The hidden “syntax” disorder

grammar and syntax for speech therapy

What do you do when this happens? 

I’m talking about those times we get referrals for kids, and everyone hopes we (the SLP) have the magic answer. Those times we have students on our caseloads, especially if you are in the schools, where we know the 1-2 speech sessions per week just aren’t cutting it. I had a situation come up like this in the spring this year, and like so many times before, I’m left scratching my head trying to figure out what to do.

Here’s the story. “E” is a first grader who has received speech and language services since preschool. He talks so fast most people cannot understand him a large percentage of the time, but he doesn’t technically have what I’d call a phonological delay based on formal assessments or even what you’d consider atypical sound errors. His words run together, he doesn’t emphasize word boundaries and sounds, and he’s completely oblivious to the fact that people don’t understand him.

At first blush, “E” sounds like a clutterer, and that may partially be the case, but here’s where it gets complicated. He’s not lighting the world on fire in math, but he’s plugging away and making progress. Reading, on the other hand, is a hot mess. While he’s less than a year behind his peers based on reading level, he has poor awareness of the “sounds” in words. He struggles to “hear” the sounds in words, so he can’t think of the orthographic symbols to write when he’s trying to spell words, and same goes for when he’s trying to decode words. This student is falling further and further behind his classmates in reading, spelling, and writing.

This spring, when the teacher was wondering what to do with him, the school psychologist decided it was time to see if this student has a specific learning disability. I crossed my fingers and hoped he would qualify so I could get a little help with this case, but no such luck…he didn’t qualify. Over and other again-I keep hearing the same thing from my colleagues-“It seems like a speech issue,” or “He spells/writes just like he talks,” or “He just makes up words when he’s reading and doesn’t know how to make sense of the sentences.”

Long story short- “E” still doesn’t meet criteria for any other disability than “speech and language impaired” which means case manager duties fall on me.

I’m left with the same questions that come up time after time.

What do you do when you have students who have obvious learning problems, but don’t quite meet the criteria for other disabilities?

What do we do when the student’s true underlying issue is a language disorder, but we feel their current speech/language IEP is not enough?

I decided to rethink my direction with “E” that was originally focused on “speech”. Though I’ve always thought of him as a clutterer, I’m starting to wonder WHY he does this. Why does he just mumble through sentences? Why does he just run through words at light speed without really pronouncing the sounds? When I actually try to slow him down to say one day at a time, he doesn’t know what words to say. He has no idea what words to say, so he just mumbles through and uses made up pseudowords to fill in the blanks.

Aha! This is an issue with sentence structure. With a little probing and language analysis, I confirmed my suspicion. 

Lately, I’ve switched gears and have been using tools focused on building syntactic structure, and have used vocabulary intervention and target word selection as the foundation. I talk about how to get started in this free video training:

tier 2 vocabulary; school speech therapy; language therapy techniques

So we’ve identified that this is a language issue, rather than a “speech” or “articulation” issue, but I keep coming back to that same question: What do you do when this happens?

Do I keep doing what I’ve been doing, teaching this student to use a pacer when he’s talking to slow down, and cross my fingers that the reading and general education teachers will fix it? After all, I can’t “teach reading” because I don’t have a 40 minute block each day devote to an entire reading class-it doesn’t quite work under the current service-delivery model. Do I throw up my hands and give up, and then go complain in the teacher’s lounge about how much this system sucks? My guess is this wouldn’t get me anywhere.

Despite my frustration, I did come up with a plan. Here’s what I’m doing for “E”:

1. I’ll write in some direct service delivery minutes with the special education teacher on his IEP in the area of reading a spelling. He’s already seeing the special education teacher in a small group to target these skills as a Tier 2 intervention, so we’ll just make it official. I feel like we have sufficient data to justify this based on classroom-based assessments, even though he doesn’t meet the criteria for a learning disability. Because his language skills are impacting his ability to learn to read and spell, I think we can justify providing this service under his current disability diagnosis.

2. I’ll consult with the special education/reading/general education staff to make sure they are explicitly targeting phonics skills and phonemic awareness. He doesn’t really grasp how sounds go together to form words, and he doesn’t grasp how those sounds correspond with written symbols. We need to hit these skills hard-and ignore any other less effective strategies anyone may have given him. I’ve been given lists of decoding strategies in the past that included things like “look at the picture”, or “ask a teacher”, or “think about it”. None of these strategies get at the root cause of the decoding issue this student is having, because they don’t encourage student to use phonics skills. Rather they encourage guessing-which is exactly what “E” is doing. Instead of teaching a handful of strategies that don’t work, or that only work a little bit, let’s just teach the ones we KNOW work and that the student is lacking. Phonics and phonemic awareness.

3. I’ll hit skills like syntax, orthography, and phonological awareness in therapy through TONS of print exposure. I’ve starting doing this already using some specific strategies for sentence structure like semantic feature analysis. I may not be able to address phonics and phonological awareness as much as the teachers, but I can model and reinforce with the opportunities that I have. What I can do is directly explain what words are in a sentence, and draw attention to the way words go together to form sentences. Sentence structure seems to be the biggest area of impact, so that is where I’m going to direct my focus during my service minutes.

With this plan, we’ll be hitting all the areas “E” needs the most: orthography (attention to the written symbols of language), phonological awareness (awareness of the sound units of language), and syntax (knowledge of the way words make up sentences). So far, I’ve found tools such as the No Glamour Sentence Structure Interactive Software to be useful, and I may consider the No Glamour Grammar resources as well. I love this series as a comprehensive, no-frills resource that helps you get down to business and target key skills. I’ve also been using my vocabulary booster to help build syntactic structures.

So what do you think? What do you do when this happens? Post a comment and let me know!

In the meantime, one of the first things you can do is to pick the right concepts to address in therapy, so that you can teach your students to use robust vocabulary with diverse sentence structures. In this free video training, I talk about the essential first step of picking the right vocabulary.

You can click the button in the image below to get it (you’ll also be added to my mailing list, which means I’ll send you the best evidence-based practices for language therapy every week).

tier 2 vocabulary; school speech therapy; language therapy techniques


2 Responses to “The hidden “syntax” disorder

  • Ann McDowell
    12 months ago

    Brilliant plan. Wouldn’t you consult with the SpEd Teacher prior to writing him/her into the IEP as direct service time? If I did as you did in plan point #1 above, I’m sure there would be more than a few raised eyebrows!

    • Great question! I would absolutely consult with the special ed teacher, and psychologist as well. I actually have people asking me to do write “special ed minutes” in to IEPs for kids with “speech and language impairment” as their label more often than it should be done (mostly well-meaning teachers who just want the kids to get help). I’ve really tightened the reigns on how often I write in minutes with the special education teacher, because otherwise people will ask me to do it all the time, and the “speech and language impaired” label ends up being a way to sneak kids in the back door when they don’t qualify for anything else. I’ve gotten pickier over the years about how often I do it. With these cases, I always have the psychologist and special education teacher in the loop so we’re taking the necessary documentation, and only write in minutes if I really have enough documentation to prove that the academic issues are coming about due to the language impairment.

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