Language Development after Adoption

animal dominos

Photo by woodleywonderworks

My husband and I met our children and our grandchildren at a restaurant the other day. I stayed with my grandchildren at the table while their parents were busy gathering the children’s and their food. As I was monitoring all the activity and sat down beside my granddaughter, she remarked, “You’re very quiet today!” Coming from a 4 year-old, it sounded quite hilarious and made me think that she must have heard and stored this adult-like statement to retrieve it for the appropriate moment. This is an example of the process of language acquisition. Children listen to, process, store, retrieve, and produce language in dynamic and flexible ways. It is, at times, an amazing process to document and observe.

For internationally adopted children, they begin listening to and producing their birth language. After adoption, they often stop listening to and expressing their birth language to focus on learning an adopted language. For some children, their adopted families are able to provide a nanny or teacher who continues to speak to their children in their birth language while the parents and community may speak the children’s adopted language. Several researchers have documented the rapid acquisition of the adopted language where adopted children score within normal range on most standardized general language and articulation tests in their adopted language by 2 or 3 years post-adoption (Glennen, 2007; Hwa-Froelich & Matsuo, 2010; Roberts et al., 2005). Yet other studies have documented that internationally adopted children use special services more often, may have problems with social communication (Glennen & Bright, 2005), and have poorer school achievement than same-aged peers (van IJzendoorn & Juffer, 2010).

Though rare, in some cases internationally adopted children appear to be developing the necessary prerequisite skills for academic and social success but later on begin to have learning difficulty. I have assessed children between 1 to 4 years after adoption and have had a few children demonstrate speech, language, and cognitive delays later as opposed to early in their post-adoption development. For some children, their developing relationship with their parents may not develop which may adversely affect the children’s communication or their inattentive and overactive behaviors begin to negatively affect their learning and development. For other children, their speech fails to mature and what were considered developmental articulation errors at 2 years of age, become delayed articulation or phonological problems at 6 years of age. Because of these cases, I recommend that families seek follow-up evaluations if their child continues to demonstrate speech or communication problems at older ages or if the child develops new and different speech or communication problems.


Glennen, S. (2007). Predicting language outcomes for internationally adopted children.
Journal of Speech, Language and Hearing Research, 50, 529-548.

Glennen, S., & Bright, B. J. (2005). Five years later: Language in school-age
internationally adopted children. Seminars in Speech and Language, 26(1), 86-
101. Retrieved from

Hwa-Froelich, D. A., & Matsuo, H. (2010). Communication development and differences in children adopted from China and Eastern Europe. Language, Speech, and Hearing Services in Schools, 41, 1-18. doi:10.1044/0161-1461(2009/08-0085)

Roberts, J. A., Pollock, K. E., Krakow, R., Price, J., Fulmer, K. C., & Wang, P. P. (2005).
Language development in preschool-age children adopted from China. Journal of
Speech, Language, and Hearing Research
, 48(1), 93-107. doi:10.1044/1092-

van IJzendoorn, M. H., & Juffer, F. (2010). Adoption is a successful natural intervention enhancing adopted children’s IQ and school performance. Current Directions in Psychological Science, 14, 326-330. doi:10.1111/).0963-7214.2005.0039.x

Deborah Hwa-Froelich, Ph.D., CCC-SLP, is a Saint Louis University associate professor and International Adoption Clinic coordinator with interests in social effects on communication such as culture, poverty, parent-child interaction, maternal/child health, and international adoption.

The King’s Speech (Part 1): My Impressions

Poster for the movie "The King's Speech"

I was recently surprised to find an email in my inbox from Scott Squires of The Stuttering Foundation. Why would someone from The Stuttering Foundation be contacting me… after all, I’m a self-described “Voice Guy” with significant interest in adult language disorders. As it so happens, Mr. Squires, the foundation’s Director of Marketing and Communications, had read my posts for ASHAsphere and wondered if I’d like to interview the organization’s president, Jane Fraser, about the movie “The King’s Speech.” In the interest of conducting an informed interview with Ms. Fraser (which constitutes the upcoming “Part 2” of this post), I thought it best that I see the movie first. Because it was only in limited release at that time, my wife and I ventured from the wilds of Clarion two hours south to Pittsburgh and took in a showing.

The Kings Speech” is the story of King George VI’s attempt to overcome his stuttering as he ascends to England’s throne in the mid-to-late 1930s. Along the way, he is treated by an Australian speech therapist, Lionel Logue, who, through persistence and the application of various therapeutic techniques, convinces the future king that his stuttering can be cured. The movie culminates with King George’s speech to the British Peoples on September 3, 1939 announcing Britain’s entry into what would become World War II. (The actual speech can be heard here.)

During the movie I couldn’t help but be drawn to Geoffrey Rush’s portrayal of eccentric speech therapist Lionel Logue. Now I’m not a movie critic or a stuttering expert or a historian…what I am is an SLP who teaches in a university program responsible for the training of future SLPs. So it is from this perspective that I viewed Rush’s performance (and later “boned up” on the real Lionel Logue). What could I take from the movie to illustrate various facets of professional practice for my students? The movie was rife with examples, both of what to do and of what not to do as an SLP. I’ve chosen one from each category for brief discussion.

From the moment I first heard it, Logue’s promise to cure the future king’s stutter rankled me. And make no mistake, a cure is guaranteed in the movie (“I can cure your husband, but I need total trust”). I fully recognize that I’m viewing Logue’s promise of a cure within the context of contemporary ASHA practice standards. Maybe it was acceptable to guarantee a cure during the period depicted, a form of practitioner bravado or self-assurance designed to instill hope and confidence in one’s patients. Today, however, such an action would be foolhardy, potentially open the practitioner to litigation, and, most significantly, would violate the Code of Ethics to which we adhere as holders of ASHA’s Certificate of Clinical Competence. Specifically Principle I, Rule J: “Individuals shall not guarantee the results of any treatment or procedure, directly or by implication…”. Perhaps my discomfit is simply testament to the degree to which this tenet has been instilled in me by the organizational climate of the profession. And, for the sake of historical accuracy, the king was never “cured” despite Logue’s intervention, but rather continued to manifest a degree of disordered speech. In a December 2010 interview with Mark Medley of Canada’s National Post, Mark Logue (Lionel Logue’s grandson) described King George VI’s speech during a 1944 radio broadcast as manifesting the “watermarks of a speech impediment, signs in the hesitations and the pauses and the breathing.”

ASHA’s Code of Ethics states “individuals shall not reveal, without authorization, any professional or personal information about identified persons served professionally …” (Principle I, Rule N). When working with students in the clinical setting this is a stricture discussed over and over and over again. Logue practiced confidentiality to an admirable extent and could most definitely serve as a role model for students, both as depicted in the movie and in his actual life. At no point does he reveal his client to be the future King of England, not even to his wife and sons (though he, in one scene at the dinner table, is sorely tempted to do so). In fact, Logue’s family never finds out that his client is the king until George the VI shows up in their parlor and, in so doing, reveals himself. Imagine how hard it must be to keep something of this nature to oneself, not even confiding in one’s spouse…to strictly observe all that confidentiality explicitly and implicitly requires…especially when, like the future king, the client is sometimes exasperating and a source of professional discontent.

“The King’s Speech” might be the first exposure some in the general public have to the practice of speech therapy. As such, and despite being a “period piece”, the movie has the potential for shaping how the layperson views the practice of contemporary speech-language pathology. To this end, it behooves SLPs to critically look at the movie from a professional perspective, deciding what on the screen represents an accurate representation of today’s practitioner and what does not (historical differences notwithstanding). The above are but a few of my impressions. What did you like about the portrayal of SLPs? What didn’t you like? Please feel free to share your impressions in the comments section.

The next installment of my series reviewing “The King’s Speech” will share my discussion with Jane Fraser, President of The Stuttering Foundation.

You might find the following sources pertaining to Lionel Logue and “The King’s Speech” both interesting and informative (these were pieces I referred to as I prepared to write this post):

Bowen, C. (2002). Lionel Logue: Pioneer speech therapist. Speech-language-therapy dot com. Retrieved January 12, 2011, from

Dana. (2011, January 5). Review: The King’s Speech. Stimulated Boredom. Retrieved January 12, 2011, from

Hallett, V. (2010, December 14). Surviving royal treatment: ‘The King’s Speech’ provides history of stuttering treatment. Retrieved January 12, 2011, from

Medley, M. (2010, December 13). As a speech therapist, he was fit for a king. National Post. Retrieved January 12, 2011, from

The Stuttering Foundation. (2011, January 10). Stuttering and The King’s Speech. Retrieved January 12, 2011, from

Kenneth Staub, M.S., CCC-SLP, is an Assistant Professor, Communication Sciences & Disorders at Clarion University of Pennsylvania. He will be a regular contributor to ASHAsphere and welcomes questions or suggestions for posts.

First Words

The tragedy in Tucson and the miraculous recovery of Gabby Giffords has me thinking about first words. Is there anything sweeter than hearing someone’s first words? The world is waiting to hear what Gabby’s next words are. For her, the words that come next will be with the help and expertise of a speech-language pathologist. Every day I turn on the television with the hope that we will hear about Gabby’s words that come next. Not her first words, but even sweeter.

Indulge me for a minute and consider the news we have heard about this tragedy. I’m reminded of my training about concussion injuries versus a gun shot, anatomy and physiology of the brain and the amazing strength of the human will to survive such a tragedy. What sticks with me is the simply stated importance of communication. This tragedy has pulled us into the extended friends and family of well-wishers for Gabby. Vicariously, we are living the caregivers’ experience. We are hoping and praying for her recovery, for those next words. Waiting. We don’t want to hear about how likely her recovery is. Her family, and the world, wants to know what we can do to help. How her caregivers can provide an environment that will help her to communicate and recover to the full extent possible. The importance of what we do can only be measured by what the family, caregivers and patient actually hear and understand. As professionals, we can tell them all about the neuroanatomy of why a recovery may or may not be likely. But, I would argue that our time with them is better spent telling them about what they can do to help make that recovery happen.

I have faith in the expertise of the team of professionals working with Gabby. I know that they have what it takes to make her recovery the best that it can be. In the meantime, as Gabby’s extended caregiver, I know I stand united with SLPs as we collectively wait to hear those first, still as sweet, next words.

Andrea “Deedee” Moxley is Associate Director for Multicultural Resources at ASHA. She worked at Montgomery County Public Schools prior to coming to the National Office. Deedee is responsible for responding to technical assistance questions, developing resources for working with diverse populations and co-managing the S.T.E.P. Mentoring Program. Her areas of interest include cultural competence, bilingualism and health literacy.

The Communicative Function of (Blog) Commenting

Diagram of blog comments

Photo by cambodia4kidsorg

Blogs are a pretty recent entry in the history of the written word, and a lot of people don’t quite know what to do with them. Our ancestors seem to have known that it would have been considered rude to pick up the paint or chisel to respond to their neighbors’ musings via cave painting or stone tablet. Books and magazines have been similarly non-interactive; it seems senseless to deface these writings with our thoughts- “Right On!”- when the author would never see our ball-point pen scrawlings. But here we are in a new age, that of the “Social Web,” and anyone who wants to put their writing out there can, and does! Why? Well, we all have different motives, but in the case of SLPs and other educators who blog, I believe it all boils down to sharing. I recently was at a conference, and a wonderful Massachusetts principal- who is so pro-sharing that he keeps his desk in the middle of his high school lobby- put it something like this (excuse my paraphrase if you should ever see it, @bhsprincipal): “It’s not that I think I know better than everyone else, it’s just that no one else is sharing.” That “no one” has thankfully gotten a bit inaccurate in the past year, with the blossoming numbers of SLPs who blog. And we are definitely seeing that you read, so THANK YOU.

However, because we are demanding little creatures, we SLPs, we have something else to ask you for: comments. Comments feed us! It’s really great to know that others have read and have thought about our writing, and, being in the same profession, have ideas to share back. This is why we choose blogging as a medium, rather than trying to track down a publisher: we don’t want it to be just a one-way conversation! So, we know it’s hard to break out of that mode of reading that dates back to “I better not write anything on Shakespeare’s Folio,” but now, really, we are asking you to write all over our posts. In addition to meeting bloggers’ seemingly insatiable need for attention, your comment will live on with that post, along with your expertise, and enhance the experience of all who read it!

See that little “LEAVE A COMMENT” link? Unfortunately, it means no one did. But I’m not asking you to feel bad for me. OK, I am a little. But also, I put that there so that first of all you know HOW to comment.

When you click there, you’ll see this, a similar form to what you would see on any blog:

ASHAsphere asks you to leave your (real) name and email address, though others can’t access that email through this blog (be careful on other blogs- I sometimes use a “spare” email address, like my yahoo account to make a comment on a blog I don’t often frequent). Should you feel bad if you leave the Website field blank? No. ASHA and other readers don’t care if you don’t have a website. So what to write in that “Comment” field? It’s up to you, but here are a few suggestions to spark your commenting:

  • “Add a Thought”Michelle Garcia Winner posed this excellent explanation of what a comment is- it’s simply when we “add a thought” to what has already been said. In our literacy classrooms, this is described as “Making a Connection” to one’s own experience, and the best blog commenting uses this strategy. Yet another way to think of this type of comment relates to the positive momentum of improvisational performances, which use the rule of “Yes, And…” to keep the interaction going! We can think of our conversations, real or virtual, as following the same principle.
  • Feel free to disagree (but maybe not eviscerate)– My suggestion of “Yes, And…” as a guideline for commenting should not be interpreted as meaning that you should never disagree with a blogger, especially when his or her opinion is “out there.” However, I have seen some pretty harsh (in the case of YouTube and news websites, almost inhuman) comments written in social web outlets, and I know that we SLPs, as communication specialists, can avoid that pitfall. Using the sandwich technique is always helpful: site a positive you found in the post, then a negative, and end with a positive. Maybe you can’t find two positives? Make it an open-faced sandwich! In any case, we all know that the written word looks harsher because it is devoid of all our contextualizing nonverbal signals; so it’s best to remember that sharing is caring and give bloggers a little slack when disagreeing, eh?
  • Questions Welcome– Was there something you did not quite understand about the post or do you want to delve a little further into the topic? If the post described something new and techie, do you need help? Throw that up there in a comment! I always try my best to get back to people on questions, and though it might take us a few days, you should check back on the blog for an answer. In general, the blogger will leave a response there rather than bother you at your email address!

As a blogger, I know that one way to encourage comments is to end with a question. So: what has been your experience with professional discussions, commenting and questioning online? How have you seen it change, and how has it shaped your practice?

Sean J. Sweeney, M.S., M.Ed., CCC-SLP is a speech-language pathologist and instructional technology specialist working in the public schools and in private practice at The Ely Center in Newton, Massachusetts. He has presented on the topic of technology integration in speech and language at the ASHA convention and is the author of the blog SpeechTechie: Looking at Technology Through a Language Lens, which won the 2010 Best New Edublog Award.

Stuttering Versus Cluttering – What’s the Difference?

"speech bubble" balloons

Photo by milgrammer

What is stuttering?

Stuttering is a disruption in the fluency of verbal expression characterized by involuntary, audible or silent, repetitions or prolongations of sounds or syllables. These are not readily controllable and may be accompanied by other movements and by emotions of negative nature such as fear, embarrassment, or irritation (Wingate 1964). Strictly speaking, stuttering is a symptom, not a disease, but the term stuttering usually refers to both the disorder and symptom. The stutterer is doing the opposite of what normal speaker would do: He is trying to talk on inhalation instead of after inhalation. He does this as a reaction to the fact that most of his air being exhaled BEFORE it can be used for phonation.

What is cluttering?

Cluttering is a disorder of both speech and language processing that frequently results in rapid, dysrhythmic, sporadic, unorganized, and often unintelligible speech (Daly, 1993).

How can we differentiate between stuttering and cluttering?

The clutterer vs. stutterer:

  • Talks BETTER under stress
  • Talks BETTER when interrupted
  • Talks BETTER on longer sentences
  • Talks BETTER in a foreign language
  • Reads BETTER unfamiliar texts
  • Doesn’t seem to care how he talks
  • Doesn’t have remissions in his speech disorder
  • Talks WORSE when calm
  • Doesn’t pay attention to what is said
  • Unaware of his speech

Can they co-exist? YES!

A patient may show symptoms of BOTH disorders together. Thus, he will be classified as clutterer-stutterer and will show: word-finding difficulty, poor reading abilities, poor memory, poor story-telling abilities and interestingly, superior skills in math and science (Daly, 1993).

How do we treat stuttering and cluttering?

Treatment for stuttering disorder is not easy – since we don’t really know the cause for sure, we try to manipulate the speech production using: mind control/attitudes, changing the speech patterns (clinically proven to help a lot of patients!), changing breathing patterns  (most beneficial to those patients that acquire hoarse voice due to their stuttering!), and teaching muscles relaxation.

Treatment for cluttering might be even harder and differs from treatment of stuttering. We typically will be working on awareness of the patient towards his speech problem , teaching oral-motor coordination exercises  (to stop the mumbling effect), teaching relaxation drills, emphasizing organizational language treatment, teaching memory strategies, teaching rate control techniques (clinically proven to help a lot of patients!).

Gal Levy M.Sc. CCC-SLP, has more than 21 years of experience in clinical treatments of Voice, Fluency, Articulation and Language. Gal is working as a school based SLP, Home health SLP and in his private practice at Frisco, TX. He also writes professional articles on various speech disorders and state of the art treatments on Google’s new Encyclopedia, Helium and AC writers websites. Gal participated on Community Focus radio monthly shows with Dr. Griffin advising KEOM 88.5 FM listeners on voice, fluency and tongue thrust clinical issues.

Assessing Language Development in Internationally Adopted Children

Photo by ClaTalpa

Being the proud grandmother of two bright and charming grandchildren, I can’t help but keep track of their development. My son often asks me to “assess” his children’s development. He, like many parents, hope that their children are like Lake Wobegone residents in that they are all above average. My grandson is like most toddlers, babbling and using CVs and CVCs with meaning but sometimes we adults have to fill in missing consonants and words to arrive at his intended communication. Still my son wants to know, is he developing typically?

Parents who have adopted children from abroad often ask me the same question, is my child developing like other children who have been adopted from abroad? Before children are adopted, they are born in different countries of origin and exposed to different birth languages ranging from African or Asian languages to Russian or other Slavic languages. When children have been exposed to different languages and are adopted by a family who does not speak the child’s birth language, the child stops listening to or expressing his or her birth language within 3 to 6 months (Nicoladis & Grabois, 2002). Regardless of the child’s birth language (Russian, Korean, or Chinese), research studies, clinical reports and case studies have provided evidence that children between the ages of 1 and 5 years old who are adopted from different countries demonstrate similar phonetic and phonological development with little first language interference (Glennen, 2007, 2009; Pollock, 2007). If a child demonstrates poor intelligibility or delayed articulation or phonological development, they should be referred for assessment by a speech-language pathologist familiar with research on internationally adopted children.


Glennen, S. (2007). Predicting language outcomes for internationally adopted children. Journal of Speech, Language and Hearing Research, 50, 529-548. doi:10.1044/1092-4388(2007/036)

Glennen, S. (2009). Speech and language guidelines for children adopted from abroad at older ages. Topics in Language Disorders, 29(1), 50-64. doi:10.1097/TLD.0b013e3181976df4

Nicoladis, E., & Grabois, H. (2002). Learning English and losing Chinese: A case study of a child adopted from China. The International Journal of Bilingualism, 6(4), 441-454. doi:10.1177/13670069020060040401

Pollock, K. E. (2007). Speech acquisition in second first language learners (Children who were adopted internationally). In S. McLeod International guide to speech acquisition (Pp. 107-112). New York: Thompson-Delmar Learning.

More abstracts of Karen Pollock’s research on speech-language development in children adopted internationally

Deborah Hwa-Froelich, Ph.D., CCC-SLP, is a Saint Louis University associate professor and International Adoption Clinic coordinator with interests in social effects on communication such as culture, poverty, parent-child interaction, maternal/child health, and international adoption.

New Year’s Resolutions

Photo by Fernando Coello Vicente

Happy New Year!!

I, like many reading this entry, have started the new year with a list of resolutions to guide my actions over the course of 2011. Recognizing that 78% of those who set such resolutions fail (Wisemen, 2007), I’m attempting to maximize my potential for success by tapping into the wisdom of one of today’s more popular “self-help gurus,” Dr. Mehmet Oz. According to Dr. Oz’s Facebook post of December 31, 2010 success can be more readily achieved if one’s resolutions are realistic, have a plan of action underlying their attainment, and are publicly declared. This entry represents my public declaration.

Now I’ll grant you I could probably stand to lose a few pounds…cut down on the swearing…become fluent in another language…etc. Because Dr. Oz recommends that the goals one sets are realistic, however, I’ll be focusing on other things in this public declaration. More specifically, I’ve decided to share my professional resolutions, those actions which might optimize my effectiveness as a speech-language pathologist working in the university setting. Here goes:

RESOLVED…I will earn half the CEUs needed for an ACE…ASHA’s ACE is automatically awarded to those who attain 7.0 CEUs within a 36 month period. To me, this is an important award because it represents my (and my discipline’s) commitment to lifelong learning and continued professional development. With the many different and cost-effective mechanisms for earning CEUs presently available, this award is accessible to anyone…my next will be my third.

RESOLVED…I will improve the learning environment in the classes I teach…For the most part I receive good student evaluations. Students like my enthusiasm for the subject matter, my content knowledge, my sense of humor. What they don’t like is how fast I sometimes talk. My rate inhibits complete and accurate note taking, makes classes feel rushed, and may reduce communicative effectiveness. I am a professional. I take pride in what I do and know I can always do better. As such, I will reduce my speaking rate during class presentations and in the process, hopefully, improve my students’ learning environment. P.S. … I’m open to suggestions.

RESOLVED…I will facilitate student interest and involvement in research…The benefits of student participation in research-based endeavors are numerous and include (but are definitely not limited to): the enhancement of analytic skills, critical thinking, and problem solving; the opportunity to apply classroom theory in a hands-on manner to solve real-world problems; stimulation of lifelong learning; etc. (Utah State University, 2007; Weber State University, 2011). Recognizing these benefits, I’ve always wanted to start a departmental research group comprised of faculty and students. The only problem is I’ve never really had a concrete idea of how to exactly go about putting such a plan into action. That is until I read an article by McComas, Fry, Frank and Fraley in the October 2010 SID 10 Perspectives which provided a blue print that just might enable me to transform my idea into a program reality.

RESOLVED…I will make significant progress on my dissertation…In many respects I’m an exception, if not an anachronism, in contemporary higher education. Namely, I’m a tenured faculty member holding the rank of assistant professor though I do not possess a doctoral degree. It’s not for lack of trying, though, in all honesty, I must admit to sometimes suffering from lack of motivation. I completed all coursework toward a Ph.D. at The University of Georgia in the mid-1990s but never took the final step. I’m currently in the process of writing a dissertation to meet the requirements for an Ed.D. in Administration and Leadership Studies at Indiana University of Pennsylvania. To be truthful, however, my project has languished during the past year. Well no more! I might not complete my dissertation this year, but I will make significant progress toward doing so. How do I define significant progress…all data collected and chapters 1, 2, and 3 completed by this time next year.

RESOLVED…I will continue to write for ASHAsphere (if they will have me)…Rereading the above it seems I’ve set an ambitious agenda for myself in 2011. Despite this I’d still like to write a blog entry for ASHAsphere on at least a bi-weekly or monthly basis (as I currently do). Maggie McGary, ASHAsphere’s “editor,” has provided something important for the association…the opportunity for members to present themselves and their ideas in a relaxed, less formal manner than what we might typically be used to. Not only that…its fun! Want to find out what the likes of Vince Lombardi and professional cyclist Saul Raisin have to do with our profession…well continue looking for my posts, as these are just a few of the things I’d like to write about in the coming year. Ideas…I’ve got ideas.

Well, I’ve now gone on record and publicly declared my resolutions for 2011. Look for periodic updates to find out how I’m doing. Now let me provide the opportunity for you to increase your chance of success for accomplishing the professional resolutions you might have developed. Please feel free to list any of your professional resolutions for 2011 in the comments section of this blogand, by so doing, consider that your public declaration of intent.

Kenneth Staub, M.S., CCC-SLP, is an Assistant Professor, Communication Sciences & Disorders at Clarion University of Pennsylvania. He will be a regular contributor to ASHAsphere and welcomes questions or suggestions for posts.

Communication Wellbeing and Social Wellbeing….an Aspect of Health

Photo by Nancy Moilanen

Social Isolation is a common complaint of persons with neurogenic communication disorders.  Social Isolation is a negative aspect of “Social Wellbeing.”  The World Health Organization includes the concept of positive “Social Wellbeing” in its definition of “Health.” “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. WHO, 1948.

The definition was created in 1948 and has not changed since.  If “Social Wellbeing” is an aspect of health; then, might the concept of “Communication Wellbeing” be a measurement tool to assist in defining one’s communication skills as pertaining to one’s health?  Might the concepts of “Communication Wellbeing and “Social Wellbeing” be measurement tools to define and support medical justification for Speech Pathology treatment?  Can we, as therapists create environments which allow assessment and treatment of communication disorders within social community-building settings?

The Well Together Neuro Rehab program has accomplished just that.  The program supported by, Frank Howard Memorial Hospital in Northern California has been providing community-building, multi-sensory, intensive, integrated group treatment since June, 2007.  Well Together Neuro Rehab is an Evidenced Based Practice applying cutting edge research to individualized treatment plans.  We meet in one month block sessions; two days a week for four hours.  Individual and group treatment are provided on each day; with a follow-up individual session one time weekly on a third day.

Speech Pathology professional literature is full of intensive and group therapy research programs demonstrating positive outcomes for increased communicative effectiveness and quality of communication life.  (Elman, R. J., Group Treatment of Neurogenic Communication Disorders, 2007). The Well Together Neuro Rehab program has utilized this past research in program development and has reached further, applying new research to its programming.


The Well Together Neuro Rehab program utilizes music and singing as a major treatment component.  Singing taps into a multitude of skills such as rhythm, prosody, pitch, oral-motor awareness, coordination and strength, visual tracking & reading, respiratory function & body awareness, cognition: memory, focus and following directions…not to mention how singing is just “plain fun” and socially bonding.  As Speech Pathologists, we have experienced the benefits of singing as a part of treatment for communication disorders; however, now fMRI studies demonstrate specific evidence “Music engages huge swathes of the brain – it’s not just lighting up a spot in the auditory cortex;” states Dr. Aniruddh Patel, neuroscientist, Neurosciences Institute in San Diego.

We now know when we sing…..our entire brain lights up!  The implications for stimulation to both parts of the brain remain wide open.  For right now, we are seeing Well Together participants change and develop in all of the above areas.  Along with these changes outcome studies are showing an overall increase in Social Wellbeing.


In addition to music, participants of Well Together have social time eating lunch and spending time, through language/communication exercises getting to know one another.  Participants learn how to support one another.  Essentially, we form community.  Each person discovers that he/she has valuable life experiences to share. Each person develops a sense of positive self worth, a sense of commonality and knowledge that they can positively impact someone else’s life. They learn that supporting one another becomes a significant contribution to their own wellbeing, other participant’s wellbeing and the overall wellbeing of the group.  According to the World Health Organization, community involvement is an identified aspect of Wellbeing. “Social Wellness is the process of creating and maintaining healthy relationships through the choices we make.  It embraces relationships at home and work, friendships, and our relationships with all people and future generations.  The social dimension encourages contributing to your human and physical environment for the common welfare of your community.”

Themes, Movement & Daily Structure

Treatment sessions are designed with a daily theme and predictable structures. This offers participants (who need it) cognitive support.  They have an idea of what to expect.  Since the theme is repeated throughout the day, recall becomes easier.

Examples of theme days are: “Animal Day,” “Shopping in Red,” “Flag Day,” “Everyone Loves a Flea Market” “I’ve Got a Talent,” and so on.  Themes are only limited to the therapist’s imagination.

Movement is an integral portion of each day.  In addition to Physical Therapy, we spend time focusing on posture, respiratory support, stretching and balance (proprioception).


To measure Well Together’s efficacy; industry Gold Standard Measurements tools were utilized: The Communicative Effectiveness Index, (Lomas, J., et al) The Quality of Communication Life Scale (Paul, D. R., Holland, A.L., et al) and The American Psychology Association’s, Fordyce Happiness Measures (Fordyce, M). Outcomes of these tools were compared to outcomes of the Communication Wellbeing Index, Horowitz Moilanen, 2009.

The Current study (prospective), What are the links between “Communication Wellbeing” and “Social Wellbeing”?  How do communication skills change when patients receive intensive multi-sensory therapy in thematic community-building environments?; was presented this past November in Philadelphia at ASHA’s national convention.  Outcome trends showed increases over 30 days, 60 days and 90 days in Communicative Effectiveness, Quality of Communication Life; overall “Happiness” and “Communication Wellbeing” with a concurrent reported decline in Social Isolation.

With a decrease in “Social Isolation” an increase in Social Wellbeing occurs, and thus an increase in health.  It is reasonable to suggest, based on treatment outcomes of this Evidence Based Practice and the World Health Organizations’ definition of Health; Well Together Neuro Rehab treatment impacts health (via Social Wellbeing) and is therefore, “medically necessary” as a form of health care and rehabilitation. Further, this treatment may act as a form of prevention of further medical complications. The Well Together Neuro Rehab program offers a prevention and rehabilitation treatment model for Health Care Reform.

Continuing Education

An expanded version of the ASHA presentation/course will soon be offered for continuing education.  Course work will include lecture and hands on participation/observation of treatment with support for developing a similar program in one’s own practice.  For details please visit Well Together’s website or email me.  I welcome and look forward to your comments and, perhaps, meeting you.

Nancy Horowitz Moilanen, M.A. CCC SLP, Licensed Speech Pathologist, California; private practice in rural setting since 1979; Founder/Director, Well Together Neuro Rehab and Speech Pathology Department, Frank Howard Memorial Hospital, Seminar Presenter at ASHA convention, 2010.