By: Christine McClary Jimenez, MS, CCC-SLP, and Mirza J. Lugo-Neris, PhD, CCC-SLP 

There is a growing need for collaboration between dyslexia providers and speech-language pathologists (SLPs) in the schools, particularly for children who are bilingual and have been identified to receive both dyslexia and speech-language therapy services and particularly with the recent updates to Texas’ Dyslexia Handbook in 2021. 

The Texas Education Code defines dyslexia as “a disorder of constitutional origin manifested by a difficulty in learning to read, write, or spell, despite conventional instruction, adequate intelligence, and sociocultural opportunity” (TEC §38.003(d)(1)-(2), 1995). A speech or language impairment is defined as “a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child's educational performance” (19 TAC §89.1040). 

The overlap between dyslexia and speech and language disorders has been well documented in the literature and has shown that children with both speech-sound disorders as well as developmental language disorders are at a higher risk for having specific learning disabilities such as dyslexia (Adlof & Hogan, 2018; Bishop & Snowling, 2004; Cabbage et al, 2018). SLPs have a unique opportunity to help identify children who may benefit from referral for additional testing or supports in the educational environment. As SLPs, we also have unique knowledge in the development of the components of language that can support learners with dyslexia.  

Unique Considerations for Spanish-English Bilingual Children with Speech-Language Impairments and Dyslexia
While bilingualism is not a risk factor for having speech/language or reading disorders, children who are bilingual are not exempt from presenting with literacy-based language disorders such as dyslexia. Just as there is a shortage of bilingual SLPs, there is a shortage of qualified bilingual dyslexia evaluators and providers; thus, providers should collaborate to support bilingual students who present with difficulties in both areas. 

When assessing bilingual children suspected to have both reading and speech-language disorders, clinicians need to consider children's knowledge of and exposure to “everyday” oral language as well as phonological awareness and literacy experiences in both languages (Ijalba, Bustos, & Romero, 2020). It is important to consider a child’s level of biliteracy in addition to oral language proficiency, given that the amount of literacy instruction a child receives in each language may differ from the amount of oral language exposure they receive. The assessment process also must account for possible first language loss, which may impact children's performance on measures of vocabulary, phonological awareness, decoding, and comprehension. Due to these factors, comprehensive assessment in both languages is especially critical to make a differential diagnosis. 

There are significant benefits to systematically supporting both languages when working with children who have concomitant speech/language and literacy disorders, specifically in terms of metalinguistic skills and performance on executive function tasks (see Vender, Vernice, & Sorrace, 2021 for review). For children who are literate in their home language (e.g. Spanish), some skills may facilitate cross-linguistic transfer to the less orthographically transparent language (see Ijalba, et al., 2020 for review). Bilingual children, even those with dyslexia, also may have an advantage in their overall morphological awareness (Vender, et al., 2018). In a recent comprehensive literature review, Vender et al. (2021) did not find any studies that indicated that bilingual children with dyslexia could not become literate in two languages. Thus, continued exposure and careful instruction across languages is necessary, particularly for children with dual diagnoses of speech-language disorders and dyslexia. 

Challenges and Solutions To Support Emergent Bilingual Students with Dyslexia and Speech Impairment
In an effort to identify challenges that most frequently arise when working with emergent bilingual students with speech impairment and dyslexia, we interviewed two dyslexia specialists working in North Texas public schools and reflected on our own experience working with this population. We then sought out ideas and resources for meeting these challenges with the goal of maximizing growth and progress for our emergent bilingual students with dyslexia. We reached out to Dr. Elsa Cárdenas-Hagan, a bilingual speech-language pathologist and Certified Academic Language Therapist, who provided us with some fantastic resources and guidance. You can read more about Dr. Cardenas-Hagan’s work here. We hope that the challenges and solutions provided below will be a helpful starting point for SLPs who wish to learn more about supporting emergent bilingual students with dyslexia. 

Challenge: Language of Dyslexia Intervention
“My student uses English with his siblings and Spanish with his parents at home. He has attended a dual-language class since kindergarten, in which literacy instruction has been provided primarily in Spanish. Now he is in second grade, his preferred language socially is English, but his dominant language for academics is Spanish. Next year, literacy instruction will be provided 50% in English and 50% in Spanish. In what language should dyslexia intervention be provided?” 

Does this situation sound familiar? It certainly does to us! Determining the language of intervention for emergent bilingual students with dyslexia is one of the most common challenges that we have seen when working with this population. Of course, just like when working with any student, there is no one-size-fits-all answer. But thankfully, there are some resources that can help guide us in determining the language of intervention. 

The recently updated TEA Dyslexia Handbook includes a section on working with emergent bilingual students. TEA states that the Admission, Review, and Dismissal (ARD) or 504 Committee making intervention decisions should include a language proficiency assessment committee (LPAC) representative and should consider the following questions: (1) What language allows the student to adequately access dyslexia services?; and (2) What is the student’s current language of classroom instruction? 

Dr. Cárdenas-Hagan explained that, typically, the language of dyslexia intervention will align with the language of literacy instruction. For students who are receiving literacy instruction in both languages, we need to consider each student’s linguistic profile of strengths and weaknesses. “The good news is that many skills transfer across languages,” Dr. Cárdenas-Hagan said. “Bilingual students with dyslexia can achieve biliteracy.” 

Challenge: Emerging English Proficiency
“My emergent bilingual student is still in the process of acquiring English. Literacy instruction is being provided in both languages, and dyslexia intervention is being provided in English. However, my student is not making as much progress in the dyslexia program as her monolingual peers because she does not have the vocabulary. What can I do?” 

Language proficiency issues were one of the greatest challenges named by the dyslexia specialists we interviewed, with vocabulary knowledge being most frequently cited. One teacher stated, “I have a couple of students who are able to decode words but lack confidence in speaking in English. They struggle with pronouncing the words correctly… because they lack knowledge of the words.” Another shared, “I find that when I compare the different sounds between English and Spanish, students understand them and can see similarities. But when we start making words, they have trouble reading them… I can teach them the word sled, and they can decode it, but they don’t know what it means.” One teacher shared that she will hear students decoding words correctly under their breath, but then because they do not recognize the word, they change it. 

For emergent bilingual students who are receiving both dyslexia intervention and speech therapy services, this is a great opportunity for the SLP to provide literacy-based intervention that actively builds vocabulary knowledge in meaningful contexts while targeting the student’s speech and language individualized education program (IEP) goals. I (Christine) find that, on my caseload, I am often targeting phonology and morphosyntax goals with my students with dyslexia. While building vocabulary in English is not the goal of my speech therapy sessions (and it is important that our colleagues recognize that this is not the purpose of speech therapy), I can target phonological goals while reading a story about wintertime that exposes my students to new vocabulary like sled and snow. 

In addition, the SLP can share strategies and best practices with the classroom teacher and/or the dyslexia specialist related to vocabulary learning. Which brings us to our next challenge. 

Challenge: Effective Collaboration
“My student is receiving instruction from two classroom teachers (one in English, one in Spanish), inclusion support from the special education (SPED) teacher, dyslexia instruction from the dyslexia specialist, and speech therapy from the SLP. How can we effectively collaborate to help the student make more progress?” 

While our schedules are packed throughout the school year, collaboration is key to helping students progress. Setting aside even a small amount of time to share challenges and align on goals with other professionals can set the foundation for more efficient and effective intervention throughout the year, resulting in greater gains for the student. Dr. Cárdenas-Hagan provided us with a helpful list of places to start when collaborating with your dyslexia specialist:

• Write goals collaboratively, and share specific goals with each other.
• Decide how to work on particular goals together.
• Monitor progress, and share results.
• Update goals based on your progress monitoring results.
• Discuss successful strategies that have benefited the student.
• Share challenges you have encountered when working toward the student’s goals.
• Brainstorm ways you can teach and integrate language and literacy skills through the four modalities of language—listening, speaking, reading, and writing. 

As an example, recently the dyslexia specialist on my campus reached out to me about a shared emergent bilingual student who was struggling to pronounce certain words that they were targeting in dyslexia intervention. The student was becoming increasingly discouraged that she could not say the words. The dyslexia specialist passed along the list of words to me, and we used them as articulation targets during speech sessions. Once we achieved success on correct pronunciation of the words, I shared with my dyslexia specialist the types of prompts I had used to help the student. Not only did this lead to progress in a specific area of difficulty but we also have seen our student’s confidence grow. 

Challenge: Dyslexia Resources for Emergent Bilinguals
“It seems like all of the resources out there are geared toward English-speaking students with dyslexia. Where can I find more information about dyslexia support for emergent bilingual students?” 

The International Dyslexia Association (IDA) has some resources for understanding dyslexia in bilingual students. The IDA provides fact sheets, many of which are available in English and Spanish, that describe appropriate assessment and intervention for dyslexia. Also available on the IDA’s website are the knowledge and practice standards (KPS) for teaching reading in English and Spanish. Dr. Cárdenas-Hagan recommends that SLPs reflect on their own knowledge and skills related to teaching literacy to students who struggle. The more knowledge we possess in this area, the better we will be able to partner with dyslexia specialists and support our joint students. 

The recently completed Multi-Tiered Support Systems (MTSS) for English Learners website provides research-based resources and practices for supporting literacy development in English learners. You can find parent resources in English and Spanish, literacy briefs, and an MTSS rubric for implementation. 

In addition, Amplio, a digital learning management system that aims to provide technologies and resources to accelerate learning for students with special needs, has partnered with the Texas Education Agency to provide the Esperanza curriculum for free to all Texas public school districts. Esperanza is a Spanish-language dyslexia curriculum developed by Dr. Cárdenas-Hagan. The curriculum is designed to provide a multisensory-structured language approach for teaching reading, writing, and spelling and has shown to be an effective instructional tool for Spanish-speaking students with dyslexia. 

Lastly, Dr. Cárdenas-Hagan’s book Literacy Foundations for English Learners: A Comprehensive Guide to Evidence-Based Instruction is a fantastic resource for those looking to build their knowledge and skills in the area of literacy instruction for emergent bilingual students.

Conclusion
In conclusion, bilingual children with concomitant speech/language disorders and dyslexia are capable of achieving bilingualism and biliteracy. SLPs and dyslexia providers have overlapping yet unique areas of knowledge and expertise in effectively supporting language and literacy development. Therefore, it is important for SLPs and dyslexia providers to collaborate when supporting bilingual children with speech/language disorders and dyslexia in order to maximize progress for each child. 

References

Adlof, S. M., & Hogan, T. P. (2018). Understanding dyslexia in the context of developmental language disorders. Language, Speech, and Hearing Services in Schools, 49(4), 762-773. 

Bishop, D. V., & Snowling, M. J. (2004). Developmental dyslexia and specific language impairment: Same or different?. Psychological bulletin, 130(6), 858. 

Cabbage, K. L., Farquharson, K., Iuzzini-Seigel, J., Zuk, J., & Hogan, T. P. (2018). Exploring the overlap between dyslexia and speech sound production deficits. Language, Speech, and Hearing Services in Schools, 49(4), 774-786. 

Ijalba, E., Bustos, A., & Romero, S. (2020). Phonological–Orthographic Deficits in Developmental Dyslexia in Three Spanish–English Bilingual Students. American Journal of Speech-Language Pathology, 29(3), 1133-1151. 

Vender, M., Hu, S., Mantione, F., Savazzi, S., Delfitto, D., & Melloni, C. (2018). Inflectional morphology: evidence for an advantage of bilingualism in dyslexia. International Journal of Bilingual Education and Bilingualism, 24(2), 155-172. 

Vender, M., Vernice, M., & Sorace, A. (2021). Supporting Bilingualism in Vulnerable Populations. Sustainability, 13(24), 13830.

Acknowledgements
The CLD Committee would like to thank Dr. Elsa Cárdenas-Hagan for her valuable insights and contributions to this article. We would also like to thank Kay Rosenfield and Gayle Helms-Pirtle, dyslexia service providers at Fort Worth ISD.

The CLD Corner was created in an effort to provide information and respond to questions on cultural and linguistic diversity (CLD). Please follow the Communicologist and TSHA’s website in order to obtain new information provided by the CLD Committee. If you have specific questions or topics that you would like for us to cover in future issues, please email publications@txsha.org.