Comprehending Comprehension: Selected Possibilities for Clinical Practice Within a Multidimensional Model.

Purpose: In this discussion as part of a response to Catts and Kamhi's "Prologue: Reading Comprehension Is Not a Single Activity" (2017), the authors provide selected examples from 4th-, 5th-, and 6th-grade texts to demonstrate, in agreement with Catts and Kamhi, that reading comprehension is a multifaceted and complex ability. The authors were asked to provide readers with evidence-based practices that lend support to applications of a multidimensional model of comprehension. Method: We present examples from the reading comprehension literature that support the notion that reading is a complex set of abilities that include a reader's ability, especially background knowledge; the type of text the reader is being asked to comprehend; and the task or technique used in assessment or intervention paradigms. An intervention session from 6th grade serves to demonstrate how background knowledge, a text's demands, and tasks may come together in the real world as clinicians and educators aim to help students comprehend complex material. Conclusions: The authors agree with the conceptual framework proposed by Catts and Kamhi that clinicians and educators should consider the multidimensional nature of reading comprehension (an interaction of reader, text, and task) when creating assessment and intervention programs. The authors might depart slightly by considering, more closely, those reading comprehension strategies that might facilitate comprehension across texts and tasks with an understanding of students' individual needs at different points in time.

Improving clinical practice: a school-age and school-based perspective.

PURPOSE: In this article, the author presents a conceptual framework for intervention at school-age levels reflecting upon a number of aspects raised by Kamhi (2014) in the lead article of this forum. The focus is on the persistence of traditional practices, components of language intervention, and prioritizing goals for students with language learning difficulties. Weaving together learning and generalization challenges, the author considers advanced levels of language that move beyond preschool and early elementary grade goals and objectives with a focus on comprehension and meta-abilities. METHOD: Using a 3-tiered macrostructure, the author demonstrates how integrating students' background knowledge into intervention, helping them develop an awareness of structure and content interactions, and addressing the increasing demands of the curriculum provide a roadmap for improving clinical practices at school-age levels. CONCLUSION: Reiterating some of Kamhi's notions, the author addresses gaps that exist between available and, often, exciting research in language, literacy, and current practices in schools. Professionals are challenged by the persistence of approaches and techniques that defy what they know about children and adolescents with language learning disabilities. Nonetheless, there are reasons to remain optimistic about the future.

Auditory processing disorder and auditory/language interventions: an evidence-based systematic review.

PURPOSE: In this systematic review, the peer-reviewed literature on the efficacy of interventions for school-age children with auditory processing disorder (APD) is critically evaluated. METHOD: Searches of 28 electronic databases yielded 25 studies for analysis. These studies were categorized by research phase (e.g., exploratory, efficacy) and ranked on a standard set of quality features related to methodology and reporting. RESULTS: Some support exists for the claim that auditory and language interventions can improve auditory functioning in children with APD and those with primary spoken language disorder. There is little indication, however, that observed improvements are due to the auditory features of these programs. Similarly, evidence supporting the effects of these programs on spoken and written language functioning is limited. CONCLUSION: The evidence base is too small and weak to provide clear guidance to speech-language pathologists faced with treating children with diagnosed APD, but some cautious skepticism is warranted until the record of evidence is more complete. Clinicians who decide to use auditory interventions should be aware of the limitations in the evidence and take special care to monitor the spoken and written language status of their young clients.

Peeling the onion of auditory processing disorder: a language/curricular-based perspective.

PURPOSE: This article addresses auditory processing disorder (APD) from a language-based perspective. The author asks speech-language pathologists to evaluate the functionality (or not) of APD as a diagnostic category for children and adolescents with language-learning and academic difficulties. Suggestions are offered from a curriculum-relevant/strategic-based language approach that places APD symptoms within a broader framework and takes into account the complex interaction among the language knowledge, skills, and strategies needed for academic success. METHOD: Using the metaphor of peeling an onion to get to its core, the author demonstrates how auditory perceptual processing is influenced by and dependent on language abilities. Examples of curricular content are used to highlight the language savvy needed by students with language-learning disabilities (LLDs) to access the curriculum. CONCLUSION: At the heart of the article is the question of what is (or are) the most effective way(s) to treat problems defined as "auditory" in nature. The article concludes with 10 suggestions that remind clinicians to consider the usefulness of viewing auditory processing problems as isolated events that can be "fixed." Practical guidelines for creating authentic and functional intervention targets at school-age levels are also provided.

Making a broader case for the narrow view: where to begin?

PURPOSE: This final article covering the topic of the interplay between decoding, comprehension, and content versus structure knowledge describes a set of language initiatives that are focused toward content area learning. Inspired by the work of their colleagues from diverse fields and their own work, the authors offer suggestions to clinicians who are interested in creating and delivering curriculum-relevant and strategic-based language intervention to school-age students with language learning disabilities (LLD). METHOD: The discussion covers selected topics that form the foundation for an evolving intervention framework, including (a) understanding the content and structural requirements of textbooks, (b) integrating metacognitive and metalinguistic techniques into intervention goals and objectives, and (c) emphasizing meaning-based activities that cut across connected discourse (macrostructure levels) and sentence/word components (microstructure levels) of spoken and written language. CONCLUSION: Starting with ways to find clues about "what to do" with students by looking in their textbooks, the authors continue with examples that integrate content and structure knowledge using social studies and science as backdrops for language intervention. The article ends with a reminder to clinicians to consider ways that preschool language intervention can be more effective in helping children prepare for the academic demands of the future.