Joshua was a small Year 7 boy who was struggling in his lessons. Although he appeared to be quietly getting on with his work at the back of the class, his teachers began to notice that the work he completed bore little resemblance to what he had been asked to do, and that he struggled to follow instructions. When they grew concerned, he was referred for a Speech and Language Therapy (SALT) assessment with me.
But I don’t “get” it…
Joshua had never been referred to SALT services before, so there were no previous case notes to go on. When we met, he came across as a quiet, polite and compliant student. Although he was not very forthcoming, he did acknowledge that he had been struggling to understand what was going on in his lessons. I decided to administer some subtests from the Clinical Evaluation of Language Fundamentals 5 (CELF-5) to get a clearer picture of his difficulties.
Although Joshua’s scores for vocabulary and expressive language were broadly within the normal range, he scored very poorly on both the Following Directions (FD) and the Understanding Spoken Paragraphs (USP) subtests. A low score on the FD subtest may indicate difficulties with auditory memory and/or processing as well as understanding of a range of concepts and complex sentence structures.
A low score on the USP subtest might indicate difficulties across a whole range of areas. Given that listening and reading comprehension both involve processing of language, but through different channels, some of these are discussed in my post on reading comprehension: https://secondaryschoolslt.com/2026/03/26/why-do-some-students-struggle-to-understand-what-they-read/.
Joshua’s score for this subtest was in the 0.1st percentile, meaning that he scored lower than 99.9% of students his age. He forgot many details from the first two paragraphs and completely misunderstood the final paragraph. Even when it was read to him again, he struggled to fully grasp its meaning. Even more interesting was the fact that Joshua was able to correctly paraphrase individual sentences from the paragraph. Yet, he struggled to understand the text as a whole.
I concluded that Joshua had various underlying difficulties, including with auditory memory and processing as well as with higher level inference skills. But as we continued working together, I discovered that he also had a very particular difficulty that was severely affecting his understanding.
I had been reading about anaphoric reference and textual cohesion in Larson and McKinley’s (2003) incredibly helpful book, Communication Solutions for Older Students: Assessment and Intervention Strategies. According to them, producing and comprehending textual cohesion devices can be an area of difficulty for older students with language disorders. And I wondered whether this might be something Joshua was struggling with.
Anaphoric what?
Cohesion devices refer to the grammatical and lexical elements that help a text hang together as a whole, rather than being a series of disconnected sentences. Whilst conjunctions such as “because” link propositions within sentences, adverbial conjuncts such as “furthermore” signal connections between sentences or even paragraphs. These words can express a whole range of relationships between ideas, such as additive, causative, adversative, etc.
Pronouns are another type of cohesion device. So, a personal pronoun such as “she” or “it” might refer back to a noun already mentioned in a previous sentence, such as “Mrs Winters” or “France”. The second sentence cannot be understood without reference to the first, so we could say that the two are grammatically linked. When a word refers back to something mentioned previously, we call this anaphoric reference, and when it refers forward, we call this cataphoric reference.
To read a more in-depth account of textual cohesion, please see my blog post: https://secondaryschoolslt.com/2026/06/26/difficulties-with-text-cohesion-why-some-students-struggle-to-understand-connected-text/.
What is lexical reiteration?
A particularly interesting form of anaphoric reference is called lexical reiteration. Sometimes, instead of using a personal pronoun, writers will use a different noun – often a synonym, superordinate, or a word in the same category – to refer back to the first noun. For example, I might make the following statement about my Italian holiday: “We fed some stray kittens at our villa. The poor things were so hungry”. In this statement, “the poor things” means “the kittens”.
Lexical reiteration is a device used commonly by journalists to avoid repetition and as a convenient way of packing in more information, and sometimes sharing a personal feeling about their subject whilst saving words. In the previous example, my use of the term “poor things” probably gave you a sense of my feeling towards the kittens: I felt sorry for them.
For another example, please see this recent article about England’s new prime minister, Andy Burnham, and his rise to power: https://www.bbc.co.uk/news/articles/cp8pml5z8p6o. The writer refers to him by multiple names, including the “northern PM”, “the 56-year old”, “the new prime minister”, “the music-lover”, and, simply, “Burnham”.
Whilst a politically aware British adult may find such an article more easily comprehensible than someone with less knowledge of the subject, most people are able to use their grammatical knowledge to help clear up any ambiguities. The same cannot necessarily be said for students with language disorders.
Indeed, whilst Joshua’s grasp of basic pronouns seemed okay, he was struggling with more complex lexical reiteration. One day, I showed him a short article requiring little specialist knowledge, about a hero bus driver referred to by several names: “the bus driver”, “the driver”, “the worker” and “the hero”. When I asked Joshua who these people were, and how many people he thought were in the article, he told me there were three characters.
I was shocked – imagine the implications of believing there are several different characters in a story when there is only one! No wonder he was having trouble understanding what was going on. It was clear that this was an area we needed to work on.
A newspaper intervention
We began by defining “nouns” and “pronouns”, and coming up with a list of examples for each that we put into a table. I showed him how one could replace the other in a sentence. Once this was clear, I explained how sometimes writers also use other words to replace the first noun, and we added some further examples to the table.
Then I told two stories: a “very boring story” and a “story about me”. For the “very boring story”, I said something like, “Mohammed walked into Tesco. Mohammed went down the vegetable aisle to look for tomatoes. When Mohammed got there he saw that the cucumbers were on sale. Mohammed put two extra packets of cucumbers into his basket. When Mohammed got to the checkout he was surprised at the cost”.
I asked Joshua what he thought of the story and whether it was interesting to him. Try to elicit the idea that repeating the same noun endlessly gets very boring after a while, but that if we use different words or phrases to describe the main character then our story becomes more interesting and varied. Don’t be afraid to exaggerate to get the point across!
Next, I told him a “story about me”. It went something like: “After she’d finished breakfast, Tawna left her flat and got on the bus. The Speech and Language Therapist arrived at school at 8.30am and started getting ready for her sessions. By 9am, Miss Mitchell was ready to see her first student”.
I highlighted the words “Tawna”, “she”, “Speech and Language Therapist” and “Miss Mitchell”, and explained that all of these different terms referred to me. We again discussed how using a range of words makes our story more interesting. These words can also tell us more information about the main character.
Next, I told Joshua that it was his turn to make a story up about himself. We came up with a list of words to describe him, e.g. “the Year 7 student”, “the school boy”, “the young footballer”, “the keen gamer”, “the twelve-year old”, “the older brother”, etc. Joshua then wrote a short paragraph about himself using these words, with my support.
During the next phase of the intervention, we worked on newspaper articles from the free daily newspaper. I initially tried to choose short, general knowledge articles with simpler vocabulary, and one main character. I had Joshua identify the name of the main character and write it at the top of a sheet of paper. After that, I showed him how to go through the article and highlight all of the pronouns as well as any other reiterated nouns or phrases used for that character.
These were written underneath the character’s full name. Again, we discussed how all of these words referred back to the main character. I also showed Joshua how to check his answer was correct by replacing the noun or phrase he had found with the character’s full name. If the sentence still made sense, then he had likely found one of the anaphors we were looking for.
Breaking through
Next, it was Joshua’s turn to practice. He initially appeared very lost and required a lot of support from me. I remember wondering if what we were doing was helping at all. Then, during about the 5th session of this intervention, it was as if a switch flipped inside Joshua and he suddenly seemed to “get it”. He began to complete the activities more independently, and to understand more of the articles we were reading.
As Joshua progressed, I introduced more varied articles where the subject was not a person, but an animal, or even an inanimate object. In this article, for example – https://www.nationalgeographic.com/animals/mammals/facts/grizzly-bear – the writer refers to grizzly bears by multiple terms, including “grizzlies”, “awe-inspiring giants”, “females”, “cubs” and “top-of-the-food-chain predators”.
And in this article, a naval ship is referred to as “HMS Queen Elizabeth”, “the 65,000-tonne aircraft carrier”, “the £3.2bn warship”, “the vessel” and “the carrier”: https://www.bbc.co.uk/news/articles/cwyz6728veqo.
We then moved onto articles featuring more than one main character, where there was greater potential for ambiguity. We discussed how to work out which words and terms referred to each character. For example, we could look at the context, consult our general knowledge, consider which character was mentioned last, and look at the words themselves for clues, e.g. “grizzlies”.
Once we had located all the anaphors, I asked Joshua what he had learnt about the different characters from the different terms used to describe them, and what he had understood from the article.
Thriving independently
When I assessed Joshua the following year, his scores on both the FD and USP subtests had improved to mildly below average. And by Year 9, when I last saw Joshua, he had made so much progress that his USP score was just within the average range. This was a considerable improvement considering where Joshua first started.
But most importantly, Joshua told me that the sessions had helped, and that he was no longer struggling at school. Strikingly, when I asked him to complete a feedback form, Joshua reported feeling confident with understanding his teachers’ lectures, following instructions in class, finding the main idea in a text and answering questions about his reading and writing: all things he had found so hard before.
And when I spoke to Joshua’s history teacher, he confirmed that Joshua was doing well, and that his understanding in history was very good, despite being removed from so many lessons to go to his SALT sessions! Given Joshua’s progress and his expressed desire to try supporting himself independently from then on, he was discharged and has not come back on my radar since.
I should qualify this by saying that this was only one of a number of areas that Joshua and I worked on together, so his progress cannot be completely put down to his success with this particular intervention. For example, I also taught him a note taking strategy to support him with his auditory memory, as well as morphological analysis and contextual abstraction strategies to help him work out the meanings of new words.
But I wanted to share this story because developing an improved understanding of anaphoric reference felt like a significant moment in Joshua’s journey. If you have ever had trouble understanding why your student is not understanding… then I hope this story inspires you. Difficulties with anaphoric reference could be one of the reasons why.
PLEASE NOTE: Key details including names have been changed to protect my students’ identities.
Notes
“Andy Burnham: Northern PM’s Long Journey to Power.” BBC News, 16 July 2026. bbc.co.uk.
Grizzly Bear.” National Geographic, 17 October 2026. nationalgeographic.com.
Gudge, Ethan. “Royal Navy Aircraft Carrier Departs for Training.” BBC News, 6 September 2026. https://www.bbc.co.uk/news/articles/cwyz6728veqo.
Larson, V.L. and McKinley, N.L. (2003) Communication solutions for older students. Thinking Pub.
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