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

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.  

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. 

   

 
  

Segregation and Stereotypes 

QT
is trying to be controversial. – so was Toby Young when he called pupils with SEN troglodytes. 
But when does controversy actually become plain offensive? When does controversy perpetuate stereotypes of students with learning difficulties? 

And when does controversy forget that the group they are offending are children? And children with the least resources available to them? Children who may not be able to fight back? 
In my Speech and Language Base (students who access SALT and English but otherwise are educated in the mainstream) are learners who are quiet, studious and tremendously hard working against all odds. Despite the fact that school runs in fast forward for them, some of my students’ attendance records are excellent, behaviour exemplary and they crave quietness so they can concentrate. Yet to QT they are lumped with chair throwing pupils. Let’s be clear; they’re are many neurotypical chair throwers too.
So if we are to segregate by quiet and studious what is the other group? Loud and unscholarly? And are these all people with SEN ? I struggle with opinionated rugby players can we have a separate school for them?
Where does segregation begin and where does it stop? I find people often agree with such ideologies until they or their children are excluded. 
Worst of all, as segregation really is just the inclusion debate between mainstream and special school, no, worst of all is the gross generalisations made about those who the author wishes to segregate. Anyone who has agreed with the blog is complicit in reducing children with SEN to derogatory stereotypes which border on the grotesque. If you’ve met a child with SEN you’ve met one child. 
So no I’m not with you QT and I’d be really disappointed if anyone were. 

Segregation and stereotypes 

QT
is trying to be controversial. – so was Toby Young when he called pupils with SEN troglodytes. 
But when does controversy actually become plain offensive? When does controversy perpetuate stereotypes of students with learning difficulties? 

And when does controversy forget that the group they are offending are children? And children with the least resources available to them? Children who may not be able to fight back? 
In my Speech and Language Base (students who access SALT and English but otherwise are educated in the mainstream) are learners who are quiet, studious and tremendously hard working against all odds. Despite the fact that school runs in fast forward for them, some of my students’ attendance records are excellent, behaviour exemplary and they crave quietness so they can concentrate. Yet to QT they are lumped with chair throwing pupils. Let’s be clear; they’re are many neurotypical chair throwers too.
So if we are to segregate by quiet and studious what is the other group? Loud and unscholarly? And are these all people with SEN ? I struggle with opinionated rugby players can we have a separate school for them?
Where does segregation begin and where does it stop? I find people often agree with such ideologies until they or their children are excluded. 
Worst of all, as segregation really is just the inclusion debate between mainstream and special school, no, worst of all is the gross generalisations made about those who the author wishes to segregate. Anyone who has agreed with the blog is complicit in reducing children with SEN to derogatory stereotypes which border on the grotesque. If you’ve met a child with SEN you’ve met one child. 
So no I’m not with you QT and I’d be really disappointed if anyone were. 

Teaching Assistants 

I’ve been reading a lot about deployment of TAs recently the Keyinsights article
set me off and I’ve followed the great links to the Education Endowment Foundation (EEF)

and others. 
So, I’ve done some reading. 
I have also discussed this on numerous occasions with Twitter colleagues.
So I’ve sought opinions and advice. 
I think most would agree the following: 
1. TAs should be used effectively 
But what is effective? The EEF have 7 pointers which are superb.
2. TAs should be trained.
This is something our school and area partnership have been working hard to improve.
We had a day looking at 1:1 literacy interventions, we’ve done some assistive technology training and in February we’re having a whole day with a series of workshops looking at language, reading, spelling, phonics and writing. 
3. TAs should not be taking role of teacher, especially for those with learning difficulties where the gap between them and their peers is widening. 
This can be problematic – if a teacher wants to teach whole class they may ask TA to take an individual (usually in secondary) or a small group (more primary?) out to consolidate and reinforce information. 
I have no problem with this as long as the teacher is leading the learning. We must be sure TAs have been suitably trained to do this type of intervention however, sometimes they have more experience than teachers around SEN and working closely with the teacher can be a sublime relationship pushing the student/s on to make progress. 
We can however get this hideously wrong – a TA who doesn’t know how to teach phonics can do more harm than good and often with the very children who need specialist teaching the most. 
I’m afraid this is the fault of the teacher – they have abandoned this child and given full responsibility to the TA for the pupil/s with least resources available to them. 
I’d hope all would agree this is bad practice. 
What of the 1:1 TA who is with a child who has complex communication needs? 
This relationship is complicated. – the TA should have knowledge of the child’s need and know how best to include him or her into the mainstream using inclusive strategies. 
A best practice situation might be: 
Weekly planning with teacher – tweaking how and when child can cope in class and how they are accessing curriculum. 
In secondary, this is harder; while the student may have a key worker, it is likely a number of TAs will be involved and numerous teachers – how do we keep continuity and plan effectively for the student?
And the one for me which causes most angst is the student who, for social and emotional reasons as well as learning difficulties is only coping in mainstream secondary with a TA by their side. 
How can we maximise this relationship so it is constructive rather than destructive? Can we plan for the student to learn independently yet keep their anxiety at a level where they don’t shut down completely? 
If a student requires a sensory diet but also benefits from break times with their peers, how can we fit this into a full timetable? How can the TAs and teachers plan for this? 
These are questions I have no answers to. 
Then there’s the child who requires a scribe and reader? Does this mean they sit back while the TA does the work for them? Are they engaged? For some, the TA copying off the board or making notes for the student means he or she can concentrate on the content without their literacy putting a barrier up for them. For others however, have they learned helplessness and while the TA is scribbling away they are busy distracting others, completely disengaged?
Another problem for both teacher and TA to solve. 
When school has a student whose attendance is poor due to refusal, illness or mental health how should the TA be used in these circumstances? Continue to attend classes and make notes? Prepare resources to enable the student to catch up on their return? Act as a class TA to help others or, often in our case, ask the TA to help other students in other classes as sickness affects TAs too. 

Then there are Higher Level Teaching Assistants (HLTAs) who performance manage other TAs, take on other responsibilities such as small group interventions and literacy support. This work is done outside a mainstream classroom. 

I don’t think we’re getting everything right but I know I see some incredible practice between TAs and teachers. I also know we can improve the system but how? 
Communication is key but we struggle in the rapid, fire fighting environment we work in. Things change too- what works one week can be disastrous the next. An argument with another student or teacher can mean a student with difficulties is affected for weeks. 
The only way to keep improving is to keep checking, keep changing, trying new things but I’m also aware this can have an exhausting affect on teachers and TAs. Thank goodness they’re so adaptable – for to include our students with needs we have to to be flexible and make adjustments – we may not get it right all the time but sometimes, with these students no research has been done yet – the situation is a new one (even to me after 15 years) and we have to work within the parameters of knowledge,  experience and the structure of school. We might also think the unthinkable, sometimes it’s like trying to be creative in a tiny box and it is the TAs who can liberate us – we must use them wisely and effectively but as part of the system not as an alternative. 

Day 26 – #5 Simple Tips to Help With Reading from a Screen – Assistive Technology #28daysofwriting

#youwillseehowdifficultitistoreadthiswithoutspace

There is a US study which claims to show that increasing the gap between letters may make reading easier for struggling readers. VoiceDream will do this for you (Day 14) but for most students this is not possible.

Some easier steps may help however:

1. A larger font – this can be seen just from children’s books to adult books but if you are showing a lot of text on the whiteboard, it would be useful if the font were 14 or 16 rather than 12.

2. The right font – evenly spaced sans serif font such as Arial or Tahoma is recommended. There is a free font called Open Dyslexic which can be downloaded. It then just sits in the font choices along with all the others in Word. Some students, those who report moving letters particularly, seem to like this font as it is weighted. Others however hate it and prefer Arial. It is worth encouraging students to try different fonts to see if it makes a difference.

3. Changing the background colour – this is one of the easiest things a student can do. Many seem to choose electric blue or pink – no idea why. A few of my students choose a black background with white or orange text. Again, if they say it helps, why not? I like buff – it just reduces the glare of the white background and makes reading less stressful (before anyone rushes to the comments box to tell me there’s no research, I don’t care, it helps me and seems to help the occasional student). Some teachers will change the background colour on their whiteboard to an off white or light pastel colour which is a nice gesture.

4. Underlining – this can really confuse students who struggle to read – not only are they trying to decipher the letters and the word but there’s another bit of print underneath to contend with. ALSO WRITING IN CAPITALS IS DIFFICULT TO READ.

5. Preferable to underlining and italics is to use bold and bullet points. This emphasises text without changing the shape of the letters. Big blocks of text with no obvious break can be difficult to read and breaking it down into smaller sections or text boxes (even with different colours) can help students. 1.5 line spacing helps.

If you want to research this further, work is being done by E.A. Draffan at Southampton University and JISCtechdis offer good advice.