Sketch and Speak: An Expository Intervention
Using Note-Taking and Oral Practice
for Children With Language-Related
Teresa A. Ukrainetz
Purpose: This preliminary study investigated an intervention
procedure employing 2 types of note-taking and oral practice
to improve expository reporting skills.
Procedure: Forty-four 4th to 6th graders with language-
related learning disabilities from 9 schools were assigned
to treatment or control conditions that were balanced for
grade, oral language, and other features. The treatment
condition received 6 30-min individual or pair sessions
from the school of speech-language pathologists (SLPs).
Treatment involved reducing statements from grade-
level science articles into concise ideas, recording
the ideas as pictographic and conventional notes, and
expanding from the notes into full oral sentences that
are then combined into oral reports. Participants were
pretested and posttested on taking notes from grade-
level history articles and using the notes to give oral reports.
Posttesting also included written reports 1 to 3 days following
the oral reports.
Results: The treatment group showed significantly greater
improvement than the control group on multiple quality
features of the notes and oral reports. Quantity, holistic oral
quality, and delayed written reports were not significantly
better. The SLPs reported high levels of student engagement
and learning of skills and content within treatment. They
attributed the perceived benefits to the elements of simplicity,
visuals, oral practice, repeated opportunities, and visible
Conclusion: This study indicates potential for Sketch and
Speak to improve student performance in expository reporting
and gives direction for strengthening and further investigating
this novel SLP treatment.
Supplemental Material: https://doi.org/10.23641/asha.7268651
Child language intervention is primarily about young
children. However, language issues do not dis-
appear when concerns shift from talking and listen-
ing to reading and writing and labels change from language
impairment to learning disability. Longitudinal studies have
consistently found that half or more of children with devel-
opmental language disorders go on to have significant liter-
acy and academic issues (Conti-Ramsden, St Clair, Pickles,
& Durkin, 2012; Dockrell, Lindsay, & Connelly, 2009;
Fey, Catts, Proctor-Williams, Tomblin, & Zhang, 2004;
Nippold, 2017; Tomblin, Zhang, Buckwalter, & O’Brien,
2003). The pervasive, persistent nature of language impair-
ment means that students need help beyond the early grades.
Speech-language pathologists (SLPs) are well situ-
ated to address the language and learning skills of older
students through their clinical strengths in individualized
intervention, oral language interactions, attention to under-
lying linguistic and cognitive processes, and independence
from but connection to the classroom and curriculum
(American Speech-Language-Hearing Association, 2010;
Ehren, 2006; Nippold, 2017; Ukrainetz, 2015a, 2017;
Ukrainetz & Fresquez, 2003). However, SLPs lack treat-
ment procedures suited to students beyond the early elemen-
tary grades, particularly for informational or expository
language. This article reports on a preliminary investigation
of a novel SLP expository treatment involving note-taking
and oral practice.
Sketch and Speak Treatment
Sketch and Speak teaches students how to turn ideas
from informational text into their own firmly held words for
authoring oral and written academic works. The treatment
Department of Communicative Disorders and Deaf Education, Utah
State University, Logan
Correspondence to Teresa A. Ukrainetz: firstname.lastname@example.org
Editor-in-Chief: Shelley Gray
Editor: Kerry Ebert
Received March 15, 2018
Revision received May 23, 2018
Accepted June 29, 2018
Disclosure: The author has declared that no competing interests existed at the time
Language, Speech, and Hearing Services in Schools •Vol. 50 •53–70 •January 2019 •Copyright © 2019 American Speech-Language-Hearing Association 53
procedure, designed around the expertise and opportunities
of SLPs, is intended to produce noticeable changes in learn-
ing relatively quickly. The Sketch and Speak strategies can
be used in two different but overlapping ways: (a) as teach-
ing strategies, wherein SLPs facilitate student learning of
the concepts and language of treatment texts, and (b) as learn-
ing strategies, wherein SLPs teach students to use the strate-
gies independently outside treatment.
Sketch and Speak employs the representational tools
of conventional bulleted notes and simple sketches called
pictography within reductions and expansions of oral lan-
guage from informational texts. It was built on the author’s
early use of pictography in narrative intervention (McFadden,
1998; Ukrainetz, 1998). The core procedure consists of re-
peatedly identifying ideas from a text, orally condensing
the information into key ideas, making quick and easy, just
enough to remember notes, and expanding the notes back
into the student’s own well-formed sentences, then com-
bining the rehearsed sentences into full oral reports. The
note it simply, say it fully process invokes the reduction, re-
organization, transformation, retrieval, and revision of
ideas and language needed for learning academic exposition.
Sketch and Speak is a contextualized skill treatment
that scaffolds targeted skills within communicative tasks.
Key features of quality intervention are present: repeated
opportunities for systematically supported, explicit treatment
that engages and motivates the learner (e.g., R. B. Gillam
et al., 2008; Torgesen et al., 2001; c.f. Ukrainetz, 2015b).
Important components of strategy instruction also occur:
instructor modeling, practice with feedback, matching sup-
port to learner level, and a routinized format (Gersten, Fuchs,
Williams, & Baker, 2001; Rosenshine, Meister, & Chapman,
1996; Swanson & Hoskyn, 1998).
This author-designed treatment was initially explored
as a teaching procedure in a university SLP clinic over a
period of 6 months with student clinicians and eight clients
ranging from third grade to high school (Ukrainetz, Ross,
& Peterson, 2017). Ross, a university SLP clinical educa-
tor, found that the clients and their caregivers viewed the
treatment as useful and academically relevant. The clients
were able to sketch iconic images to temporarily represent
abstract concepts that aided turning expository text state-
ments into their own sentences. Repeatedly practicing
the sentences from the notes resulted in confident, fluent
presentations of ideas from the taught texts. Ross further
noted that the systematic oral rehearsal had been missing
from her other expository interventions (c.f. Ukrainetz
& Ross, 2006). These clinical explorations, the author’s
prior work, and the larger literature on note-taking
and oral practice formed the foundations for the current
Taking Notes for Learning
Note-taking is a fundamental academic learning skill
(or strategy when intentionally deployed). Not only is
there the basic benefit of recording information for tests
and projects, but active note-taking improves information
retention and learning. As kernels of information extracted
from a larger whole, notes are rich in ideas but have low
writing demands. They require only enough words, gram-
mar, spelling, and punctuation to be reconstituted, reworded,
and integrated with other information for tasks like pre-
sentations, essays, and tests.
Notes can be described in terms of quantity, quality,
and representation (Piolat, Olive, & Kellogg, 2005). Quan-
tity reflects the number of concepts and words. Whereas
a greater number of concepts are better, the inverse is true
for words. Efficient representation involves reducing the
words used per concept—but not so far that it hinders
recall—having just enough of the right words. Notes should
represent only relevant and important concepts, in as few
words or alternate representations as possible, make connec-
tions among ideas, and organize information, all matched
to the task purpose. Representational changes involve con-
densing source language: abbreviated lexical units, tele-
graphic word strings or alternate symbols (e.g., +, =), and
transforming text into nonlinear and nonverbal formats,
such as graphs, icons, or concept maps.
Taking notes falls within the broad pedagogical
approach of “writing-to-learn,”along with diverse activi-
ties such as journal writing, summaries, essays, and term
papers. Systematic reviews have found that these writing
tasks are beneficial for content area learning and reading
comprehension (Bangert-Drowns, Hurley, & Wilkinson,
2004; Graham & Hebert, 2011; Kobayashi, 2006). Effects
are strengthened through active involvement by mental
elaboration, organization, and retrieval (Arnold et al., 2017).
Elaboration involves connecting what one is learning to
words or concepts one already knows. Organization, better
termed reorganization, involves placing the information
into a structure that differs from its source. Retrieval is
collecting information from memory rather than copying
segments of source texts.
Note-taking that involves reducing, transforming,
and retrieving information substantially improves learn-
ing of lectures and readings compared with more passive
ways of studying (Boyle & Rivera, 2012; Kobayashi, 2006).
Active note-taking helps students analyze textual informa-
tion, differentiate main from secondary ideas, and combine
new material with prior knowledge (Chang & Ku, 2015).
It invokes other important learning strategies, such as self-
questioning, summarization, paraphrasing, and inferring
word meaning (Kamil et al., 2008; National Reading Panel,
2000). For example, Bretzing and Kulhavy (1979) and Slotte
and Lonka (1999) found that notes that summarized and
paraphrased prose passages produced better immediate and
delayed explicit and inferential learning than verbatim notes
or notes that followed the text order.
Note-taking is hard to do well. Students across the
grades have been observed to take incomplete notes, miss
important ideas, and write verbatim a mix of impor-
tant, minor, and tangential ideas (Boyle & Forchelli, 2014;
54 Language, Speech, and Hearing Services in Schools •Vol. 50 •53–70 •January 2019
Hebert, Graham, Rigby-Wills, & Ganson, 2014). For some
students, writing decipherable notes and reading what they
wrote is also difficult. Note-taking may be supported with
teacher-prepared notes and worksheets, but little formal
instruction in effective note-taking occurs at any grade level
(Boyle, Forchelli, & Cariss, 2014; Chang & Ku, 2015).
Note-taking instruction research has dealt mainly
with older students, with and without learning disabilities
(Boyle & Rivera, 2012; Kobayashi, 2006). A variety of
procedures have shown benefits, which have generally been
greater for weaker students. Some studies have shown suc-
cess with young learners. For example, Lee, Lan, Hamman,
and Hendricks (2008) improved recall of nontaught infor-
mation from science lecture videos for typically achieving
Taiwanese third graders with just four training sessions
and a form that prompted students to identify the topic,
main points, and new words compared with no-treatment
Chang and Ku (2015) investigated a more compre-
hensive note-taking instruction that emphasized retrieval,
elaboration, and reorganization of science information
for typically achieving Taiwanese fourth graders compared
with no-instruction note-taking and free-recall writing
conditions. The 5-week whole-class instruction addressed
identifying main ideas, reducing information in paragraphs,
identifying relationships and text structure (e.g., causal,
comparative), and using graphics and tables. Chang and
Ku found that, while treatment did not increase the number
of notes, notes improved in quality, with a reduction in
verbatim copying and words per concept, and greater use
of alternative representations. On nontaught texts from
the same subject area, students improved comprehension
compared with the other two conditions.
Pictography as a Note-Taking Strategy
A key element of Sketch and Speak is the notation
system of pictography or picture writing. Pictographic
note-taking involves quickly sketching simple iconic ele-
ments to temporarily represent and organize ideas. It taps
imagery and nonverbal avenues that can be helpful for
turning expository material into student-owned ideas and
Pictography has long been used clinically as a quick
and easy and just enough to remember notation for nar-
ratives (Paul & Norbury, 2012; Ukrainetz, 2015b). It
can serve as an SLP’s treatment tool to support language
development and as a student’s own learning tool. As a
teaching tool, pictography has been incorporated into
literature-based intervention (R. B. Gillam & Ukrainetz,
2006; Ukrainetz, 1998) and manualized treatments (e.g.,
S. Gillam, Olszewski, Squires, Snyder-Wolf, & Gillam,
2018; Petersen et al., 2014). As an SLP, this author used
pictography to plan her own narratives that she used later
in treatment. Having a competent adult writer find the strat-
egy useful spurred her efforts to use it with her students
as their own notation tool within treatment. However, as
with much of the strategy research (Gersten et al., 2001;
Ukrainetz, 2015b), this author did not coach students into
independent, generalized use outside of treatment.
Clinical experience and studies indicate that pictogra-
phy facilitates planning, recall, and revision of narratives
(McFadden, 1998; Ukrainetz, 1998; cf. Ukrainetz, 2015b).
Students can add, subtract, reorder, or modify events. It is
easily learned by students in first grade and beyond. Stu-
dent use of pictography improves the length, organization,
complexity, and overall quality of taught and nontaught
oral narratives compared with written and static picture
plans. An important part of pictography is the focus on
ideas and content by avoiding the cognitive load of writ-
ing. Composing sentences from the nonverbal notations
requires the elaboration, transformation, and recall that
promote learning (Arnold et al., 2017).
Pictography has been used primarily for narrative
planning, but there is some evidence that it can be applied
to child exposition. Karmiloff-Smith (1979) reported that
7-year-olds could invent and use map notations, such as
schematic forks in the road or R for “take the right fork.”
This author has examples of an 8-year-old’s invented picto-
graphic choreography plans that she used to guide her
dance performances. It is unknown how well pictography
can be used for representation of more abstract ideas, but
certainly, logographic Chinese script represents the full
range of human concepts. Regardless, in the current
application, pictography is intended only as a temporary
notation tool for fairly imageable texts.
Adding Oral Practice to Note-Taking
Sketch and Speak treatment combines “writing to
learn”with the SLP specialty of “talking to learn.”Teach-
ing talk extends instruction from how to take notes to how
to use notes, which has been often ignored in note-taking
research (Boyle, 2010). Using notes involves both teaching
through interactive talking and listening and teaching how
to talk and listen to oneself.
A direct comparison of teaching through talking ver-
sus through writing by Clarke, Snowling, Truelove, and
Hulme (2010) supports the benefit of “talking to learn.”
Clarke et al. delivered 30 hr of intervention over 20 weeks
to third graders with specific comprehension deficits in
three conditions: primarily written instruction, primarily
spoken instruction, and combined instruction. The largest
improvement in reading comprehension was obtained by
the spoken interaction group followed by the combined
Teaching students to talk to themselves is the other
part of “talking to learn.”Reciprocal teaching, with its
scaffolded peer dialogues around summarizing, clarifying,
question generating, and predicting, has been shown to
move external talk into self-talk, resulting in improved read-
ing comprehension (Palincsar & Brown, 1984; Rosenshine
& Meister, 1994). In another self-talk study, McDaniel,
Howard, and Einstein (2009) examined a procedure called
read–recite–review. Learners read the text, set it aside, recite
out loud what they remember and, then, reread the text to
Ukrainetz: Sketch and Speak Intervention 55
check recall accuracy. College students improved compre-
hension of simple informational passages better than for
note-taking and rereading conditions. With a more difficult
passage, the self-talk was equivalent to note-taking, but
A version of self-talk applied to fourth graders ap-
pears in Hebert et al. (2014). For the recital condition, in
one whole-class session using a science passage, students
were shown how to identify and verbalize important ideas
to themselves. In a note-taking condition, students prac-
ticed writing big ideas in brief words and phrases, identify-
ing important information, and grouping information. In
an essay condition, students underlined important informa-
tion and put it together in compare and contrast paragraphs.
On a history passage, the writing conditions showed slightly
better comprehension than the recital condition. However,
the investigators observed that the notes and essays were
poorly done and did not check the student verbalizations.
This author conjectured that better results might be ob-
tained by better teaching of a combination of note-taking
and verbalization, thus inspiring the current study.
The Current Study
Combining note-taking (writing to learn) and oral
recitation (talking to learn) and delivering it through in-
dividualized oral instruction may be an effective way to
improve expository learning. Note-taking has minimal
writing demands, which can be decreased even further with
the established treatment tool of pictography. Pictography
assists students to record ideas, express these ideas in their
own words, and practice those sentences. The rehearsed
sentences allow recall and delivery of well-formed exposi-
tory discourse even from a few misspelled or misshapen
notations. Finally, teaching through talk allows the inter-
active scaffolding that is the hallmark of SLP intervention:
eliciting, modeling, expanding, revising, and confirming a
The current study investigated the effect of Sketch
and Speak on expository note-taking and reporting skills.
The research questions were, for fourth- to sixth-grade stu-
dents with language-related learning disabilities, compared
with a no-treatment control condition, whether a brief ap-
plication of the treatment would improve (a) the quantity
and quality of notes taken on a nontaught text, (b) oral
presentations immediately after composing the notes, and
(c) reports written from the notes 1 to 3 days later. The
first hypothesis was that students would improve their in-
dependent note-taking with whichever format, pictogra-
phy, or bulleted notes that they chose to use. The second
hypothesis was that the improved notes, along with the
prior practice in treatment, would improve students’inde-
pendent oral and written reports. Improved expression and
comprehension of the treatment texts were also expected,
but the control group did not have exposure to those texts,
thus preventing experimental testing of this hypothesis.
To obtain a sense of within-treatment effects and clinical
perspectives, reflective essays from the SLP instructors
were examined through grounded thematic analysis.
The participants were 44 fourth- to sixth-grade stu-
dents with individual education programs in language,
reading, and/or writing. Students identified with intel-
lectual disability, autism, or emotional disability were
excluded. SLPs reviewed IEP files from their school to
locate qualified candidates. All students who returned
consent forms participated with no attrition. The core
language scale of the Clinical Evaluation of Language
Fundamentals–Fifth Edition (CELF-5; Wiig, Semel, &
Secord, 2013) was administered for descriptive and balanc-
For condition assignment, two groups were formed
from a coded list of participants and balanced for grade
and CELF-5, then further balanced for gender, ethnicity,
services, and school rate of free/reduced lunch (see Tables 1
and 2). The groups were randomly assigned to treatment
or control conditions. While maintaining balancing, several
coded participants were shifted to result in one to five
treatment participants per school. The final conditions did
not significantly differ on grade or CELF-5; χ
(2) = 0.168,
p= .920, ϕ= .062; t(42) = 0.180, p= .858, d= 0.06.
The SLP instructors were also study participants be-
cause their perceptions formed part of the study results.
Eleven SLPs volunteered. Two were unable to recruit stu-
dents but attended the trainings and used the treatment
procedure informally with caseload children. The SLPs
were American Speech-Language-Hearing Association cer-
tified, except for one in her clinical fellowship year. The
mean work experience was 14.1 years (SD =10.8,range:
1 to 36 years).
Nine trained school SLPs taught six 30-min individ-
ual (or in two cases, pairs) sessions within a span of 4 weeks.
The study treatment replaced regular speech therapy or
Table 1. Participant demographic feature by condition.
Feature Treatment Control Total
Age (years;months) 10;10 11;2 11;0
Grade 4 6 7 13.
Grade 5 10 10 20.
Grade 6 6 5 11.
FRL% 51.5 55.2 53.4
Boys 12 14 26.
White 14 13 27.
Black/Hispanic 8 9 17.
N22 22 44.
Note. FRL% = mean percentage of free/reduced lunch by school.
56 Language, Speech, and Hearing Services in Schools •Vol. 50 •53–70 •January 2019
resource room services, with details varying by student.
Control participants received only their typical educational
services. All treatment documents and at least one audio re-
cording of each of the six sessions for each SLP were
The treatment consisted of three 2-session cycles,
with each cycle starting with pictography notes. The SLP
read aloud the beginning of an animal article, with the
print in view of the student. The SLP had the student iden-
tify a few important or interesting ideas and where they
would go on a formatted note sheet. The SLP then started
over and stopped after each paragraph to identify ideas,
say each simply and note it with quick and easy, just enough
to remember pictography and, then, say it fully with a
full, well-formed, fluent oral sentence about the idea repre-
sented. If the student hesitated or had difficulties formu-
lating a full sentence, the SLP scaffolded an improved
version. The SLP progressed through as much of each arti-
cle as possible, using her clinical judgment on pacing and
scaffolding. After the first session, opening and closing
sentences were introduced with a note (e.g., tell about inter-
esting, hope you enjoyed) written at the top and bottom
of the form. The student then gave a full oral report from
the pictography notes and was shown a photo of the
The second session in each cycle targeted bulleted
notes. The student started with a full oral report from the
prior session’s pictography notes, without viewing the arti-
cle. The student then restated each pictographically cued
oral sentence and reduced it to quick and easy, just enough
to remember spoken words. Each reduction was written
in a bulleted-initiated note with no period and best guess
spelling and, then, expanded into the same or similar full
oral sentence. After all the pictographically cued oral sen-
tences were turned into bulleted notes and back into full
oral sentences, the student orally presented the whole report
from the bulleted notes.
For all six sessions, the treatment skills of pictogra-
phy, bulleted notes, and oral practice were previewed
and reviewed. When the SLP asked what the students
were learning, allowable answers were about the skills, not
about the article content. Each session involved oral reduc-
tion, notation, oral expansion, and presentation. In the
sixth session, the oral report was dictated by the student
to the SLP who wrote exactly what was said. The SLP
then showed the student how this written report had been
authored by the student from the article using notes and
Treatment Texts and Note Sheet
Three science articles on unusual animals were used
in treatment: Cassowary, Axolotl, and Aye-Aye (Appen-
dix A). Unusual animals were chosen to minimize the
effects of background knowledge. The original texts were
obtained from http://a-z-animals.com/animals/, supple-
mented by Wikipedia. The texts were revised to improve
sentence structure and cohesion and make them similar in
information, organization, length, grammar, and vocabu-
lary. The texts followed a descriptive–explanatory discourse
structure: Each animal was introduced with a notable
feature and geographic location, then facts followed about
appearance, diet, reproduction, habitat, and human en-
croachment. The texts fell within the “stretch”readability
bands for fourth and fifth grade (see https://www.lexile.
com) with Lexiles of 940 to 980 and mean word counts of
456 to 477.
The formatted note sheet was constructed based on
observations in local schools and note-taking research
(Boyle & Rivera, 2012). It was a generic two-column form,
with a topic line at the top, five categories on the left,
and blank boxes on the right. The categories of group and
location, habitat, appearance and behavior, food, and
special characteristics were chosen to match the topic and
discourse type but were not specifically matched to the
content of the texts.
Five hours of SLP training over three group sessions
were led by the author with assistance from the clinical
educator who had shared in piloting the procedure. The
Table 2. Participant oral language and special education services.
Scores and services Treatment Control Total
CELF-5 Mand SD 83.64 (12.72) 84.27 (10.59) 83.7 (11.72)
CELF-5 range 66–125 67–122 66–125
Severe learning disability 11 13 24
Speech-language impaired 7 3 10
Other health impaired 4 6 10
Reading 19 21 40
Writing 18 18 36
Language 14 9 23
Math 18 16 34
N22 22 44
Note. CELF-5 Core Language standard score. Two students scored below 70 (67, 66), and three students
scored above 91 (103, 122, 125). Frequency counts for other categories. Other health impaired were
attention-deficit/hyperactivity disorder (treatment = 2, control = 1) or unknown. CELF-5 = Clinical Evaluation
of Language Fundamentals–Fifth Edition.
Ukrainetz: Sketch and Speak Intervention 57
training included explanation, demonstration, and role
play, with a checklist and procedure detailing the mate-
rials, physical arrangement, steps, planned statements, and
possible scaffolds. The SLPs were instructed to stay focused
on the treatment goals, maximize practice of full sen-
tences, and not engage in vocabulary instruction or other
language enrichment. They were warned that a lot of
modeling, repetition, and support would be needed in the
first sessions but that they should “trust the process.”The
SLPs practiced the procedure on their own with a non-
study child. Further guidance occurred when the author
observed the first two treatment sessions for at least one
student for each SLP and, after the session, discussed how
it went. If an element was missed or incorrectly carried
out, the SLPs were prompted to correct it. The main re-
minders were to have the student say a full sentence after
each note was made, have the student say the sentence
again if the SLP revised it, show the animal photo, and con-
duct skill review or preview.
Documentation showed that the SLP instructors
administered all six sessions to all the treatment partici-
pants. A fidelity checklist (Appendix B) was completed by
a research assistant (RA) via audio recordings and treat-
ment documents on 54 of the 124 sessions (44%): one of
each of the six sessions for each of the nine SLPs. An aver-
age adherence of 95% (89% to 100%) was obtained. The
SLPs used the materials correctly and carried out the basic
procedures with appropriate skill focus and scaffolding.
The aspects occasionally missed were verbally reducing a
text statement (say it simply) before making a note, making
opening/closing statements for the latter two pictography
sessions, giving the full report from the pictography notes
at the beginning of the bulleted note sessions, and skill
Individual 20- to 30-min testing sessions were con-
ducted primarily by undergraduate RAs with supervision
and some pretesting by the author and the clinical educa-
tor. All testers were blind to participant condition at the
time of testing. All sessions were audio-recorded. The oral
report was also video-recorded. The two testing articles
were counterbalanced across participants between pre-
testing and posttesting.
The study was about whether participants learned how
to take and use notes, not whether they had learned spe-
cific species or broader zoological concepts. As a result,
topic knowledge was controlled by changing the subject
area for testing to historical Apaches and Incas. The texts
were obtained from http://www.readworks.org/ and revised
to improve written expression, remove narrative elements,
and have similar information, organization, length, gram-
mar, and vocabulary (850 Lexile, Apache was 535 words,
Inca was 533 words). The testing articles were easier but
longer than the treatment articles to ease independent
rereading demands while giving many information selec-
tion options. The testing note form followed the same
two-column format as the treatment note form. The five
categories were historical time and place, events and activi-
ties, shelter and transportation, preferred foods, and special
features, again chosen to represent typical information from
that type of article but not matched specifically to the articles.
In the first pretest session, six weeks before treatment,
four CELF-5 subtests were administered for a core com-
posite language score. The second pretest session, 1 week
before treatment, was for the notes and oral report. The
tester read aloud the Incas or Apache text with the print in
view, then testers said, “Now you will have a few minutes
to take notes on the important and interesting ideas from
this article to help you in your oral report.”The student
wasgiven10mintotakenotes and was told to use best
guess on spelling and say when the notes were done. If a
student asked what to write or if drawing was allowed,
testers said to do, “whatever you think is best.”If the stu-
dent asked about word meaning, the tester could briefly
explain up to two words. After the note-taking, the tester
said, “Now, you will give me an oral report about the in-
formation from the article. You can use your notes to help
remember and organize your ideas. Before you start, look
over your notes. Tell me when you are ready to start speak-
ing. You can look at your notes while you are presenting.”
If a student said he or she was ready immediately, the tester
said to look at the notes a little longer. After presenting, if
the student did not indicate completion, the tester asked
if there was more to say.
For the first posttesting session, administered the
week after treatment, the note-taking and oral report pro-
cedures from pretesting were carried out again, with
students receiving whichever text they had not received in
pretesting. In the second posttesting session, 1 to 3 days
later, the notes were returned to the students, who were
given 15 min to write a report of the information, with
their best guess on spelling. A multiple-choice comprehen-
sion test was then administered but is not included in this
Tester and Scorer Training
Testers were trained in two 2-hr group sessions with
additional independent practice between sessions. Testers
followed standardized administration procedures on the
CELF-5 and scripted procedures for the other testing pro-
cedures. The author or clinical educator observed at least
two testing sessions per tester and spot checked additional
For the data scoring, training was conducted by the
author individually with the time varying by the complexity
of the scoring procedure. One RA did the scoring, and
58 Language, Speech, and Hearing Services in Schools •Vol. 50 •53–70 •January 2019
a second RA did the reliability check for each measure.
Participant notes or transcripts that represented a diversity
of possibilities were practice scored, with follow-up com-
parisons and discussion. The training notes or transcripts
were then rescored with the rest. The scoring underwent
several developmental iterations. Each time, scorers were
retrained and reliability checks redone.
Outcome Measures and Reliability
The notes were scored for quantity and quality (Ap-
pendix C). Quantity consisted of the number of notes.
Five quality features on format (Topic, Bullet), brevity
(Quick), sufficiency (Enough), and paraphrasing (Own)
were each rated on a 0- to 3-point scale. A parallel rubric
rated pictographic (Picto) notes for simple, differentiated
(Diff ), interpretable images. The rating scales were devel-
oped by the author based on the treatment and the litera-
ture on effective notes, which primarily involves reductions
and transformations of source statements to quick and
easy, just enough to remember written and graphic nota-
tions. The scoring rubric was revised until the operational-
ization differentiated perceived quality and could be rated
reliably. For a random selection of 18 (21%) written notes,
the point-to-point independent interrater agreement was
97% for number of notes and 83% to 100% for the five
features. For two of three (67%) pictographic notes, agree-
ment was 100% on number of notes and 90% on summed
quality features (one disagreement of 1 point on one
Oral and Written Report Features
The oral and written reports were transcribed and
segmented into C-units using Systematic Analysis of Lan-
guage Transcripts (SALT Version 18; Miller & Iglesias,
2015). Oral reports were marked for pauses and mazes
(repetitions, restarts, reformulations, and filler words). Writ-
ten reports were transcribed with corrected spelling or X
for undecipherable words. All transcriptions were checked
and corrected by the author.
From the SALT transcripts, quantity and quality
measures were obtained. For quantity, SALT generated
total number of words (words), and total number of C-units
(sentences) were used. A difficulty with any quantity mea-
sure was that a high score could be from verbatim repro-
duction of poorly understood but complex sentences from
the source article. However, the two measures used would
also give credit to the more active learning reflected in a lot
of the students’own sentences, even if they were not long,
complicated, or particularly well-formed.
For quality, SALT transcript C-units (referred to here-
after as statements or sentences) were coded for six features
related to treatment and what reflects a good report. Better
reports, even if they are shorter, should show relatively more
full, open/close, and modified and fewer verbatim, catego-
ries, and extraneous. Independent interrater point-to-point
agreement for each feature on 28 (21%) randomly selected
oral and written reports was 84% to 100%.
•Full: full, well-formed, grammatical sentences that
made sense. Errors in tense and number were permit-
ted, such as Apaches ride horse bareback. Full could
co-occur with modified.
•Open/close: crafted openings and closings, such as
My name is X, I want to tell you about X, a title,
The end, or I hope you enjoyed my report, but not
a basic task statement such as I’m done.
•Modified: Sentences that differed by at least one
substantive or two grammatical words from the note,
including recall verbatim from modified notes, but
not read verbatim from notes.
•Verbatim: whole sentences or most of long sentences
copied from the source into the notes and then
into the report (The Inca Empire was largest kingdom
in ancient times, Apaches were known as skilled
horsemen). Sentences could differ by one grammatical
•Category: category labels not in a sentence, such as
saying only shelter and transportation.
•Extraneous: comments about the task, such as I forget
what this says or I wrote buffalo here.
Oral Report Quality
For overall quality, a holistic comparison of pretest
and posttest oral reports was conducted. For each student,
three RAs who had not tested that student rated excerpted
video recordings and gave reasons for their ratings. The
rating options were as follows: Apache is substantially better.
Apache is slightly better. Apache and Inca are similar in
quality. Inca is slightly better. Inca is substantially better.
For data analysis, somewhat and substantial were combined
into one better rating. Of the 44 comparisons, two or more
raters independently agreed on 41 of postbetter, no difference,
or prebetter ratings, for a 93% agreement.
After the treatment was completed, all 11 SLPs wrote
essays reflecting on their experiences. The prompt was as
follows: Describe how you applied the intervention in your
school district including with what students and for how long.
Evaluate how it went. Explain, with examples, two ways that
participation in this project has changed your understand-
ing and practice of intervention for expository writing and
comprehension. The essays were initially analyzed collabo-
ratively by the author and an RA for repeated statements
that suggested themes. The RA then tallied the essays
that mentioned those themes and returned to the author
to check about uncertain items or possible additional
themes. For dependability of scoring, another RA was given
the final seven themes and independently tallied presence
in two (18%) of the essays. The two scorers agreed on 12 of
14 (86%) mentions.
Ukrainetz: Sketch and Speak Intervention 59
This study examined the effects of a brief treatment
(TX) compared with a no-treatment control (CON) on
notes and reports made from nontaught expository texts
and SLP instructor perceptions of learning. For this ex-
ploratory study, all significance levels were set to an al-
pha level of .05, and standard effect size magnitudes
from Cohen (1988) were used: small for dof 0.20 and
or ϕof .02, medium for 0.50 and 0.15, and
large for 0.80 and 0.35.
Notes From Nontaught Texts
Of the 44 participants, 40 made fully written notes,
one used a combination, and three made fully pictographic
notes. Participant notes were first analyzed for the total
sample (see Table 3). The mean number of notes showed a
greater gain from pretest to posttest for TX than for CON,
but a repeated-measures analysis of variance (RANOVA)
Group × Time interaction effect was not significantly
different, F(1, 42) = 0.812, p= .373, partial η
= .02. For
quality, TX showed a significantly greater gain on the sum
of five feature ratings on an RANOVA interaction effect,
F(1, 42) = 17.41, p= .001, partial η
= .28. For each of the
five features, no significant differences were present at pre-
test on pairwise Mann–Whitney Utests, with all pvalues
greater than .40, which allowed a direct comparison of
posttest performance. Bullet/Picto and Quick posttest
performance was significantly higher for TX than CON;
U= 81.0, p= .001, d= 2.61; U= 80.0, p= .001, d=1.40.
Posttest Topic, Enough, and Own/Diff pairwise compar-
isons were not significantly different, with pvalues greater
For the 41 written or combination notes only, the
same results were obtained: On a mean quantity of 6.21
(SD = 2.18) and mean summed quality of 9.11 (2.16), an
RANOVA interaction effect was not significant for quan-
tity, F(1, 39) = 1.49, p= .230, partial η
= .04, but was for
quality, F(1, 39) = 12.56, p= .001, partial η
= .24. The
three fully pictographic notes did not change in quantity
(seven to six, six to six, six to five) but increased in quality
(10 to 13, eight to 14, eight to 13).
Oral and Written Reports From Nontaught Texts
The oral reports were scored on two quantity mea-
sures and six quality measures (see Table 4). TX Sentences
and Words decreased from pretest to posttest, whereas
CON stayed the same or decreased slightly, but the dif-
ference was not significant on an RANOVA interaction
effect. The quality features of Full and Modify occurred
most frequently, at two to four statements across conditions
and testing points. Open/Close was least frequent, with a
mean of less than 0.5, resulting from fewer than a quarter
of participants producing one to three statements and the
rest producing none. Independent ttests showed no signif-
icant differences at pretest, with all pvalues greater than
.40. To determine if TX showed more quality features with
length controlled, analyses of covariance were run on post-
test features with posttest Words as a covariate. Full, Open/
Close, and Modify were significantly greater, and Extrane-
ous was significantly less for TX than CON at posttesting.
Although Category was distinctly lower for TX than CON
at posttesting, the difference missed significance with a
pvalue of .06. Verbatim had no significant TX versus CON
For the written reports, only posttesting occurred.
Sentences and Words were slightly lower for TX than
CON, but the difference on an unpaired ttest was not sig-
nificant (see Table 5). Five of the written report features
were quantitatively in favor of TX, but none were sig-
nificant on analyses of covariance with length controlled
(so shorter reports would not be penalized) by using the
pretest written Words as a covariate.
For holistic ratings of relative quality of the oral re-
ports, seven of 22 posttest TX oral reports were rated as
better by at least two of three raters, whereas 11 of 22 CON
oral reports were rated as better. This difference favored
CON with a medium but nonsignificant effect, χ
(1) = 1.504,
p= .220, ϕ= .19. The reason given for all but three of the
36 higher ratings in either direction for either condition was
Table 3. Quantity and features of pretest and posttest notes.
Treatment, n= 22 Control, n=22
Pre Post Gain Pre Post Gain
Quantity 5.09 (1.66) 6.14 (2.03) 1.05 5.05 (1.84) 5.45 (1.68) 0.40
Quality 6.59 (1.47) 9.68 (2.50) 3.09
7.00 (2.76) 6.86 (2.10) −0.14
Topic 0.68 (0.84) 0.68 (0.89) 0.00 0.73 (0.94) 0.73 (0.94) 0.00
Bullet/Picto 0.41 (0.50) 1.64 (1.09)
1.23 0.41 (0.59) 0.36 (0.49)
Quick 1.00 (0.93) 2.27 (0.88)
1.27 1.14 (1.08) 0.91 (0.97)
Enough 2.23 (0.69) 2.36 (0.85) 0.13 2.36 (0.79) 2.18 (0.80) −0.18
Own/Diff 2.27 (0.94) 2.73 (0.70) 0.46 2.36 (1.14) 2.68 (0.57) 0.32
Note. Quantity = mean number of notes; quality = mean sum of five features, each out of 3 points; standard
deviations in parentheses; Picto = pictographic; Diff = differentiated.
p< .01 for comparison of gains.
p< .01 for non-parametric pairwise comparison of post-test with pre-test
60 Language, Speech, and Hearing Services in Schools •Vol. 50 •53–70 •January 2019
longer with more detail. In contrast, six of the seven (86%)
higher ratings of posttest TX reports, but only two of
the 11 posttest CON reports (18%), were described as better
style and organization. All seven better TX posttest reports
(100%), but only six of the CON posttest reports (55%),
were described as more presenter confidence or fluency.
SLP Perceptions of Learning in Treatment
From a grounded examination of the SLPs’reflective
essays, seven themes emerged. The first was that all 11 SLPs
liked the intervention, with seven specifically mentioning
appreciating having a treatment for expository discourse.
The SLPs judged that topic knowledge and oral expression
improved for the taught texts. They considered the informa-
tional articles initially very challenging but noted that the
students quickly became at ease with the texts and engaged
in the tasks. The SLPs said that the students were able to
“state their thoughts in a clear, organized manner, produce
complete sentences, [make] a great oral report that was in-
teresting and easy to listen to”and “remember these reports
after a few days, and that they demonstrated how much
they really had learned about this non-fiction text.”
The SLPs attributed the observed improvements to
five themes (see Table 6): simplicity (six mentions), quick
and easy visuals (nine), orally creating sentences (six), re-
peated practice (five), and visible progress (nine). One SLP
commented that her two students liked the bulleted notes
better than the pictography. Another said that most of
her five students enjoyed the pictography more. One SLP
reflected on her difficulty staying focused on the treatment
goals: “I had a tendency to expand during reading of the
article, making inferences and comparisons, as well as
teaching vocabulary…when my student would formulate
a sentence, I would tend to try and expand their thinking,
giving suggestions to add more detail.”An SLP who pro-
vided pair treatment observed that, although it was difficult
to get through all the steps in the time available, the stu-
dents helped each other figure out ideas to note and ways
to note them.
The final theme was that nine SLPs commented that
the treatment was functional and easily linked to classroom
Table 4. Quantity and quality features of pretest and posttest oral reports.
Treatment group, n= 22 Control group, n= 22 Effect
Pre Post Gain Pre Post Gain F(1, 42) ppη
Sentences 8.09 (2.88) 7.41 (3.07) −0.68 8.95 (5.09) 8.95 (2.80) 0.00 0.25 .621 .05
Words 58.82 (26.42) 51.73 (24.35) −6.89 62.82 (43.12) 59.14 (19.06) −3.68 0.10 .748 .00
Full 3.27 (2.43) 4.23 (2.72)* 0.96 3.64 (3.74) 3.00 (2.29)* −0.64 6.88 .012 .14
Open/Close 0.23 (0.53) 0.36 (0.85)** 0.13 0.18 (0.50) 0.05 (0.21)** −0.13 8.55 .006 .17
Modify 2.50 (1.85) 4.18 (2.56)** 1.68 2.45 (2.37) 2.68 (2.01)** 0.23 12.33 .001 .23
Verbatim 0.50 (1.14) 0.36 (0.95) −0.14 0.64 (1.50) 0.27 (0.63) −0.37 0.10 .749 .00
Category 0.73 (1.24) 0.32 (0.95) −0.41 0.95 (1.62) 1.36 (2.01) 0.41 3.70 .061 .08
Extraneous 0.68 (1.12)* 0.32 (0.89) −0.36 0.68 (1.21) 1.27 (1.58)* 0.59 5.73 .021 .12
Note. Mean with standard deviations in parentheses; Full sentences, Open/Close sentences, and sentences Modif(ied) from the notes are
desirable; Verbatim sentences from source article through notes to the report, isolated Category statements, and Extraneous statements
are undesirable; for Words and Sentences, effect = repeated-measures analysis of variance interaction effect for Group × Time; for other
features, effect = with pretest differences nonsignificant, posttest group analysis of covariance with posttest words as covariate.
*p< .05. **p< .01.
Table 5. Quantity and quality features of posttest written reports.
Feature Treatment, n= 22 Control, n= 22 Difference
Sentences 6.36 (3.17) 6.59 (2.96) −0.23 0.25 .807 0.08
Words 45.82 (32.10) 49.73 (26.71) −3.91 0.44 .663 0.15
Full 3.45 (2.11) 3.36 (2.30) +0.09 0.20 .659 0.01
Open/Close 0.45 (0.74) 0.41 (0.85) +0.04 0.25 .623 0.01
Modified 3.64 (2.65) 3.45 (2.15) +0.19 0.63 .433 0.02
Verbatim 0.32 (0.65) 0.27 (0.77) +0.05 .034 .854 0.00
Category 0.00 (0.00) 0.09 (0.43) −0.09 1.78 .190 0.04
Extraneous 0.23 (1.07) 0.36 (1.33) −0.13 0.02 .903 0.00
Note. Mean frequency of words and features; parentheses = standard deviation, Full sentences, Open/Close sentences, and sentences
Modif(ied) from the notes are desirable; Verbatim sentences from source article through notes to the report, isolated Category statements,
and Extraneous statements are undesirable; For Sentences and Words, effect = unpaired ttest with Cohen’sd; for other features, effect =
analysis of covariance with Words as covariate and partial η
Ukrainetz: Sketch and Speak Intervention 61
projects, written work, and academic standards across grades.
Some specifically mentioned the potential for equipping
students with learning strategies, without judging that the
students were ready to do it on their own: “Both students
understood how they could generalize these new strategies
and reported different class projects where they would like
to apply their new skills…. The students ultimately have to
acquire the skills themselves and feel confident enough to
apply the learned skills in multiple environments.”
Individual improvement requests were for longer
treatment, shorter sessions that would fit schedules better
or longer sessions for pairs of students, an option to com-
bine bulleted notes and pictography, a procedure to fix up
facts if the students get mixed up, a designated space on
the form for openings/closings, and more variety in texts to
help generalize skills.
This preliminary study examined whether a simple
combination of two idea notations and oral practice would
improve expository note-taking and reporting for fourth to
sixth graders with language-related learning disabilities. A
brief application of Sketch and Speak, delivered by school
SLPs, was compared with a no-treatment control on texts
from a different subject area.
Taking Notes for Expository Reports
The proximal indicator of treatment benefit was the
notes taken before and after treatment. Over 90% of the
students chose to use written notes at both testing points.
The group outcomes were the same whether or not the
Table 6. Some speech-language pathologist reasons for observed benefits and value of Sketch and Speak.
•It isn’t complicated. Students appeared to quickly grasp how the process worked. This seems crucial to the idea of carry over. If they are
going to be using this strategy on their own, it has to be simple enough to remember and not require significant materials.
•This form of notes was so quickly done and more easily remembered by children who generally do not have the skills to take “standard
notes,”let alone to do so fast enough.
•The general simplicity, while rule based and deeply seeded in the clinician’s knowledge of language and development, of the treatment
procedure and how easy it was for my students to access, despite their difficulties with language.
Quick and easy visuals
•Grasp[ed] the pictography strategy relatively quickly in the first session. She seemed to enjoy coming up with the quick pictures.
•With the focus on “quick and easy, just enough to remember,”many of my students who typically lose focus were more able to come
up with a picture or a few words to use for their notes.
•Pictography strategy helped kids remember the meanings of words such as “nocturnal”and “amphibian.”
•Students remembered ideas from their pictography and were able to put the picture back into sentences…. After turning their pictography
into a bulleted note…they remembered the information and could continue to form a complete sentence.
•Without the oral practice, it would be essentially just teaching a study skill.
•The most important skill I will continue to use in all of my therapy is the importance of repeated practice of complex sentences. Modeling
sentence structure has always been a part of my practice, but to see the benefit of the student’s continued repeated practice of complete
sentences was eye opening…. The more practice they received, the more complex their sentences appeared to become.
•The oral practice phase. A concept I grasped well for younger learners…. However, I was failing to understand how this concept looked
for older students. The oral practice piece of this intervention was the answer and it makes so much sense.
•Having the student practice the full sentence until a good grammatical sentence was achieved…it paid off for the students when giving
the full report.
•The repeated oral practice appeared to build the confidence of both students…. With the repetition and strategies, by the third article
each student was eager to not only tackle the article and learn about the interesting animal, they also immediately identified details with
more independence and overall confidence. With this increase in confidence, the students included additional details compared to
previous sessions and spoke in complete sentences with an awareness of what they were verbalizing.
•Participation in this study has confirmed my knowledge that students with learning difficulties excel when they have visual supports and
•Repetition has always been a key factor in effective treatment; however, this study emphasized repetition, which continued to build on
the previous work completed and was carried from one note-taking strategy to the next. This repetition built the confidence of the student
from session to session.
•Once a well-formed sentence was established, the student took ownership of the sentence and successfully implemented these complete
sentences in well-formed oral reports.
•Rapidly gained confidence in their story retell skills. I could literally see them gaining confidence in their academic skills during the sessions.
•Students engaged in learning and excited about the progress…they were able to see great success progressing through the steps of
•It will be helpful to make our language intervention contextual where students are producing a product similar to what is expected in
their classroom. This will also help me tie our sessions into the common core and state standards.
•It was exciting to experience the rapid, functional growth of my students through this program and I look forward to exposing more
students to the power of bulleted notes and pictography.
•I plan to implement this note-taking strategy across my school setting and hope to impact more expository discourse at all grade levels.
•I can see this process being hugely impacting to [the students] in the classroom, both now and further on into junior high and high school.
62 Language, Speech, and Hearing Services in Schools •Vol. 50 •53–70 •January 2019
few pictographers were included: Quantity of notes did not
increase, but quality did. Four of the five note quality fea-
tures increased more for the treatment condition, with two
showing significant changes with large effect sizes. The
average summed quality was significant with a medium
effect size. According to Cohen (1988), a medium effect
size is “large enough to be visible to the naked eye”(p. 26).
Although the pictographers had clearly learned this novel
notation from treatment, even with their contributions
removed, a significant medium effect persisted. The con-
trast in quantity and quality was similar to Chang and Ku
(2015), who found fewer words per idea and more alter-
nate representations but no increase in number of ideas for
their fourth graders.
Improvement in the quality of the notes could be
linked to what happened in treatment. Two areas showed
the largest increases: use of initiating bullets without periods
and reductions of source article statements to key words
and phrases. Those two elements were central to the instruc-
tion. To a lesser (and nonsignificant) degree, treatment
participants improved in their use of paraphrased rather
than verbatim statements. The trend was to reduce and
paraphrase more while increasing sufficiency of the notes
to cue coherent oral statements.
The features of topics and opening/closing notes
showed no change. A topic was written by about a quarter
of the participants in each condition and at each test point.
Only one participant wrote opening/closing notes. Both
features were addressed in treatment but, perhaps, not
explicitly enough, such as by pointing out that topic words
cue an opening sentence and having students write brief
opening/closing notes themselves. Initiating bullets were
consistently modeled and elicited, which seemed to work:
No treatment participants used bullets at pretesting, but seven
did so at posttesting, versus one and zero control partici-
Using Notes for Oral Reports
The second outcome was the oral report length and
quality. Features measured were those that linked to what
was taught in treatment and that should contribute to
appealing reports. The oral report was affected by the nature
of the notes and how the students used them.
Treatment did not result in longer oral reports at
posttesting. In fact, there was a trend to shorter reports.
This tendency for brevity made sense: With quick and easy
notes, the students were likely to produce shorter but pos-
sibly more student-owned sentences in their oral reports,
suggesting more active processing of ideas and language.
For the quality features, there were significant dif-
ferences at posttesting compared with the control group:
a greater density of full sentences, openings/closings, and
sentences modified from the notes and fewer extraneous
comments in the oral reports. Although not significant, iso-
lated category labels also tended to decrease with treatment.
Only verbatim productions did not decrease: Treatment
students still copied sentences from the articles, albeit at a
far lower rate than their modifications of sentences. The
treatment students more often expanded or reworded their
written or pictography notes into different and fuller sen-
tences. The Modify category included verbatim sentences
recalled from brief notations but not copied directly from
the article to the notes to the report, which was a further
example of active processing and retention.
The holistic ratings were intended to capture over-
all improvement in oral reporting: A student might have
grammatically awkward sentences but present a lot of
information fluently and expressively. The trend in this
case was toward the control group, with the reasons being
most often greater length and detail. This was disappoint-
ing but reasonable if the treatment participants were trying
to turn brief notations into sentences instead of reading
longer sentences. A substantially greater proportion of the
favored treatment reports included reasons that could be
attributed to treatment: better organization, fluency, and
Pictography for Expository Note-Taking
Pictography was used in treatment to promote
paraphrasing, bypass writing difficulties, and double the
learning opportunities. Students could continue to use
pictography as an alternate note-taking tool outside of
treatment, and the Apache and Inca testing texts were
amenable to pictographic representation, but there was
no treatment emphasis on later independent use, and the
testing instructions did not indicate that it should be
used. If students were at all uncertain about making notes
from the unfamiliar texts, copying a few words would
likely have seemed safer than using this novel nonverbal
The SLP essays and treatment records revealed that
students immediately caught on to creating quick and
easy, just enough to remember sketches. They could ex-
pand the pictography into their own well-formed sentences
and use the pictography to cue oral reports at the start
of the next session. The SLPs were confident that pictogra-
phy was a useful teaching strategy within treatment. How-
ever, unlike McFadden (1998), which directly compared
pictography to writing and drawing for narrative discourse,
this study did not directly test the utility of pictography in
representing expository discourse in either a scaffolded or
In terms of independent use at posttesting, three par-
ticipants used only pictography, and one used it for one
category of information: types of Apache shelters (to be
discussed in the next section). The notes for the three full
users improved 3 to 6 points out of 15 possible points.
Two of the oral reports were associated with better holis-
tic ratings. Despite higher feature scores for the posttest
notes, the third participant’s pretest and posttest oral reports
were similar in individual feature scores and were rated as
One participant showed a particular affinity to pic-
tography. Donal (pseudonym) was an African American
Ukrainetz: Sketch and Speak Intervention 63
fifth grader who was identified as having specific learning
disability with reading, writing, language, and math ser-
vices and a CELF-5 of 73. The SLP said that Donal imme-
diately enjoyed the pictography and willingly engaged in
the expository tasks with it. Donal showed reasonably
good note-taking at pretesting with concise, organized,
readable items in all five categories that could be expanded
into sentences (Supplemental MaterialS1).Despitethis,
at posttesting, Donal asked if he could draw pictures. He
proceeded to make simple, differentiated, interpretable pic-
tographs in all the categories (Supplemental Material S2).
Donal included an idea not from the source text: a grass
squiggle, for which he said, “llamas were herbivores, which
meant they only ate plants.”This was a good sentence and
suggested incidental vocabulary learning and application
from the very different subject area of the treatment texts,
which discussed omnivores and carnivores.
Donal’s pictographic notes supported better oral
reporting than his fairly competent written notes. Donal’s
posttest oral report was rated holistically better than his
pretest report, with the reasons given as more details, better
organization,andbetter presentation gaze and voice.Donal’s
number of statements stayed the same at nine, but his
complexity and elaboration improved considerably, with
the word count going from 29 (“Decent fighters. They
hunt.”)to63(“When people insult the god they are thrown
off a big cliff. They also got animals called llamas.”). Donal
improved on his opening and closing statements, from a
pretest closure of “I learned that they are horsemen”to
posttest naming of the people in a formal ending (“The
Inca Empire, And I hope you enjoyed learning about Inca
Donal’s improvements and those of the other picto-
graphers indicated potential for this alternate notation as
a learner strategy in addition to its practice and idea trans-
formation benefits during treatment. It is unknown how
many other students would have used pictography if they
had thought they could have. Explicitly allowing words or
pictures in the testing instructions might have resulted in
different student choices and outcomes.
Oral Practice as a Learning Strategy
The treatment was conceived as teaching note-taking
strategies through oral intervention or “talking-to-learn.”
The treatment had been designed to work around literacy
deficiencies by reading texts aloud and scaffolding repeated
expansion of brief notes into oral sentences and reports.
Oral practice was intended to allow barely decipherable
notes or nonverbal pictography to cue fluent, well-formed
sentences that flow together into an oral report or are held
in mind for composing written texts. In this application
of Sketch and Speak, students were told how important
oral practice was but were not systematically scaffolded
into independent use. It became apparent that verbal re-
hearsal was the missing third leg of the learner strategy
stool. Students needed to independently rehearse saying
full sentences as they created and reviewed their notes. Some
students appeared to review their notes, but there was little
overt indication of what they were saying. However, one
student provided a window into his learning.
Tyrone (pseudonym) was an active, talkative African
American fourth grader. He had an attention-deficit/
hyperactivity disorder diagnosis, received reading and writ-
ing services, and scored 80 on the CELF-5. Despite his
attentional disability, Tyrone had talents: At pretesting,
his notes (Supplemental Material S3) and oral report scores
were higher than average, and he enjoyed performing. His
performance after treatment got even better (Supplemental
Material S4). His notes increased in quantity, from three
to 10 items, and in quality, from 7 to 15 out of 15 points.
At posttesting, he wrote the topic, opening/closing notes,
bullets, and brief but sufficient statements. Tyrone was
the only student to use a mix of written notes and pictog-
raphy. Although he did not speak in any detail about
the Apache shelters, his images of teepees, wikiups, and
hogans captured more than a few written words could
Tyrone’s posttest oral report was also substantially
better. Number of statements went from nine to 12 and
words from 30 to 100, with statements changing from pre-
test (e.g., The shelter is [the an*] the ancient empire)to
posttest (e.g., This is about [a least um] the Apache nation
least then a hundred years before [Spanish] Spanish people
were [n*] like farms ranches and towns). Tyrone’s posttest
oral report had more openings/closings and modified
sentences, fewer extraneous statements, and a unanimous
rating of better by all three raters. His written report had
opening and closing statements and even more full and
modified sentences than his oral report.
Tyrone showed substantial improvement that could
reasonably be associated with treatment. However, the
main reason for highlighting this student was his prepara-
tory behavior at posttesting. For his note review, Tyrone
glanced at his paper, then said he was ready to present.
The tester told him to take a little more time to look over
the notes. Tyrone looked back at his notes and made non-
sense “dadada”sounds with exaggerated head shaking.
Then, he began looking steadily at his notes, saying sen-
tences very quietly while extending his fingers as if count-
ing items. After 28 s of this, Tyrone said he was ready,
looked at the camera, and began to fluently and expres-
sively speak from his notes.
This movement from distracted behaviors into fo-
cused concentration on a task, with subvocal rehearsal and
tracking gestures, is exactly what is needed to successfully
compose fluent, well-formed discourse from brief notes.
Vygotsky (1978) describes external self-talk as an interme-
diate stage between other regulation and self-regulation
and a revealing window into the learner’s mind. Ukrainetz
(1998) observed a similar mental window for a third grader
who had spelling-focused self-talk while struggling to write
an undecipherable narrative versus content-focused self-
talk as he pictographically planned a retrievable, coherent
story. Tyrone made visible what all the students needed to
64 Language, Speech, and Hearing Services in Schools •Vol. 50 •53–70 •January 2019
The importance of oral review and rehearsal is con-
sistent with the larger research on note-taking and use (e.g.,
Kobayashi, 2006). Boyle (2010) commented that even high
school students need to be guided to use the notes they have
been taught to take. McDaniel et al. (2009) developed an
explicit self-talk review procedure for college students. Hav-
ing students engage in independent strategy use, even in
tasks and settings very close to the learning environment,
is hard no matter the age (Gersten et al., 2001). Learner
strategies need to be simple, flexible, and clearly related to
the task purpose; all of which fit verbal rehearsal. However,
students also need to be better supported into independent
use than what occurred in the current application.
Learning to Use Notes for Written Reports
A study hypothesis was that this primarily spoken
language treatment could generalize to written language.
In treatment, the students did not do any report writing,
and the SLPs demonstrated it only once, but the note-taking
and oral practice were expected to improve writing. If such
a benefit occurred, it would be a powerful testament to this
brief oral intervention.
It turned out that no significant effects on report
writing were obtained. There were positive indicators though:
Five of six quality features were slightly in favor of treat-
ment. A design complication was that the writing task
occurred days after the oral task. It is unknown how the
writing outcome would have fared if it had been done in
the first testing session. It is also possible that benefits
might have shown up even with the time lag if students had
used pictography and/or oral rehearsal. While this study
tapped the lower end of the grade range of note-taking
research, and added the challenge of learning disabilities,
such students must deal with tasks such as these. Sketch
and Speak allows students to access grade-level ideas
and language in ways that do not rely on strong writing
SLP Perspectives and Implementation
This study included a qualitative investigation of
instructor perceptions of learning within treatment. These
mostly very experienced SLPs strongly endorsed Sketch
and Speak. They judged it to be a simple procedure that
was easily implemented in the school setting. In her treat-
ment notes, one SLP describe the process as “empowering”
for her students. They commented on how easily the students
learned the notations, composed oral sentences, recalled
article information, and stayed on topic and organized.
The SLPs saw potential for integrating the treatment into
more comprehensive interventions and applying it to
classroom texts and activities at this level and for their older
The themes that emerged from the reflective essays
matched the design of the treatment. The SLPs repeatedly
cited the two notation systems, the oral practice, and the
visible changes. Another theme was the benefit of repeated
practice for the targeted skills.Intheiressaysandanec-
dotally, the SLPs commented that they were not so skill
focused and did not give so many practice opportunities
in their typical language interventions. In the training, sev-
eral SLPs wanted to preteach vocabulary or explore ideas
during the article sharing. In the first week of treatment,
two SLPs had to be restrained from doing so, with one in
her reflective essay noting how she had difficulty letting
the treatment remain simple. Contextualized treatments,
with their naturalistic communicative activities and innu-
merable skill possibilities, are particularly challenging
to keep a skill focus (Ukrainetz, 2005). Although rich lan-
guage is generally desirable, in treatment, it can distract
from target skills and reduce practice opportunities (Plante,
2018). To make noticeable change, treatment involves not
trying to do it all, but rather repeatedly and systematically
focusing on a few skills that come together in meaningful
What About Comprehension?
Despite the benefits obtained from this treatment for
note-taking and expository expression, the question of com-
prehension is likely to arise. Note-taking research invari-
ably focuses on effects on reading comprehension, rather
than on empowerment of students to author their own ex-
In the current study, a multiple-choice comprehen-
sion test was administered. It showed no benefit and very
low scores across the sample. It was not included in this
report because, and unlike the expressive scoring, the prob-
lematic items could not be refined after administration.
Another way of measuring comprehension is by the quan-
tity, quality, and integration of text ideas in student free
recall and essays. This would have fit the treatment better
and accords with Hebert, Gillespie, and Graham’s (2013)
systematic review finding that the strongest results are ob-
tained when the comprehension measure aligns with the
instructional activity. Nevertheless, this author’s impres-
sion was that the two conditions were similar in understand-
ing, despite the better formed notes and oral reports of
the treatment condition. Given the brevity and focus of
treatment and the independence required in testing, it is
unlikely that the treatment students, half of whom had
severe reading deficits, would have shown better compre-
hension. Chang and Ku (2015) and Lee et al. (2008) showed
improvements on multiple-choice tests with similar age
students. However, these studies differed on the scope
of treatment, testing conditions, and participant literacy
The SLPs were confident that Sketch and Speak im-
proved students’learning of the texts used in treatment.
However, the SLPs only saw their students’scaffolded per-
formance. Furthermore, the topic knowledge, which so
energized these SLPs, was not tested, such as by having the
students independently answer questions about a taught
animal or composing an oral report on a different animal
that tapped any newly acquired zoological knowledge.
Ukrainetz: Sketch and Speak Intervention 65
Investigations that contrast such learning, or more exten-
sive instruction that might produce independent reading
comprehension benefits, and contrasted with conditions
exposed to the same texts and taught with different proce-
Limitations and Future Directions
This study investigated a simple treatment procedure
that teaches pictography, bulleted notes, and oral practice
to support expository reporting for students who struggle
to understand, speak, and write about academic texts. The
findings from the group results, SLP perceptions, and
individual case analysis support continued development
and investigation of Sketch and Speak. Some concerns and
next steps have been identified. Other possibilities are
The most immediate next step is to increase attention
to student ownership of the strategies. The research on
teaching nonvisible comprehension strategies such as self-
questioning, summarization, and inferring word meaning
typically examine whether comprehension has increased,
not whether the taught strategies were used to arrive at the
answer or whether the strategies were used outside of the
instructional setting (Gersten et al., 2001). This research is
often not so much about learner strategies but rather about
use as teaching strategies (Ukrainetz, 2015a, 2015b, 2016).
This initial study examined independent use on unfamiliar
texts, but it was similar to other strategy research in its
lack of systematic instruction toward learner ownership.
Even so, after only six treatment sessions, students used
more of the features of effective written notes, and a few
used the pictography. Of the three strategies, the pre-
dominant concern was oral practice. The author and col-
leagues have followed up with a case study examining
an extended Sketch and Speak (Risueño, Ukrainetz, &
Peterson, 2018). This version has more attention to scaf-
folding independent use of verbal rehearsal across varied
teaching contexts. Permission to use “words or pictures”
and a learner awareness interview were added. The re-
sults were positive and will inform the next controlled
Another interest is the effect of learner features, espe-
cially interactions between language and self-regulatory
skills. The two students with CELF-5 over 120, more than
a standard deviation higher than any other participant,
did not differ notably from the rest of the sample on the
outcomes. In contrast, the star learner was a student with
attention-deficit/hyperactivity disorder and CELF-5 of
80, who gained self-regulatory control and substantial im-
provement. Related to this is how Sketch and Speak would
work for older students with more metacognitive and self-
regulatory awareness. Although Ukrainetz (1998) indicated
pictography was less useful for working on sentence struc-
ture and specific word choices, with the addition of oral
practice, that limitation might be surmounted: A recent clini-
cal exploration with an adolescent indicated that he could
revise his mentally held sentences into more complex syntax
and cohesive discourse.
Finally, although this study employed numerous
experimental controls, its application in a school setting
had inherent limitations. Having so many instructors and
sites, with the treatment carried out in the regular work
day, introduced undesirable variation. The SLPs’clinical
expertise meant that less instruction in interactive scaffold-
ing was required compared with preprofessional RAs,
but it also meant that clinical inclinations could affect treat-
ment fidelity. A more tightly controlled study is needed
to better determine the efficacy of this treatment.
This study investigated Sketch and Speak, a new ex-
pository treatment procedure for oral and written exposi-
tory reporting. School SLPs taught fourth graders with
language-related learning disabilities to reduce ideas from
challenging informational texts to quick and easy, just
enough to remember pictography and bulleted notes, then
expand the notes into full oral sentences and reports. Fol-
lowing treatment, significant gains were obtained for
aspects of independent notes and oral reports but not for
written reports tested days later. Individual case analysis
revealed particular value for the pictography and oral prac-
tice. The SLP instructors liked the treatment and judged
that the simplicity, visual supports, oral practice, repeated
opportunities, and visible progress produced noticeable
benefits. Sketch and Speak shows potential as an effec-
tive treatment that should be further developed and
This study was supported by a Utah State University new
faculty research startup grant. The author would like to thank
Catherine L. Ross for her clinical insights in the development of
this treatment and early assistance in this project. The author
thanks Laramie County School District SLPs and their students
for giving of their valuable time and energy, especially Amy K.
Peterson, whose participation inspired her to pursue a doctor of
philosophy. Appreciation goes to the dedicated research assistants:
University of Wyoming’s Haley Hight and Riley Dolezal and Utah
State University’s Kristin Pritchard, Tristin Hampshire, Nicole
Pearson, and Megan Keate, with particular thanks to R. J. Risueño,
who far exceeded expectations for an undergraduate assistant.
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68 Language, Speech, and Hearing Services in Schools •Vol. 50 •53–70 •January 2019
Treatment and Testing Article Excerpts
Sketch and Speak Treatment Fidelity Checklist
Treatment article: unusual animals
The Cassowary is a species of large flightless bird. It is found in northeastern Australia and the
island of New Guinea. The cassowary is closely related to emus and ostriches. It is the third
tallest and second heaviest bird in the world….
The Axolotl, or Mexican salamander is found naturally only in two connected lakes in
southcentral Mexico. It is also kept as a popular freshwater aquarium pet. Axolotls are
sometimes called Mexican walking fish because they look like fish with legs….
The Aye-Aye is a species of lemur that inhabits the rainforests of Madagascar. Madagascar is a
huge island near the southeast coast of Africa. The Aye-Aye is the world’s largest nocturnal
primate. They are not dangerous, but are feared by local people….
Testing article: historical peoples
The Inca Empire was the largest kingdom in ancient times on the American continent. It covered
the country of Peru and parts of Ecuador, Bolivia, Argentina, Chile, and Columbia. The center
of Incan government was the city Cuzco in the Andes Mountains. In the Inca language, Cuzco
meant “the navel of the Earth.”Gold statues, elaborate fountains, and beautiful gardens were
The Apache are one of the most famous Native American groups in the United States. Apaches
were known as skilled horsemen and fearsome fighters…. The Apache originally called
themselves something like “na-dee,”which means “The People”….The Apache first came to
what is now Arizona, New Mexico, west Texas, and southern Colorado long before American
settlers started arriving….
Y/N Sessions 1, 3, 5: oral report from pictography notes
____ 1. Preview learning of pictography and oral practice
____ 2. Read aloud about half Article A, B, or C with student following text
____ 3. During reading, identify two ideas and where on note sheet
____ 4. Reread text for pictography of 2–3 ideas per category
____ 5. Say simply for each idea
____ 6. Sketch pictography for each idea
____ 7. Emphasize quick and easy,just enough to remember for pictography
____ 8. Say fully for each pictography
____ 9. Explain concepts only occasionally, incidentally, & briefly
____ 10. Return to reading text, pictography, and oral practice for as much as time allows
____ 11. After pictography, show illustration for Article A, B, or C
____ 12. S3 & S5: Say fully, simply, pictography, & fully for begin & end sentences
____ 13. Say full report from pictography
____ 14. Review learning of pictography and oral practice
____ 15. For all steps, keep attention on text and tasks
____ 16. For all steps, scaffold student learning with appropriate support and challenge
Y/N Sessions 2, 4, 6: oral or dictated report from bulleted notes
____ 1. Preview learning of bulleted notes and oral practice
____ 2. From pictography for Article A, B, or C, say full report
____ 3. Say simply from each pictography
____ 4. Bullet note from each pictography
____ 5. Emphasize quick and easy,just enough to remember for bulleted notes
____ 6. Say fully for each bulleted note
____ 7. Refer to text for clarification only if necessary and occasionally
____ 8. Say fully, simply, bullet note, say fully for begin and end sentences
____ 9. Say full report (S2 & S4) or dictate full report (S6) from bulleted notes
____ 10. S6: Compare notes to full dictated report for sentences and organization
____ 11. S6: Compare dictated report to article for paraphrasing and summarizing
____ 12. Review (for S6, preview use) of pictography, bulleted notes, and oral practice
____ 13. For all steps, keep attention on text and tasks
____ 14. For all steps, scaffold student learning with appropriate support and challenge
Ukrainetz: Sketch and Speak Intervention 69
Written and Pictographic Notes Scoring Rubric
A. Quantity: How Many Notes Quantity count = _______
•Count number of separate items; Not by closely examining meaning, can be repetitions
•Listed vertically or separated by spaces, periods, sentences, or and between very different ideas; 1 item for sentence or phrase list even if
B. Quality: Efficiency & Effectiveness of Notes Quality /15 = _______
•Compare to source article for information clarity and accuracy
•Compare to oral report for reporter’s interpretations for ratings
1. Topic & Open/Close
3 = Relevant topic at top and open or close note in words or pictograph
2 = Relevant topic at top but no open/close note
1 = Topic identified incidentally within first category
0 = Topic identified other than in first category, not identified, or incorrect
2. Bullets (Good) & Periods (Bad) 2. Pictography
3 = All items with bullets and no periods (exclamations or questions okay) 3 = Strong evidence: Three or more pictographs (separated
images, not touching or creating a single scene)2 = More than half items have bullets, regardless of period use
2 = Moderate evidence: Two pictographs1 = Some items have bullets or more than half items have no periods
1 = Some evidence: One pictograph0 = No items have bullets
0 = No pictography3. Quick & Easy Written Notes
3. Quick & Easy Pictography3 = All brief items, info dense: short sentences, lists, phrases, key words,
abbreviations, small grammatical words omitted, no category repetition 3 = All images are simple not detailed
2 = More than half brief or reduced items 2 = More than half images are simple
1 = Half or fewer brief or reduced items 1 = Some images are simple
0 = No brief items 0 = No images are simple
4. Enough to Remember
3 = All items clear enough for reporter to generate coherent report statement (ok if not well-formed or grammatical); credit one note even if
multiple statements or both notes if combined in statement
2 = More than half adequate items: inadequate = misinterpret own note, only isolated word or with mismatched category; not from source;
skipped in report even if clear to rater
1 = Some adequate items
0 = No adequate items
5. Use Your Own Words 5. Differentiated Pictography Images
3 = All own sentences or only part of source sentences; no almost
3 = Each pictograph differs
2 = More than half own sentences
2 = Two pictographs essentially same
1 = Half or fewer own sentences
1 = Three pictographs essentially same
0 = No own sentences
0 = Four or more pictographs essentially same
70 Language, Speech, and Hearing Services in Schools •Vol. 50 •53–70 •January 2019