Language Learning Impairment – the poor relation to dyslexia and autism?

Bishop 2015 Does a child’s diagnosis depend on professional seen?

Overlap of specific learning difficulties


After seeing this

Tweet which triggered this post.

 I glibly stated that I wanted to blog on Language Learning Impairment (LLI)/Specific Learning Impairment (SLI).

Do you know what it is? Perhaps you’ve heard of Specific Learning Difficulties (SpLD)? If you have you may think it’s dyslexia, dyspraxia, ADHD, ADD, dyscalculia or Autistic Spectrum Condition/Disorder ASC/D (used to be called Asperger’s or high functioning autism but now changed due to DSM-5) but not LLI. 

I’ll prompt you again, Speech and Language Therapy (SALT). Oh right yes, now I know what you mean. It’s speech problems, articulation? Or don’t SALT work with ASD and social communication? I think I may even have heard Complex Communication Difficulties used recently – what’s that? 

So, is LLI a communication difficulty?  
You can see the problem here…so many labels, many overlapping because it is the exception rather than the rule for difficulties to be pure – comorbidity is far more common; ASD with dyspraxia for instance or ADHD with dyslexia. Even the decision on diagnosis could be linked to which professional a student sees as shown in Professor Bishop’s slides above.

In the new SEN Code of Practice communication difficulties are described as Speech, Communication and Language Needs – SCLN – this is a catch all phrase and can mean various forms of difficulties in communication. 
Alternatively, it may be that a professional decides what the student’s primary need is, language disorder or autism? The really complex children are often a severe mix; so my students with speech and language difficulties will often struggle more if this co-occurs with ASD or dyslexia.

 It is also further complicated as language is the precursor to literacy. As an example I had two year 11 students whose language scores suddenly improved – it appears now they are soaking up phonics and their reading is improving rapidly. In the transition notes to college I have been very clear that they will need phonic based dyslexia support.

If you listen to SENDCos and specialists in schools across the country I’m pretty sure you’d hear the ‘ey’ diagnoses; ‘he’s a bit languagey’ or ‘she’s spectrumey ‘ – horrifying for psychologists  I’m sure!

Trends also show how certain labels fall out of use:  Asperger’s for instance and dysphasia are no longer officially used whereas verbal dyspraxia, attachment theory, sensory overload and auditory processing disorder are terms which seem to be common at present.

Returning to the above tweet however, LLI is one of the most common learning difficulties in mainstream schools yet possibly the least understood by teachers in both primary and secondary. It’s also had the least research which equates to less money spent on it. Language Learning  Impairment is the true hidden disability. 

SLI was until recently the preferred term but concerns that it suggested too narrow a group of children led to LLI which encompasses any child with language impairment regardless of underlying ability.

A crude comparison could be with dyslexia; whereas this signifies a set of behaviours linked to struggling with reading, writing and spelling, LLI behaviours are with talking and understanding language. These are expressive and receptive language difficulties. It is also possible to have strength in one and weakness in the other. 

LLI is at least as common as dyslexia and more common than autism. It’s expected that there is one student with LLI in every classroom (Bishop 2014).

A typical student in mainstream with LLI may have basic functional literacy (although not always) so does not get picked up by screening tests. Once a comprehension test is given, it may become more apparent but as these students often appear ‘typical’ and read and write OK, it’s not until you begin chatting to them individually that you start to see where the difficulty lies. They may even have hidden that quite well coming across as quiet or a bit rude, dismissive even and monosyllabic. Or perhaps, they’re quite chatty but don’t make much sense; I often say to teachers that these students may talk round a subject, never quite getting to the point. A good indicator is to ask yourself, what have they actually just said to me? If you struggle to work it out then there may be some language difficulties. Other students with LLI are often described as not listening, staring out the window, blank, in their own world. He or she might be incredibly frustrating as they never do what you ask, they clearly weren’t paying attention as what they’ve written has absolutely nothing to do with the task you set. Worse still they haven’t written anything.

The student may get into trouble in group situations, outside at break time or in class. They look guilty, they couldn’t explain what had happened whereas the other student was able to fluently describe the incident, the child with LLI just shrugged and walked off or was somehow appearing cagey so thought to be guilty.  

These are typical students with LLI. It is no surprise to learn that statistically, a student with language difficulties is more likely to end up in prison – perhaps they struggle to get out of tricky situations or may not have realised what they were being asked to do – everyone else has reacted quickly and run off. In the court room under cross examination, they become confused – it’s going so fast, so much language being fired at them – just as they’ve processed a question it seems another is asked, confusing them further. They appear truculent, aggressive yet are more likely to be frustrated and unable to react quickly. 

I’ve painted a depressing picture here haven’t I? It doesn’t need to be like this however, similar to dyslexia, although residual difficulties will remain in adulthood, the language deficit can be remediated through specialist support, by teaching language and offering strategies. By making reasonable adjustments in the classroom these students can thrive in a mainstream school.

Here are some tips

Time, time and more time – schools go so fast – but allowing the sudent with LLI just a little more time to answer a question of complete a task will make a lot of difference.

Visual visual visual – no, I’m not saying they’re a visual learner but when language is a barrier, using visual prompts can help to signpost activities for a student with LLI and trigger memory. By using images of the subject you’re discussing, it will help the student to link the information and categorise for storing. 

Modify language – for many students it is good to challenge them with extended vocabulary but for the student with LLI, it is the carrier language and phrasing which can confuse them. Try to concentrate on the knowledge you want them to learn and simplify the other bits of language. 
 Keep your sentences short and concise. Use simple language with the key words they need to learn.

Students with LLI may also need literal language, struggling to cope with metaphor and idioms. 

Break down instructions into small steps – you can get your TA to break tasks down with a tick box after each one. Chunk instructions and information.

Knowing that just because they’ve nodded at you does not necessarily mean they’ve understood is a vital skill for the teacher of a student with LLI. Asking them to repeat back what they have they to do is a useful strategy (but allow them time to do this).
Being sympathetic to language overload and spending 5 minutes with them explaining with some spot images (like bullet points but small pictures) can make a difference. 
Asking the student to repeat back what they have to do will help them.

Further reading 
Professor Dorothy Bishop researches and champions LLI. She is part of RALLI – raising awareness of language impairments (RALLIcam). There are many excellent YouTube clips. 

http://www.youtube.com/RALLIcampaign
Professor Bishop is also good to follow on Twitter @deevybee and her blog is one of the best out there. http://deevybee.blogspot.com/

Professor Pamela Snow (@PamelaSnow2) has influenced me and knows much about literacy and language (and phonics). Her blog, The Snow Report is here: http://t.co/sP2ewQ80YB. I think she has persuaded me to change my mind on a number of occasions too.
Susan Ebbel, a speech therapist, has created shape coding – it’s a visual strategy for grammar using shape and colour.
Stephen Parsons (@WordAware) has been a useful contact and has a great book. http://www.thinkingtalking.co.uk/

I Can Charity has many resources and knowledge on LLI (@iCANcharity).
@afasic is also an excellent source of information as is Communication Trust (@comm_ntrust).

NAPLIC is the association for language impairment in children.

There’s hashtags #LLI_ #SLpeeps and @WeSpeeches is a collective Twitter account for speech and language professionals. They often have useful chats on Twitter. Caroline Bowman as @speech_woman is another account to follow. 

M
Links

http://www.councilfordisabledchildren.org.uk/media/547918/sli_handbook_early_support-040413.pdf

3.5 Educational arguments which irritate me.

1. The phonic check, we’re told, ensures we spot the 20% of society who are functionally illiterate.

Yet one of the arguments against it says children who can already read make the nonsense words into real ones. Or, like Lucy Powell MP’s daughter, who can read really well, still failed the check. I’m told these children (despite any research I’ve read showing if children can read at 5 their literacy and academic achievement is likely to be excellent) have hidden phonic difficulties and will need to know the alphabetic code because there might be a really, really, really long word they can’t decode one day. Knowing the phonemes in the year 1 phonic check will stop this problem that isn’t actually a problem. If it is a problem, these students who can read but fail the phonics check are definitely not going to be in the 20% this check is designed to identify. Indeed they’ll be the students who can read and spell whatever method is used.

2. Those who criticise most vociferously OFSTED and its grading system because it criticises how teachers teach, seem to be the most critical of how teachers teach if it isn’t the way they want teachers to teach.

3. The ‘every second counts’ clan spend much energy telling us how students must be on task all the time and we can’t waste a second making puppets or posters; we will let the children down and they will be doomed for all eternity. Teachers who do group work are wasting children’s time which is precious, precious, precious. 

Mention private schools however and they’re all – marvellous, marvellous, marvellous. But private schools have longer holidays and sporting trips and drama activities which take time out of the curriculum. It’s not a problem to miss an afternoon’s school for a rugby match but I’m not allowed to make a puppet in a state school English lesson.

3.5 Similarly this ‘every second counts’ doesn’t seem to include the children who are excluded – they can be off as long as they like because they’re ruining the education for others. It’s also likely this cohort fall into the 20% functionally illiterate category but let’s not worry about that; someone else should be sorting that out.

Advice on botch jobs for DFE

I’m not a wise old owl but I am old and have some experiences. I’ve done lots of jobs and I’ve been a parent, I’ve moved around the UK and lived abroad a number of times. That does not make me an expert, I realise that. Over the years however, there are a few things I’ve learned, so I think I can offer some tips to the DFE which might help them refocus.

Tip 1 – Patience is a virtue
This is difficult for people who are naturally impulsive; they want to do everything and they want to do it straight away. They think of something during breakfast and announce it by lunch.
While occasionally making a quick decision is vital, particularly in a school, on a structural level taking time to think things through, ask for opinions, tweak things before finally launching an idea is good practice. The less you plan the more likely something which you hadn’t thought of but which seems glaringly obvious once it’s been pointed out to you will be pointed out to you, by the person you didn’t ask because you couldn’t wait. 
Fill in the DFE impatience initiative here…………………………………………………………………………………………
Tip 2 – Check details published online should be published
In a large institution, it should not be possible to publish anything online without it being agreed by various levels of authority. Red tape is annoying but it’s there for a reason.  
Fill in DFE error here………………………………………………………………………………………………………………………..
Tip 3 – When lots of people are against an idea don’t become even more determined to implement it
OK, sometimes unpopular decisions have to be made. It may be due to money, due to a safeguarding issue, even a disciplinary one. But, when you force an idea on lots of people when it has obvious flaws and is even unpopular with your allies it might be best to back track a little or change. Stubbornly insisting an idea should go through backed up by dodgy reasoning does not make you look stronger, it makes you look like an idiot.
Fill in DFE unpopular and flawed idea here:……………………………………………………………………………………..
Tip 4 – Research is finite
Research can show varying results: it might show this, or it could mean this however other research says this. Weighing up all research is good. Using research to suit your own argument is bad. We all do it to a certain extent but when you have to make massive decisions, it is probably good to speak to people who disagree with you too and find a workable solution.
Fill in DFE research which has been cherry picked to suit ideology here………………………

Tip 5 – Take your staff with you. 
You can be a strategic genius but if you don’t bring your staff with you, you will fail. They have to carry out your brilliance; they have to make your innovative creations come to fruition. If you annoy them, don’t respect them and make constant changes they will eventually tell you to shove it and leave.  
Fill in DFE changes here:………………………………………………………………………………………………………………..
And their poor treatment of staff here:……………………………………………………………………………………………

This post was originally posted fir @LabourTeachers

 

No Excuses

When I watch those videos from the No Excuses schools in the US, I am scanning the room for the type of children I teach. The ones that have sensory difficulties; that really isn’t an excuse.  In fact it’s probably one of the most research heavy areas there is in SEND.

I see the ones who look slightly bewildered; that’s not an excuse either. The pace of some of the teachers’ chorusing would not be helping those with slow processing and/or language learning impairments. 

And I see the eye tracking thing.  Eye contact is very difficult for some students with autism (also not an excuse) and I often ask teachers who say a child is never listening whether they’ve checked by asking them. Some students (often with ADHD in my experience) might be concentrating when they are not looking at the teacher. Others are really listening while playing with Lego or fiddling with play doh. In fact,sometimes I think that when you ask a child to look at the teacher it might be when she is listening the least: have they noticed the mole on an eyebrow? Are they looking at the detail of a patterned shirt?

And then I see the students who are not following the words to the songs, and the chants and the recitals because they can’t remember the words; they are pretending by moving their mouths but they’re out of sync with the rest. These are the ones that are just about coping. I wonder however about the ones who have walked out, sworn at the teachers, won’t sit still, won’t keep quiet, I wonder about them – where are they? They exist, I know they do.  

What makes it better for children who struggle is a differentiated curriculum, an understanding of their needs, strategies to recognise why they blow and places to go when they do. Reasonable adjustments are not excuses.  

Correlation and Causation – PX and Prison 

Correlation doesn’t equal Causation 

I had my first holiday Twitter spat on Saturday (I know I couldn’t even last one day). 

It was on permanent exclusions. After a tweet from the Prison Reform Trust arguing the case for criminal leniency for children in care, I drew a comparison with the fate of students excluded from school. 

Lord Laming who undertook the report, was on Radio 4 earlier this week with one example of the police being called because a child in care had taken food from a fridge without permission. 

This story horrified me; I look at my kids who have all done much worse and weep at the idea of them in the care system if my husband and I died. Statistically I know they’re likely to be separated as there are four of them; I know my son at 13 will be the hardest to place and having identical twins, they’d be kept together surely? But if they weren’t, the separation would be doubly damaging, so strong is their bond. 

I also know if one of them had SEN it would place further pressure on the care system and any behaviour issues (two are feisty, two compliant) would be dealt with more severely than we would at home. My goodness, if it’s food out the fridge; I may as well have 999 on speed dial. 

A criminal record for children in care, Lord Laming argues is assuring a future burden on society.

Back then to my Twitter spat; I claimed 47% (although probably a higher proportion as this includes non care system kids) of them, if excluded, were likely to end up in prison. This is the percentage of the prison population who have been permanently excluded from school. 
I was picked up here (probably fairly as I jump on anyone blaming parents for language and literacy difficulties using correlation as cause) because it doesn’t necessarily mean that those 47% wouldn’t end up in prison anyway and that schools may have done everything they could to prevent the exclusion. Fair enough, mea culpa.

My point though was that the label of being permanently excluded is as damaging as the criminal record Lord Laming was criticising. He’s not asking these to be lifted for dangerous criminals but for the petty  instances, allowing care children the best start in adult life.

Many excluded children have: 

SEN 

experienced bereavement 

witnessed domestic violence

been sexually abused

been physically abused

There is a similar pattern for prisoners and with whopping percentages of language and literacy difficulties among the prison community.

Yet, we may not see these children as victims and neither will society when they have a criminal record and permanent exclusion stamped on their forehead before the age of 16. 

Can’t we do better for these kids? Find models known to work and replicate them? These children matter and are society’s responsibility.

http://www.prisonreformtrust.org.uk
http://troublesofyouth.pbworks.com/f/occ71-exclusion.pdf (75% of excluded pupils end up with a criminal conviction)

 http://www.prisonreformtrust.org.uk

We’re teachers not Demigods

I’m tired of teacher bashing. As far as I can see we self loathe ourselves enough without others having to do it for us.

Bennett’s criticism of posters, group work, DVDs and role play in a recent tabloid article has won hands down this Easter for irking me.

It was easy pickings journalism. Adding stereotype to anecdote to take another swipe at the beleaguered teacher. This was no better than OFSTED grading my lessons, no less frustrating than having Gove call me an enemy of promise. Yet again teachers were being judged on their classroom practice.

Criticising posters particularly smacks of perfectionism – this is similar to the perfect parenting fetish. ‘Don’t use forward facing buggies your child will have speech difficulties’, ‘dummies will ruin your child’s teeth’ and ‘never sleep with your child, it’s unhealthy for their emotional resilience’. These judgments are there to make us feel guilty, no wonder we all feel crap especially if we’re parents and teachers.

Society bombards us with images of perfect parents and the media expect similar perfection in teachers. Not only do we have to get our children to learn efficiently every second of the day, we have to do it while looking amazing and rocking a BMI within the average range.

The most damaging issue I see in schools is having to use supply teachers. Drafted in for long term sickness, usually linked to teachers becoming stressed and exhausted from having worked too damned hard and having been set up with unrealistic expectations.

Teachers need to pace themselves, allow time for marking and slots where they’re not continually teaching from the front. 

Consistently mediocre should be the new excellence – anyone who thinks teaching is like Dead Poets’ Society is part of this fake idealism. Students need a teacher who is present, consistent, knows her subject, can engage students to learn it and ensure progress is made: that’s it. We all do this differently. 

Of course be inspirational if we want to be but not every lesson – spread our  brilliance out evenly and give ourselves a break. We’re teachers not demigods.

Image from ActiveApparel 

Segregation – a collection of responses

Edu blogging and edu Twitter can be extremely rewarding but also nail bitingly painful. When you work in SEN, in the current climate, it can be really difficult reading ignorant comments and hearing views from teachers who clearly believe students should be elsewhere. They have less idea where they should go just ‘away from me’.  

When  QT wrote a blog claiming devil’s advocate I thought actually, the blog was not provocative just prejudiced and in extremely poor taste. So I wrote a rather ranty blog. I also questioned how ‘normal’ you have to be for mainstream a while ago.

What happened next though was better: the Titans of SEN began to respond – I’ve used this image before – over the brow of the hill came the voices and it made me feel proud – here they are: 

Nancy writes beautifully but harshly on ‘Rose  tinted spectacles’ giving some statistics which we should all read.
Simon writes an excellent post challenging the views that we all find ‘like minded’ people and suggesting teachers should be looking for solutions to mitigate difficulties.
Chris tells us how children can be learning opportunities for teachers and that investigating options as a teacher is rewarding.
Jarlath responded with an aspirational blog lamenting how some dwell on the deficit model of SEN rather than seeing students who have a lot to give and achieve. 

New to me is  Kate who writes a positive post on inclusion based on real experiences which was a pleasure to read.

OldPrimaryHead ‘s stonking blog sums up the problem but also the solution – a decent head who believes in inclusion past test results.

And Sue reminds us, of course that #Everychildmatters

Lena writes an interesting post encouraging more understanding and commitment to inclusion. 

Why is inclusion so important? Read Jude ‘s post – it brilliantly bashes away the prejudiced arguments for segregation.

A post from Liane on how teaching students with SEN has made her a better teacher. 

Beth reminds to to look for triggers behind the behaviours and that segregation could be yet another knock back for some vulnerable children.

Cherryl gives some examples of students in special school and asks the question; should all children be in mainstream?

JordyJax tells us SEND is not going away and gives some very practical advice on spotting SEN in students causing difficulties in school. 

Rob compares the lack of funding for flood defences with inclusion and how the subsequent fall back costs far more – he’s right, we need more money and more accountability for students with SEN – provision is currently a lottery.

To complement Rob’s blog, Aspie has written a blog on accountability structures for students with SEN – this is not an easy solution but one which certainly needs improving to protect our most vulnerable students.

Bennie has written a fantastically moving tribute to teachers on why we teach  – the stats are shocking too.

Maryisherwood, a special school headteacher writes how inclusion is personalised and inclusion for one student may mean a special school and for another mainstream.
Matt, a parent should have the final Words – these are his comments from QT’s blog.