LSHSS
Tutorial
Laying a Firm Foundation: Embedding
Evidence-Based Emergent Literacy
Practices Into Early Intervention
and Preschool Environments
Pamela Terrella and Maggie Watsona
Purpose: As part of this clinical forum on curriculum-based
intervention, the goal of this tutorial is to share research
about the importance of language and literacy foundations
in natural environments during emergent literacy skill
development, from infancy through preschool. Following
an overview of intervention models in schools by Powell
(2018), best practices at home, in child care, and in preschool
settings are discussed. Speech-language pathologists in
these settings will be provided a toolbox of best emergent
literacy practices.
Method: A review of published literature in speech-language
pathology, early intervention, early childhood education, and
literacy was completed. Subsequently, an overview of the
impact of early home and preschool literacy experiences are
described. Research-based implementation of best practice
is supported with examples of shared book reading and
child-led literacy embedded in play within the coaching
model of early intervention. Finally, various aspects of
emergent literacy skill development in the preschool years
T
he purpose of this tutorial is to help speech-language
pathologists (SLPs) develop a “toolbox” of tech-
niques, strategies, and activities designed to help
children develop emergent and early literacy skills. As
Powell (2018) noted in the lead article of this clinical forum, a
great deal of research has demonstrated strong links between
early oral language skills and subsequent literacy achieve-
ments. These connections have been referred to as the
a
School of Communication Sciences and Disorders, University of
Wisconsin–Stevens Point
Correspondence to Pamela Terrell: pterrell@uwsp.edu
Editor-in-Chief: Shelley Gray
Editor: Ashley Meaux
Received June 12, 2017
Revision received August 19, 2017
Accepted October 24, 2017
https://doi.org/10.1044/2017_LSHSS-17-0053
Publisher Note: This article is part of the Clinical Forum: Exploring
Curriculum-Based Language Assessment and Interventions.
148 Language, Speech, and Hearing Services in Schools • Vol. 49 • 148–164 • April 2018 • Copyright © 2018 American Speech-Language-Hearing Association
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are discussed. These include phonemic awareness, print /
alphabet awareness, oral language skills, and embedded /
explicit literacy.
Results: Research indicates that rich home literacy
environments and exposure to rich oral language provide
an important foundation for the more structured literacy
environments of school. Furthermore, there is a wealth
of evidence to support a variety of direct and indirect
intervention practices in the home, child care, and preschool
contexts to support and enhance all aspects of oral and
written literacy.
Conclusions: Application of this “toolbox” of strategies
should enable speech-language pathologists to address
the prevention and intervention of literacy deficits within
multiple environments during book and play activities.
Additionally, clinicians will have techniques to share with
parents, child care providers, and preschool teachers for
evidence-based literacy instruction within all settings during
typical daily activities.
“speech-to-print” continuum of development, acknowledging
the foundational skills of oral language to written language.
The information in this tutorial focuses on the development
of emergent literacy (EL) skills, such as print awareness
and phonemic awareness (PA), alongside the development
of pretend play, and oral language skills, such as vocabu-
lary, narration, and conversational skills.
This tutorial is organized to first provide the theoret-
ical base for the connection between oral and written lan-
guage, as well as how to enhance development in both.
Next, we will describe how oral and written literacy skills
can be targeted in tandem across environments, including
home, child care settings, and preschools. Then, we will
present information regarding the multitude of linguistic
skills that can be developed while reading with children,
followed by information on how to develop critical skills,
such as print and PA with examples and explanations
Disclosure: The authors have declared that no competing interests existed at the time
of publication.
 offered in Appendixes A and B. Finally, a timely review
of the impact of electronic media on oral language and
EL skills of infants, toddlers, and preschoolers will be dis-
cussed. Throughout, specific suggestions and examples will
be presented so that clinicians can create their own toolbox
designed to assist children’s development of critical language
and early literacy skills across a variety of settings.
EL and Oral Language
Saracho (2017) defined EL as “literacy-like” behaviors
that are acquired prior to formal instruction in reading and
writing. Some of those behaviors are developed during the
first 3 years of life, such as book handling, labeling pictures,
and listening to stories. As children age, more advanced
EL skills emerge. These emergent behaviors simulate actual
reading and writing activities, such as pretending to read,
scribbling a “note” as part of play, and connecting stories
to real-life events. It is important to remember that, during
this time, children are still advancing oral language skills
that are also essential for the eventual development of read-
ing and writing. Children incorporate new vocabulary in
their own speech and begin to use complex morphological
and syntactic structures. Developmentally, both EL and
oral language skills progress simultaneously and typically
within social environments. Saracho (2017) further stated,
“…emergent literacy shows the way written literacy abilities
surface progressively in the framework of oral language
development” (p. 306). Just as being exposed to “language-
rich environments” is important for the development of
oral language abilities, literacy-rich environments provide
children with opportunities to learn about, interact with,
and experiment with print.
Connecting Theory With Practice
One of the most powerful tools an educator can have
is the ability to understand theories associated with language
acquisition along with the ability to translate theory to
practice. This implies knowing the continuum of development
for both oral and written language, as well as how those
linguistic domains interact over time. SLPs will need strate-
gies and techniques to help caregivers apply theoretical con-
structs in their daily interactions with children, as well as
when providing direct intervention services.
Vygotsky’s theories have been embraced by the educa-
tional community and form a foundation for many peda-
gogical beliefs and current practices, which are especially
relevant for the development of emergent and early literacy
skills. One of the key constructs of Vygotsky’s theories is the
notion of the zone of proximal development (ZPD). ZPD
may be described as the gap between a child’s actual devel-
opmental level when completing a task independently and
the level of potential development with advanced guidance
from adults. The ZPD can vary depending on the kind of
task, the type of instruction given, and the child’s current
developmental level in that area. (Vygotsky, 1986). For
example, an 18-month-old given a board book might turn
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the pages, look at the pictures and, perhaps, act upon the
book by petting a picture of an animal. However, as a care-
giver models pointing to a picture and saying the name of
the object (e.g., ball and cow), the same child might point to
pictures, label pictures, vocalize appropriate sounds (such
as animal noises), and answer simple questions with the
adult mediating the literacy experience. If the caregiver ex-
ceeds the child’s ZPD and asks more abstract and linguisti-
cally complex questions (e.g., “Why do you think the boy
is weeping?”), the child may become frustrated. Conversely,
if the caregiver stays below the child’s ZPD level and does
not provide enough scaffolding (e.g., turns pages with no
linguistic input), the child may become bored and inatten-
tive. The ZPD is ever-changing as the child learns and
develops new skills and interests, so caregivers must be
closely attuned to the child’s disposition, attention, and
engagement. Scaffolded instruction within the child’s ZPD
has been shown to occur in mother–child pairings as mothers
labeled pictures following a child’s point, expanded a child’s
verbalization, asked questions, tracked print with a finger,
pointed out print conventions, and recruited attention to
text, pictures, or story grammar (Bus & van Ijzendoorn, 1988,
1997; Sénéchal, Cornell, & Broda, 1995). This type of in-
teraction influences both oral and written language skills.
As caregivers learn to work within a child’s ZPD
when engaging with print, the child may develop increased
understanding about EL. This incorporates another impor-
tant aspect of Vygotsky’s theory, exposing children to
slightly more complex information and concepts. For exam-
ple, as adults track print, they might verbalize “that’s a long
word,” which provides more advanced information about
the connection between print and words. This may help chil-
dren understand that sentences are composed of words and
that words are separate entities as compared with individual
letters or sentences. Ultimately, through mediated instruc-
tion, the child discovers that words are formed with letters
on the basis of auditory speech sounds. While this is occur-
ring, the child’s understanding changes from the initial
adult-directed social process to internalizing the concepts
for himself (Vygotsky, 1986). Scaffolding can occur across
activities, including shared storybook reading, pretend
play, and daily activities, such as grocery shopping and
following recipes while cooking.
Snow, Tabors, and Dickinson (2001) discussed the
importance of early language skills that “replicate the
demands of literacy” and labeled those as “extended dis-
course.” Examples of extended discourse include narra-
tives, explanations, and dialogue that accompany pretend
play. This type of discourse offers children the opportunity
to learn new vocabulary words and use language in a non-
literal manner and for a variety of social functions, such
as explaining, problem solving, perspective taking, and
negotiating. Katz (2001) specifically noted the importance
of preschool children interacting with adults while playing
pretend and developing the language skills necessary to
participate in extended dialogues and convey meaning that
goes beyond the immediate context, stating “it is this ability
to build and understand larger language structures that
Terrell & Watson: Laying a Firm Foundation 149
 contributes to children’s later literacy” (p. 68). Katz (2001)
reported that the frequency of using and being exposed to
“pretend talk” (e.g., enacting roles and scripts and describ-
ing how to use objects symbolically) by 3- and 4-year-olds
positively correlated with language and literacy skills when
they were in kindergarten.
Numerous research studies have shown a strong con-
nection between early literacy attainments with subsequent
academic achievements (Bodrova, Leong, & Shore, 2004;
Invernizzi, Landrum, Teichman, & Townsend, 2010;
National Early Literacy Panel [NELP], 2008). As Powell
(2018) noted in the previous article of this forum, the skills
of phonological awareness, vocabulary, and comprehen-
sion are among the five key components of effective read-
ing instruction. Children with good EL exposure and skills
enter kindergarten primed to begin explicit reading educa-
tion. Authors of a report from the NELP (2008) reviewed
over 500 research articles to determine those EL and oral
language skills critical for reading development. The emergent
skills that best predicted subsequent literacy development
included alphabet knowledge (both name and letter–sound
recognition), phonological awareness (the ability to analyze
spoken language into smaller components), rapid automatic
naming of letters/digits and objects/colors, writing letters/
own name, and remembering verbal information (phono-
logical memory). Other variables cited in the NELP report
as important were concepts about print, print awareness,
and early word-decoding skills. Expressive language skills
were also found to play a role in predicting literacy skills,
especially those involving more complexity or composite
measures of oral language that included grammar, word
definitions, and listening comprehension (NELP, 2008).
Thus, an important addition to the SLPs’ literacy
toolbox is an understanding of the strong relationship
between oral language attainments with subsequent liter-
acy skills (Dickinson & Porche, 2011; NELP, 2008; Pelatti,
Piasta, Justice, & O’Connell, 2014). This information is
necessary when interacting with young children to help cir-
cumvent potential oral and written language delays. That
is, both written and oral language skill development should
be addressed when working with young children through
activities that provide social interaction and opportunities
for adult-mediated instruction.
EL Development in Various Environments
(Birth to 5 Years)
Home Literacy Environment
The first experiences with print and early reading
activities typically occur in the home within parent–child
interactions (Edwards, 2012). Early exposures to letters
and print happen through picture and story books, children’s
television programming (Bus & van Ijzendoorn, 1988), and
other electronic media (e.g., smart phones and tablets), as
well as through language play in the form of songs and
nursery rhymes. Shared picture book reading is a corner-
stone of EL because, during those interactions, young children
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learn about picture and symbol representation. Shared
reading also exposes them to print and print concepts,
such as directionality in a decontextualized format (Bus
& van Ijzendoorn, 1988, 1997; Lawhon & Cobb, 2002;
Sénéchal et al., 1995). In their study of infants’ and pre-
schoolers’ EL experiences, Bus and van Ijzendoorn (1988)
found that most mothers indicated that they did not pro-
vide reading instruction to their children during storybook
activities. However, the results of their investigation observ-
ing middle-class mothers and their children (three groups
of 1.5-, 3.5-, and 5.5-year-olds) engaged in shared reading
demonstrated that the mothers were naming and talking
about letters and drawing connections between oral words
and their alphabetic representation without realizing it.
Mothers tended to follow the child’s lead if the child showed
some interest in letters and reading.
A literate home environment begins with the presence
of easily accessible reading and writing materials in the
home and is shaped by the child’s experiences with print
materials, family attitudes about literacy, and adult modeling
of reading and writing activities (Bus & van Ijzendoorn,
1988; Lawhon & Cobb, 2002; Roberts, Jurgens, & Burchinal,
2005; Sénéchal, LeFevre, Thomas, & Daley, 1998). Activities
that develop an awareness of rhyme, prosody, and rhythm,
such as nursery rhymes, songs, and fingerplays help build
a foundation for reading as well (Lawhon & Cobb, 2002).
Investigations of literacy environments have been conducted
using a variety of checklists and criterion-based instruments.
They were designed to examine the amount and type of
books in the home, the child’s access to books and writing/
art implements, other literacy artifacts (e.g., recipes, receipts,
and mail), and family reading behaviors and routines and
community literacy experiences, such as the library and story
time (Caldwell & Bradley, 2003; Hanna, Hinrichs, Mahar,
DeFrain, & Durden, 2010). Research has indicated that a
home that is rich with literacy experiences and adult models
with many types of reading materials readily accessible to
young children positively influences the EL skills of young
children and impacts school-age literacy skills (Edwards, 2012;
Pinto, Pessanha, & Aguiar, 2013; Sénéchal & LeFevre, 2014).
Children living in poverty are especially vulnerable
to not receiving early literacy experiences and form the
largest group of children demonstrating delayed literacy
development (Tichnor-Wagner, Garwood, Bratsch-Hines,
& Vernon-Feagans, 2015). Thus, they are often not ready
for the literacy instruction offered within preschools and
child care centers. Children living in poverty had less expo-
sure to books in their homes and were often not exposed
to public libraries as compared with children from higher
socioeconomic groups (Baker, 2003; Farver, Xu, Lonigan,
& Eppe, 2013; Slates, Alexander, Entwisle, & Olson, 2012).
Adults may not readily expose their children to literacy due
to a lack of education and literacy skills (Boyce, Innocenti,
Roggman, Norman, & Ortiz, 2010; Li & Christ, 2007).
Farver et al. (2013) further stated that children from low-
income families and those whose first language is not
English face “considerable challenges” in acquiring read-
ing skills.
 Thus, additional needs for the SLP’s toolbox include
strategies and techniques to help prevent the effects of
limited home literacy experiences (Appendix A). Tichnor-
Wagner et al. (2015) provided suggestions to help parents
bolster their ability to increase and improve their children’s
EL experiences. These included advocating for programs
that provide literacy resources and educational programs
for parents, including direct instruction through classes,
providing books for the home, and increasing access to
educational digital resources. These programs require fund-
ing and personnel devoted to improving the EL experiences
of young children along with educational opportunities for
their caregivers. However, SLPs can help parents make
some simple adjustments to take advantage of environmental
print that exists in most homes. This can include artifacts,
such as food packaging, mail, and the textbooks /homework
of older siblings. Yet, another avenue to help improve young
children’s early literacy experiences is through interactions
with older siblings. Older siblings who have developed some
reading skill can be taught or encouraged to engage in shared
reading and other literacy-focused activities (e.g., playing
school) with the younger children in the home. This may
be especially useful for families whose primary caregivers
do not speak the language of instruction (Kibler, Palacios,
Simpson Baird, Bergey, & Yoder, 2016).
Heath (1983) urged educators to capitalize on
the “authentic literacy experiences” that may be occur-
ring in the homes of children not living in mainstream
society. For example, Boyce et al. (2010) developed a
“strengths-based” program for increasing literacy skills
of Spanish-speaking migrant preschoolers. The authors
helped Spanish-speaking migrant families create oral nar-
ratives about everyday events and, then, turned those into
books the families could use repeatedly. The books were
relevant, functional, and culturally appropriate. Parents
were given strategies to use while sharing the books with
their children. Mothers improved quality of language and
literacy support compared with the control group; children
increased the number of words and different words from
pretest to posttest. On the other hand, some families may
have a strong cultural storytelling heritage, and they should
be encouraged to continue that tradition. Their young
children may be exposed to descriptive language and story
grammar concepts through listening to stories.
Child Care and Early Preschool Literacy Environments
According to the U.S. Census Bureau (2013) results,
61% of American children ages birth to 4 years were cared
for by someone other than their parents while the parents
worked or were involved in other activities or obligations.
Twenty-seven percent were in the care of a relative, whereas
25% attended organized child care facilities. Because approx-
imately one out of every four children attends a child care
center, the literacy environments of those centers also bear
consideration. For example, Norris (2017) found that
child care centers staffed with teachers who had bachelor
degrees and low adult–child ratios (2:8) also had more
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space and materials for literary activities than those staffed
by teachers with high school degrees and a larger adult–
child ratio (2:12–16). Pinto et al. (2013) found similar
results when examining child care centers in Portugal. Using
a longitudinal design, the researchers rated Portuguese
child care centers on factors, including room arrangement
and furnishings, listening and talking, program format,
and interactions. Pinto et al. (2013) found that “child care
classroom quality” was associated with children’s develop-
ment of language and literacy skills.
Child-led literacy experiences have also been shown
to be beneficial for EL skills. In focus group interviews
with preschool (birth to age 3 years) teachers in Sweden,
teachers did not feel like they were engaging in specific
literacy instruction (Hvit, 2014). However, as the teachers
began to describe activities and routines within the day,
it became apparent that they were “doing literacy” frequently,
with less explicit literacy teaching. These teachers were
following the lead of the children and embedding early
literacy experiences throughout the day. For example, when
a young boy was drawing circles with a stick in a sandbox,
his teacher commented how he made an “O” like the first
letter in his name. During shared book reading, children
were encouraged to dramatize and retell stories, using photos
of their play as visual support. Additionally, these toddlers
were encouraged to “read” books to dolls and each other
and to write (scribble) their names. While the teachers
thought they were lagging in literacy instruction, the oppo-
site was true. Literacy experiences were playful, sponta-
neous, hands-on, and child-led within child care routines
(Hvit, 2014). However, this study underscores the need
for child care and preschool teachers to have explicit in-
struction in EL development and strategies to facilitate
language and literacy in group and classroom settings
because the teachers were unaware that literacy experiences
could be serendipitous and occur during play and in simple
narratives.
Pretend play centers in classrooms (e.g., home living,
grocery store, and office) can provide embedded literacy learn-
ing opportunities, thus bridging the gap between home and
school reading exposure (Lawhon & Cobb, 2002; Whitehurst
& Lonigan, 1998). A study by Neuman and Roskos (1993)
found that children in Head Start classrooms equipped with
an office play center containing print artifacts, such as calen-
dars, phone books, and writing materials, scored higher
than control classrooms on environmental print tasks. When
a trained adult volunteer modeled and scaffolded the chil-
dren’s play by referencing print (e.g., “Let me look up that
price.”), the children performed even higher on environmental
print tasks than children in the rooms with office centers
and no adult volunteer. These types of creative learning
experiences can foster cohesion between the home and pre-
school literacy environments. In a separate study, Neuman
and Roskos (1997) took the embedded preschool literacy
concept a bit further. This time, they created a post office,
a restaurant, and a doctor’s office setting within Early Start
classrooms and provided related literacy tools, such as
stamps, envelopes, menus, receipts, eye charts, pill bottles,
Terrell & Watson: Laying a Firm Foundation 151
 credit cards, and so forth. Students also went on a field trip
to a post office, and teachers modeled how to play “post
office” in the classroom. Gradually, the teachers faded out
of the play to become observers. The 3- and 4-year-old pre-
schoolers learned literacy procedures (e.g., writing and
mailing a letter), names and purposes of literacy materials
(e.g., stamp, envelope, and menu), literacy routines (e.g.,
ordering from a menu while server writes down information),
and print knowledge (e.g., open/closed sign on restaurant)
all within natural pretend play (Neuman & Roskos, 1997).
Although most child care centers rarely have a formal literacy
curriculum for children younger than age 3 years, they do
often have dramatic play centers. Thus, adding a few literacy
items to each play center and showing teachers and para-
professionals how to model and scaffold would be an easy,
proactive way of including literacy into play.
Shared Book Reading
In the most general sense, shared book reading in this
tutorial refers to any time an adult and young child share
a book experience together, typically with the adult reading
to the child or talking about the book. During shared book
reading experiences, infants and toddlers begin to progress
through preliterate developmental stages (see Table 1). Inter-
active book reading is a specific type of shared book reading
in which an adult uses techniques to engage a small child
(or children) in the text (Institute of Educational Sciences,
2015), and it is a hallmark of early literacy experiences in
terms of frequency and benefit. Interactive book reading
may include strategies, such as pointing to pictures, asking
questions, acting upon the pictures (e.g., petting the kitty),
labeling pictures, and making associated sounds (e.g.,
“meow”). Another category of shared book reading is dia-
logic reading in which the adult reads to the child and asks
open-ended questions, is highly responsive to the child’s
Table 1. Preliterate development of book handling and interaction.
Approximate age Preliterate book skill
Emerges younger than Book handling
12 months • Mouthing books
• Patting or grabbing pictures
• Holding books
• Turning pages
Emerges 12–18 months Verbal and nonverbal referencing
• Making sounds and gestures
in response to pictures
• Responding to adult comments/
questions by pointing, making
sounds, or labeling
Emerges 12+ months Behavioral
• Increased attention to books
• Staying still during reading
experiences
Note. Based on Bus and van Ijzendoorn (1997); DeLoache,
Pierroutsakos, Uttal, Rosengren, and Gottlieb (1998); and Sénéchal
et al. (1995).
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comments and questions, and follows the child’s utterances
with feedback, such as praise, expansion, or repetition
(Hargrave & Sénéchal, 2000; Institute of Educational
Sciences, 2015; Whitehurst et al., 1994). Shared book read-
ing provides a natural environment for literacy exposure,
and as children snuggle in the lap or sit beside the adult
reader, positive emotions may also be associated with the
experience.
In 12 mother–child or father–child dyads from White
middle-class to upper-class families in Canada, Sénéchal
et al. (1995) found significant increases in the amount of
parent questioning and the number of children’s vocaliza-
tions as the ages of the children increased. Across all age
groups (9–27-month-olds), parents were consistently percep-
tive and responsive to a child’s gaze. Parents used pointing
to follow and maintain a child’s attention to a particular
page or picture and incorporated attention-recruiting com-
ments (e.g., “See the ball?”) and elaborations (e.g., “That’s
her favorite toy.”) with infants and more questions (e.g.,
“What’s he doing?”) and feedback (e.g., “Yes! That is a
big dog!”) with older toddlers (Sénéchal et al., 1995).
Edwards (2012) found mothers (middle to upper socio-
economic status; M = 19 years of education) tended to
reference written language skills, such as story grammar
and book conventions (and, to a lesser extent, print), but
not phonological awareness, while reading to their toddler/
preschool children (18–34 months). Other research has
indicated that most adult readers do not naturally incorporate
print referencing (PR) nor do young children spontaneously
attend to it (Justice & Ezell, 2000; Justice, Kaderavek, Fan,
Sofka, & Hunt, 2009). Therefore, parents, caregivers, and
teachers could benefit from some education regarding the
importance of early phonological awareness (e.g., rhyming)
and PR (e.g., following print with finger).
Shared story book reading also benefits preschoolers,
both in a caregiver–child dyad at home and in small
groups within the classroom and warrants consideration
as part of a child care/early childhood (EC) center curricu-
lum. Dialogic reading in particular, which includes asking
wh-questions, following the child’s lead, repeating and
expanding child comments, and praising the child, is effec-
tive in increasing vocabulary (Hargrave & Sénéchal, 2000;
Whitehurst et al., 1994) and increasing frequency and
length of book-related conversations (Milburn, Girolametto,
Weitzman, & Greenberg, 2013). These benefits were noted
with 3- to 5-year-old children who engaged in dialogic book
reading at home and at school, but strongest effects were
observed with a combined home and school approach or
home only (Milburn et al., 2013). Blewitt, Rump, Shealy,
and Cook (2009) found that the most effective way to
incorporate dialogic reading with preschoolers was to
start with low demand questions (e.g., Who? What?) and
gradually scaffold up to more complex “How?” and “Why?”
questions, while incorporating more complex vocabulary
from the book (“Where does the marsupial live?”). Finally,
it should be noted that the studies above included children
from a variety of socioeconomic levels, as well as children
exposed to two languages at home.
 Although enjoyment of shared book reading comes
naturally for most children, those with language impairments
are often difficult to engage in shared book experiences.
Some simple adjustments in both one-on-one and group book
reading may improve the child’s engagement, the reader’s
language facilitation, and the benefit of shared book reading
(Kaderavek, Pentimonti, & Justice, 2014; van Kleeck, Vander
Woude, & Hammett, 2006). Manipulative books, such as
lift-the-flap books, and books with less text and shorter sen-
tences have been demonstrated to increase the attentiveness
and responsiveness of children with language impairments
(Kaderavek & Pakulski, 2007; Kaderavek et al., 2014).
If the book has more text, child engagement may be en-
hanced by the adult talking about the book using shorter
utterances and not feeling compelled to read the text verba-
tim. Additionally, dialogic reading and scripts, with an em-
phasis on literal language (e.g., “What is the dog doing?”)
before scaffolding to inferential and abstract language
(e.g., “How do you think the dog feels?”) has been dem-
onstrated to increase receptive vocabulary with smaller
gains in abstract language for children with language
impairments (van Kleeck et al., 2006). Caregiver and
teacher responsiveness, sensitivity to the child’s ZPD for
book reading, and allowing additional response time may
also help children with language impairments benefit more
from shared book experiences (Dale, Crain-Thoreson,
Notari-Syverson, & Cole, 1996; Kaderavek et al., 2014;
van Kleeck et al., 2006).
The SLP’s Role
Birth-to-Three Intervention
Research has led to some effective methods to in-
corporate literacy awareness and skills in everyday routines
and activities at home, at child care, and in the community.
Often, the focus of early intervention is on eliciting first
words and phrases, increasing the phonetic inventory and
speech complexity, and developing skills, such as play and
joint attention (American Speech-Language-Hearing Asso-
ciation [ASHA], 2008). However, because early literacy
exposure can have a significant impact on infants’ and
toddlers’ later literacy and academic development, SLPs
in birth-to-three practice should attune to the home and/or
child care literacy environments of the families that they
serve. Instruments, such as home literacy questionnaires
during the routines-based interview and assessment process,
may be helpful for determining the extent of a child’s early
language and literacy exposure during daily routines. Because
children with speech and language impairments are already
at risk for written language problems, addressing literacy
within routines in home, in child care, and in community
settings is an intervention priority. By helping parents and
child care providers embed literacy learning opportunities,
the impact of language impairment on EL development
may be lessened. Additionally, children with language defi-
cits will be better prepared for future learning environments
where EL skills will be explicitly taught.
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Guidelines by ASHA (2008) on the roles and respon-
sibilities of SLPs in early intervention state that due to docu-
mented connections between early literacy experiences (e.g.,
shared book reading) and later literacy development, lit-
eracy should be addressed in the early intervention con-
text as a prevention, if not intervention, measure. Current
best practice in early intervention service provision is a coach-
ing model (Rush & Shelden, 2011). In this team-based,
transdisciplinary model, there is a primary service provider
(PSP), who may or may not be the SLP. The PSP would
provide literacy instruction, model facilitative literacy tech-
niques and, then, provide feedback to parents, caregivers, and
child care teachers as they implement the strategies. If the
SLP is not the primary provider, then the SLP would be
additionally tasked with educating and consulting with the
PSP (typically a physical therapist, occupational therapist,
or EC educator) about evidence-based EL techniques (Rush
& Shelden, 2011; Shelden & Rush, 2013).
Literacy coaching might involve modeling a technique
in Appendix A, such as dialogic reading, to the caregivers.
For example, the PSP would explain a basic type of dialogic
reading, such as asking simple wh-questions about the pic-
tures and story. The PSP might then place the toddler in
her lap and model the strategy by reading the text and/or
talking about the pictures while interspersing questions
occasionally, such as “Where is the puppy going?” “Uh-oh!
The baby looks sad, doesn’t he?” or “Who is driving the
car?” In the next stage of coaching, the adult caregiver
would engage the child in reading while the PSP observed
and offered feedback. Asking reflective questions often
leads to self-discovery and better feedback than telling the
adult the pros and cons of the interaction. Questions such
as “What do you feel went well while you were reading?
How did you feel when your child lost interest and started
squirming? What could you do differently to help your child
pay attention longer next time?” are more constructive than
telling a mother she asked too many questions or forgot to
point to the pictures. Recording and replaying brief videos
on a tablet or smart phone can be very helpful during this
self-evaluation process. It is also crucial to provide only one
or two tools from the toolbox initially so that parents are
not overwhelmed. The PSP should reinforce the concept that
the focus of the activity is language enrichment/facilitation
and literacy, not accurate speech sound production. It is
important for the caregiver to understand that the goal is
building vocabulary, narrative skills, and “grammar” (i.e.,
morphosyntax) skills and not precise articulation. Finally,
the PSP should always find something to praise about the
interaction.
Preschool Intervention (Age 3–5 Years)
EC education is delivered in a variety of settings,
including prekindergarten classrooms, Head Start, and
child care centers. Across those environments, children from
diverse ethnic, social, and economic backgrounds are pro-
vided with foundational skills to prepare them for more for-
mal schooling. Some of those children enter those programs
Terrell & Watson: Laying a Firm Foundation 153
 with well-developed EL skills, while others may have had
limited exposure to print. Other students may lag far behind
their peers due to disabilities or limited exposure to the lan-
guage of instruction. Nevertheless, teachers are given the
charge to ensure that their students enter kindergarten
with the necessary skills to develop the ability to read and
write. In fact, the Common Core State Standards (National
Governors Association Center for Best Practices, 2010)
specify that children in kindergarten should recognize/name
alphabet letters, associate sounds with letters, and be profi-
cient in a variety of phonological awareness tasks, including
identifying phonemes in simple words and substitute phonemes
in single words to create new words (see Appendix B).
Early literacy skill development in EC education has
received a great deal of attention due to the link between
EL skills and later academic achievements (Invernizzi et al.,
2010). Many researchers have shown that educators in EC
classrooms may not be providing satisfactory support or
learning opportunities for their students to develop EL skills
(Girard, Girolametto, Weitzman, & Greenberg, 2013; Mihai,
Butera, & Friesen, 2017; Pelatti et al., 2014). In their review,
Mihai et al. (2017) discussed that EC teachers often do not
always foster the development of vocabulary and phono-
logical skills, nor do they conduct shared book reading in
a way that encourages the development of more complex
language. For example, Pelatti et al. (2014) observed 81 EC
teachers and their students during a time that was “repre-
sentative of typical classroom procedures.” The mean length
of each observation was 93 min (range = 24.33–151.42 min).
Results showed that the average amount of instruction
time devoted to EL skill development was 18 min (range =
0.73–47.80 min). The authors noted that “only a handful”
of the teachers in their study provided specific learning
opportunities for critical skills, such as vocabulary devel-
opment, print concepts, and PA. Rohde (2015) also discussed
the existence of a gap between what research has shown to
be important for high-quality reading instruction and what
actually happens in many classrooms. Reasons for this gap
include preschool educators not having adequate training
on literacy development/instruction, as well as a lack of
understanding of the component skills essential for literacy
development and how those skills interact.
In their investigations of EC teaching environments,
Justice, Mashburn, Hamre, and Pianta (2008) showed that
teachers’ use of “high-quality literacy interactions” with
children was more important than the materials used for
instruction. Thus, SLPs may need to add strategies or adapt
a curriculum to collaborate with EC teachers on best prac-
tices for developing children’s oral and written language
skills. These strategies should include arrangement of the
physical space for easy access of books and writing utensils
and how teachers can intentionally support children’s use
of such materials throughout the day. Methods to embed
written language development in a variety of contexts can
also be demonstrated. Finally, explicit instruction of develop-
mentally appropriate print and phonological awareness
skills can be modeled through co-teaching and coaching
using service delivery models, as described later in this tutorial.
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Children With Language Impairments
Because the development of EL is dependent on many
oral language skills, children with language impairments
are at risk for developmental reading difficulties. Numerous
studies have shown that many children with oral language
deficits have concomitant reading difficulties (Catts, Fey,
Zhang, & Tomblin, 2001, 2002; Murphy, Justice, O’Connell,
Pentimonti, & Kaderavek, 2016). These delays may be docu-
mented in kindergarten, a time when more formal reading
instruction often begins. For example, Catts et al. (2001)
showed that language problems exhibited by children in
kindergarten predicted reading problems at subsequent ages.
Catts et al. (2002) also showed that children identified as
language impaired as kindergarteners exhibited reading
difficulties in second and fourth grade at a rate of six times
greater than their nonimpaired peers did. In a retrospective
study, Murphy et al. (2016) found that reading difficulties
demonstrated by children in kindergarten was predicted by
oral language skills, alphabet knowledge, and print knowl-
edge evidenced when the participants were enrolled in EC
special education classrooms. Thus, differences between good
and poor readers can often be discerned prior to formal
literacy instruction. Murphy et al. (2016) found that print
concept knowledge and oral language skills were related
in their group of subjects. The authors discussed that print
concept tasks often use complex instructions, such as “point
to the longest word on the page,” thus providing further
support of the link between oral language and early reading
development.
Justice (2005) described children with language impair-
ments as “vulnerable” for acquiring reading skills. She
further stated that the lack of adequate reading skills would
be the “most significant handicap these children will face”
(p. 7). Justice then delineated the roles of SLPs regarding
intervention for and prevention of reading difficulties in
children. Thus, it is imperative that children with language
impairments be identified early so that intervention for both
oral language development and EL skills can commence as
soon as possible. This directive puts SLPs in a position to
effect change in both domains, as well as fill a collaborative
role with classroom teachers in the delivery of services.
Therefore, tools SLPs may find useful include methods for
early identification of those children at risk for difficulty
developing literacy skills, which includes collaborating with
EC teachers. This collaboration should involve both early
identification and intervention.
The SLP’s role in helping children develop reading
and writing skills has been documented in a position state-
ment and technical report (ASHA, 2001). Rather than
being seen as prescriptive, these documents can help SLPs
determine how to best assist the acquisition of EL skills
and continued development of oral language of children
enrolled in EC classrooms. Schuele and Larrivee (2004)
suggested that the SLP’s role is not to replace what the
classroom teacher is doing but rather to “supplement and
augment” instruction. However, this advice is tempered
by the previous discussion on the premise that many EC
 teachers are not offering best practices in EL instruction
on a consistent basis. Thus, one role the SLP may take on
is that of mentor and coach. For example, positive effects
have been reported when SLPs have served as coaches
and mentors to EC educators in an effort to improve EL
instruction (Girolametto, Weitzman, & Greenberg, 2012;
Milburn et al., 2015). Coaching with child care and pre-
school teachers can follow the birth-to-three paradigm as
described earlier, with the SLP explaining a strategy from
the EL toolbox, modeling the strategy in the classroom,
then observing the teacher and providing supportive feed-
back. For example, the SLP would explain that identifying
initial sounds in words is an important skill for phonological
awareness. During circle time, the SLP would model how
talking about initial sounds could be embedded in the
calendar routine, such as “It’s November. What sound
does November (slight emphasis on /n/) start with? /n/–that’s
right! And it’s the fourth. Does ‘fourth’ start with /m/
or /f/?” The SLP then gives constructive feedback to the
teacher once the teacher begins to implement the strategy.
Response-to-Intervention
The response-to-intervention (RTI) framework also has
implications for the SLP’s role in helping children develop
literacy skills, as described in Powell’s (2018) lead article
for this forum. The use of RTI in EC classrooms can be
helpful for both prevention and early identification of EL
difficulties (Justice, 2005, 2006). Specifically, for Tier 1 and
Tier 2 instruction, SLPs can help classroom teachers focus
on critical EL concepts, including print concepts, alphabet
skills, and phonological awareness. Justice (2006) suggested
that SLPs can make a strong impact on reading potential
by influencing the scope and content of Tier 1 EL instruc-
tion. By helping develop and implement scientifically-based
curricula designed to foster EL skills, SLPs can be a part
of an educational team charged with preventing reading
difficulties. For example, SLPs may assist with designing
instructional practices, learning opportunities, and physical
environment to help children acquire EL skills (NELP,
2008). Using a collaborative model of instruction, SLPs
may be able to identify those children at risk and require
more intensive instruction by systematic monitoring of
children’s skill development. If needed, the SLP can then
provide Tier 2 instruction to supplement learning opportuni-
ties already provided to all of the children in the classroom.
These Tier 2 interventions should be designed to accelerate
children’s EL skill development because research has shown
that, without adequate instruction, poor readers are not
likely to catch up with their peers (Juel, 1988). Through
proactive collaborative instructional design and delivery,
SLPs may help reduce the number of children with reading
delays in elementary school by focusing efforts to provide
a strong foundation for oral language and EL skills for pre-
school children.
The training that SLPs receive in speech-language
development and disorders, phonetics, and language inter-
vention techniques provides a solid foundation to build EC
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educational programs that encompass both oral language
and EL learning (Gillam & Ukrainetz, 2006). Although
SLPs can enhance literacy development in many ways, two
important avenues are PA and print concept knowledge.
As stated by Powell (2018) in the lead article, “teachers lack
the fundamental knowledge of linguistic principles that are
the foundation for reading instruction” (p. 11). Thus, addi-
tional critical components of the SLP’s toolbox include
strategies and techniques to foster children’s development
of phoneme awareness and print concept knowledge.
Phonological Awareness Instruction
Phonological awareness is the ability to identify and
manipulate units of oral language, such as counting the
number of words in a sentence or syllables in a word. PA,
a subset of phonological awareness, specifically involves
showing an understanding of individual sounds in words,
such as identifying the first sound in a spoken word or
deciding if two words begin with the same phoneme (Yopp,
1992). The connections between spoken and written language
should be explicitly taught, then that knowledge needs to
be transferred to reading and writing tasks. Children most
at risk for difficulties developing PA skills include those
with language impairments, children whose first language
is not English, and those from low-income socioeconomic
groups.
PA skills progress along a continuum and with care
to ensure that children receive developmentally appropriate
instruction. Gillon (2003) provided a list of phonological
and phonemic skills, along with suggestions for adjusting
task difficulty. Those skills most appropriate for preschool
children are presented in Appendix B. This information
can also be used to create differentiated instruction within
lessons. For example, some children may be ready for more
challenging segmenting activities (e.g., segmenting words
containing consonant clusters into individual phonemes),
whereas others still need to work on separating words into
onsets and rimes (e.g., “p—ig”).
Callaghan and Madelaine (2012) recommended provid-
ing short but frequent PA lessons to preschoolers. One way
this can be accomplished is by integrating PA instruction
into classroom activities. For example, during a lesson on
farm animals, children could be asked to identify animals
whose name starts with a “k” sound. Those words could
then be a part of both blending and segmenting activities.
Providing instruction at varying levels of challenge (see
Appendix B) within the same lesson can meet the needs of
diverse learners. On the other hand, dedicated time could
be devoted to providing specific PA instruction in the context
of small groups. This offers an opportunity for the SLP to
conduct in-classroom intervention, especially for children
already receiving speech and language services. Children
could be grouped according to ability levels in order to spe-
cifically focus instruction as advocated by the RTI model.
For example, the SLP could work only with children who
may be struggling with lower level PA skills. Another option
is that children with varying levels of PA abilities could be
Terrell & Watson: Laying a Firm Foundation 155
 grouped together, with the SLP differentiating instruction.
That way, children with lower abilities could be exposed to
“what is yet to be learned” and benefit from the modeling
and social interaction more skilled children may provide.
The content, or “what to teach” for PA instruction,
can be derived from specific curricular materials (Blachman,
Ball, Black, & Tangel, 2000) or can be “teacher-made,”
if on the basis of scientific teaching principles. Koutsoftas,
Harmon, and Gray (2009) created their own teaching
sequence for PA instruction for preschoolers, including
probes for monitoring progress, scripts for instructors,
and a suggested sequence of teaching objectives. Gillon
(n.d.) also provided extensive resources that can be used
in PA instruction. Those resources include both a handbook
that provides background information and teaching instruc-
tions, along with printables (e.g., pictures and worksheets)
that can be used to facilitate teaching. Goldstein (2016)
created “PAth to Literacy” to help children with delays in
EL skills.
The recommended teaching strategies for PA develop-
ment include explicit descriptions about each specific task.
This instruction should include modeling and providing
multiple cues as needed. For example, success with PA
activities is highly dependent on the ability to process audi-
tory information; however, teachers can also exploit other
cues, such as pointing out the visual (e.g., lips together for
bilabials) and physical characteristics (e.g., continued airflow
for fricatives) of phoneme production. PA training should
also offer children many opportunities to learn and practice
each PA skill. Scaffolding should be used to provide children
a means to increase their ability to respond, and correc-
tive feedback needs to be provided as often as required.
Olszewski, Soto, and Goldstein (2017) also showed that
“instructive feedback” (feedback telling the child that their
response was correct and why) also supported gains in PA
skills. Importantly, the concept of “sound” or “phoneme”
must be separated from the concept of “letter.” For example,
the letter “m” (pronounced / m/) makes the /m/ sound.
Further, the report from NELP (2008) indicated that PA
instruction was most effective when combined with training
on letter–sound relationships. This additional training may
help children associate PA skills with word decoding, as
well as their own attempts at writing words.
Appendix B provides suggestions for direct and indi-
rect instruction for a variety of PA tasks. Numerous research
articles have demonstrated the value of PA training for
children with delays in early literacy skills (Goldstein et. al.,
2017), speech impairments (Gillon, 2003; Kirk & Gillon,
2007), language delays (van Kleeck, Gillam, & McFadden,
1998), and childhood apraxia of speech (Moriarty & Gillon,
2006). Other research has shown the benefit of combining
PA training along with alphabet instruction (Olszewski
et al., 2017; Piasta & Wagner, 2010; Whitehurst & Lonigan,
1998). Readers are encouraged to use the teaching strategies
described above when modeling, eliciting responses, and
providing feedback. In addition, the suggestions provided
should be used as a catalyst for additional ideas and activi-
ties, relevant to each educational environment.
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Print Knowledge Instruction
Justice, Bowles, and Skibbe (2006) described print
knowledge as an “umbrella term” encompassing both print
concept knowledge and alphabet knowledge. Print concept
knowledge involves knowing that print is meaningful and
how it functions, whereas alphabet knowledge is shown by
the ability to identify and name alphabet letters (Justice
et al., 2006; Justice & Ezell, 2004). PR has been presented
as a method to help preschool children attain print con-
cepts (Justice et al., 2009; Justice & Ezell, 2004; Lovelace
& Stewart, 2007) and should be included in the SLP’s liter-
acy toolbox. PR strategies include verbal and nonverbal
cues to help children attend to the “forms, features, and func-
tions of written language” (Justice & Ezell, 2004, p. 186).
These strategies may be easily embedded while reading
to children and include tracking print, pointing to specific
letters or words on a page, asking the child to identify let-
ters or words, providing specific comments about print,
and asking the child to find specific letters or words. The
goal of instruction is for children to develop the knowledge
of how print functions and is organized. An understanding
of print forms can allow students to distinguish alphabet
letters and realize that letters can be combined in a variety
of ways to convey meaning.
Like PA training, print knowledge instruction can
be embedded throughout the day within EC classrooms or
presented in specific instructional contexts, such as during
shared book reading with children (Justice, Logan, &
Kaderavek, 2017; Justice, McGinty, Piasta, Kaderavek, &
Fan, 2010). Results demonstrated that using a PR strategy
while reading to children can help improve their ability to
write their names, as well as increase their alphabet and
print concept knowledge. Reading to children using a PR
style has been shown to improve the print knowledge of
children with language impairments and those from lower
socioeconomic households (Justice et al., 2017; Lovelace &
Stewart, 2007).
However, research has shown that many EC educators
do not often reference print while reading to their students,
thus missing valuable learning opportunities (Zucker, Justice,
& Piasta, 2009). This provides yet another opportunity for
SLPs to model, mentor, and collaborate with EC teachers
in the provision of EL skill development. Justice and Ezell
(2000, 2004) have shown the benefits of training parents
and teachers in Head Start programs and how to effectively
reference print, thus improving EL skills.
SLPs can assist EC teachers in helping their students
develop print knowledge in many ways. For example, SLPs
can work alongside classroom teachers and model PR when
reading to groups of children. SLPs can also recommend
books that contain high print saliency. Books with speech
bubbles, changes in font size and style, and print embedded
within illustrations provide opportunities to point out and
discuss print. SLPs can also help teachers develop appropri-
ate print concept objectives. Justice et al. (2017) provided
a list of objectives teachers can use to structure shared book
reading sessions. These objectives encompass four categories,
 including print organization, the meaning of print, letters,
and words. When teaching about print organization, informa-
tion, such as the title/author, would be specifically mentioned.
The adult may also track print showing that books are read
top to bottom, as well as from left to right. To encourage
the development of print meaning, the adult would point to
specific units of print and announce, “That says….” Speech
bubbles and print embedded within illustrations are espe-
cially good stimuli to develop print meaning. Letter knowl-
edge can be taught by specifically pointing to and naming
letters, pointing out the difference between uppercase and
lowercase letters, or asking children to find specific letters
on a page. Finally, knowledge of words can be facilitated
by pointing out the difference between long and short words
on a page, drawing attention to highly frequent words, and
showing how each printed word represents a spoken word.
Similar to PA, instruction can be differentiated in order to
meet the needs and abilities of diverse learners.
Digital and Electronic Media
An article about birth-to-five literacy in 2017 would not
be complete without a mention of digital literacy. Although
technology seems omnipresent, and it is difficult to remember
life without laptops, smartphones, and tablets, the discussion
of children’s interaction with literacy other than print is
not new. Children’s television programming began a new
trend in 1969 with the debut of Sesame Street. Sesame Street
was specifically created to appeal to an inner-city audience
with its urban set, diverse cast of human and Muppet char-
acters, and its focus on letters, numbers, and other preschool
concepts (van Kleeck & Schuele, 2010; Sesame Workshop,
n.d.). It set the stage for other preschool and children’s pro-
gramming from the vintage Mister Rogers’ Neighborhood
to the more modern Daniel Tiger (http://www.pbskids.org).
The preschool programming boom led to the American
Academy of Pediatrics (AAP, 2016) issuing a policy state-
ment in 1999 discouraging any television viewing for children
under 2 years of age. However, this was revised in 2016 to
address the now-ubiquitous digital media. New recom-
mendations for infants through preschoolers are located
in Appendix A.
In the past 20 years, there has been an increase in pro-
gramming aimed at infants and toddlers with the advent
of videos like Baby Einstein (http://www.kidsii.com/brands/
babyeinstein) geared for children ages 6 months to 3 years.
There may not be much learning happening with these
“educational” shows for the youngest children. Anderson
and Pempek (2005) found that young children have a “video
deficit,” which means that they learn less from television
than from actual experiences with other people, particu-
larly children younger than 3 years old. Toddlers learn play
schemes, imitation, object retrieval, and vocabulary better
from real-life interactions than watching a video of a similar
scenario or play sequence (Anderson & Pempek, 2005;
Kirkorian et al., 2016; Kremar, Grela, & Lin, 2007). This
video deficit is most significant in children age 2 years and
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younger, therefore underscoring the AAP recommendation
for no screen use in infants and toddlers (AAP, 2016).
In addition to television, infants, toddlers, and pre-
schoolers are now interacting more with handheld technol-
ogy, such as smart phones and tablets. The notion of digital
literacy is a recent concept and defined as “the ability to
use information and communication technologies to find,
evaluate, create, and communicate information, requiring
both cognitive and technical skills” (Visser, 2012, para. 2).
Common Sense Media (2013) noted that 38% of children
under age 2 years have used a tablet or smartphone, and
that number jumps to 80% for children age 2 to 4 years old.
Tablets and smartphones differ from books in that they
offer a haptic interface (interaction through touch), which
modifies the narrative experience, changes how text is navi-
gated and shared, and impacts the creation of meaning, as
literacy moves beyond printed text and into an increasingly
connected world (Harrison & McTavish, 2016; Merchant,
2015). Hourcade, Mascher, Wu, and Pantoja (2015) analyzed
208 YouTube videos of infants and toddlers interacting
with tablets. Just as there is predictable progression in print
book-handling skills, children seem to acquire skills in screen
navigation in a consistent developmental manner. These
type of screen skills included transitioning from whole hand
or multiple fingers to a single finger to manipulate a tablet,
then learning to swipe and drag the screen to access content
(Hourcade et al., 2015). Additionally, toddlers handled
tablets the same as holding books, often with the tablet
in the child’s lap and being held with the child’s hands
(Hourcade et al., 2015; Merchant, 2015).
SLPs in early intervention and EC special education
may be tempted to digital applications (apps) in practice
because tablets offer the benefit and ease of portability and
the potential to expose children to new settings, such as a
zoo or park through dynamic apps (Artemenko, 2014). For
early intervention home visits, Artemenko (2014) suggested
using picture apps to build vocabulary and interactive
apps for play sequences and to model scenes from everyday
experiences, such as setting the table, baking, and playing
with an interactive dollhouse. However, current best prac-
tice in early intervention requires that providers do not
bring any toys, books, or other materials into the home
because early interventionists should use toys and manipula-
tives already present in the environment so that parents can
follow through during the week (Rush & Shelden, 2011).
Even if there are no toys or books in the home, the parents
can be coached to create rich play out of sofa cushions,
bowls, and boxes and literacy experiences out of mail and
food packaging. Bringing a tablet into the home that the
parents may not have access to between visits is contrary
to early intervention principles. It is important to remember
that children younger than 3 years of age prefer and learn
more from adult interaction than from screens. This corre-
sponds to Vygotsky’s socially mediated language theory
in which adult-mediated interactions within the children’s
ZPD improve learning, as well as Piaget’s description of
the sensorimotor stage from birth to age 2 years (Piaget,
1936; Vygotsky, 1986). In the sensorimotor stage, young
Terrell & Watson: Laying a Firm Foundation 157
 children experience and learn about the world through all of
their senses and motor movements. Although they can see
and hear apps, toddlers cannot grasp, taste, feel, or manip-
ulate them with their whole bodies (Piaget, 1936). It is im-
perative that SLPs serve in a preventative role and educate
parents, teachers, child care providers, pediatricians, and
other educational and health care workers about screen in-
teractions with young children.
Edwards and Dukhovny (2017) found that most SLPs
select apps on the basis of recommendations from peers
and colleagues, and they posit that SLPs need to engage in
more critical thinking about app usage in therapy, even those
described as educational. One reason for this is that apps
and technology platforms change so quickly that the research
may be out of date by the time it is published. This is why
SLPs should question “evidenced based” apps. While some
apps have been tested and reported via the peer review pro-
cess, other apps may be loosely based on an evidence-based
model, such as behaviorism or video modeling (Edwards &
Dukhovny, 2017). More importantly, there is currently not
a strong evidence base for the use of apps in intervention or
casual home use. Because of the potential negative impact
of handheld devices on infants and toddlers, SLPs, parents,
and educators must be especially cautious and thoughtful
as they select apps and mobile technology for young children
with developmental disabilities. Although some apps provide
access to augmentative and alternative communication at a
lower cost, such as Proloquo2go, Proctor and Wang (2015)
encourage parents and professionals to consider app quality
because app developers may not have expertise in speech
and language development or understanding of how young
children learn. Additionally, SLPs and teachers must think
about the relationship of language and literacy goals and
curriculum to an app or tablet function. Is using an app
the best practice for supporting learning, or is it being used
because it is shiny and new? Finally, Proctor and Wang
(2015) suggest handheld devices only when they have the
potential to enhance communication rather than providing
an opportunity for children to withdraw and engage in a
solitary activity.
With the popularity of handheld electronics, electronic
toys and electronic books (e-books) have also increased
in use among young children. Generally, parent–child in-
teractive play with electronic toys, such as electronic shape
sorters and barn/animals versus traditional nonelectronic
versions of the same toys, tended to decrease the amount
and quality of the parents’ verbal input with toddlers (Sosa,
2016; Wooldridge & Shapka, 2012; Zosh et al., 2015). Sosa
(2016) found that, when interacting with young toddlers,
age 10–16 months old, mothers said fewer words, and
there were fewer conversational turns, parental responses,
and productions of content-specific words when playing
with electronic toys as compared with playing with tradi-
tional toys and books. Children also vocalized less when
interacting with parents in the electronic toy condition.
Play with books resulted in richer language exposure and
interaction in all measures as compared with play with elec-
tronic toys, and play with traditional toys led to increased
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conversation and parent responsiveness (Sosa, 2016). When
playing with electronic toys, parents often sat back and let
the toy do the talking. As discussed above, young children
do not learn as efficiently or comprehensively from non-
human interactions, so this is an area for ongoing parent
education and modeling. For parents who may not be read-
ing to young prelinguistic children or whose children do
not sit still for books, play with nonelectronic toys still offers
a significant linguistic advantage over electronic toys (Sosa,
2016).
Reich, Yau, and Warschauer (2016) conducted a meta-
analysis of research on young children’s use of e-books. They
suggested that time away from screens was most beneficial
for infants/toddlers as the bulk of research indicated that
face-to-face interaction was superior for learning than screen
time. However, results from studies were mixed when pre-
schoolers and e-books were considered. Some studies indi-
cated increased parent–child conversation during print,
whereas others noted increased speech during e-book reading.
It should be noted that, often, the conversations centered
on how to “work” the book by pushing buttons or swiping
versus focusing on the story itself (Reich et al., 2016). They
recommended that any e-books for preschoolers should
be designed to support and scaffold learning (as compared
with including games and sounds irrelevant to the story)
and that e-books have the most impact when mediated
and shared with an adult (Reich et al., 2016).
Concluding Thoughts
In summary, a rich home literacy environment, pre-
tend play embedded with a variety of literacy tools, shared
interactive book reading, and explicit instruction all serve
important functions in creating a strong foundation of EL
for infants, toddlers, and preschoolers. Implementing EL
strategies into the home, child care, and preschool settings is
relatively low cost, can be fun, and strengthens the oral–
written language connection. Children with exposure to
diverse oral language of varied complexity, exposure to print
materials, access to writing implements, and an awareness
of the function and purpose environmental print enter
kindergarten primed for literacy learning. Shared book
reading experiences, accompanied by PR and extratextual
talk, also create a strong EL base that provides more linguis-
tic benefit than electronic toys, e-books, tablets, and smart
phones. Therefore, SLPs have a valuable role to play in
partnering with parents, caregivers, child care providers,
and preschool teachers to educate, share, model, and sup-
port a variety of evidence-based practices for the develop-
ment of crucial EL skills in all environments for infants,
toddlers, and preschoolers.
Acknowledgments
The authors wish to thank graduate students Anna Weisbrod,
Moriah Bemke, and Abigail Wallace for their assistance in proof-
reading this tutorial.
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Terrell & Watson: Laying a Firm Foundation 161
 Appendix A ( p. 1 of 2)
Interactive Book Reading, Environmental Print, and Digital Media Strategies
Description
Dialogic reading:
• Adults should be reminded that they are
not compelled to stick to the text. Books
with limited text and/or short sentences
can be more engaging for children with
communication impairments.
• Igniting background knowledge, making
predictions, asking questions,
commenting, and pointing to pictures and
text are important ways to interact with
books, keep young children engaged, and
scaffold language.
• Above all, follow the child’s lead. If the
child points, then the adult should label or
describe what the child is pointing to.
• Allow children with language impairments
more time to respond.
Playing in the book:
• Interactive books, such as touch-and-feel
and lift the flap books, naturally
encourage manipulating the book.
• Standard board books and picture books
can be made interactive by the reader.
• Increases child’s attention and makes
literacy experiences more interactive and
enjoyable, which is especially important
for children with communication
impairments.
• Vary vocal intonation and use facial
expressions to indicate emotion and
different characters.
Following child’s lead:
• Never hold a child and force a reading
interaction. Reading together should be a
pleasant experience with physical
closeness, such as the child in the adult’s
lap or by the adult’s side, invoking
positive interactions, and warmth.
Print referencing/book-handling strategies
Description
Include print referencing into literacy
experiences by using a finger to follow the
print while reading aloud, as well as making
comments that refer to the print.
Young children can be taught book
conventions, such as how to hold a book
and turn pages, as well as book and print
directionality. They can learn to care for
books and treat them differently than toys.
162 Language, Speech, and Hearing Services in Schools • Vol. 49 • 148–164 • April 2018
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Dialogic reading strategies
Example Evidence base
Background knowledge: Blewitt, Rump, Shealy, & Cook, 2009; Dale
This little girl has a kitty just like you. et al., 1996; Hargrave & Sénéchal, 2000;
Remember when we went to the zoo? Institute of Educational Sciences, 2015;
Making predictions: Kaderavek & Pakulski, 2007; Whitehurst
What will the puppy do? et al., 1994
Uh-oh! What happened?
Asking questions: Where’s the ball? What
is the baby eating? (scaffold to more
difficult how/when/why questions, such as
“How does the bear feel?”)
Commenting:
That’s a yellow flower.
That cookie looks yummy!
Model petting the pony or popping the Bus & van Ijzendoorn, 1997; Kaderavek &
bubbles in the bathtub in a picture and Pakulski, 2007; van Kleeck et al., 2006
use gentle hand-over-hand if necessary.
Shake a finger at a naughty puppy in a story
with an exaggerated, “No, no!,” pat a
sleepy baby in a book while saying, “Shh.
Night-night,” or pretend to pick cupcakes
off the page and eat them “Mmmm.
Yummy.”
Sometimes when an adult allows a child Bus & van Ijzendoorn, 1988, 1997; Kaderavek
to get up and wander, but still reads the & Pakulski, 2007; Lawhon & Cobb, 2002;
story with an animated voice and lively Sénéchal et al., 1995
expressions, the child will be drawn back
into the narrative or other book experience.
Keep utterances short and simple and choose
books that relate to child’s interests.
Example Evidence base
Verbal references while pointing to: Bus & van Ijzendoorn, 1988, 1997; Justice
Words as distinct units: “There are 1, 2, 3, & Ezell, 2004; Justice et al., 2009;
4 words on this page.” Justice et al., 2017; Lawhon & Cobb,
Long versus short words: “This word is a 2002; Sénéchal et al., 1995
long word” while pointing to “elephant.”
Salient print on a page: “This writing on the
bus says, ‘school bus.’”
Letters: “Puppy starts with ‘p’ like in your
name, ‘Paul.’”
Directionality of print: “We starting reading
here at the top of this page.”
Demonstrate turning pages right to left, Bus & van Ijzendoorn, 1997; DeLoache,
reading top to bottom, holding the book Pierroutsakos, Uttal, Rosengren, &
right side-up. Talk about the parts of the Gottlieb, 1998; Sénéchal et al., 1995
book, such as title, author, illustrator,
page, pictures, and words. (“Here’s the
title. It tells us the name of the book.”)
(table continues)
 Appendix A ( p. 2 of 2)
Interactive Book Reading, Environmental Print, and Digital Media Strategies.
Description
Create a home or child care environment in
which infants and toddlers have easy
access to age-appropriate books, such as
cloth or board books and pictures books.
Also, have writing implements, such as
chalk, markers, crayons, pencils, and paint,
available to toddlers with supervision.
Point out environmental print in the home,
child care setting, and the community.
Take advantage of the public or school library,
if possible. If transportation is a problem for
families, look for bookmobile routes or
“Little Free Libraries” in the area
neighborhoods.
Description
Encourage families to create media plan and
refrain from using electronic and digital
media as a babysitter. Carefully monitor
screen usage (TV, computer, tablet, and
smartphone). Engage in prevention and
educate families/educators about potential
risks/downfalls of digital media, especially
with infants and toddlers.
Engage in dialogic reading with electronic
books, as discussed above. Also remember
to discuss the story, not the device.
When children do use tablets and watch TV,
engage with them.
Help parents, child care providers, and
educators select traditional toys that
promote oral language and pretend play.
Electronic toys tend to decrease adult and
child language and limit symbolic play.
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Literacy environments
Example Evidence base
Encourage parents and teachers at home Caldwell & Bradley, 2003; Edwards, 2012;
and in child care settings to create some Hanna, Hinrichs, Mahar, DeFrain, &
natural play areas that include literacy Durden, 2010; Pinto, Pessanha, & Aguiar,
scripts/routines and materials, such as 2013; Sénéchal & LeFevre, 2014
envelopes, menus, bills, and coupons.
Show adult how to embed and scaffold
literacy within natural play contexts, for
example, playing restaurant with a menu
or taking a short child-friendly (words and
pictures) grocery list along when
shopping.
Consider using a home or classroom
literacy checklist to identify strengths
and weaknesses of literacy environments.
Stop signs, exit signs, coupons, TV shows, Caldwell & Bradley, 2003; Hanna, Hinrichs,
cookbooks, tabloids and magazines at Mahar, DeFrain, & Durden, 2010; Justice
the checkout lane, menus at restaurants, & Ezell, 2000
names on child care cubbies—the
opportunities to notice and discuss print
are endless.
“See that red sign? It says ‘STOP.’”
“Oh! Look at those words. It’s Paw Patrol.”
“Look. It says ‘Emma.’ That’s where you hang
your coat.”
Most libraries now have board books for the Baker, 2003; Farver, Xu, Lonigan, & Eppe,
youngest readers and have group play 2013; Slates, Alexander, Entwisle, &
times, story hour, and other interactive Olson, 2012
literacy events for children from infancy
through school age. More and more
libraries are including a variety of toys and
manipulatives for young children as well,
both to be played with at the library and
some available for checkout.
Note: Dolly Parton’s imaginationlibrary.com
website provides free books each month
for children ages birth to 5 years.
Digital toys and media
Example Evidence base
AAP (2016) recommends: AAP, 2016; Anderson & Pempek, 2005;
• No screen media except video chatting Kirkorian et al., 2016; Kremar, Grela, &
for children age < 18 months Lin, 2007
• 1 hr/day of high-quality programming
for children ages 2–5 years
A family media plan can be found at http://
www.healthychildren.org
“The boy laughed. I think he’s happy” (in Reich et al., 2016
response to a child pushing a button/
picture in an interactive e-book).
Describe what is happening on TV, ask Anderson & Pempek, 2005; Kirkorian et al.,
questions related to the story, and make 2016; Kremar, Grela, & Lin, 2007; Reich
comments. Talk about letters and words; et al., 2016
point out symbols and icons (“This button
with the big, red ‘N’ is for Netflix. That’s
the one for movies”).
Shape sorters, puzzles, vehicles, farm sets, Sosa, 2016; Wooldridge & Shapka, 2012;
blocks, dolls, toy food, and so forth offer Zosh et al., 2015
more opportunities for creative play and
language.
Terrell & Watson: Laying a Firm Foundation 163
 Appendix B
Tasks to Develop a Variety of Phonemic Awareness Skills
Task Explicit task
Syllabication Orally present a list of words of
varying lengths and clap out
the number of syllables for each,
for example, “monkey,” “cat,”
“bicycle.”
Rhyming Offer word pairs and ask if they
rhyme (e.g., cat/bat; cat/log).
Ask children to generate their own
rhymes; for example, “what words
rhyme with pig?”
Play guessing games, “what drink
rhymes with silk?”
Phoneme Ask children to say the whole
blending word when present with words
separated by onset and rime
(“p-ig”).
Ask children to say the whole word
when given individual phonemes
(“p-i-g”; “p-l-u-m”).
Syllable and Ask children to omit a syllable from
sound longer words, (e.g., “say railroad
deletion without the ‘road,’” “say bicycle
without the ‘bi.’”
Ask children to omit a single phoneme
from words (e.g., “say bone without
the /b/”; “say smoke without the
/s/”).
Ask children to omit a phoneme from
a cluster in CCVC or CVCC words
(e.g., “say black without the /b/”
and “say mask without the /k/”).
Syllable and Ask children to produce compound
phoneme words when provided with
segmentation component words (e.g., “what
word does grape plus fruit make?”).
Ask children to produce longer words
when provided component syllables
(e.g., “what word does ham-bur-ger
make?”).
Ask children to produce the whole
words when given those words in
parts; for example, “p-ig,” “b-e-d,”
“s-l-e-d,” “f-a-s-t,” and so forth.
Phoneme Introduce a phoneme such as /b/,
identification recite a list of words, and have the
children raise their hands when
they hear a word beginning with
that sound.
Have children group pictures based
on initial sounds (e.g., foods that
begin with /p/).
Create memory games where
matching pictures begin with the
same sound (e.g., “sink and sun”).
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Embedded task
When reading or playing with children,
occasionally draw attention to longer
words as they occur spontaneously,
and clap out the number of syllables;
for example, “caterpillar.”
Sing songs and lead finger plays; for
example, “Down by the Bay.”
Read books that have a strong rhyme
component, such as Dr. Seuss
books.
While playing, create silly words that
rhyme (e.g., “honeybunny”).
Occasionally call on children by
segmenting the phonemes in their
name, for example, “J-on” and
“S-a-m.”
When reading with children,
occasionally produce a word
without one of the phonemes
and see if they can provide the
correct phoneme to complete
the word (e.g., “he rolled up
his ‘at’/mat”).
Occasionally, while playing, point
out the components of compound
words, (e.g., “racecar and racetrack
both contain the word ‘race’”).
Help children create “menus” while
playing restaurant, emphasizing the
syllables of some of the longer words
(e.g., “wa-ter-mel-on”).
While playing restaurant, order items
by producing one phoneme at a time
and see how quickly the children can
guess your order (e.g., “m-i-l-k”).
When pretending to cook, call attention
to foods that begin with the same
sounds and (e.g., “bacon and bread
both start with /b/”).
When reading books with alliterative
text, occasionally call attention to
the repetitiveness (e.g., “Sheep in a
shop, I hear the ‘sh’ sound twice”).
Connect with print
Point to printed words in books and
other materials and mention their
length or number of “parts” in
each word.
Print pairs of rhyming words and
compare and contrast the letters
with each other; for example,
compare and contrast the letters
in “hop” versus “mop.”
Use print to show how different
initial sounds can be added to
rhymes to create many rhyming
words.
Use print or letter tiles to show how
to use individual letters can be
combined to create words. Tiles
can include both individual letters
and common rhymes, such as
“at” and “ed.”
Print compound words and words
of varying syllabic length on a
whiteboard and demonstrate what
happens when certain parts of
those words are erased; for
example, erase the last syllable
from “butterfly” to show that
“butter” is left.
Break down words, such as
“cupcake” to “cup” “cake”
and “up.”
Print words on cards and show
how they can be manipulated
and combined with each other to
create a variety of different words;
for example combining “bed” with
other words to create “bedroom”
or “bedtime.”
Print the word “key” on a card and
on separate cards print syllables
such as “tur,” “mon,” and “don”
to show how those parts can
be combined to create “turkey,”
“monkey,” and “donkey.”
Provide children with a list of items
in the classroom along with
picture icons if necessary, and
ask them to find objects whose
names begin with a specific
sound and check off each one
they find (e.g., desk, dog, dot,
and door). If possible, encourage
children to write the initial letter
next to the appropriate item.