're talking written language, we want to look at decoding spelling, um, reading comprehension and written expression.

So the whole gamut of written links. [00:15:00] It's very common for, uh, assessments to use nonsense words when you're looking at decoding and spelling. And I get parents ask me that too. They ask me that all the time and I had one mum recently, actually, she, um, she was so frustrated with it. She's like, I just don't understand.

She's like, why, why would you have to use nonsense words? Cause obviously they do that in the schools too. And, um, so just explaining that, you know, these students also often have very good visual memories and so they're good at memorizing words. So if you give them real words, you run that risk of them being familiar with that word and just knowing it.

So if you use the nonsense word, then you're really assessing that sound letter correspondence, that orthographic knowledge. And that's what we need to know. We need to know where the breakdown is. And so just kind of explaining that to the parent. Obviously, when we're talking about a younger student, you're not going to be assessing their decoding skills depending on their exposure.

If they're in preschool and how much they've been exposed to the alphabet and letters, you can even just [00:16:00] look at their alphabet knowledge. Um, their early phonological awareness skills is it's the big one to look at that the rhyming syllable segmentation, um, and then again, the oral and oral language, speech sound productions, but then as students get older, that's when you're going to do some more of the written language assessments, the decoding spelling.

I always like to look at Dakota and spelling at the word level, sentence level, and then even in like passages, um, I have them do a writing sample and then also do like a reading comprehension task of a passage. Um, say my decoding. So decoding at the word level, sentence level, and then like an oral. Task, um, as well as looking at that reading comprehension, when I'm looking at written expression, I like to break it down into, you know, word errors.

How many errors do you see? Um, I do look at capitalization, punctuation, um, sentence fluency, all those areas, and then also executive function skills. I think this is an area that we [00:17:00] often forget about. Um, but I think it's one of the most vital areas that we can look at in these students is assessing their executive function skills as well.

[00:17:10] Venita Litvack: And like what types of executive function, skills, organization, 

[00:17:14] Heather Caska: organization planning, um, their ability to task monitors really big. Um, I often see these students. When we talk about dyslexia. So I, I kind of have two patterns that I often see one that are really struggling phonological with that phonological processing.

And then some that are more orthographic. They may have stronger phonological skills though, sound components, but it's the orthographic knowledge that they have. And oftentimes I see, um, those students struggle more with the executive function, so their ability to, um, organize the information and planning.

Um, and an execute the task appropriately to recall how to use spelling patterns. They know [00:18:00] it. If you ask them, they can verbally tell you and explain, you know, what the pattern is and what letters do you use to represent what sounds, but then to apply it, it just kind of all falls apart. So, um, I often will use just like a questionnaire.

Um, the brief two is the one that most common that I use. I also have, um, tear Sumpter's another SLP. I don't know if she's, um, been on your podcast yet, but she is an executive function guru, and I love all the work that she puts out. She just recently came out with a book and has the questionnaire. Um, and she also had recommended a book to me by George McCloskey who has, um, who's very well known in the field for, um, executive function and he has with his book.

Um, I don't have it off the top of my head. Um, has some questionnaires in there. Um, that like classroom observations, questionnaires for teachers, lots of different, um, questionnaires, but then just observations. And that's what I tell a lot of, even like my grad students that [00:19:00] I work with, you should constantly be taking notes while you're assessing a child about how they're performing, um, strategies you're seeing them use, because that in itself is going to give you a lot of information about their executive function skills.

[00:19:15] Venita Litvack: Um, yeah. No, that makes sense. And then in terms of the nonsense words, do you have any examples of the types of words that you've 

[00:19:23] Heather Caska: used? Yeah. So I always think of, I use the tilts a lot and so some of the nonsense words on there are, um, Dabe tech, Glenda. Um, building so words that sound similar to real words.

Um, but they're not real words. And so that's something in that assessment specifically, you say, you know, I'm going to give you a list of words that are not real words, but they're like real words. Um, and so there's a task where they have to read them out loud and then there's a task where they have to, they listened to the list of words and every it's like a nonsense word repetition.

So they [00:20:00] hear the word and then they have to say it back, you know, the best that they can, as clearly as they heard it. And then on the next sub test directly after that, it's the non-word spelling. So they hear that same list of words, but then they have to spell those words. And every time the kid you see their face go like what?

Like I have to spell those words now. Um, and so those are just a few examples of, of some of those nonsense words. 

[00:20:22] Venita Litvack: Hmm, that's interesting. I'm thinking of a client. I hope you don't mind 

[00:20:26] Heather Caska: if we like, 

[00:20:28] Venita Litvack: they study really quick. I'm thinking of a client and this client I inherited from another caseload, but they are being, you know, their goals are written specifically for our words.

Um, but I kind of backtracked a little bit to do a little bit like of auditory discrimination. Um, for those are words and I had done it with two clients. They pretty much have like the same goals or they seem like they're on the same level. The one client was able to identify the. [00:21:00] Um, post vocalists are like ending or so if I was, if I said like air or let's see I'm aware and they had to identify which ending it was.

So was it air, was it, or was it, or a hundred percent? No problem. The other client that I originally brought up, um, all over the place, like if I had said aware they might've picked for, or they might've picked four or they might've picked like ear, does that have anything to do? Like, should I be digging into that 

[00:21:31] Heather Caska: deeper?

Yeah, it definitely could be. I mean, I think just doing a quick screener of like his phonological processing phonological awareness, um, cause it sounded like there could be, um, concern of just how he's processing the sounds, his awareness of the sounds. So even doing something that, you know, maybe not.

Sound that he's working on, but if you do, um, like cats are, and you know, what sound do you hear at the beginning of cats [00:22:00] or, um, or even, you know, uh, say, say the word, um, say the word cats, what sounds do you hear at the end of cats and then have them produce this sound? So just, I would do a quick and if, and if he's struggling with that, then you'd probably want to do it more in depth assessment of his phonological processing.

[00:22:19] Venita Litvack: Okay. Yeah, it seems like it's primarily with like the, um, the post vocalists are, but I'll, I'm sorry. Yeah. Close for Kelekar. But also, um, and then when I kind of explain the task a little bit more, the performance went up a little bit, but it still was like, not ideal. It was like maybe like 65% or something.

So yeah, I'll try that. I'll find after we talk about assessments, maybe I'll pick one of those out, um, and 

[00:22:48] Heather Caska: try that. Yeah, he does. Yeah. It's very interesting. And just to kind of piggyback off of that really quick something I want, I know we kind of already talked about, um, some of those early identification [00:23:00] sounds, but going back to the scene, speech sound productions, and that just reminded me when you're looking at a student.

Um, and, and deciding, is this a concern, is this something that could be more re, um, re or. Early indicator for later reading difficulties. Um, when we talk about those speech sound production areas, it's more of those phonological and those underlying phonological deficits that are kind of those early warning signs versus, um, maybe just like an articulation, like, like our, you know, where sometimes it's more of a Metoric placement where they're struggling with that.

Um, so just kind of keep that in mind too, when you're looking for those early indicators. Okay. Thanks for sharing 

[00:23:42] Venita Litvack: that. Yeah. Very helpful. Um, and then the rapid automatic naming, can you give an example of that as 

[00:23:50] Heather Caska: well? Yeah. So the C top is one on which we'll talk about, I think on the next couple of slides is just an assessment.

And so there is another, um, there's another rapid [00:24:00] automatic naming task, but that's the C top is the one that I use. And so it's usually just, uh, like rows of whether it's letters or numbers. Color's pictures. And then they're timed, um, and asked to, um, say the names of the letters or say the names of the numbers, the colors, or whatever it is as quickly as they can without, um, like skipping any.

And so there you tell them when to go and then they just list all the colors and numbers until they get to the very end and you time them, it kind of keep track of their errors. So it's just looking at how quick a child's can retrieve and name those. So it's, it's correlated to, um, it's highly correlated to reading fluency.

Um, but it's interesting because the research has shown, and this is, um, David PillPack and Phil Patrick is also very well known, um, in his work for dyslexia and he has a ton of great resources available. Um, but one assess a book, either read about assessing dyslexia or assessing reading disorders. It [00:25:00] states in the book that working specifically on rapid automatic naming does not show any.

Improvements in reading, however, as reading fluency increases, um, and you see that improve, you also will see those that rapid automatic naming. So there is a correlation there, just not quite sure how exactly it is related if that, 

[00:25:22] Venita Litvack: so does that mean you shouldn't write a goal for rapid automatic naming progress monitoring tool?

[00:25:27] Heather Caska: It could be a progress monitoring or again, just one of those things that you're looking for to know that that's just another indicator that there's something else going on. So I, I definitely would recommend it still be included in part of that process, but yeah, you don't want to write a goal for that.

It's, it's one of those goals, um, that I, and I haven't seen that too often, but it's also those goals I often sometimes will see goals written specifically from like a task on the self, like will name eight numbers. [00:26:00] Like a, you know, like those digits, the rapid digit, um, not the rapid digit naming, but the digit recall like digit span.

Thank you. Um, so when you, I'm going to say Alyssa numbers, and I want you to repeat it back to me. I don't find it effective to write a goal for that, but more so identifying why are they having difficulty with that? Why? And this is also, this is a good example because this is a good phonological memory test.

So if I'm going to say a list of numbers and I want you to say it back to me, and you start with 1 6, 2, 4, and they get longer and more complex. So if a child is struggling with that recall that phonological memory, I wouldn't write a specific goal to, for a child to be able to do that. Cause that's not super functional, but why, like we need to understand why are they having a hard time saying those and writing a goal and addressing that more specifically?

Um, so that's the same thing for that rapid automatic naming. We know they're having a hard time with it, but it's not inappropriate. Um, [00:27:00] to work on. Okay. 

[00:27:02] Venita Litvack: Yeah, I know we're not going to really fully dive into goal writing today, but maybe we could give a couple of examples before we wrap up if that would be okay.

Um, and then in terms of the oral language skills, are we gonna address like what those kind of subsections would look like under that area when we get to the assessments or? Okay, perfect. So we'll wait until that, then anything else you want to share before we move on? 

[00:27:29] Heather Caska: Um, no, I don't think so. I think again, um, just, I ask one thing to point out here too, is these are the most common and the most essential areas.

Um, I think one of the biggest debates and misconceptions in our field is one that SLPs can't and shouldn't diagnose dyslexia. Um, but two, the app has to be done by, um, like a neuropsychologist or a school psychologist. Um, So I think all of these areas that you see listed are areas [00:28:00] that we already are assessing or can assess.

And so I think that that's important too, just to advocate for our field that we absolutely can. We know Ashleigh said it's within our scope of practice, but these are all areas that we're already assessing, um, in, in our practice, you know, whether we're in the school or in, or in a private practice. Um, so I think that's just an important thing to point out.

[00:28:24] Venita Litvack: Does the IEP have anything to do with that? Like I know in the district that I worked, then we had reading specialists who were often, you know, types of educators. They weren't speech pathologist and it was kind of, I didn't do therapy at the district level. I did more AAC assessments, but, um, it was my understanding that it was a reading specialist who did the assessments and provided the trainings and what.

[00:28:53] Heather Caska: Yeah. Um, and I think that kind of goes, um, I think kind of in the next slide that we're going to talk about [00:29:00] too, about can SLPs diagnose, is that the next slide? Yeah. Yeah. Perfect. Um, no, but that's a great question. So I think, um, that's very common. I see that all the time too, whether it's the reading specialist or the school, um, school psychologist, we, we can, again, I stress this all the time that SLPs can diagnose dyslexia.

Um, but our roles are going to vary across settings. So I own a private practice. I see kids privately. Um, but I also contract out to schools. Um, one of the schools I CA I contract out to it's a private school that specializes in learning, um, with students with learning disabilities. And they hired me specifically for reading intervention.

Um, the SLPA that works with me. She, we do provide all the speech services as well, but I was directly hired for reading intervention, another small charter school. I worked. That's not my I'm, you know, I've, I've mentioned dyslexia, I've had, you know, um, but that's not [00:30:00] my role in that school. I educate, I try to educate and I advocate, but I don't diagnose dyslexia.

I have a good relationship with the school psychologist, which is great. And she knows she has a very strong background in dyslexia as well. And so we're able to kind of pick each other's brains and piggyback off of that. But, um, in most cases, especially in schools and SLPs role is not to work with kids with dyslexia or to identify, but I think that's something, a huge, important piece that my goal is to change and get SLPs to kind of start advocating for our roles more.

Not that we need more work. Um, I know that our, we wear so many hats in the school already anyway, but with what we're already doing, Just helping them recognize it's not doing anything in addition to what we're already doing, but recognizing how, what we're already doing, relates to dyslexia and how we can use that to advocate and train and, and be an important part [00:31:00] of that team when we're identifying these students.

So I think it really just depends on your district, what your expected role is going to be. Um, and to be honest, a lot of times, most in most cases, I hear you get a lot of pushback, um, because that's not, you know, it's not well known that this is what we do or we should be doing. And even from SLPs in the field often, they're like, I don't teach reading.

That's not my, that's not my job. Um, that's what, you know, the special education teacher does or the reading specialist, which is you're absolutely correct. But I think just being aware of how, what we're already doing is so connected with that. Um, It was the important piece. Not that you need to start teaching this child how to read, not that you should start getting all the reading kids, but just recognizing how important what we're already doing can affect those students.

I think it's really important. [00:32:00] 

[00:32:02] Venita Litvack: Yeah, no, absolutely. Um, at what point do you find that students are being referred for assistive technology for reading devices and not getting the type of like dyslexia intervention they really need in the schools? Do you see that happening?

[00:32:21] Heather Caska: Yeah, I think, and you see it more, especially in those older students, I mean, that have not been identified.

And so they're now in fourth and fifth grade and still reading at like a kindergarten or first grade level and can't access the curriculum. And so now they're trying to. You know, get those that assessive assistive technology in place to kind of aid and help them, you know, modify the curriculum or help them give them those accommodations to help them be more successful.

Um, so it's, I often see it more in the older students. Um, one of the, uh, little girl that I just evaluated too, she's [00:33:00] homeschooled now. And, um, mom had asked me specifically, like, do I just stop teaching her? How, um, you know, do I stop doing a reading curriculum with her? Or, you know, she just, wasn't quite sure what to do.

And this student specifically, her listening, comprehension scores, Out of this role extremely high for her age. Um, and I said, no, absolutely not. I said, this is where you really utilize those audio books for her and that assistive technology, because she can, she's still learning the thing that's holding her back is the actual decoding part of it.

We can work on that, but she don't withhold any curriculum from her. It can still be presented. It just needs to be presented either someone reading it to her or her having an audio book to access that. And so I think that that's, that's really important. Um, and again, this goes back to where we were saying, I was saying earlier, even if a student's oral language skills are not [00:34:00] a concern at the initial diagnosis of dyslexia, we know that oftentimes they can develop, you know, a weaker vocabulary skills, um, with her oral language skills, because they're not having the same access to, to the language.

Um, through reading as students that don't struggle to read are. 

[00:34:20] Venita Litvack: Yeah. Um, I know with like AAC there's research that shows that using AAC doesn't inhibit the production or the acquisition of natural speech. Right. Um, it either stays the same or it increases. Is there a research that shows like, you know, if you give us a piece of technology to a student with dyslexia, like do their reading skills, like decrease, does it stay the same?

Does it increase? Do you know any about 

[00:34:49] Heather Caska: research? No. I don't know any research off the top of my head in terms of like reading. Cause when we talk reading, there's a big spectrum. So are we talking, you know, comprehension, decoding. So I don't know any of any [00:35:00] research specific to like decoding, um, word recognition.

Um, but I do know that if, if you continue to, um, Expose that child to literature, through audio books, that's going to increase, you know, their language development as well. But I don't know any research off the top of my head, but that's definitely something good to look into. I'll have to make a note of that.

[00:35:24] Venita Litvack: Yeah, no, that would be interesting to find out, but, um, yeah, we get this question a lot when we have webinars on dyslexia. So I'll just go ahead and ask it. Do SLPs needs special certifications to assess, diagnose, treat dyslexia? Would it make them feel more confident if they were trained in a particular program or we're going to go into the assessment piece?

So that will probably answer some of this too, but I'm curious to hear your thoughts. 

[00:35:53] Heather Caska: Um, that's I know that's always like the number one question I get too. So I do [00:36:00] not have any additional certification besides my CS. And I'm a big advocate that I don't necessarily think you need any additional certifications.

However with that said, I feel confident in my, um, knowledge and skills in the area, because I've done a lot of work over the last five or six years. I've read books and research articles and I've attended conferences. Um, I, so my background is I did go and get trained, um, through the academy of Orton-Gillingham practitioners and educators.

Cause I didn't know the first thing about teaching a child, how to read the phonics piece of it, the spelling patterns, the rules, all of that, nothing. I knew nothing about that. So that was very helpful for me. But another thing that I really found, um, when I was at this training, it was a total of nine days, um, training that I went to at the university of Colorado and I, as an SLP, had so much [00:37:00] to contribute.

Um, I was, there was a couple other SLPs, but the rest were teachers, parents, um, reading specialists, Um, from my background as a speech language pathologist in the area of phonology and language, I had so much that I could offer during the training as well, um, to kind of connect everything. And so that to me was also just a huge eye-opener that like, why are we not more involved in this?

Um, so that, without that training, I, you know, I wouldn't definitely wouldn't be where I am today because I, again, it, it was very helpful in terms of like the phonics instruction that, um, that alphabetic principle piece learning. Um, you know, when we talk about structured literacy, we talk about, um, you know, the syllables and the sound letter correspondence.

So that was really helpful. I also have experience with the lips program, which was, um, has been really great. I have experienced with parts Barton, a little bit of Wilson, but I've never been formally [00:38:00] trained in any of those. Um, I'm not certified, um, So, I don't think, I think they're helpful getting experienced in any of those programs.

Any of those trainings is going to be helpful. I always recommend some sort of, or in Gillingham based program, but then also going into it, knowing that like not every program is the best fit for every student. And that's like a huge soapbox of mine, um, that I can go on about for four hours. But, um, so I think it's beneficial.

But with that said our scope of practice as a speech language pathologist is so broad. So I'm also not going to go in to a hospital and pretend that I can do a fees exam or an, and, or an MBS because that's within my scope of practice because I don't have any formal training on it. I don't know. So I think it goes the same with dyslexia.

It's just one of those areas of expertise in our broad. Um, that you don't [00:39:00] necessarily need, um, an extra certification, but formal training, uh, in this area is, is needed. You can't just give a few assessments and say, yep, that's what it is. 

[00:39:14] Venita Litvack: That's such a good distinction between certification and formal training.

And I think that, uh, you know, it applies to so many areas in our field. Like you said, the fees, um, 

[00:39:24] Heather Caska: AAC are so broad, you know, I 

[00:39:30] Venita Litvack: feel the same about so many other areas and now I'm doing telepractice. So it was like a couple months of getting reacquainted with, uh, you know, a variety of diagnoses and treatment methods all over again.

You know, thankfully it's not, not dysplasia at this moment. Um, but yeah, I know what you mean once you get so. Like, I don't like to say pigeonholed, but once you've been like in one area for so long, it makes it hard to think about doing those other areas. [00:40:00] 

[00:40:00] Heather Caska: Yeah, it really is. And I have, um, because I've always worked in outpatient, so I always saw a variety of different things, dysphasia, um, you know, speech sound disorders, AAC I've had I've I have had a couple of AAC clients and I just, um, yeah, and those are just areas.

Now I am, you know, that's just not my area of expertise. Let me refer you to somebody who is, because I, I just really feel that there's so many of us who are so good at these specific areas that I know if I needed to take my child somewhere. Um, even though I know you can technically work on this, but if there's someone else that's going to be a better fit, like I just I'm.

I think that's so important. And, um, I'm really lucky. I there's a group of four. Four of us speech, language pathologist, and we kind of all live all over the country now, but worked all worked together at one time and we all kind of have our little areas. I have one friend who's AAC, guru. Um, so she's our AAC girl.

And then we have another executive [00:41:00] function and she, um, she's prompt trained and then another, um, the other one is, um, O M uh, she's knows all about the OEM. So we kind of have our own little resources. We have our own little, um, areas that we can kind of pick each other's brains about. And I think that that's, that's really important.

It's to kind of, again, to surround yourself with other amazing therapists that kind of know about other areas too, to kind of have those ideas. And it's, we're also inner connected anyway. Um, but yeah, it's just, it's again, it's just one of those areas that I think just feeling confident and getting that formal training, but not necessarily needing.

Uh, certification. I mean, at one point I was going to go back to school and get my certification as a reading specialist. And then, um, there was just so many different roads. I almost went down that I look back now and I'm like, God, thank God. I didn't do that because it just would have been, you know, um, [00:42:00] a lot of wine, a lot of money and just certifications that, you know, I just, we haven't, I haven't needed, you know, to get where I am. So… 

[00:42:08] Venita Litvack: yeah, no, you're absolutely right. We have the certification. Right. We have 

[00:42:12] Heather Caska: our, I always say, yeah, yeah. 

[00:42:14] Venita Litvack: You know, some educators who like to specialize in this, that's like the additional training that maybe they didn't get with the general like education type of degree. Whereas like ours was specifically, you know, um, this is specifically within our scope of practice, so yeah.

Thanks for sharing that. Okay. Um, let's talk about assessment protocols now. So which ones can SLPs use to evaluate dyslexia? 

[00:42:40] Heather Caska: So, um, all of these that I've listed here are, um, accessible to SLPs. Uh, I used to, for the most part, um, most of these, I don't, I don't own the cell five in my practice anymore. Um, or I never have it.

I did have it at one point in, uh, in other clinics, but the top is one that I always, it's [00:43:00] almost always a go-to for, for before I'm evaluating, when I do have concerns with dyslexia. Another thing I will say about the sea top. If I'm getting ready to discharge a student that I was just seeing for a speech sound disorder, um, whether I'm in the school or in private practice before I discharge, I always administer the see top to make sure that there isn't something more phonological going on.

Um, because again, you can remediate those speech sound disorders, you know, those early, if you have them in preschool, you know, three, four five-year-olds, and they're getting ready to go into kinder and you bring mediated all those speech sound productions, but that doesn't mean you're not going to see those reading difficulties, um, start to, to kind of show themselves once they start learning how to read.

So I always recommend to my grad students, um, if you're discharging a student, whether it's private or, um, in the schools for a speech sound disorder, I'd [00:44:00] recommend administering the C tub just to see if there's anything else underlying phonological. Um, the past is the phonological awareness screening test by Dr.

David Kilpatrick. And I don't have the book with me, but he has a book called, um, reading for success, um, which is very popular, very well known. Um, it's one of the number one resources that I recommend to speech language pathologists, um, that are kind of digging their, um, they're digging a little bit more into, into dyslexia.

So, um, you can actually download this assessment, this screener for free, um, online. So that would be perfect for you to give, um, this, the student that you were talking about earlier, just to download this and give him, um, the screener and just to kind of see how, um, the student does, but I do highly recommend the book because it does include some one minute drills that I do with every, all of my students, um, for phonemic awareness tasks.[00:45:00] 

[00:45:00] Venita Litvack: Okay. Cause it, in your reference to section the book, 

[00:45:02] Heather Caska: um, I believe it is. Yeah. I believe this. Um, and then just spoken language. So I typically give it depending on the student. Um, and I also, again, it goes back to the setting. Are we in the school? Are we private practice? So if I have students that are coming to me in the, um, like at my, at my practice, I always ask the parents for any testing that's been done.

So if they've had assessments done at the school, sometimes if they've had a recent assessments and they're looking for a diagnosis, I may not even really need to give anything new. Cause they've given all of these assessments. Um, it's just a matter of interpreting and whether or not an individual feels comfortable with giving that diagnosis.

So, um, but I typically will try to look at all areas of oral language, so expressive language vocabulary, following directions, um, receptive vocabulary, um, sentence, formulation, grammar, all of that I think is very [00:46:00] helpful. Um, another kind of just like a side note, when you're talking about looking at syntax and grammar, oftentimes when you have a student that they have a hard time marking those grammatical, um, grammatical markers, in words like in jumped, um, sometimes that's not even really a language, it's more of a phonological because if you think about it, you're adding that extra sound.

And so it's more of a phonological deficit, not necessarily language. So that in itself is going to be just, um, useful information as you're going through and giving, giving assessments to kind of look at. So, um, especially in the castle too, if I've, if I have a student and there's no oral language concerns, I also just like to give more of the, um, the super linguistic assessments to kind of look at that higher level language inferencing, um, looking at, um, Non-literal meetings taking meaning from context.

Um, I like to get that information just because [00:47:00] that's going to kind of give me an idea of the child's. Um, sometimes even their compensation strategies or their compensation skills. Cause I recently evaluated another student where he is really struggling with reading fluency. Um, but he's, he's not, has not been identified, but his super linguistic language skills were extremely high.

So again, that was just one of those. He has these amazing strengths that are kind of, um, helping him mask these underlying. Word recognition, word recognition deficit. So I think really looking at their, their, all of their language skills as important, because that's going to kind of help you see what are their strengths.

We're not always, you know, you don't want to just assess to find their weaknesses or areas of difficulty, but what are their strengths? How are they? Especially in our older students, how have they managed to get all the way to fifth grade without being recognized? [00:48:00] Um, but now, you know, the skills have only gotten them so far and now they're really struggling.

So,

[00:48:10] Venita Litvack: yeah, I I'm sure like the hallmark of dyslexia or the most recognized sign is mixing up letters or writing like different letters. Um, like from a layman's understanding of it. Do you feel like that's why. Children get overlooked sometimes, you know, in the classroom, they're not referred for an official evaluation.

[00:48:36] Heather Caska: Um, I think, yeah, I think so. And that's an, and really that's one of the biggest misconceptions is that dyslexia is like, where they're just like slipping letters and reversing letters and they see them backwards. And I was doing a training for a school one day and I had a, uh, teacher tell me, she was like, oh, she's like I have dyslexia.

And when I was younger, I was only able to read if I was reading upside [00:49:00] down, that was like, and so, and I was like, well, um, I don't know if that's necessarily dyslexia then, um, it's very common for, um, individuals with dyslexia to also have like visual processing difficulties. And I think that's where that misconception comes from that like kids with dyslexia, see words moving, and the letters are moving on the paper, or there are just mixed up.

Um, cause that's not dyslexia. We know dyslexia is that phonological. So like the hallmark di um, an indicator for dyslexia is a phonological processing deficit. Um, but we do know that that's not, you know, there's different profiles and that some kids may have stronger phonological skills where, um, more of that orthographic knowledge is, is where they're struggling.

Um, so I think another, so going back to your question on why, why do these kids get overlooked? [00:50:00] One, I just think it comes from like the misconception around dyslexia. It's just in even recently at one of the schools, one of the teachers had expressed concerns about dyslexia to one of the students. And in the, one of the special education teachers is like, she's not qualified to make that.

And that's a medical thing anyway. And I was like, actually, it's not, you know, dyslexia. It's, it's, it's technically a medical diagnosis. You can give a medical diagnosis of dyslexia, but dyslexia it's here. It's here. It's it's in our schools. Um, it's even if we're not calling it dyslexia, All of these kids that are specific, you know, SLD in, in, in the schools.

And I don't, I don't have the resource for this, but I've seen this stat so many times that I need to just, I need to try and find where the, where it comes from, but I've seen that 80% of our students that are eligible under the SLD [00:51:00] category would qualify as being dyslexic. So I mean that in itself, we're just not calling it that.

So I think, again, going back to some of those early indicators, one is letter reversals that, like you said, that's the most universally known. Well, they flip letters and they reversed letters that isn't, that can be an early indicator, but not all kids with dyslexia do that. But a lot of what we see, um, in these, as these early, as these early indicators are typical, you know, they're, they are typical up to a certain age, so it's always that little let's just wait and see, that's not.

Atypical. So let's just wait and see what happens. Let's just wait and see. We'll just keep practicing, just read to them and have them read to you and it'll get better. And then before you know it, now they're in third grade and there is here in Arizona. We have a move on when reading, they have to pass the reading test, um, to, to move on, um, in the, in third grade.

And, but now they're not, they're not reading still. And so [00:52:00] it kind of all comes back because then that's where yes, some of these are some of these early indicators are not uncommon. It's part of that typical development, but you have to look at the whole child and look at all of these other early indicators.

They haven't, that's where we come in. You know, we're the ones that have been seeing these students since they were four in preschool, because they couldn't say certain. Or they were having a hard time learning vocabulary. And now they're in kindergarten and first grade and they're struggling. Well, let's just keep practicing, you know, just work with them over the summer.

These are those students that are key that keep just getting overlooked. Um, and especially if they're not, unfortunately if they're not a behavior problem, you know, if they're just those kids that are quiet and going to do what they ask and they work hard, then they don't, you often don't see that.

Getting identified until later. So it's just, I think that's where, and that's where my passion comes from is I hear the [00:53:00] same story over and over and over again. You know, they had difficulties when they were younger with speech, um, productions. They couldn't remember in preschool, the letters they worked for, but then it was they're in kindergarten and they're really struggling to learn letters and well it's okay.

You know, they're just now being exposed. And I think people always think of, well, they haven't had a lot of exposure to reading, you know, cause they're in kindergarten and it just takes time for them to catch on to it. Yes. For some students. But what about all these early indicators they have to, what about, well, their dad's struggled with reading.

Um, their brother is getting pulled out for services for reading. Um, they've been in speech since they were three. So it's all these early, early things that we need to kind of look for too. That we're, that we're often seeing. So I think there's a bunch of different reasons why they get overlooked, but that's okay.

The biggest, um, the biggest things that I see or have seen in my, in my [00:54:00] experience, uh, 

[00:54:01] Venita Litvack: thank you for sharing that. I think that was super helpful to kind of paint the picture of like what's really happening because like you, when I was in the schools and providing assistive technology in AAC, I supported the middle schools and just got so many referrals for assistive technology.

Um, Let's see, do we have one more section or this was it? 

[00:54:24] Heather Caska: I think this is it. I think there's one more slide for this. Um, so looking again. Yeah, the phonological processing, spoken language, um, academic and educated educational testing. Um, I recently purchased the Wyatt for, and I love it. It does have a math component, like math sub tests.

And I have not administered that, but I really like, um, especially with this new version, I wasn't familiar with the Wyatt three, but just based on what I've read in the manual, some of the newer composite scores, I, I really have enjoyed this one. It also comes with a dyslexia index. So you can start by just giving them the distance, like a [00:55:00] dyslexia screener.

Um, and then it will give them, it'll rate them based on their score, their, their risk of dyslexia and whether or not you, um, they would warrant further evaluation. So I really liked the Wyatt for, in my experience. You more often see, and especially in the, in the schools specifically school psychologists give these two assessments.

Um, But, um, in my private practice, I started, um, administering the white for, um, and I actually recently, um, administered it to an adult who is in grad school, needing accommodations for like finals and things like that. So, um, but I, again, I really liked that assessment and then these are just different, um, written language assessments, um, the tower, the gore, um, QRI again, um, a lot of these tests I have, I always more often saw school psychologists giving them or neuropsychs, but they are within our scope to be administering these assessments as well.

[00:55:59] Venita Litvack: Okay. Um, [00:56:00] thank you for sharing this list. This is going to be super helpful for people. Uh, the quote that you had shared about the prevalence of dyslexia under the SLD umbrella, and that Washington had actually shared that as well in a previous dyslexia webinar that we did. I don't remember the source either, but I remember Jeanette Washington had referenced it.

She also has a dyslexia screening that we, um, give away for free it's under her course as well. So if anybody's interested in that, and I really love that you shared about the past, because I am going to get that and I'm going to share it with some of my colleagues, because we had like a general discussion of like, what are you doing to address reading difficulties?

Um, because you know, none of us are certified either. And so, but we have clients that could benefit from that type of instruction. Um, Wonderful. Anything else you wanted to add before we share the references section and start [00:57:00] the Q and A? 

[00:57:01] Heather Caska: Um, I don't think so. Um, I'm again, I'm thank you so much for having me on.

I just, I, my, my passion is really just getting SLPs to be more involved. And specifically that early intervention I think is so important because I think for us to really start advocating, um, and with us being those first students, like we were, um, are those first professionals to come in contact with these students, I think is really the key to increasing that early identification and early intervention for, um, for these students.

And I think, again, there's just a bigger picture that, you know, is just a topic for a different day, but, um, knowing that these students are, are at risk for, you know, bigger, you know, mental health disorders and, and anxiety. And I think even just keeping that in mind that that's, um, That's something that we're, we're working towards eliminating too, is so many of these kids develop [00:58:00] these, um, this anxiety and these insecurities because they're struggling and they recognize that their peers are able to do things.

So I just, I think it's, I can't say enough about how important our role is and in identifying and, and, um, these students. 

[00:58:15] Venita Litvack: Yeah, no, I completely agree with you. And I think there's a huge interest in this area from SLPs, because it's always like the most. Uh, popular topic whenever we present on it. So I feel like there's this huge interest, there's this huge misconception conception that it's not within our scope of practice, or you need a special certification because there's other professionals who are, and kind of make us feel that way.

Or, you know, there's certain roles already established in particular settings. So this was super helpful for people to just get more familiarized with the assessment process, because some of the other presentations we've done were more broad about like treatment or just resources. So I, [00:59:00] I so appreciate you deciding to, or agreeing to present on assessment.

Thank you again. So if anybody's interested in the references, um, I see Kilpatrick is here either one of these. 

[00:59:15] Heather Caska: Yep. So it's the equipped for reading success. Um, that's the one with the screener. You can download the screener for free, but it also has the phonemic awareness and fluent word recognition, um, tasks in there.

And that's really great. And then the one right above it is the, um, if I could, if I could recommend any book on assessment, it would be that one, the essentials of assessing preventing and overcoming reading difficulties, um, would be the other book that I would highly recommend for. 

[00:59:42] Venita Litvack: And this handout will be shared in the.

Course, um, you know, on the task flow platform. So you can download the handout and get the references. And, um, is there any, this is your Instagram handle and my Instagram handle. Is there anywhere else? You'd like to [01:00:00] point people if they're interested in connecting with you? 

[01:00:02] Heather Caska: No, I'm just my Instagram. Um, and I haven't, I wasn't active on it at all this past year, but we are in the process of developing some courses and some trainings.

Um, so that should, um, be up in, um, hopefully you'll see me more on Instagram and the share. 

[01:00:20] Venita Litvack: Awesome. Well, thank you so much again, we'll go ahead and open up the Q and a now to see if anybody has any additional questions.

[01:00:30] Heather Caska: Okay.