Episode 38 - DLD, Language, and Systemic Change in Reading – Dr. Tiffany Hogan Returns!

Tiffany P. Hogan, PhD, is a Professor in the Department of Communication Sciences and Disorders at MGH Institute of Health Professions in Boston, Director of the Speech and Language (SAiL) Literacy Lab, and Research Associate at Harvard University. Dr. Hogan has published over 100 papers on the genetic, neurologic, and behavioral links between oral and written language development, with a focus on improving assessment and intervention for children with Developmental Language Disorders, Dyslexia, and/or Speech Sound Disorders.  Her advocacy for children with reading difficulties has led her to co-found a DLD informational website: www.dldandme.org, host a podcast, SeeHearSpeak Podcast (www.seehearspeakpodcast.com), and contribute information for articles in numerous news outlets including the New York Times, the Boston Globe, along with several television and radio appearances.

[00:00:00] Danielle Scorrano: Hello READers in the research, education, and advocacy world. Isn't it the best world to be in? I mean, throughout this journey I have met and collaborated with so many leaders who I admire and look to for guidance, solace a lot of the time, expertise, energy, inspiration. I mean, I could go on and for me, this guest is a leader. I wish we're actually on a stage in front of y'all. I think I'm waiting for a standing ovation and maybe Harry who's editing this might actually include some standing ovation soundtrack. But without further ado, I would like to welcome to the READ Podcast, Dr. Tiffany Hogan.

[00:00:40] Dr. Tiffany Hogan: Oh, what an honor it is to be here, and I'm so excited to talk to you again after our great discussion in episode six. So thank you for having me.

[00:00:48] Danielle Scorrano: Thank you for being here and like I said, I would say welcome, but it's actually welcome back because you are so important to our community at Windward. And a quick history, as Dr. Hogan said, you were on an episode [00:01:00] six of the READ podcast, the second person actually I recorded for READ. And what was so funny is we recorded this ahead of the times. We were already doing this on Zoom even before the pandemic.

[00:01:12] Dr. Tiffany Hogan: That's right.

[00:01:13] Danielle Scorrano: Yeah. That was so fun. Well, we are actually recording this as well prior to your lecture, but when our READers are listening to this, you were just here at our White Plains campus delivering the 2022 Fall Community Lecture: "Developmental language disorder, the highly prevalent learning disability hidden in plain sight." So if you weren't able to check out the lecture, we will have a recording. Dr. Hogan, I'm so excited for you to come, and if people were listening to this, we were so excited to have you. I'd like to start by introducing you to our READers, for those of us that know you, but also READers who are just being introduced to you.

So Dr. Hogan is a professor in the Department of Communication Sciences and Disorders at MGH Institute of Health Professions in Boston, director of the Speech and [00:02:00] Language Literacy Lab and Research Associate at Harvard University. She has published over 100 papers on the genetic, neurologic, and behavioral links between oral and written language development with a focus on improving assessment and intervention for children with developmental language disorders, dyslexia and speech sound disorders. I also heard that you are a corn hole enthusiast, I saw on Twitter.

[00:02:23] Dr. Tiffany Hogan: Oh no. See Twitter, that's where all the secrets come out.

[00:02:26] Danielle Scorrano: Yeah. Seriously.

[00:02:27] Dr. Tiffany Hogan: I love corn hole and played in a league in Nebraska when I was there.

[00:02:32] Danielle Scorrano: Oh, that's so fun. I was a little bit of a corn hole enthusiast myself or more into pickle ball. But before we get into the sport or, what we do after outside of work, I want to tell our READers to get your calendars ready because even if you attended the lecture or if you are going to tune in asynchronously, Dr. Hogan is going to be back with The Windward Institute on Thursday, January 24th, 2023 from 4:30 - 6:30, and [00:03:00] your class is going to be titled "Language Based Learning Disabilities from DLD to Dyslexia". So that's going to be more application based?

[00:03:07] Dr. Tiffany Hogan: Exactly.

[00:03:08] Danielle Scorrano: So, what can people expect from that class?

[00:03:11] Dr. Tiffany Hogan: So, in the lecture that I'm going to be giving next week, which listeners, it will have passed by the time this is out, it will set the foundation and I will go over that foundation briefly. But what I'm focusing on in the January workshop is actionable items around supporting children with learning disabilities including dyslexia and developmental language disorder.

[00:03:32] Danielle Scorrano: That sounds so exciting. I know that I have already signed up and before we get into the interview, I want to start by thinking about how I approach this interview and the word integration came up for me. I was first introduced to the word integration in the research world as it pertains to research by actually Dr. Brené Brown, and I see you as a role as integrator. And it wouldn't be a podcast on language and literacy if I didn't go to my fancy resource etymonline and [00:04:00] look up the word integration, because I was fascinating to find that it originated in the 1610s, but it actually has two meanings. It means bring together parts of a whole and also renewal and restoration. And when I think about your career, I see you bringing in different facets of society through podcasting, through being active on social media, but all the more formal work that you're doing in schools, in research and in policy. And to me, you're a pioneering integrator in how you bring different people together through your work with implementation science and across fields, the field as a whole. So everyone put a pin on the word integration because we'll definitely return to that. And as you know, Dr. Hogan, every episode I begin with a guest story. And you talked about in episode six, so knowing your background, I'd like to know more actually about how your work has shifted during the pandemic. Has there been a through line? What have you been working on, and how has the pandemic been for you in the work that you've been focusing on?

[00:04:58] Dr. Tiffany Hogan: That's a great question. And [00:05:00] in terms of integration, I just really appreciate you bringing that up because that's something I've resisted truthfully in my career is, trying to figure out what you're contributing within your field and across fields, and over time, I definitely have pushed more into integrating multiple areas that I study and also with my own personal life as well. So through the pandemic, it was a tough time for the pandemic for me and for many others. I was home with three children and trying to manage full-time job and my husband's schedule and it was really crazy. And then right down in the middle of it, right in the middle, I was diagnosed with breast cancer and then had to take medical leave.

 But you know, the pandemic was really transformational for my work and for my myself as a scholar because I did truly come through the pandemic and I felt a sense of urgency, not only ]because of going through cancer diagnosis, you really do reflect on the time you have left. And I think the pandemic made all of us [00:06:00] realize how precious time is just in general. Many people lost people during the pandemic and we were under an extreme amount of stress. So through the pandemic, what I really tried to focus on was implementation. How do I bridge the gap between research and practice, but also practice and research? We often hear about this, and I throw around the statistic that it takes 17 years for only 14% of research to get implemented.

And then it's not related to how efficacious the research is, but it's really related to how much it is within the parameters of the research and how that matches parameters of practice. The better match, the more likely it's implemented. So what I tried to think about was accelerating the work that I've been doing around awareness, school practices, interprofessional, and collaboration. How do I accelerate that? And I had really focused a bit before the pandemic on this process of implementation science. Now through the [00:07:00] pandemic, I really wanted to accelerate this work and I learned more about implementation science. Because after my medical leave, I also took a sabbatical, which was already planned. It wasn't the sabbatical I thought it would be because of course it was after cancer treatment. So there was a lot of recovery, also, not a lot of travel with covid times, but it gave me the time to think through how to better apply implementation science to my work. And then also as a cancer patient, I got to see implementation from the stakeholder point of view, from the patient point of view, because the work I was involved in was really at the implementation level – the treatment I received. And at MGH, I was enrolled in a lot of different studies where I could give my perspective, and it got me thinking more about how to make sure that I'm including the perspective of those that I'm working with, including all stakeholders, not only educators that I work with and speech language pathologists, but also those who have the condition of dyslexia or developmental language disorder and how to be a better [00:08:00] advocate all around. So it was really informational for me to really push into implementation science and improve my work in that area and to share what I'm learning with others through an implementation science conference That was put on in the spring that I'll continue to put on every year.

[00:08:17] Danielle Scorrano: Whoa. I mean, there's so many questions that I have now. I knew obviously about your story, and what you went through personally throughout the pandemic, and in fact, you had served as an example from afar between New York and Boston for me. And to see how you were able to integrate all those personal experiences, I mean, it's almost like you're broadening and building. And so there are a lot of different directions I think I want to go in. And see, I knew we were already going to throw away the questions because here I go asking all these other questions and having all these other curiosities. But I want to start, with looking at those children that we were serving during the pandemic, and it was something that you have spent your entire career.

[00:09:00] And I've recently have seen a lot of the work that you've been reporting on in terms of New York Times articles and in the popular media, as well as contributing to research and implementation. And truthfully, the pandemic has hit all of us so hard, and for those children in vulnerable populations, children, including those in high poverty schools, have been hit the hardest when it comes to reading. And I pulled a quote from a recent New York Times article where you said in the Boston regional alone, 60% of students at some high poverty schools have been identified as at high risk for reading problems twice the number of students as before the pandemic. Now we're looking at a problem prior to the pandemic that it takes about 17 years for 14% of research to be implemented. And there's just this uncomfortable disconnect, I will say. And so as you were thinking personally about how research has affected you as a person. Then you're looking at these students, [00:10:00] these individuals in schools, thinking about, well then how is the research in literacy affecting where they're sitting at that moment?

And I don't want to assume or even indicate to people that these conversations about how we implement research and practice are happening in silos because they're not. We, for people like you, there are large communities of people that are doing this work. I also like to think about then, what is the story that's being tied to these statistics? Because in the story you told about yourself and the way that you were in your cancer diagnosis and your cancer treatment, working with researchers, , they were collecting data on you, but you were a lived story. And so when I think about these children and their stories, what have you and your labs and your colleagues learned about how these children were experiencing reading during the pandemic?

[00:10:48] Dr. Tiffany Hogan: Yeah, that's a great question. At the beginning of the pandemic, one of my doctoral students, Xue Bao, came to me and we started talking about, with school closures, what could we predict over time might happen [00:11:00] with children's literacy skills? So we used an extant database that was already there that looked at change over time and in particular looked at gaps in learning due to the summer slump or just the summer time off. We know that it's pretty consistent that children will lose some of their skills during the summer, and it takes a bit of time to get those skills back. So we used a prediction model. We used the data we knew from summer loss and we predicted it out. Now, that was in the beginning of the pandemic. Remember when we used to think it was going to be like a two week? Oh my gosh. I laugh now when I think about that. Right? I remember like saying goodbye to my daycare provider, see you in two weeks.

Oh my goodness. No! Then we thought, well maybe it'll be two months. And then we thought, well, maybe it'll be until fall 2020. Well, it just extended on. But we did projections and we saw that the loss was just, cumulative over time. So we were preparing ourself for that in, in general. And we were also, we were pulling our community partners closer because in a crisis you often do [00:12:00] that. I think you really make those connections deeper. So working with one of our schools in Boston, you know, I found myself texting the principal. We had never done that before. I met him outside of the school, gave him books. He walked to the children's homes to provide them the books from an intervention that we were giving that was cut short. So we started to really connect more with our community partners and in particular with our parents, because then we moved to Zoom like a lot of people did. And you're interacting more with families, you're seeing houses, all of those things occurred during the pandemic. And what we saw is that everything that we noticed before the pandemic, that was what I would think of as a crack in the system became wide gaps during the pandemic.

I didn't see anything come out of the pandemic that I hadn't already seen in the educational system as a major problem that everyone was dealing with. It just became so much larger and because of that paper that we [00:13:00] published on predicting the learning loss through Covid school closures, I was invited to go to these different conferences during the pandemic on, Covid Learning Loss. And what struck me is, in particular, I went to a conference that was online in the UK and they were sharing a lot of their different work and it really struck me because they were talking about how so many children they interacted with flourishing during the pandemic, they were flourishing because they could really control what they were doing. They had choice in what they were reading, and I just felt like, what? No, that's not what we're seeing. What we are seeing is children with unique learning needs that were not being met. We saw families who had spent years developing these communities that supported their family and their children, and that was gone. That web of support was just lost.

And so there was data coming out showing differential loss that some [00:14:00] children did accelerate and some really lost. We saw that in the communities that we served in that data that you mentioned, where we saw double the risk for loss in those children. You know, that was a community that had a lot of transient population and had in the kindergarten year, they had almost a third of their kids that they had no contact with because they didn't go back at all. They had no in-person schooling. Now, contrast that with some of the wealthier school districts we were working with, where they were never, they really didn't stop much at all, and they had no technology breakdowns. They were in communication with the parents and the children readily in contrast to a district where a third of their children, they literally have no contact. They have no idea where they are at all.

[00:14:45] Danielle Scorrano: Mm-hmm.

[00:14:46] Dr. Tiffany Hogan: And so, and then we were dealing with all kinds of technology breakdowns and we kept trying to work through them. Oh, you don't have a computer, Let's get you a computer. Well, you have a computer, but you don't have internet access. Why not? Okay. Because you hadn't been able to pay the bill before. [00:15:00] How can we get that bill? Just consistently dealing with the context around school. It really flooded in It wasn't just the school day where you could just say, Oh, I'm just going to work very carefully on my hour by hour and really provide the support.

All of a sudden it was everything that's happening in that child's life flooded in to their school day- food insecurity, inconsistencies at home, parents trying to juggle work, and a lot of parents didn't have the luxury that I had of working from home. They were outside of school and their high schooler, for instance, might be online, but then have to quit to babysit. They can't be doing both, and really seeing these cracks turn into wide gaps. What I also saw during the pandemic is, parents becoming more aware of their child's unique learning needs because they're seeing what their child's doing and they're seeing the effort their child's putting in.

I had lots of parents tell me, I knew he struggled, but I didn't realize how hard he worked, and he's still struggled. And I think that's created a new set [00:16:00] of stakeholders in the work that we're doing is really listening to parents and creating some support for them to be able to support with their child and work with the school. These are problems we knew about before the pandemic. There had been such a movement around the science of reading and I know you've talked with a lot of your guests about this, but now I think that the urgency is there. So I think it has the moment now, and we have the spotlight and I think there's some urgency to not only helping children, to really taking the time to think through what we're doing with children in terms of literacy and also other areas. Because you know how it is, there's so many problems to deal with that, who knows, in a year we'll be onto the next problem. We have to really focus on this issue now and try to do as much as we can. The urgency. I feel the urgency every day, even though it's not a sprint, it's a marathon. We still have the urgency and the focus around education, so we should use it wisely.

[00:16:55] Danielle Scorrano: Absolutely. And as you were talking, urgency was just almost like[00:17:00]  making sirens in my head. I mean, I don't know. When you're in, when you come to visit in New York, you'll just hear every time, every day I hear these different sirens and that's what I associated this sense of urgency, sirens, because with reading and literacy, again, I'm not making a large generalization, but some of the things that I would hear was, "it's an education problem for kids who struggle, it's a special education problem." But it's a societal problem, and every single person that has some sense of connection with children or people who don't even have connection with children that are in the workplace, they have a responsibility, at some level to understand why reading is important and how we get more kids to learn to read.

And that brings me to obviously, the science of reading and evidence-based reading instruction. That also brings me back to the point where you said that parents, when they were home and families when they were home, saw their kids struggle in the way [00:18:00] that they had never seen kids struggle before. And I guess my question for you before we get into dyslexia and DLD is we have certain statistics that measure the number of kids that have DLD,. I think right now, it's like one in 14 or two out of every children in classrooms have DLD, and dyslexia, is one of the most common learning disabilities. And so would you project that more children, given that there is better screening of these disabilities, , would you project that more children would be diagnosed with these learning disabilities?

[00:18:35] Dr. Tiffany Hogan: Yes. I do think so. It's really an interaction between the genetics, the neurobiological makeup of the child and their environment. So, we know that dyslexia and developmental language disorder, it's a difference in the brain. So it's a brain structural difference that a child's born with. That in one case with dyslexia, makes it very difficult to connect letters and sounds to learn to read words. And with developmental language disorder, it makes it difficult to really [00:19:00] keep up on the statistical probabilities in the ambient language that they hear every day. So learning new vocabulary words, learning the syntax of the language, and putting it all together. So, I don't predict that the brain difference will change in terms of prevalence, but what we do know is that you're born with a brain and then that brain is interacting with an environment. And if you have a very strong, for instance, with dyslexia, a strong early systematic approach to word reading that's multisensory and systematic and has a high dosage, we can really mitigate the long term difficulties around word reading that we see in children with dyslexia. But that doesn't mean that they don't have dyslexia. It doesn't mean that their brain structure fully changed, but what we do know is that the environment does rework the way that their brain starts to read words. And the earlier we do that reworking, the longer [00:20:00] term positive outcomes we see. So if we don't have that strong base of instruction and support and environment, then the pathways of the brain become a little more difficult to remediate, although remediation is always possible, support is always helpful.

 So what I imagine we will see is that the severity of these learning disabilities might increase and that we might be later at detecting some of them because of the loss in learning that's occurred, and that the environments that they were in, if they were less stimulating, then we're going to see longer term need for support than we do early on.

[00:20:41] Danielle Scorrano: Mm, yeah. And you talked about the sense of severity. I'm thinking about all the additional side effects. I mean, what are those side effects for when children aren't identified as early as they should be?

[00:20:55] Dr. Tiffany Hogan: Oh, good point. That's maybe the most important point, actually, is that the side [00:21:00] effect is a child who is internalizing a negative view around literacy. So you know, it's hard for them. They don't like it, and because of that, they start to avoid it and feel a lot of shame. Learning to read is the first formative educational experience that a child has. And if they struggle to learn how to read, even in the context of a ton of other strengths, they're gonna internalize that they're not good at because that's their first real learning experience. And so, the downward negative spiral is real. And I think we're gonna have to do a lot of post-traumatic instruction, post-traumatic stress instruction around getting positive attitudes around literacy when children have been struggling.

[00:21:47] Danielle Scorrano: Mm. That's a really good point. And as you're talking, I'm thinking about, I'm a systems thinker. I like to think about how, again, the integration between the system and the self, and there are so [00:22:00] many salient points that you made about what we can do as individuals as humans, as selves looking, whether, you think you know someone with DLD or dyslexia, or you don't. And actually in episode six you said you may think that you don't know someone with DLD, but because of the prevalence, you likely do. And that to me has stuck with me for years. I mean, I don't really remember many quotes from guests on READ, although I'll be sleeping and I'm like, Oh yeah, that one point that Dr. Terry said in episode, I don't know 26, I remember that. But that point has just stayed with me and I think it will stay with me for the rest of my life. And so I guess my point for where I'm coming to this is what do we do from ourselves as humans and to our systems? So I want to talk people, humans first, what do you wish more people, whether it's educators or just the public in general, knew about [00:23:00] DLD and dyslexia?

[00:23:02] Dr. Tiffany Hogan: Hmm. Oh, there's so much, but I think it really, at the heart of it, it goes down to neurodiversity because it really is that we're born with different ways of processing the world and it's on a continuum and we all have strengths and weaknesses. I wish that, at a person level, that we just had a very clear understanding of unique differences that children bring to the table and that there's, there's really no laziness. It doesn't exist that children are doing the best they can with what they have. And our job is to really try to meet them where they are. And not blame them and really try to take the blame out of it.

Like in, you know, not telling them to pay attention or try to pay attention, try to focus, work harder, sit still. All of those things that we tend to do, and I've done them as a parent myself as opposed to [00:24:00] really recognizing that child is in a context. They are bringing themselves to the context, and we can control some of the context. So we have to have a better match in terms of what the child brings to the table and that every single child has a strength and it is our job to try to figure out what that strength is and use that strength to help them overcome some of their weaknesses.

[00:24:24] Danielle Scorrano: Mm. Yeah. I'm thinking even just how we as let's say neurotypical, would that the person is, would you use a "neurotypical" person? I don't like that because you talked about neurodiversity.

[00:24:37] Dr. Tiffany Hogan: I don't know, someone without, I really struggle with this. I sometimes say peers who are typically developing, but I don't really like that either. I think we do need to, we're at a point in our fields where we do need to think more carefully about labels, and I think I mentioned this even before we started the pandemic, before we started the podcast. I'm trying to be more careful with even how I label, like how do I say,[00:25:00] I'm trying to think of unique learning needs rather than disabilities. That doesn't negate the difficulties that a person will experience, but I think it provides a more appropriate label because it is unique learning needs. And also even thinking about, I'm very careful when I use the word help, even like, who am I to help? I'm going to try to support, not help. I'm not going to try to correct, there's nothing to correct, nothing's wrong. And I think that's what we really tried to think through, in thinking about neurodiversity. The other thing I want to say about neurodiversity, it relates to the continuum. When we throw labels like developmental language disorder and dyslexia, you know, if you've looked at any set of data, and I know you look at data all the time too, is that when you look at it, it's all on a continuum. When I say, when I decide who has developmental language disorder, it is truly an arbitrary cut point of what I decide is the low of the distribution. We have the same thing with dyslexia. So,[00:26:00] yes, the prevalence of dyslexia really depends on where you cut it, right? If you cut it at the 16 percentile, then population statistics will say that 16% of persons have dyslexia. So it's on the continuum. And so I think thinking in a way that's on the continuum helps us to realize that you can have, at the lower end of the continuum, you start to have more differences in the brain processing that's occurring. But that doesn't mean that someone who was one point away from being quote unquote diagnosed dyslexia doesn't have their own unique learning needs that need to be addressed. Because we also know in longitudinal data that if someone misses the cut point, like in the first year later on, they're probably going to be there. Right? And so I think understanding that continuum would be really important as well.

[00:26:47] Danielle Scorrano: I think that's a really good point and I like that last piece that you talked about, that there could be, it's not only a continuum, but it's across time periods. And when you talk about decisions of cut points, it's based on [00:27:00] data and research on what you're being presented with that, let's say sample participant group. And I want to check my understanding as someone who is a non researcher, when you talk about the cut point, that again, from seeing the research and the commentary responding to research, again, I don't want to  make an overgeneralization, but what I see is that then there are some people that say, Okay, well if you can't decide on a cut point, or you're making this arbitrary and you're deciding that child A, because they are one point below child B, that they have dyslexia, the other person doesn't. It may ruin the non-research word, " validity" of what you're looking at, right? And so I want to clarify that when you talk about continuum, even if a child is showing a different cut score, that they're still struggling and they still need the same supports that if they were at a much [00:28:00] higher point time of as you're looking at their data, right? Am I clarifying that in the right way or thinking about that in the right way?

[00:28:06] Dr. Tiffany Hogan: Yeah, absolutely. And I'll just go further and say, if you give one word reading assessment right, and you say that, 85 cut point on that assessment shows a really good sensitivity to detecting dyslexia and a good specificity showing that if you, you know, if you're high on that test, you don't have dyslexia. That's just one point of data. So if you have, let's say the child qualifies, quote unquote, as having dyslexia on that assessment, of course you would do further comprehensive assessment because we can all do poor on one assessment on one day. So then you have to do further analysis and you have to look for characteristics that would tell you, this child is struggling. A lot of times it's really more dynamic so that you start to give some of them instruction and you're like, oh, they're getting it. That must have been really a false positive. Like maybe that wasn't a great assessment of their ability. We can have the same thing where someone's right across the line, let's say 85's a [00:29:00] cut point, 87 they score. And you're like, oh, they're fine. But then you start to give them instruction and you realize, Whoa, it's really hard for them. It takes multiple repetitions and more time. But that 87 really reflected the time they put in. And so it is a bit complicated in that way. But back to your comment about what's needed, what the research has shown is that what helps children with dyslexia is helpful for all children. So that's the nice aspect. I mean, that's, that didn't have to be the case, but that is the case, what the science shows us. And so that means that when you set in a good curriculum for all children, you're going to help those who are struggling with dyslexia. Those who are maybe sub-clinical or have very mild dyslexia, maybe some of them who have some strengths that they compensate, so they're able to compensate for a brain that processes words, like a child with dyslexia. But having that strong intervention right up front is going to be critical for all children. And we find that with language too. So having a strong language [00:30:00] rich classroom is going to be helpful for all children, not just those who have developmental language disorder, but we have science and, we look at it and ask, what do we need in terms of dosage? We need a lot more dosage.

What do we need in terms of sequencing it out? The work on dosage with children with language difficulties is quite interesting because it shows that sometimes more dosage isn't better. It's more about the time between the dosage, and the cumulative dosage. So we can start to really get in the weeds with this, which is great because that's what these children need. But all children can benefit from what we find out is supportive for children with dyslexia or developmental language disorder.

[00:30:39] Danielle Scorrano: I love all those points, and as you were talking about understanding characteristics, I think it's really empowering for, putting my teacher hat on into seeing the types of difficulties my students are having and advocating for a child based on the difficulties they're having beyond what a test score might show or what might support a test score,[00:31:00] and using those approaches to ultimately empower and support that child to bring them to where they need to go. You talked about language environments and my next, in my next, in my head, framework of looking from the self, my next level is classroom and home environments, and what are those pieces of language rich environments. we all might intuitively include, or maybe that we need to be a little more intentional? And by we, I mean the public, educators, families, parents, anyone who interacts with a child with dyslexia or DLD. What are those pieces that are really important or specifically important for kids with language difficulties to have as they're interacting in their social and academic lives?

[00:31:46] Dr. Tiffany Hogan: I think that the first step, I believe, is awareness. So work on making, educators aware, the public aware, so everyone being aware. I love this video that was created by the Raising Awareness for DLD campaign [00:32:00] RADLD, , they have a video 1, 2, 3 DLD. It's a short, very adorable British video. And they interview an adult who has DLD and they say, you know, how does know you have DLD empower or make your life better. And she says it's so powerful because she says, it's hard to explain, but when people know I have DLD, it helps and I think that's huge. Like it's hard. It is hard to explain. Why does awareness help? There are many factors. You could really start to think about why awareness helps, but just the awareness that it's not the child's fault, it's not the parent's fault that this is the brain that the child was born with and now we meet that child where they are.

It's huge. So the awareness, I think is number one, baseline awareness that this exists. And the first thing we can do for awareness too is to screen. I mean, I'm the biggest proponent of universal screening. It's not unlike screening for vision. I mean, how many people do you know who say, I didn't know I [00:33:00] had needed glasses until I was screened in third grade in the schools.

Right? It's not that their parents weren't attentive, didn't take them to doctor's appointments. It's not that they were neglected, but it's not always obvious when a child can't see. It's just not obvious. And that's the same case with reading disabilities and language disabilities in particular. Language is especially hidden because these children can come off as shy, hesitant. There's a lot of, I don't necessarily want to say that it is mischaracterization, but it's really that there's a lot of family stories that occur around children who have DLD, like, they'll say, they don't talk because their brother talks for them. Oh, they don't like school because they're really all about playing outside. I mean, these things are not mutually exclusive. So I mean, you could play outside and still be good at school. There's just a lot of like stories we tell to try to explain why a child might not meet the language milestones when truthfully, this [00:34:00] child may have developmental English disorder and it's just something that's a bit hidden.

So I think first we have to have awareness, and then with awareness, we need to have universal screening and we need to screen wherever the child is. So if we screen in the pediatrician's office, great, we screen in the schools, I think that's a great place to screen. And we have a lot of screening going on now. We have a call for dyslexia screening. Dyslexia and DLD are 50% overlap. We need to have DLD screening with dyslexia as well. They're not the same. So I think that's important. And then I think that with that foundation supporting children, I think it boils down to, and I'm speaking from a parental role here as well, not just a researcher. I think it boils down to creating routines that fit into our everyday life that are language rich. So a routine, for instance, is reading books. So if you create a routine where you go to the library consistently or you just, you know, we brush our teeth, sit down, look at a book, even I have been very exhausted and [00:35:00] very busy and have neglected this at times, but most of the time, I make sure my kids have brushed their teeth and they have one book and it's a nice downtime. It kind of sets the stage, but it's a routine that I've created. Or even just routines like in the bath, you know, doing some language stimulation, talking about new words. I think creating a language rich environment doesn't have to be arduous for parents and caregivers in general. I think it really can be around just the routines.

I had on my podcast I had my colleague and friend Emily Zimmerman, who talked about language routines around feeding. So, when you're feeding children, I mean, we all eat. So when you're feeding them thinking about how to teach vocabulary talk, talk through the day and those kinds of things, I think that's one thing we can do to really support children. I do think talking about individual differences is so important for them to realize that everyone has strengths and weaknesses. Everyone's doing the best they can. Let's work together to make sure you feel supported. [00:36:00]

[00:36:01] Danielle Scorrano: I like that through line. There were so many actionable steps that you offered in your explanation and coming as an educator, as a family member, older sister, of a child with a developmental language disorder, creating the space for them to know and to understand their disability. And then as an educator understanding, where your implicit bias might be. As I'm someone who does not have a developmental language disorder or dyslexia, but I worked with students who did, and so how was I creating the space for them through language rich environments and the space of belonging for them to understand and truly live in a way where they were not only showing their strengths, but having the space to work on the things that they need. And then when you talked about even just taking those moments of routines, it's micro moments. I like to say micro, but mighty, having those opportunities to build and continue to build these language rich environments.

 I forgot in your bio, I [00:37:00] didn't talk about SeeHearSpeak. And so I'm putting a pin on that, but I want to stay with our self to system framework. So at a system, from school and you can maybe talk about policy, research institutions. What are the things that we can do from a systems level to continue to advocate and provide empowering environments for children with dyslexia and DLD. And you might want to talk a little bit more about implementation science as well.

[00:37:25] Dr. Tiffany Hogan: Yeah, so, I think implementation science gives us a nice framework and roadmap for how to integrate components of the system and how to make system-wide change. So with implementation science, it is the science by how we implement what we know works. And so there's so much, you know, it used to be thought like, do the science and then everyone reads it somehow, I don't know how, and then they just do it. There's a big disconnect there. What it doesn't take into account is the context and so everyone has different contexts, so every school district has some probably consistent [00:38:00] systems in place that most schools do, but then there's always unique aspects of every system.

And so in implementation science, we think about the barriers and the facilitators to implementation. So barriers being what's stopping us from implementing. Of course, facilitators are what's helping us with implementation. So when we think about barriers, we think about strategies to get around barriers. So one strategy to get around knowledge barriers, for instance, is that if everyone doesn't know what dyslexia. One strategy would be to provide a professional development. But of  course there's a science to professional development too. So we'd have to think about the science behind the best professional development strategies for adult learners.

But that's just one example. But what we ultimately want to do in a system is we want to look first, think about what are the barriers and facilitators. A lot of times, we have something new, you know, and I do this too. I think, like, oh, this is new. We're going to do this. I do this in my own lab. I'll be like, we're going to do this new thing. But instead of, what I do is I pile on, it's a zero sum game, so I have to take something out if [00:39:00] I'm doing something new. But of course we don't do that. We just pile on, let's do this. So there's actually a science of de-implementation too, which is really, the flip side of the coin, the same coin, which the other side is, as we implement, we have to think about de-implementation as well. But we pile on. And we don't first step back and think what are the barriers in facilitators or the pre-implementation work that has to be done. And a big part of pre-implementation is talking to the stakeholders. And what do I mean by stakeholders? I mean anyone who's involved in that process.

So when we think about education, our stakeholders, of course, our students are stakeholders. The teachers are stakeholder. Administration, our parents, are stakeholders, so there's lots of different stakeholders, but if we are implementing and we don't include the perspective of all the stakeholders, then it's not going to be implemented well.

Well, I mean, how many times do you know, when I worked in schools, you would have an administrator, and this is again, not unlike me as a lab director coming in, like, we're going to do this. You know, instead of like actually asking the people who are. [00:40:00] What do you think about this? What's the thing that's stopping you from doing this? What's the thing that's helping you to do this? Those facilitators and barriers if we don't flesh that out ahead of time, then our implementation will likely fall flat or it just won't be as stellar as it could be. And then when we're implementing, we have to continually evaluate our implementation to make it better.

And then we have to think about sustainability because I don't know about you, but I've never really implemented something and wanted to stop, right? I mean, when I started, I want it to be a habit. I mean, if I've decided to implement it, it must mean that I thought it was good. But we don't think about that. We don't think about the sustainability of what we're implementing, like what is going to provide sustainability. And of course, sustainability is really meeting the context where it is. If you count for those facilitators and barriers and have a really good match with the needs you have with the work that you're doing and implement, it's going to stick. That whole process is a cycle. And you can't see because I'm on a podcast, but I'm moving [00:41:00] my finger in a circle. It used to be thought of as a pipeline. Like you do the research and then you disseminate the research and then it would be like first step, next step, and then you evaluate the effectiveness and then you implement it and then you just move forward. Like all of a sudden, it's done. Like it's just a pipeline. But what we know is it's a circle. So it's pre-implementation, implementation, sustainability, back to it. Just constantly circling through in an iterative process of how we can make improvement in implementation.

[00:41:29] Danielle Scorrano: It's interesting that you talk about that because I come from a background at Hopkins, Johns Hopkins with an improvement science framework. Same iterative cycle plan, study, do act, and you can see that. I think what one thing that we underestimated as leaders is like, okay, well we may have to pivot a little bit or based on this new information or what the stakeholders are saying. Our initial plan may have to shift, and that's okay as long as it's reaching what our ultimate goal is. I love how you frame that and I almost just want to pull out that piece and [00:42:00] just disseminate it to like every leader who's coming up with different intervention work and not research intervention work, but large scale programs that were intended to intervene and ultimately support kids struggling to read.

Speaking of that, you are a busy leader in the field of reading and language and education and research. So what is the work that you're really excited about right now? I talked about, SeeHearSpeak Podcast. I forgot, I don't know why in your bio I was so excited to talk to you that I didn't talk about SeeHearSpeak. But can you tell us about some of the projects that you're excited for in the next year, currently and in the near future?

[00:42:38] Dr. Tiffany Hogan: Oh, I'm excited about a lot of things right now. You caught me at a great time. I think a lot of scholars feel this way after coming out of a sabbatical. You have a bit of time to really think through. I'm very excited to think about system level change and really connecting the dots in terms of how we support children, how to identify and support [00:43:00] those who have unique learning needs. I was recently, we were chatting about this before the podcast, but I'm very excited that I'm was invited to be on the New York City Mayor's Literacy Advisory Board, where we're working with a large group of stakeholders to think through how to make improvements in literacy instruction in New York City schools, a very large school district as you know, and that's very exciting.

I'm really pushing into implementation science and I learn something new every day. I'm trying to share what I learn and I'm very excited to think more about partnerships, and how, we really don't do this work well without partners. And I think doing that, we have to think through, what's the currency that we need as, researchers versus educators. And what I mean by currency as, what do we have to do to keep our jobs to improve the lives of children? The currency in my job as a researcher is publications, grants, teaching my [00:44:00] doctoral students. And I think with educators I talk to, their currency is very different. If I say, hey, you want to write a pub with me? That's not really their currency. The currency is really more about continuing education, improving student outcomes, quality improvement projects, developing their leadership skills. And their stakeholders, are different than mine in that way. So I think making those connections and working together on a shared problem and how to do so with life's barriers is something I'm really interested in. And I'm excited to continue on to hold the implementation science conference each year and this focus is going to be on partners. I'm also excited, speaking of partners, of partnering with you. I mean, this is so exciting, Danielle. I mean, we've met I think at IDA in 2019 the first time and are so impressed with how you think through these issues and it's nice to meet a kindred spirit. We have different views though, and what we do on the day-to-day basis

So I'm very excited to, partner with you [00:45:00] through your training opportunities there at Windward. There's just so much to be excited.

[00:45:05] Danielle Scorrano: Oh, thank you. I appreciate that. And feelings are mutual. I've seen you present. I've seen the work that you've been doing and I'm just excited to bring you more to our community to make this long-lasting change. I'm also excited for you, your work on the New York City Literacy Advisory Board. As someone who was at the first implementation science conference, I'm just so excited to see where that goes, because when you think about how holistic you can be and how maybe there was someone actually working at a hospital setting in my group when I was in the implementation science conference and how much I actually learned from that setting as an educator and really that we have all this opportunity to collaborate with each other beyond even our own professional work, so thank you for sharing that. Last question. Where can we find you? Where can we learn more from you? I know you talked about other opportunities and events, but if I were listener learning from you immediately, what can I just [00:46:00] directly go to read more about your work or listen to you on your own podcast. Where can we find you?

[00:46:07] Dr. Tiffany Hogan: So I have a podcast, SeeHearSpeak podcast, and you can find it on most podcast platforms. I try to put out an episode about once a month, but it truly is a hobby, and so it's out there when I can. I am approaching my 50th episode, so that's pretty exciting. I can be found on Twitter. I'm pretty active at Tiffany P. Hogan, I have also been involved with an educational website, dldandme.org. So I highly recommend that one. We create short articles, writeups for parents and educators and persons with DLD to talk more about, what is that like. And I'm often giving talks. I'll basically give a talk for anyone who asks me, I'll try to give a talk about DLD. I really want to keep raising the awareness. We're recording in October and October is well known as being Dyslexia Awareness Month, but we also have DLD [00:47:00] Awareness Day in mid-October, so we're shooting for a month someday, but right now we have a day. So that's where you can find me.

[00:47:06] Danielle Scorrano: Thank you so much, Dr. Tiffany Hogan. Thank you so much for your time and being on the READ Podcast.

[00:47:11] Dr. Tiffany Hogan: Thank you so much for having me. What an honor.