Alan Kamhi
Kenn Apel
Julie Masterson
Knowledge Explosion
 The knowledge base of developmental language
disorders has expanded at a rapid in the last 35 years.
 This expansion has been due to the increased
appreciation and understanding of the full scope of
language (syntax, morphology, semantics, phonology,
pragmatics, and written language), as well as the
natural progression of knowledge and specialization
that occurs in any discipline.
Making Clinical Decisions
 The amount of knowledge available about language
disorders and how to treat them may, paradoxically,
make it more difficult to make good clinical decisions.
 How does a clinician decide which assessment
instrument or treatment approach to use given all of
the choices available and all of the conflicting claims
about what does and does not work?
 How does a clinician decide what to work on when a
client’s language problems are not limited to one or
two areas?
 In other words, what does a clinician do with a student
who has deficiencies with morphosyntax, semantics,
conversation/narrative discourse, word-level reading,
spelling, listening comprehension, and writing?
Then vs. Now
 Clinical decisions seemed much easier 35 years ago
when language was limited to morphology, syntax,
early semantic relations, and the processing abilities
measured by the ITPA.
Clinician Orientations
 The Grammar Clinician
 The Conversational Discourse Clinician
 The Narrative Discourse Clinician
 The Comprehension Clinician
 The Literacy Clinician
 The Program Clinician
 The Kenn Apel Clinician
 The Julie Masterson Clinician
The Grammar Clinician
 Targets sentence-level morphosyntactic problems
(e.g., aux/cop omission/agreement) because these
errors are noticeable, persistent, and not
developmentally appropriate for a 7-8 year old.
 Believes that improving morphosyntax is important
for the student’s self concept and will have positive
effects on social interactions as well as reading and
writing.
Comments
 If morphosyntax is a problem, can’t it be targeted in
conversational and narrative discourse contexts as well
as through reading and writing activities?
 Unless there is an excellent team of professionals
working on other areas of deficiency, focusing solely
on sentence-level morphosyntax will not address other
deficiencies.
The Conversational Discourse Clinician
 One of the main purposes of language (conversational
discourse) is to establish and maintain social relationships.
Children who have difficulty initiating and maintaining
conversational discourse will often have difficulty in social
situations.
 Social interaction skills are more important than academic
skills. Children can learn to read and write a little late, but
positive social interactions are important for school-age
children.
Comments
 Yes, conversational abilities are very important for
establishing and maintaining friendships, but there
are many other factors that affect friendships (e.g.,
interests, personality, gender).
 Improving conversational abilities (turn taking, topic
maintenance/change) is not easy (see Brinton & Fujiki,
2005) and may not significantly improve social
interactions.
 Conversation is context dependent and dynamic.
 It is difficult to teach rules that can be used in every
situation. For example, maintaining eye contact seems
like a general rule, but we can all think of situations
where eye contact would be inappropriate.
 Literacy activities could be used to improve
conversational abilities by having students read about
people with different conversational styles.
 Students could also write scripted social interactions
that they could use in real life situations.
The Narrative Discourse Clinician
 The ability to retell a story at age 4 is the best predictor
of language abilities at age 6. It is a good measure of
working memory and language knowledge.
 Children who have good narrative abilities usually
come from high print homes where they are exposed
to literacy artifacts, events (shared book reading,
acting out scripts), and literacy knowledge (letters,
sounds).
 Narrative discourse thus provides a strong link
between written and spoken language.
 Stories and events can be used to teach vocabulary,
morphosyntax, narrative structure, and literacy
(reading, writing, and spelling).
 Narratives (e.g., event retell) can be made
communicatively relevant and functional.
Comments
 Narrative discourse would be a good choice if one were
forced to choose a single orientation because it allows
one to target all aspects of spoken and written
language.
 But, narratives are just one aspect of language.
Consider other discourses and genres: conversation,
expository, persuasive, drama, biography, letters,
science fiction, poetry, etc.
The Comprehension Clinician
 The best way to improve academic success is to
improve comprehension. Standardized measures of
reading and many EOG tests require sophisticated
comprehension abilities.
 There are no EOG tests of spoken language, so the
focus needs to be on understanding.
 There is no one-size fits all approach to improve
comprehension. SLPs with their differential
diagnostic abilities are well equipped to design
individualized interventions to meet the needs of
diverse students.
Comments
 Because comprehension is difficult to improve, one
tends to look for simple causes for the problem
(e.g.,APD, ADHD) and put too much faith in the
interventions associated with these causes
(preferential seating, medication).
 SLPs typically do not have much experience teaching
vocabulary or listening comprehension to school-age
children.
The Literacy Clinician
 Reading proficiency is crucial for academic success.
 Because reading, writing, and spelling are languagebased skills, SLPs have the background and experience
to help students with difficulties in these areas.
Comments
 Despite official ASHA position statements about the
roles and responsibilities of SLPs in serving students
with written language problems, some SLPs do not
view literacy as within their scope of practice.
 Schools with reading specialists and special educators
may view reading as their territory.
 Some SLPs may not feel competent to treat students
with reading, writing, or spelling difficulties.
 SLPs may feel that spoken language deficits should
take priority over written language problems.
The Program Clinician
 Using a scripted program to teach language or reading
(e.g., Fast Forword, Earobics, Language!, Lindamood,
Wilson) is the most efficient and effective way to treat
students with language and learning disabilities.
 Unlike individualized treatment plans, scripted
programs have evidence that supports their efficacy
and efficiency.
 Scripted programs can often be administered to groups
and reduces planning time, which allows SLPs to serve
more clients.
 It is easier to teach a novice student or SLP to use a
scripted program than a non-scripted one that
individualizes instruction.
Comments
 The foundation of our profession is differential
diagnosis and individualized instruction.
Programmatic instruction is fine….for other
professionals who do not have our training and
background or for SLPs in private practice or in
specialized clinics.
 SLPs can play a central role in assessing and treating
“non-responders” as RTI models of service delivery
become more prevalent.
Kenn Apel, PhD, CCC-SLP
Florida State University
Background/Presenting Concerns
 10 years, one month
 Third grade student
 Repeated kindergarten and third grade
 Receiving remedial instruction: Past goals included:
 sight word reading
 reading fluency
 reading comprehension
 spelling
Background/Presenting Concerns
 Parents concerned about continued delayed reading,
writing, and spelling abilities
 School officials told Kelsi’s parents that she will never
go to college (based on report stating she had a “low
average (cognitive) ability” and “low average potential.”
Grammar Clinician
 CELF (or some other norm-referenced test that
examines “grammar’)
 Caveat: are they assessing grammar or meta-grammar?
 Language sample/DSS
Recalling Sentences
 The Recalling Sentences subtest is used to evaluate the student’s ability
to recall and reproduce sentences of varying length and syntactic
complexity. The student imitates sentences presented by the examiner.
Formulated Sentences
 The Formulated Sentences subtest is used to evaluate the ability to
formulate compound and complex sentences when given grammatical
(semantic and syntactic) constraints. The student is asked to formulate
a sentence, using target words or phrases, while using an illustration as
a reference.
Word Definitions
 The Word Definitions subtest is used to evaluate the student’s
expressive vocabulary. The student is orally presented a word, followed
by an introductory sentence that includes the word. The student is
then asked to define the word using descriptive language.
Understanding Spoken Paragraphs
 The Understanding Spoken Paragraphs subtest is used to evaluate the
student’s ability to understand information presented in spoken
paragraphs. The student answers questions about a paragraph
presented orally. The questions probe the student’s understanding of
the paragraph’s main idea, detail and sequence of events, and the
student’s ability to make inferences and predictions from the
information presented.
Conversational Discourse Clinician
 Conversational/Language sample
 Heavy emphasis on pragmatics/use
 Use of a protocol (e.g., Prutting & Kirchner)
 Possibly obtain samples across contexts
Narrative Clinician
 Narrative discourse sample
 Could obtain standard score from (TNL)
 Obtain generated (and retell, if necessary) samples


Spontaneous generation (unscripted, scripted)
Retell to naïve listener (unscripted, scripted)
 Analyze for episodic structure (initiating event, attempt,
consequence); look for multiple episodes; also examine
cohesion and “listener friendly” devices
Vocabulary Clinician
 PPVT-4
 EVT
 Word-finding finding difficulties
 Norm-referenced measure (TWF-2) and/or
conversational sample
Literacy Clinician
 Phonemic awareness (e.g., PAT, CTOPP)
 (possibly morphological awareness task)
 Reading (e.g., WRMT-R; maybe a miscue analysis/IRI)
 Writing (e.g., TOWL; maybe a spontaneous writing
sample)
 Spelling (e.g., TWS-4; maybe the SPELL-2*)
Disclosure: Apel and Masterson are co-authors and
have a financial interest in SPELL-2
Program Clinician
 A number of different norm-referenced measures
 Likely including a measure of “processing”
 Possibly use of a test/task that is a pre-test to a specific
curriculum/program
An incredibly young one!
A conver-narrative clinician
Assessment would have involved
 Conversational samples with me, a peer, and, if
possible, a familiar adult
 4-5 narratives, both spoken and written
 Possibly a norm-referenced “receptive language”
measure thrown in for good measure (e.g., TACL)
An incredibly young one (for being a grandfather)!
A conver-narra-literacy clinician/counselor
Assessment & Results
 Conversational Sample:
 Syntax: no obvious errors
 Semantics: vocabulary breadth appears somewhat
reduced; some evidence of mazes (filled pauses,
circumlocutions)
 Morphology: infrequent difficulties with use of
derivational morphemes
 Pragmatics: no immediate concerns; a tad hesitant at
first, but warmed up and conversed appropriately; no
parental concerns
 Speech: No speech sound errors
Assessment
 Narrative Discourse Sample:
 One “formal” spoken narrative during evaluation
 Kelsi hesitant at first; provided starter
 Narrative was a one-episode narrative
 Two written narratives (written at home)
 One was a one-episode narrative, the other a temporal chain

Temporal chain was about a birthday party; more difficult because she
reported not having much experiences with them
 Expected multi-causal/multi-episodic narratives
 Borderline abilities
Assessment
 Word-Level Reading:
Task
Raw Score
Percentile
SS Score
Word ID
45
14 (12-16) 84 (83-85)
Word Attack 11
17 (13-22) 86 (83-88)
Assessment
 Word-Level Reading: Miscue analysis
 Easy book: 89%; Challenging book: 88%
 Miscues involved:
deletion of words/parts of words
 guesses based on initial word cues
 partial attempts (initially decoding, then mumbling)
 self-corrected errors
 often ignored punctuation
 Below expectations/90%
 comprehension will be affected
 poor strategies for decoding

Assessment
 Word-Level Reading
 Dynamic assessment (RtI):
Explained and modeled the use of phonemic blending (aka
“continuous voicing”)
 Kelsi asked to use on five words she had read incorrectly
 All five read correctly and meaning accessed (needed
reminding of vowel in one word).
 Reading Comprehension
 No direct assessment; word-level skills too poor
 Checked with parent

Assessment
 Writing: Two samples (narratives)
 One causal, one temporal
 Relatively short (half a page or less)
 Numerous spelling errors
 Writing process
 planning conducted in her head
 wrote the narratives
 no editing or rewriting
 Written composition skills judged to be
inappropriate for her age
 May have been affected by content and/or spelling
 No knowledge/use of writing process
Assessment
 Spelling:
 TWS-4: raw score of 9, standard score of 75 (SEM: 69-85),
percentile of 5 (SEM: 2-16).
 SPELL-2:





Tested at Level 1
Spelling errors due to deficits in phonemic awareness,
orthographic knowledge, and mental orthographic images
Spelling abilities tied to morphological awareness not
assessed at Level 1
Errors were consistent with those in written sample and
TWS-4.
Thirteen goals assigned
Assessment:
One additional piece
 Kaufman Brief Intelligence Test-2
 Measures the “ability to solve new problems by assessing
an individual’s ability to perceive relationships and
complete visual analogs”
 Strong correlations with other measures of intelligence
 Obtained a raw score of 29, standard score of 100 (SEM:
94-106), percentile of 50
 Noted that “performance on such a measure does not
predict capabilities in the area of literacy or potential for
response to intervention or instruction. However, the
results of this measure suggest that Kelsi’s general
cognitive abilities are average and well-within the typical
range for students her age.”
What I Didn’t Do
 A norm-referenced vocabulary test
 Rationale: not needed; vocabulary affected by reading
 A processing task
 Rationale: don’t believe in them
 An elaborate language sample
 Rationale: nothing called for it (no intra-ocular trauma)
 A specific phonemic awareness test
 Rationale: got information from reading and spelling
measures
Possible Goals
 Word-finding goal
 Vocabulary goal
 Narrative goal
 Word-level reading goal
 Writing process goal
 Spelling goal
 Phonemic awareness goal
What Influences How I Prioritize Goals?
 My theory of learning
 Student’s “stimulability” and motivation
 Best use of time/energy (both of us)
 Possible collaborations
 Saving face with others (for the student)
 My biases
Priority A: Learning Theory
 Learners learn best when they can relate new information
to old information
 Learners only have a certain amount of working memory to
learn new information; I need to make learning abnormally
easy
 As an expert, I need to scaffold information to make
learning abnormally easy
 Learners best when they a) develop a strategy that cuts
across a language skill and b) work on the underlying
causes of a deficit
Priority A: Learning Theory
 What do I “know” (assume?) about Kelsi?
 She processes like other learners
 She does not have some basic knowledge on which to
overlay new information
 Her instruction has not been geared toward building on
old information
Priority B: “Stimulability” and motivation
 Learners who demonstrate some ability to perform a task,
even when it is with a fair amount of scaffolding, are likely
to make improvements
 For greater success, a learner must be motivated to learn as
part of the learning process
 Motivation can occur through learner choice of goal/task,
using motivating materials, and/or helping a learner
understand why a change might be necessary
Priority B: “Stimulability” and motivation
 What do I know about Kelsi?
 She is stimulable for phonemic blending
 She has not had success in school and shows signs of
seeing herself as incapable
 She is highly motivated by “anything horse”
Priority C: Best Use of Time/Energy
 With each day/month/year, learners who struggle fall





farther and farther behind (Matthew Effect)
Time with learners with special needs is generally minimal
 Most research demonstrates the importance of multiple
exposures/practice
Learners may/may not get the instruction they need
through typical instruction/curricula
Most learners with special needs have multiple needs
Poor written language skills have great effects in the
classroom
Some goals can get you a “two-fer”
Priority C: Best Use of Time/Energy
 What will get Kelsi the most for the amount of
time/energy expended?
 Kelsi demonstrates an awareness of and concern for
literacy difficulties
 Teachers and parents worried about literacy difficulties;
may lead to better cooperation
 Improvements should lead to:



Better academics
Broader/deeper vocabulary
Improved self-esteem
Priority D: Collaborations
 Collaboration can lead to:
 More authentic learning
 Allowing learners to obtain extra exposure/experiences
 Less worry about materials!
 Enlisting others to help get the job done or even do some
of the “work” for you
Priority D: Collaborations
 What kind of collaboration might be possible with
Kelsi?
 Her classroom teacher is not motivated to modify the
(rigid) curriculum
 Her other service providers are not keen on
collaborating
 We have access to her class materials
 Her parents are highly motivated to help extend
practice at home
Priority E: Saving Face
 “Older” learners quickly see themselves as different
 Learners who are retained have bleaker outcomes
(self-image)
 “Older” learners with special needs do not like to be
singled out
 Learners with special needs always assume they are
wrong, or others are usually right
Priority E: Saving Face
 What might help Kelsi save face?
 Show her “true” success as quickly as possible
 Attempt to not single her out, to the extent possible
 Allow her to “see” what others do and don’t do re: their
language skills
Priority F: My Biases
 I’m a facilitator, not a robot; I need to be able to use my
theory of learning and my clinical gut
 Language, regardless if it is spoken or written, is used for
communication. I need to ensure my goals get my student
to that point.
 Spoken and written language complement and interact
with one another. Working in one “mode” can lead to
improvements in the other. Written language, however,
affects academics more than spoken
 I need to help the student access the general education
curriculum. I can use the curriculum to meet this goal;
however, I still need to observe prerequisites
Priority F: My Biases
 How might my biases influence my work with
Kelsi?
 I won’t be using a program, or if I do, I will use it for my
goal, not as my goal
 I may spend time on word-level literacy skills, but I
won’t forsake (or let others) text-level literacy
 I will work on less goals, knowing/assuming other skills
will be facilitated because of my goals
 I won’t use the curriculum just to use it
Decisions
Learning
Theory
Stimulability
TimeBenefits
Collaboraration
Saving
Face
Biases
Wordfinding
↓
?
↓
↔
↓
↓
0
Vocab
↓
?
↓
↑
↔
↓
1
Narr
↑
?
↑
↔
↔
↑
3
W-L
reading
↑
↑
↑
↑
↑
↑
6
Writing
process
↑
↑
↔
↑
↔
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4
Spelling
↑
↔ /↑
↑
↑
↑
↑
5.5
PA
↓
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0
Kelsi’s Goals
Improve Kelsi’s
1.
Orthographic knowledge, phonemic awareness, and MOIs to facilitate
improvement of her word-level reading and spelling skills
a) Research demonstrates that intervention focused on improving these
underlying linguistic foundational skills leads to improvements in both
reading and spelling.
b) Word sorts, sound strings, “Picture This”
2. Ability to use phonemic blending (“continuous voicing”) to increase
her word-level reading skills.
a) Research demonstrates that this strategy leads to best outcomes for
decoding words and accessing meaning
b) Continuous voicing first in isolation, then in her texts
3. Use of writing process strategies (e.g., using EmPOWER; Singer &
Bashir, 2004) to improve written composition skills.
a) Researchers have shown the positive benefits of this approach for
improving writing skills
b) This is on hold until goals 1 and 2 are met/nearly met
Julie J. Masterson
Missouri State University
Background
• Male, Age 5:11
• History
– First seen at University Clinic at age 4:9
– Hearing, vision, motor skills, intelligence, oral mech
within normal limits
– Dad brought to clinic with concern that people couldn’t
understand him; had trouble following directions
– Diagnosis and treatment focused on artic/phonology
Grammar Clinician
 TACL (focus on results from grammar, syntax subtests)
 Language sample/DSS
Conversational Discourse Clinician
 Conversational/Language sample
 Heavy emphasis on pragmatics/use
 Use of a protocol (e.g., Prutting & Kirchner)
 Analysis of conversational assertiveness/responsiveness;
Discourse function (Fey, 1986)
 Possibly obtain samples across contexts
Narrative Clinician
 Narrative discourse sample
 Could obtain standard score from (TNL)
 Obtain generated (and retell, if necessary) samples


Spontaneous generation (unscripted, scripted)
Retell to naïve listener (unscripted, scripted)
 Analyze for episodic structure (initiating event, attempt,
consequence); look for multiple episodes; also examine
cohesion and “listener friendly” devices
Vocabulary Clinician
 PPVT-4
 EVT
 Word-finding finding difficulties
 Norm-referenced measure (TWF-2) and/or
conversational sample
 Language Sample: NDW, TTR
Literacy Clinician
 Early literacy skills
 Phonological awareness
 Book/Print awareness
 Letter knowledge
• Test of Phonological Awareness – Kindergarten Version
(TOPA)
Program Clinician
 A number of different norm-referenced measures
 Likely including a measure of “processing”
 Possibly use of a test/task that is a pre-test to a specific
curriculum/program
An incredibly young one! A newlywed,
3 years past High School Prom…..
Program-Grammar-Vocabulary
An IDKWHID, IHT, BA-Level Clinician
Services

Assessment
 Goldman-Fristoe
 PPVT
 Language Sample, with MLU calculated
 “Treatment”
 Goals for single sounds, Sequence (Dis, Syll, Word, Sent,
Conv); 90% 3 consec sessions; I-F-M
 IS/ARE via Fokes Sentence Builder or the Language
Master
 Vocabulary (shapes, numbers, colors) via Peabody
Language Kit
Still young…definitely 80s hair
CFU Natural Clinician
An AK-DI-BL D, IASS-ITKWID
Clinician with a Ph.D.
Assessment
 Phonology
 Conversational sample (70-100-220)
 Independent and relational analyses
 SPPT-4IAX
 Errors categorized as Discrim, Phonemic ID, Phonetic
Mapping, or Articulation
 Language
 Language Sample
 MLU, NDW, % utts with mazes, CFU
 Grammatical marker analysis
 Conversational assertiveness-responsiveness
 Clause structure description
 TACL (Differentiate vocab, grammar, syntactic receptive
skills)
Treatment
 Phonology
 Each error classified as needing motoric OR conceptual
 Imagery, minimal pairs
 Motoric Automatization
 Language: NATURAL
 CFU Goals
 Contexts that would naturally elicit target structures
 Natural consequences
 Forbid use of terms like “reinforcement,” “antecedent”)
If Kenn’s still young, so am I…..
Superwoman Syndrome
Grammar-Conversation-NarrativeLiteracy-Comprehension-VocabularyProgram
A TGF…..EBP,C,S Clinician
Good thing because my research doesn’t
really focus on preschool kids!
Phonological Skills
• Independent
– Variety of words shapes, stress patterns, all vowels present
– Nasals, Stops, Glides, Fricatives, Affricates (initial only); non
pre-vocalic /l/, no prevocalic liquids or final /r/
– Nasal + stop; stop + glide (6); /s/ + stop (3)
• Relational
– PCC = 69.2% (SD in Shriberg ref data)
– Reduction of /s/ + stop clusters: 50% operative
– Liquids
•
•
–
–
–
–
–
Prevocalic glided 100%
Non-Prevocalic: Deleted or Distorted 100%
/v/ -> [b] 50% (/f/ okay)
/ / -> [d] (I) 100%; [v] (m, f) 100%
// -> [f] 100%
/ / and / / -> [ts] 80% (/ / 90% correct)
Numerous inconsistent errors
Language Skills
•
•
•
•
MLU: 4.14 (z = -1.27)
NDW: 95 (z = -1.75)
Clause structure tended to be single verb
Grammatical markers
–
–
–
–
–
-ing 5/6
Past tense regular 4/8
Copula: 4/11
Aux (BE, DO): 2/15
Infinitive to 4/99
• Appropriate conversational assertiveness/responsiveness
• CELF Standard Scores:
–
–
–
–
–
Core 81
Receptive 75
Expressive 75
Content 73
Structure 79
Early Literacy
 Attempted administration of Test of Phonological
Awareness – Kindergarten Version (TOPA): Random
responses so discontinued
 Narrative: Retell Simple Causal
 Included setting, problem, consequence
 Omitted internal response, attempt, resolution
Possible Goals
 Vocabulary
 Grammar
 Phonology
 Narrative
 Phonological Awareness
My Considerations: Preschool Kids
 Practical
 What can I choose to have the most significant,
immediate impact?
 Proof
 What does research evidence say about goal prioritization,
treatment methods?
 Prophylactic
 Can I prevent a potential future problem?
 Progress
 Continually monitor change and be willing to adjust,
move quickly
Practical
 Parental concern and student impression was that Sam
had poor intelligibility
 Caveat to language sample results was that
intelligibility may have compromised findings
 Choice for Practical: Phonology
Proof (Evidence)
 Work on grammar facilitates grammar, but not
phonology (Fey et al.)
 Work on vocabulary facilitates vocabulary, but not
phonology (Tyler & colleagues)
 Work on phonology facilitates phonology and
grammar (Tyler & colleagues)
 Proof : Phonology
Prophylactic
 Studies indicate that children with phonological disorders
are at increased risk for academic failure, particularly in
areas of literacy (Bird et al.).
 Effect is particularly strong if language is also impaired
(Nathan et al.)
 Failure to normalize by end of first grade linked to need
for special ed services (Shirberg & Kwiatkowski)
 Treatment for PI that incorporates PA training associated
with grade-level performance (Gillon)
 Prophylactic : Phonology and Phonological Awareness
Goals for Sam
 Phonology
 Maximal contrasts
 Production of liquids (first motoric, then conceptual)
 Refinement of /v/, dental fricatives, , / / / / / /
 Phonological awareness
 Identification of rhyming words
 Identification of onsets (continuants that weren’t focus
of phonology treatment… don’t want to overload the
system)
Progress
 Production of /l/, /v/, dentals, / / / / / / better than
anticipated at single word level; however, it was
frequently necessary to provide stimulus word because
Sam didn’t know it.
 Production of /r/ somewhat laborious, but now clear in
syllables
 Rhyming words identified with almost total accuracy
the first day of presentation
 Identification of onsets
 Initially confused by task, but within 2 sessions, almost
totally accurate
Progress- Goal Adjustments
 Artic refinement work combined with vocabulary
facilitation
 All stimulus words were either already known or deemed
appropriate vocabulary targets
 Phonological Awareness extended to phonemic awareness
and segmentation goal added
 Letter-sound relationships address with PA work
 Worked with Dad on storybook reading skills that have
been documented as effective in increasing vocabulary
(Justice et al.)
Like the field, we’ve evolved…..
“Core Family Values” Still the Same…
Core Family Values
 There are always at least two perspectives on any issue
 Is the approach consistent with my theory of
language/literacy development and learning?
 Is the approach consistent with my definition of
language/communication?
 What does the literature say?
 What does my clinical experience say?
 What is important to the client and family?
 Don’t stay in a rut…..