September is literacy awareness month and today is International Literacy Day. The United Nations Educational, Scientific and Cultural Organisation (Unesco) and its partners promote the day to underline the significance of literacy for healthy societies.
All over the world, the day focuses on people’s awareness of and concern for literacy problems in their communities. As a result of this increased awareness, letters in newspapers and news reports have been published expressing concern over low literacy levels.
Other activities include literacy day projects, particularly regarding technology and literature, which are promoted by various organisations, including reading associations.
Each year, the Speech-Language Department at the Ministry of Health’s Primary Health Care Department marks this day with an activity aimed at increasing Maltese people’s awareness of this problem.
Some of the activities carried in previous years included a half-day seminar on literacy, a reading competition in schools and the development of reading intervention software. This year, the department will be distributing in schools bookmarks containing reading tips it has developed.
The department provides services to people of all ages who have communication difficulties. Very often, people associate speech-language difficulties with stuttering, or poor articulation of the ‘r’ sound. In other words, they understand that language difficulties encompass oral or spoken language. However, there is more to it than that.
Many are surprised to learn that speech-language difficulties also comprise voice and swallowing disorders. Most are shocked to learn that literacy disorders also form part of the spectrum of language difficulties.
If you consider that written language is a direct reflection of spoken language, then it is easy to understand the expertise that speech-language pathologists hold in the area of literacy. Oral language is the listening and speaking part of communication.
Oral language and vocabulary lay the foundation for reading comprehension. A child must be able to understand language at the oral level in order to be able to read it.
In other words, if a student struggles with a six-word sentence orally, he will struggle with a 12-word sentence in a book. So speech-language pathologists recommend the stimulation of oral language instruction and language-centered classrooms from a very young age.
Not only are speech-language pathologists trained to identify literacy difficulties, they are also able to provide a differential diagnosis between dyslexia as opposed to other difficulties such as Specific Language Impairment.
The problem is that many disorders share similar characteristics. For example, a child with a hearing impairment, or with specific language impairment, will also have reading and spelling difficulties. A child with attention difficulties may also have language learning and literacy difficulties in class.
It is very important to identify what is at the root of the problem. For one thing, children will be labelled as inadequate and this brings about various negative consequences on them and their family. Another reason why a correct diagnosis is important is because without it, one cannot conduct the correct intervention.
Unfortunately, misdiagnosis is an overlooked phenomenon. It seems many professionals provide generic literacy intervention in the hope that literacy skills will improve. But it is almost like giving medicine that relieves migraine to someone who has a cough.
In 2012, I completed my PhD research at the University of Malta. As a speech-language pathologist working for the Ministry of Health, I am familiar with the effects communication difficulties may have on families.
To decrease the possibility of children receiving poor (or wrong) diagnoses, I developed and standardised an English and Maltese series of tests that were found useful in the diagnosis of literacy difficulties in Malta. The logistic regression in my study provided a strong indication that tests were able to predict the presence or absence of a literacy difficulty.
Literacy is an area that extends over various professions
My research involved approximately 550 children, a number of whom were previously diagnosed with dyslexia. In the research, I found what appears to be evidence of ‘over-specifying’ the number of children developing normally, as there appear to be many children with and without a diagnosis of dyslexia, with similar scores across the tests. This suggests that children with reading difficulties were over-diagnosed prior to taking part in the research.
Furthermore, the English test series was able to correctly classify 93 per cent of children who do not have difficulties and 69 per cent who do have a reading difficulty.
This could either mean that the statistical model is underestimating the difficulties these children have, or that it is very good at identifying those with more severe difficulties but not as sensitive in identifying those with mild reading difficulties.
It is also possible that children previously diagnosed with a difficulty have similar test scores to children developing normally because they have no difficulties.
Another important issue is the widespread practice in Malta of administering English tests on Maltese children to detect the presence of a literacy difficulty. My research findings show that the language of testing is a very important factor in the diagnosis of dyslexia in Malta.
In fact, three test series can be used with Maltese children, depending on whether the child is monolingual Maltese, monolingual English or bilingual Maltese-English-speaking.
In addition, the type of school the child attends and, more importantly, the language(s) spoken in the classroom are important factors that should be taken into consideration in the identification of reading difficulties. The Maltese test series, the first of its kind, has proved to be a reliable diagnostic tool for the identification of reading difficulties in our linguistically diverse population.
We can now establish that correct diagnoses are important for appropriate, tailor-made intervention. Intervention also includes making appropriate recommendations for a child to be better able to access the curriculum at school.
It is imperative that the speech-language pathologist’s expertise in written language is recognised on a national level. Hence it should be at the forefront of any decisions taken on behalf of people with such difficulties, both at individual and strategy and policy level. It is therefore important for the role of the speech and language pathologist in literacy to be recognised and the output of these professionals acknowledged and appreciated for what it is.
It is acknowledged that literacy is an area that extends over various professions. In fact, multidisciplinary cooperation is always well recommended… in theory. In practice, unfortunately, professionals seem to be falling short of working collaboratively.
The authorities responsible for taking decisions for and on behalf of people with such difficulties should make sure that contributions by various professions are all considered to be equally important and that the final decision is an eclectic one.
The Primary Health Care Department offers its services in the health centres, district clinics and in the community. For further information contact the Speech Language Department on 2123 0822 or e-mail speechlanguage@gov.mt.
Dr Agius is a speech language pathologist, a specialist in specific language impairment and principal at the Speech-Language Department.