Understanding Clinical Diagnosis and Intervention and its Role in

Multi-lingual Classroom Instruction

Nancy Rose Steinbock, M.A., CCC-SLP
Director, Inglese Dinamico, Venice, Italy

Abstract
In recent years, dyslexia as a classification requiring educational intervention has grown in Italy. So
has the need to understand what it is, how it manifests itself in individuals diagnosed as dyslexic, when
to intervene, how to manage learning challenges posed by these individuals in the general classroom
and curriculum, and what are the specific techniques to be utilized to adapt classroom materials and
make them more accessible to dyslexic students (Costenaro, Daloiso and Favaro, 2014; Pesce and
Costenaro, 2012). One of the authors observed outcomes of the attempts to assist dyslexic students
and their teachers in order to succeed in the classroom, has been the need to elucidate from the
perspective of a speech/language pathologist specifically trained in diagnosis and treatment of
dyslexia, a richer understanding of dyslexia, beginning with indicators in early childhood (12-36
months of age) to the manifestation of lower than expected literacy acquisition in elementary school
and how best to provide meaningful educational practices that result in positive learning outcomes.
Five misunderstandings about dyslexia and intervention are presented. Then, scientifically-based
evidence for understanding how to view these multiple language-based problems, often apparent in
infancy, that evolve into dyslexia and classroom discourse problems (frequently in tandem with one
another) is discussed. Finally, best teaching practices based upon understanding what is actually meant
by multi-sensory teaching is presented. Included are specific, orderly, measurable and effective
intervention strategies that are the basis for clinical and educational classroom teaching that result
in developing the automaticity of three crucial skills: 1) decoding an alphabetic language, 2) reading and
writing and 3) enacting word, morphological and syntactic knowledge as demonstrated in The SAILS Program
(Steinbock, 2015). It is a precise multi-sensory Orton-Gillingham enrichment program (Gillingham
& Stillman, 1960) utilized as part of the multi-lingual instructional approach of Inglese Dinamico,
Venice, Italy.

Evidence-based Clarifications for Five Common Misunderstandings of Dyslexia

1) Dyslexia is a reading disorder that results from a specific language impairment generally considered
to be a phonological awareness deficit.
Evidence: Dyslexia is a term given to a learning disorder that is primarily a deficiency in decoding and
spelling of alphabetic orthographies (Berninger, 2008). Numerous studies have demonstrated that
decoding, an early, crucial emergent literacy skill, is primarily a phonological awareness skill in typical
learners that is impaired in children with literacy acquisition difficulties (Perfetti, 1985); children who
have difficulty mastering the regularities and irregularities of an alphabetic orthography, e.g., English,
later have difficulties learning to spell and read (Liberman & Shankweiler, (1979); Liberman (1983);
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Vellutino, Scanlon & Tanzman, 1984). We know that learning to decode and spell words adequately
and automatically are necessary for decoding print. But, moving from print to meaning, the essential
purpose of reading, is necessary for building higher-order vocabulary, morphological and syntactic
skills as well as critical thinking and reasoning skills; reading is dependent on developing language
comprehension skills that may or may not be impaired in challenged learners. That is, specific language
impairment is not sufficiently broad enough to explain the learning deficiencies observed once the
early years of learning to read progress to reading to learn, in English-language instruction, usually
around the 4th year of elementary (Wallach & Miller (1988); Chall, Jacobs & Baldwin (1990).
2) Dyslexics can comprehend text when it is read aloud to them.
Evidence: It is well-established that reading is a language-based skill (Birsh, 2011; Justice, L.M. 2006;
Fillmore, 2004; Liberman, 1983; Vellutino, 1989) and that a reciprocity between oral language and
written language development exists (Kamhi & Catts, 1989; Wallach & Miller, 1988). At early stages
of pre-emergent literacy, semantic and syntactic differences do not appear to be significantly
different and therefore, not factors in learning to decode, but significant differences have been
reported in children at later stages (grades 6-7) (Vellutino & Scanlon (1987). Stanovich (1986) has
hypothesized that weaker language skills (other than phonological awareness deficits) are a
consequence of persistent reading problems; this does not remove the fact that they can be
contributory as well even in the early stages of learning to read (Vellutino (1987); Liberman (1983;
Soifer (2011).
We know that what a child brings to school in terms of linguistic experience and environmental
experiences can strongly influence success in academically-based learning (van Kleeck, 2014;
Westby, 1995). Vellutino, Scanlon & Tanzman (1991); Vellutino, et. al (1996) reported significant
improvement in children from linguistically impoverished backgrounds who, with short-term
remediation in phonological awareness training in first grade, were able to overcome their initial
difficulty in learning decoding skills. Thus, it is imperative that we distinguish between those
children with experiential deficits and those with the linguistic deficits we associate with language
learning disabilities of which dyslexia is one.
When children come to school, a set of communicative skills, what van Kleeck (2015) has termed
Casual Talk or CT, can be a predictor of slow academic achievement. The CT register may not
always be consonant with or contain foundations of the Academic Register, AT. This dissonance
may result in children being at significant risk for learning difficulties including reading acquisition,
as well as understanding the language of instruction. Children who have not been exposed to a
content word-rich vocabulary, complex grammatical forms, pre-literacy experiences in print and
matching speech to print and questions that pose hypotheses, what if..?, higher-order or inferential
thinking, Why do you think? as examples, often in fact, do not have the experiential background to
follow the decontextualized language that is characteristic of stories and textbooks. Decontextualized
language refers to language that is relevant for the topic at hand but which requires knowledge of
content words, morphological markers and embedded grammatical forms not routinely found in
conversational talk. Further, they often have difficulty following teacher-directed discourse or
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classroom procedures (Heath, 1982; Snow, 1983, Westby, 1985, Wallach & Miller, 1988; Wilkinson
& Silliman, 2000; Gee, 2005; van Kleeck, 2015). Westby refers to these distinctions as oral vs.
literate messages (Westby, 1985; Westby, 1995).
Preschoolers from language-rich environments have the kind of mother-child interactions in which
academic register talk is naturally embedded in activities of daily living (van Kleeck, 2014). In
addition, exposure to word play often in literature and discourse that is relevant for text
comprehension at the semantic-syntactic levels, in less-language rich homes, is impoverished. While
the CT register is sufficient for socially-situated interaction, the underlying skills associated with AT,
are under-developed or absent. We cannot assume, therefore, that providing an aural model along
with written text will necessarily result in unimpaired comprehension. To reiterate, dyslexia primarily
arises from a phonological awareness deficit that may be the result of a paucity of language
experience or may be a part of a larger linguistic deficit (slow language development) and therefore,
cannot be characterized by only a narrow specific language deficit involving only phonological
processing and production. This latter profile is applicable only to a limited group of the dyslexic
population.
3) Dyslexics primarily rely on visual codes for comprehension purposes and teachers need to supplement with visual
aids such as large print and figure-ground modifications such as light-colored backgrounds to enhance
attention to information as part of an over-all multi-sensory teaching approach.
Evidence: Challenged learners will rely upon any means of ascertaining information in an attempt to
keep up with the pace of classroom discourse. It is a common strategy used to attempt to make
sense of written information versus utilizing all available information to drive gaining knowledge,
critical thinking, and the vocabulary and language forms that underpin these. That is, we are
programmed to be natural learners and students who do not have the requisite literacy skills will use
whatever information they have at hand, to participate in the instructional process.
The history of visual deficit as first, the presumed reason for dyslexia (Orton, 1925) and later
theories involving visual spatial orientation deficit (Hermann, 1959) and other visual sequencing and
memory deficits were roundly debunked by Vellutino (1987) and Vellutino and Scanlon (1987)
among others, in studies that scrupulously controlled for verbal coding. No differences were found
between typical and atypical learners across a range of levels (grades 2-8) in their ability to
discriminate left-right orientation or processing (Vellutino, 1987). Given the later compelling
evidence of linguistic deficit(s) as the underlying cause of word decoding difficulties, these
researchers contended that in the absence of visual perceptual differences between groups, earlier
visual deficit claims were considered pseudo-problems that have no psychological reality
(Vellutino & Scanlon, 1998, p. 9). While changing font size and color may seem useful, there is no
empirical or scientific evidence to support such techniques. In practice, students will often try to
replicate such strategies with multiple colored pencils as an example, when writing down
information. This more often than not, results in off-task behavior searching for just the right
colored pencil rather than focusing on the information being conveyed at the time of the lesson.

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Multi-sensory teaching refers to making learning accessible through a multi-modality approach (language
by eye, language by ear, language by hand and interconnecting all three) and the afore-mentioned
accommodations do not forward the learning process in a lasting way. Building memory for
information is accomplished through explicit teaching of sound-letter correspondences (phonics),
decoding of words and their phoneme segments, of understanding morphology and larger word
segments, learning to navigate complex syntactic structures and invoking background information
and active thinking strategies for content-learning. Multi-sensory teaching methodology is discussed
further in the section on intervention and educational practices.
4) Because English is a dense orthography, learning vowel sounds and the letters that represent
them is difficult and therefore, focusing on irregular consonant spellings for sounds is more useful.
Accommodations need to be made for program reading materials instead of developing phonicsbased programs that benefit all English language learners beginning in preschool.
Evidence: English orthography is remarkably systematic (Moats, 2010) and the problem with
classroom instruction has more to do with a lack of teacher knowledge regarding understanding the
structures of a target language and importantly, how to teach fundamental reading skills such as
decoding (Moats, 1994). Deficits in teachers knowledge include knowing how many phonemes there
are in a word, e.g., cat, fish, understanding syllable types and structure, e.g., closed, open, silent-e,
morphological endings (bound and unbound) and their effects on word meaning (inflected or
derivational), e.g., -est, -ness, -ed, -s, effect of stress on syllables in bi-syllabic and multi-syllabic words.
Often, they do not understand the schwa sound, a frequently occurring unstressed vowel, and
correct pronunciation of frequent, irregular words, e.g., said, would, and diphthongs, resulting in weak
instruction in the classroom. These problems are found in both mother-tongue and foreign-language
teachers who teach English.
Teachers, special educators and importantly, speech/language pathologists must be prepared in
understanding phonemic awareness, understanding the vowel, consonant and syllable systems of English, understanding
the correct sequence and methodology for teaching these concepts (Adams, 1990; Ehri, 1991; Steinbock, 2004;
Steinbock 2009; Moats, 2010; Carreker, 2011). Inclusive classroom teaching is essential and an
approach that is based upon scientifically-based reading research (SBRR) as opposed to teachers
personal judgments based upon teaching to the text regarding what should be taught must be
avoided (Steinbock, 2015). If the goal is to achieve fluent reading and writing skills, it is incumbent upon
teacher trainers, classroom teachers and interventionists to be competently trained and mentored in
oral and literate language acquisition teaching strategies including multi-sensory phonics instruction in
order to be effective and inclusive in the classroom (NICHD, 2000 (see p. 299); Chall & Jacobs,
2003; Birsh, 2011; Garnett, 2011).
5) The Computer as Tutor: Computer software can substitute for classroom teaching.
Evidence: There is a growing tendency to utilize computer programs to teach students critical
concepts they are missing in the regular classroom instruction or to complete homework
assignments with activities tied directly to textbooks used in school curriculum. In effect, often with
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lay tutors, children are moved through assignments to complete them for the purpose of completing
the prescribed program for the school curriculum goals. The mapping strategies and schemas can
often be helpful but when the goal is to target how to move through a lesson without consistent
instruction in building decoding and fluency skills necessary for achieving reading comprehension
and written composition, the long-term benefits are questionable. As noted by Hecker and
Engstrom (2011), Research shows that assistive technology can provide a bridge between students current skills
and the tasks they must perform by supporting them in skills they have not yet acquired. Emerging evidence suggests
that assistive technology can also contribute to strengthening students skills in decoding, comprehending, and spelling
and in reading and writing fluency. Assistive technology, however, is generally not effective for students with learning
disabilities unless it is combined with instructional and learning strategies that prepare students to take advantage of
the technology. Furthermore, assistive technology is often abandoned by the very students who could benefit most when
they are not adequately supported while learning to use the technology tools efficiently. (p. 659).
What is clear is that students in the general population can make significant gains in reading
comprehension and math but that struggling students, especially after elementary school, tend to
demonstrate significantly less progress relative to their typical peers and that researcher-generated
programs tended to be more effective than off the shelf software (Dynarski, M., Agodini, R.
Heaviside, S. Novak, T., Carey, N. Campuzano, L., et. al. (2007); (Pearson, et.al, 2005). Cheung &
Slavin (2012) conducted meta-analyses of computer software effects and determined that there are
advantages to teacher instruction in tandem with computer instruction but educational technology
software requires expertise on the part of the educators that employ it.
Berninger, et al. (2015) conducted an explicit writing experiment with teaching 3 lesson sets:
handwriting (an oft-neglected skill), spelling and sentence constructions on iPads. A multi-sensory
approach was designed: listening to instructions through headphones, reading text on a monitor,
speaking sounds or words when instructed to do so and importantly, writing with interface tools,
i.e., a stylus, on the iPad. Subjects were volunteers, grades 4 9, who identified as having difficulties
with handwriting, spelling and text composition but had no other developmental disabilities. Tightly
controlled trials targeted writing the alphabet from memory under 3 conditions, manuscript, cursive
and keyboarding (Berninger, et al. 2015). Sentence copying tasks and orthographic spelling tasks
completed the three writing conditions. Results (see Berninger, et al., 2015 for detailed description
and analysis) indicated that writing instruction in the upper-elementary and middle school grades
provided evidence-based proof of its efficacy with students displaying dysgraphia, dyslexia, oral
language deficits and learning disabilities.
An important recommendation from this initial research on handwriting was that students needed
specific, carefully designed handwriting instruction at all linguistic levels, i.e., letters, words, spelling
and composing. Significantly, throughout the school years into the upper grades, it was suggested
that they would require periodic handwriting instruction to maintain skill levels commensurate with
those needed for adequate academic achievement (Berninger et al., 2015). At issue is automaticity
whether through specific handwriting/paper tasks or keyboarding. Especially with the latter, direct,
systematic instruction is necessary to overcome the common practice of hunt and peck writing
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often seen in education and beyond. Keyboard fluency is as essential to spelling and composing as is
fluid, organized handwriting.
Clinical and Educational Practices: Aligning Diagnosis and Educational Treatment
What a child knows implicitly and explicitly about language (whether the primary or if from a
bilingual or multilingual background, second or third languages) is essential to understanding
academic success and failure. The focus so far has been upon dyslexia but that is a diagnosis that is
often made during the early school years even though it is well-documented what the metalinguistic
and metacognitive components are prior to entrance into school (Heath, 1982; Heath, 1983; Westby,
1987, 1995; Gee, 2005; Soifer, 2011, van Kleeck, 2014, 2015). We also know that socio-economicstatus (SES) and concomitant maternal-child communication in the home at the preschool level, are
powerful determinants of academic success (Valilyeva, Waterfall & Huttenlocker, 2008; Wells, 1985).
In effect, exposure to the forms of academic language through booksharing, discussion that contains
elements such as inferential thinking, decontextualized language, talk about mental states,
hypothesizing, giving opinions, narration to name a few areas, are associated with a childs early
achievement in learning to read, and learning through the language of instruction as ideas become
more removed from the here and now and instead become knowledge, that is information for
informations sake (Bruner, 1966; Heath, 1983; Fillmore, 2004; Gee, 2005; Silliman and Wilkinson,
(2015). As quoted in van Kleeck, 2015 from James Gee (2005), More children fail in school, in the long
run, because they cannot cope with academic language than because they cannot decode print. (p. 20).
Why Understanding Pre-school Language Development is Essential
In addition to the considerations of CT and AT registers (van Kleeck, 2015), as a speech/language
pathologist (SLP), I have to focus as well upon what are the language difficulties beyond talk
registers that a child may be experiencing prior to entering school. That is, what are the speech
and/or language deficits that are associated with success or breakdown of real-time classroom discourse
processing, with executive language functioning, as well as the skills previously discussed. This is where
speech-language pathology, classroom teaching, diagnosis and intervention intersect and are driven
by a single mutual aim to make learning accessible, and to build confidence as a learner in a child
with social and academic language challenges. We can monitor progress in a manner that reflects
progress, not based upon merely subjective observation, but also quantifiable measurements that
reflect gains and target areas of continued need for intervention or what Judith Birsh and I term,
strategic teaching.
In practice, the earlier children are identified as having slow or atypical speech/language
development, the better the outcome in social interaction and academic achievement (Justice, 2006).
That is, we can talk about phonological awareness deficit as an underlying cause in learning to decode and
spell that often may be subtle and not apparent in early childhood. If the child is not exposed to the
kinds of activities associated with AT and pre-emergent literacy, a child with slow or impaired
speech development not associated with developmental disabilities, is already exhibiting at-risk
phonological deficits that may later translate into phonological awareness deficits. We can postulate
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that the multiple articulation deficits associated with unclear speech, reflect the coding deficit that
underlies both speech and language acquisition.
Similarly, children with coding impairment may demonstrate word coding and recall errors that are
reflected in naming errors within semantic groups (dog for cat), sound groups (Cold Cream Monster for
Cookie Monster) that persist beyond the early acquisition period of 12 36 months. Historically, they
may have been quieter babies that did not follow a typical babbling progression, were slower to
reach the benchmark 50 word vocabulary that is followed by word combinations, Marco hat, and
later, inconsistent morphological use and the increasing utterance length that turns a toddler into a
conversationalist by 36 months of age. A rapid progression to being a narrator of activities of daily
living, a curious intellectual (the increase of wh-question forms, especially why around age 3) as well as a
daily explosion in vocabulary acquisition follow as children move beyond early forms of requesting,
and commenting, to fully participating as active conversational partners.
While there is variation in fluency and rate of speech (for example, it is not unusual for young
children between 24-36 months to experience a period of dysfluent speech), we must consider
quality and quantity of output based upon other factors such as opportunity to talk, personality and
quality of linguistic interaction (as previously noted). Nonetheless, while the oral-literate continuum
is not direct (Silliman & Mody, 2008), we know that children with articulation, vocabulary, grammar
and pragmatic (language use) deficits, frequently become children labelled as dyslexic, LD
(learning-disabled), or even inattentive or off-task after they enter school. Cultural norms and/or
expectations regarding level of communication skills or having a family member who is different
may preclude seeking treatment.
Executive language functioning difficulties may be evident. ELF refers to metacognitive/metalinguistic
abilities that drive how to organize and execute tasks. Dawson and Guare (2010) identify core skills
including working memory, inhibition, planning, cognitive flexibility and self-regulation. Differential diagnosis
including a team of specialists, e.g., psychologist, SLP, learning specialist and classroom teacher along with
careful interviews of parents and the child, would be instrumental to document language
development and to exclude complicating fine motor or attentional problems. I have seen, however,
that children can become inattentive or disruptive as well as labelled dysgraphic because of
undiagnosed language deficits which can also affect executive language functioning. Unfortunately,
not all school systems have the appropriate professionals and support staff in place to help with
differential diagnosis, treatment planning and delivery of support services.
Practicing Effective Educational Intervention
For 12 years in Venice and for the last 6 years in collaboration with interns from the Department of
Scienze di Linguaggio, University of Ca Foscari, in Inglese Dinamico we have practiced an
intervention approach to teaching quality speech and language skills in English for use in social
interaction, academic learning, and critical thinking. For building stronger communication and
thinking skills, we employ a process called react, reflect and respond. As our programs have extended
downward into preschool, we have been able to develop a system of seamless learning. In effect,
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beginning at the preschool level up through university level, we strive to promote both CT and AT
speech and language skills. The Building Blocks Program (Steinbock, 2007) was written and designed
for simultaneous teacher-training and language intervention for children from ages 3 to 6. A crucial
tenet of all program designs in Inglese Dinamico, is a two-pronged approach teaching teachers as we
teach students. We are also working to identify children in our preschool program who may be at
risk; remediation of language deficits at this age has been shown to reduce later academic reading
acquisition failure (Justice, 2006; Vellutino et al., 1996).
Preschool Level The Critical Developmental Period
A recent pilot program conducted in our laboratory from 2013-2015 (Chiste, 2015) demonstrated
measurable, qualitative results in two groups of preschoolers (2 groups/4 children) engaged in
interactive activities designed to build requests, turn-taking and commenting skills. Structured
activities, e.g., circle time, show-and-tell, book-sharing and board games are utilized in progressively
complex talk routines. Specific teaching goals include:
1) Building clear pronunciation skills, phonological awareness that also includes developing
inflectional morphology (e.g., plural s, past tense forms, -ing, third person s) by
emphasizing phonemic and syllabic elements during all activities.
2) The stress-time component of English is naturally built in with rhythmic clapping of syllabic
segments or words in activities and books, and with songs so that prosody is naturally
acquired. When a child produces a sound or syllable segment, immediate corrective
feedback is given to refine pronunciation. Vowel segments and pronunciation differences
present in consonants shared by Italian and English (soft and hard plosives /p,b/ and other
voiced-voiceless distinctions, /t,d/ are emphasized. Visual support through careful modelling
of the mouth, pointing out critical features such as slight lip retraction, for example, short
/i/ to distinguish it from short /a/are included.
3) Early school language is cultivated through writing activities in structured handwriting
books that emphasize multi-sensory execution of letters on special writing lines. Children are
taught to direct themselves through the task with specific verbal and gestural prompts, e.g.,
when executing the letter b: Start at the top, go down, back up and around. All language forms
are accompanied with natural gestures or with corresponding American Sign Language
forms so that coding is through ear, hand, mouth and eye.
Early Elementary
Activities described are continued in first grade as students master manuscript writing, following oral
and written directions in English. Simultaneously, they continue to develop their phonemic
awareness skills, expanding their commenting skills through game and book-sharing activities.
Beginning in second grade, phonics utilizing a structured Orton-Gillingham approach that emphasizes
multi-sensory teaching is introduced. This approach has been formalized in The SAILS Program,
Steinbock All-Inclusive Language-Speech Program, (2015) which is presently undergoing the accreditation
process by the Academy of Orton-Gillingham. It is designed to improve teachers speaking, reading
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and writing skills in English and impart this information in their classrooms as an inclusive teaching
model for all students.
Making a Dense Orthography Transparent Enriched Sequential Phonics Instruction
Utilizing a classic phonics program, Explode the Code; Essential lessons for phonics mastery (Hall & Price,
1976), a speech and language enrichment program focuses on clarity of speech, handwriting, letter
recognition and sound-to letter correspondences. A strict sequence that enhances naming and
sound production of consonants first, followed by 5 short vowels, introduction of English
orthographic digraphs and tri-graphs, then of long vowel sounds and the spelling rule, silent-e is first
taught in 2, 3rd, and 4th year elementary. Spelling combinations for easy alternate long-vowel
diphthongs, e.g., /ai, ay/are included.
Collaborative teaching is taught as well so that students who may be quicker to learn a
pronunciation or spelling form, coach group members. Constant feedback is given in terms of
place and manner of pronunciation, precise air tracing of letters as a sound is produced and later as a
syllable is produced. These sounds and words are embedded in lists for picture matching, short
phonetically regular sentences for reading practice, scrambled words and sentences to match
pictures. Vocabulary and reading comprehension are cumulative as decoding skills are paired with
pictured information. Grammar constructions including inflected morphological markers are
introduced through the carefully structured forms present in the activities for each lesson that
focuses on a specific sound and paired spelling form(s). All children are coached to achieve 100%
correct production and decoding. Verbal encouragement is given throughout each activity, selfcorrection is cultivated and stars are written onto completed pages with a supportive note, Great
job!, You did it! you learned short /o/! so that each student knows exactly what was accomplished.
Additional support is given with spelling bees, letter tiles to produce and change sounds to spell
words and dictation of words and sentences as appropriate.
An important concept here is contrastive teaching. As part of the learning process, students are
spontaneously asked to name letters in Italian and in English and to give in another exercise, the
sounds in English and Italian. We find that this reinforces the differences in the two alphabetic
systems and strengthens their oral spelling as well as clearer pronunciation of the target segments.
This strategy can be used across multiple languages as the encoding process seems to be aided by
this rapid alternation of letter sounds and names.
Upper Elementary Middle School
Work progresses through syllable types, e.g., closed, open, silent-e, and the rules for dividing them
including inflectional suffixes. Letter sequences associated with pronunciation changes dictated by
spelling forms, e.g., soft /g, c/, silent letters in spelling forms such as mb, kn- and stle are target
lessons. Increasingly irregular forms that come from Middle English /ough/ have to be taught as
syllabic segments with variant pronunciations. The program is comprehensive and utilized as late as
high school as it is often the case that students in the upper grades enter our after school labs with
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weak pronunciation, spelling and decoding skills whether they are challenged or typical learners.
Grammar, prosody and text navigation all become a part of the lessons as the exercises have
sentence or short stories that contain coordinate or complex sentence forms. For text navigation,
strategies are taught that include reviewing questions first, circling or underlining important question
forms, vocabulary, clause and phrasal forms and then speed reading of the short stories and writing
answers that focus on correct information, spelling and grammar precision (see Fig. 4).
Putting it all Together: Decoding Skills, Text Navigation and Talk
From elementary school through middle school, students work with a series, Making Connections,
(Dewsbury & Kovalevs, 2005) that progressively teaches text navigation, text comprehension and
writing skills with carefully, visually attractive designed units that focus on a specific skill, e.g., locating
details, sequence, main idea, fact vs. opinion, figurative language, drawing conclusions. Schematic activities teach
idea connections, vocabulary and inferencing skills, as examples, to encourage active engagement
with the text. Supportive teaching involves learning to pay attention to pictures and photos and their
captions, make use of titles and sub-headings, numbering paragraphs to remember where
information is located and underlying information based upon having reviewed questions and
schemas beforehand to understand reading for a purpose. Students are always encouraged to utilize
what they might know about the topic at hand, to hypothesize about a problem and its possible
solution, etc., as a means of learning and employing academic school language. Modern novels and
current films that explore contemporary issues, reinforce speaking, listening and thinking skills
High School Level
Formal writing demands are increased with learning how to write integrated and independent essay
tasks. Practice with phonics, grammar review utilizing schemas such as timelines and sentence
diagrams to reinforce the relationships between clauses and phrases at the noun and verb levels and
descriptive forms, for example, prepositional phrases, reinforce sentence production. Word maps
that emphasize roots, inflected and derivational forms as well as words containing the root form are
drawn as discussion progresses to reinforce information in context by reinforcing learning by eye,
ear, hand and the connections to the spoken segments. Idea maps proceed from questions posed to
activate critical thinking skills.

Conclusion
The techniques used in our 28 session, one-time per week afterschool laboratories (small group 4-6
students) incorporate sensitivity to speech and language acquisition and language disorder issues
associated with the work of SLPs, the best teaching practices that have come from educational
psychology, applied linguistics, curriculum design, both therapeutic and educational intervention
strategies and are, therefore, replicable in classrooms. It is strategic teaching that trains teachers to be
teaching strategists, that is, educators who understand that no single approach, e.g., teaching to the text,
teaching how I was taught, or teaching to the best students is effective, ethical teaching. Three
essential points:
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1) We must focus on developing teaching methodology that can be utilized in the general
classroom, preferably with well-prepared and mentored support teachers, that provides
scientifically based reading research teaching, understanding of social and academic language
demands and the differences. An essential skill is the capacity to recognize when there is a
learning breakdown in one or more students and then, to strategically focus on making
learning accessible, active and successful. Not all students will progress at the same rate and
some will require long-term teaching intervention or periodic specific language intervention.
2) It is incumbent upon the educational community to understand that dyslexia is highly
remediable but requires properly prepared and mentored teachers, tutors and support
teachers to recognize, plan and execute teaching strategies sensitive to the complexity of
content learning. It is not enough to teach in a language.
3) Two things are imperative: first, children need to be identified and treated by SLPs for atrisk language-learning problems prior to entering elementary school; second, it is essential
that learning be inclusive, that teaching is informed and supportive.
Good teachers are not born but made. It is a profession that has a fundamental impact upon the selfidentification of students as successful learners a lifelong effect that profoundly affects social,
educational and career development.
Acknowledgments
The author would like to thank Judith Birsh, Ed.D., New York, NY for her insight into bridging the
clinical and education divide, to Candice Bray, Sc.D., Maine for her contribution to the discussion
on phonemic awareness and critical comments, Anne van Kleeck, PhD, Professor, Callier Center for
Communication Disorders Research, UT Dallas, Texas, for her generous contribution of materials
and criticism. Special thanks to Joel Stark, PhD, Professor Emeritus, Professor and Director
Emeritus, Speech-Language-Hearing Center, Queens College, CUNY, and Elaine R. Silliman PhD,
Professor Emeritus, Communication Sciences and Disorders, University of South Florida for their
critical expertise, materials and 40 years of personal mentoring in reading and communication
disorders in school-age children. And deepest appreciation to my interns at Inglese Dinamico who have
learned and labored with me to put together our bilingual intervention approach.
References
Adams, M. (1990). Beginning to read: Thinking and learning about print. Cambridge, MA: The MIT Press.
Berninger, V.W., Nielsen, K.H., Abbott, R.D., Wijsman, E. & Raskind, W. (2008). Writing problems
developmental dyslexia: Under-recognized and under-treated. Journal of School Psychology, 46, 1-21.
Berninger, V.W., Nagy, W., Tanimoto, S., Thompson R., Abbott, R.D. (Oct. 19, 2014). Computer instruction
in handwriting, spelling and composing for students with specific learning disabilities in grades 4-9. Computers
& Education, 81, 154-168. Retrieved 8/3/2015, www.elsevier.com/locate/comedu.
Birsh, J.R. (2011). Connecting research and practice. In Birsh, J.R. (Ed.), Multisensory Teaching of Basic Language
Skills, 3rd.Ed., 1-24. Baltimore, MD: Paul H. Brookes Publishing Co., Inc.
11 | P a g e

Bruner, J. (1966). Toward a Theory of Instruction. Cambridge, MA: Harvard University Press
Carreker, S. (2011). Teaching reading: Accurate decoding. . In Birsh, J.R. (Ed.), Multisensory Teaching of Basic
Language Skills, 3rd.Ed., 207-250. Baltimore, MD: Paul H. Brookes Publishing Co., Inc.
Catts, H., & Kamhi, A. (Eds.) (2005). The connections between language and reading disabilities. Mahwah, NJ:
Lawrence Erlbaum.
Chall, J.S., Jacobs, V.A., & Baldwin, L.E. (1990). The reading crisis: Why poor children fall behind. Cambridge, MA:
Harvard University Press.
Chall, J.S., & Jacobs, V.A. (Spring, 2003). Poor childrens fourth-grade slump. American Educator, Vol. 27, (1),
14-15.
Cheung, A. & Slavin, R. (2012). How features of educational technology applications affect student reading
outcomes: a meta-analysis. Educational Research Review, 7, 198-218. Common Core
http:\\www.corestandards.org/standards/index/htm.
Chiste, Melania (March, 2015). Unpublished thesis manuscript:: Early Second Language Acquisition: An Analysis
of the English Production of Italian Mother Tongue Children, University of Ca Foscari.
Costenaro, V. & Pesce (01/03/2012). Dyslexia and the phonological deficit hypothesis: Developing
phonological awareness in young English language learners. EL.LE. Retrieved 03/26/2013, edizione
icf.unive.it/riv/exp 146/ELLE/3/309.
Costenaro, V., Daloiso, M. & Favaro, L. (July 2014). Teaching English to young learners with dyslexia:
Developing phonemic awareness through the sound pathways. EL.LE vol. 3- Num. 2, 209-230.
Dawson, P., & Guere, R. (2010). Executive Skills in Children and Adolescents: A Practical Guide to Assessment &
Intervention. New York, NY: Guilford Press.
Dewsbury, A. & Kovalevs, K. (2005) Making Connections, Cambridge, MA: Educators Publishing Service.
Dynarski, M., Agodini, R., Heaviside, S., Novak, T., Carey, N., Capuzano, L., et. al (2001). Effectiveness of
reading and mathematics software products: Findings from the first students cohort. Washington, D.C.: US
Department of Education, Institute of Education Sciences.
Ehri, L.C. (1991). Development of the ability to read words. In Barr, R.., Kamil,, M.L., Mosenthal, P.B., and
Pearson, P.D. (Eds.). Handbook of Reading Research, Vo. 2, 383-417. Reading, MA: Addison-Wesley-Longman.
Fillmore, L.W. (2004). The role of language in academic development. Paper presented at the 13th Annual
Administrator Conference, Sonoma County Office of Education.
Garnett, K. (2011). Fluency in learning to read: Conceptions, misconceptions, learning disabilities, and
instructional moves. In Birsh, J.R. (Ed.), Multisensory Teaching of Basic Language Skills, 3rd.Ed., 293-320.
Baltimore, MD: Paul H. Brookes Publishing Co., Inc.
Gee, J. P. (2005). Language in the science classroom: Academic social language as the heart of school-based
literacy. In Yerrick, R.K., and Roth, W.M. (Eds.), Establishing Scientific Classroom Discourse Communities: Mltiple
Voices of Teaching and Learning Research, 19-37. Mahwah, NJ: Lawrence Erlbaum.
12 | P a g e

Gillingham, A., & Stillman, B.W. (1960). Remedial training for children with specific disability in reading, spelling, and
penmanship (6th ed.). Cambridge, MA: Educators Publishing Service.
Hall, N. & Rice, R. (1976). Explode the code: Essential lessons for phonics mastery (Books 1-8). Cambridge, MA:
Educators Publishing Service.
Heath, S.B. (1982). What no bedtime story means: Narrative skills at home and work. Language in Society, 11,
49-76.
Heath, S.B. (1983). Ways with words: Language, life and work in communities and classrooms. New York, NY:
Cambridge University Press.
Hecker, L. & Engstrom, E. U. (2011). Technology that supports literacy instruction and learning. In Birsh,
J.R. (Ed.), Multisensory Teaching of Basic Language Skills, 3rd.Ed., 657-683. Baltimore, MD: Paul H. Brookes
Publishing Co., Inc.
Herman, K. (1959). Reading disability. Copenhagen: Munksgaard.
Justice, L.M. (October, 2006). Evidence-based practice, response to intervention, and the prevention of
reading difficulties. Language, Speech and Hearing Services in Schools, 37, 284-297.
Kamhi, A. & Catts, H. (1989). Language and reading: Convergences, divergences and development. In
Kamhi, A.G. & Catts, H.W. (Eds.). Reading disabilities: A developmental language perspective (pp. 1-34). New York,
NY: Little, Brown.
Liberman, I.Y. & Shankweiler, D. (1979). Speech, the alphabet and learning to read. In Resnick, L. &
Weaver, P. (Eds.). Theory and practice of early reading, Vol. 2, 109-132. Hillsdale, NJ: Erlbaum.
Liberman, I. (1983). A language-oriented view of reading and its disabilities. In Myklebust, H. (Ed.), Progress
in learning disabilities, Vol. 5, 81-102. New York, NY: Grune & Stratton.
Liberman, I. & Liberman A. (1990). Whole language vs. code emphasis: Underlying assumptions and their
implications for reading instruction. Annals of Dyslexia, 40, 51-76.
Moats, LC. (1994). The missing foundation in teacher education: knowledge of the structures of spoken and
written language. Annuals of Dyslexia, 44, 81-102.
Moats, L. C., & Lyon, G.R. (1996). Wanted: Teachers with a knowledge of language. Topics in Language
Disorders, 16 (2), 73-86.
Moats, L.C. (2010). Speech to print: Language essentials for teachers (2nd ed.). Baltimore, MD: Paul Brookes
Publishing Co., Inc.
Nagy, W. & Townsend, D. (2012). Words as tools: Learning academic vocabulary as language acquisition.
Reading Research Quarterly, Vol. 46, 91-108.
National Institute of Child Health and Human Development (2000). Report of the National Reading Panel:
Reports of the subgroups. Teaching children to read: An evidence-based assessment of the scientific research
literature on reading and its implications for reading instruction (HIH Publication No. 00-4754), Washing,
D.C. Government Printing Office.

13 | P a g e

Orton, S.T. (1925). Word-blindness in school children. Archives of Neurology & Psychiatry, 14, 581-615.
Pearson, P.D., Ferdig, R., Blomeyer, R. & Moran, J. (2005). The effects of technology on reading performance in the
middle school grade: A meta-analysis with recommendations for policy. Learning Point Associates, sponsored under
government contract ED01-CO-0011.
Perfetti, C.A. (1985). Reading Ability. New York, NY: Oxford University Press.
Silliman, E.R. & Mody, M. (2008). Individual differences in oral language and reading: Its a matter of
experience. In M. Mody & E.R. Silliman (Eds.), Brain, Behavior, and Learning in Language and Reading Disorders.
New York, NY: Guilford Press, pp. 349-386.
Silliman, E.R. and Wilkinson, L.C. (2015). Two challenges of the academic language register for students with
language learning disabilities. Routledge Handbook of Communication Disorders, 291-302.
Soifer, L.H. (2011). Development of oral language and its relationship to literacy. In Birsh, J.R. (Ed.),
Multisensory Teaching of Basic Language Skills, 3rd.Ed., 49-92. Baltimore, MD: Paul H. Brookes Publishing Co.,
Inc.
Snow, E.C. (1983). Literacy and language: Relationships during the preschool years. Harvard Educational
Review, 53, 165-189.
Stanovich, K. (1986). Matthew effects in reading: Some consequences of individual differences in the
acquisition of literacy. Reading Research Quarterly, 21, 360-407.
Steinbock, N.R. (2007). Building Blocks: Nursery school builds the foundation skills for Italian preschool teachers.
Proposal submitted to Comune, Venice, Italy.
Steinbock, N.R. (2009). Moving from theory to active strategies in the classroom. In Gagliardi, C. & Maley, A.
(Eds.). EIL, ELF, Global English: Learning and teaching issues. Peter Lang Publishing, pp. 105-126.
Steinbock, N.R. (2015). SAILSSteinbock all-inclusive speech-language program. A program of Inglese Dinamico,
Venice, Italy.
van Kleeck, A. (2014). Intervention activities and strategies for promoting academic language in preschoolers
and kindergartners. Communication disorders, deaf studies & hearing aids, 2:4.
van Kleeck, A. (November 2014). Distinguishing between casual talk and academic talk beginning in the
preschool years: An important consideration for speech-language pathologists. American journal of speechlanguage pathology, 23, 724-741.
van Kleeck, A. (2015). The academic talk register: A critical preschool oral language foundation for later
reading comprehension. In A. DeBruin-Parecki A., van Kleeck, & S. B. Gear (Eds.), Developing early
comprehension: Laying the foundation for reading success. Baltimore, MD: Paul H. Brookes (pp. 52 76
Vasilyeva, M., Waterfull, H. & Huttenlocker, J. (2008). Emergency of syntax: Commonalities and differences
across children. Developmental Science, 11 (1), 84-97.
Vellutino, F. R. (March 1987). Dyslexia. Scientific American, 34-41.
Vellutino, F.R. & Scanlon, D.M. (1987). Linguistic coding and reading ability. In S. Rosenberg (Ed.). Advances
in applied psycholingustics, Vol. 2, 1-69. New York, NY: Cambridge University Press.
14 | P a g e

Vellutino, F., Scanlon, D., & Tanzman, M. (1991). Bridging the gap between cognitive and
neuropsychological conceptualizations of reading disabilities. Learning & Individual Differences, 3, 181-203.
Vellutino, F.R., Scanlon, D.M., Sipay, E.R., Small, S.G., Pratt, A., Chen, R. et al. (1996). Cognitive profiles of
difficult-to-remediate and readily remediated poor readers: Early intervention as a vehicle for distinguishing
between cognitive and experiential deficits as basic causes of specific reading disability. Journal of educational
psychology, 88, 601-638.
Vellutino, F.R. & Scanlon, D.M. (March 1998). Research in the study of reading disability: What have we
learned in the past four decades? Paper presented at the annual conference of the America Educational
Research Association Meeting: San Diego, CA.
Wallach, G. & Miller, L. (1988). Language intervention and academic success. New York, NY: Little Brown.
Westby, C. (1985). Learning to talk-talking to learn: oral-literate language differences. In C. Simon (Ed.).,
Communication skills and classroom success: therapy methodologies for language learning disabled students, 181-213. San
Diego, CA: College-Hill Press.
Westby (1989). Assessing and remediating text comprehension problems. In A.G. Kamhi & H.W. Catts
(Eds.), Reading disabilities: A developmental language perspective, 199-260. New York, NY: Little Brown.
Westby, C.E. (1995). Cultural and literacy: Frameworks for understanding. Topics in language disorders, 16 (1), 5066.
Wilkinson, L.C., and Silliman, E.R. (2000). Classroom language & literacy learning. In M.L. Kamil, P.E.
Mosenthal, P.D. Pearson & R. Barr (Eds.), Handbook of reading research, 337-360. Mahwah, NJ: Lawrence
Erlbaum.

The author is indebted to Giulia Girardello for her translation.

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