Giving Aphasia a Voice in Baltimore

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Nationally, more than one million Americans are living with aphasia. Aphasia is more prevalent than Parkinson’s disease, cerebral palsy, or muscular dystrophy, yet public surveys show that only one in 100 people know about aphasia.  If aphasia is so prevalent, why are so few people aware of this condition?  The answer is simple. How can people with aphasia advocate for themselves and increase awareness when their central problem is communication?

 

Fortunately advances in technology are providing new opportunities for people with aphasia to speak up.  Individuals with aphasia who attend the Snyder Center for Aphasia Life Enhancement, a community treatment center in Baltimore, are dispelling the notion that they are unable to advocate for themselves. Members who attend the center use an array of technologies to enable their ability to express their thoughts and reveal their competencies and during Stroke Awareness Month they were, indeed, heard.

 

Forty members with aphasia who attend SCALE decided to increase awareness about aphasia in Baltimore through the arts. On May 4, SCALE hosted a play about aphasia entitled “Nightsky.” The SCALE community partnered with the Hugh Gregory Gallagher Motivational Theatre, a non-profit organization that raises public awareness of disability issues and discrimination in our society through dramatizations of real-life and fictionalized experiences. SCALE members invited the group to perform “Nightsky” to their friends, neighbors and folks from the larger community. Despite severe communication impairments they sold tickets, wrote presentations and presented to more than 135 guests.

 

Some members read their written messages orally. Those who have limited spoken output used programs such as WordQ, and Lingraphica to formulate their messages. Several SCALE members used the Vast Program to enable them to fluently produce the materials that they had written. The Vast Program is an innovative research-based application of video technology designed to facilitate and improve communication abilities for speech-impaired individuals. Following close-up video of mouth movements combined with visual and auditory cues allows individuals to readily produce speech. SpeakinMotion LLC has made this approach available to individuals with motor speech disorders such as aphasia and apraxia through its speech therapy apps and custom recording service.

Howard at NightSky

SCALE participant, Howard Snyder, presents information about “Nightsky” to an audience.

Learning to use these programs, creating their messages and practicing what they intend to say required weeks of preparation and hard work by stroke survivors with aphasia. But, the hard work paid off when they were able to deliver their unique messages themselves to advocate for themselves and to educate the public about the effects of stroke on communication and quality of life.

 

Thanks to the National Aphasia Association for uniting scale and the Hugh Gregory Gallagher Motivational Theatre for this collaborative opportunity to promote aphasia awareness.

 

Denise McCall, MA, CCC-SLP,  is the director for SCALE in Baltimore. She can be reached at dmccall@scalebaltimore.org.

Never Having to Say ‘I’m Sorry’

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“I’m sorry to tell you that Sara has a permanent hearing loss.” One of the less glamorous aspects of being an audiologist is telling a parent that his or her child has a hearing loss. Although this is difficult news to deliver, how you convey that information can potentially have as much of an impact as the hearing loss itself.

Instead of apologizing for delivering this news, another way to frame the conversation is to say, “I know this may come as a surprise to you, but…” Although semantically similar to the apologetic statement, qualitative and anecdotal research has shown that parents will remember verbatim how the news was delivered to them.  As Dr. Jeffrey Lewis, a professor of mental health counseling at Gallaudet University who also teaches counseling skills to audiology students, comments, “This kind of subliminal language, though not intentional, can have real consequences for how the family approaches this news and can set lower or even negative expectations for the abilities of the child”.

Another example of negative messaging is using the word “fail” with regard to newborn hearing screenings.  Not only does “fail” suggest a hearing loss that very well may not be present; it can also make parents defensive. As one parent commented, “How could my daughter fail a test that she didn’t know she was taking?” Many institutions, including Boston Children’s Hospital and Gallaudet University, have incorporated this language into their clinical practice.

Knowing your audience is also important. For example, some deaf parents may be excited and happy to learn that their child has a severe to profound hearing loss. As one deaf parent explained, “With my first child, my husband delivered the results of the newborn hearing screening. He came into my room saying, ‘Alright she did it! Our baby passed the test; she’s deaf!’  When this occurred with our second child however, we were both surprised to learn that he passed in the sense that he was hearing and not deaf like us.”

Other deaf parents may be disappointed or have mixed feelings about this news. Most deaf babies are born to hearing parents who are in complete shock when they learn of the results.  By framing the news in a neutral manner, you are putting yourself in a position to support the parent and answer any questions they may have.

Although we are certainly not denying the shock and grief that most parents experience when facing a diagnosis of hearing loss, the less negative we can make the message, the better. Suhana Alam, a deaf adult recently selected to speak on a panel of successful deaf college students at the Annual Early Hearing Detection & Intervention Meeting in April commented, “The provider…needs to make sure the parents understand that their child’s brain works just fine; he or she just has limited hearing capability.”

As audiologists, we can then work with the family in providing information on the full range of communication options available to them.

Regardless of whether we are seasoned audiologists with years of experience or new audiologists beginning our professional careers, we are constantly adapting to change in audiology and critical evaluation of our language and word choice are easy adjustments that we can make for our patients and family members.
Cynthia Frey wrote this article with Whitney Kidd. Both are graduate clinicians in the Deaf and Hard of Hearing Infants, Toddlers, and Families: Collaboration and Leadership Program at Gallaudet University.

Collaboration Corner: Why Finding Your Virtual Peeps Is Important

June 20

This month I wrote an article for Perspectives in School-based Issues (SIG 16), speaking to the benefits of professional learning communities (PLC). Professional learning communities are the ultimate form of collaboration (DuFour & Eaker, 2010). But consider expanding your boundaries a little further. Consider virtual PLCs; online communities through Twitter, Facebook, and online discussion threads. That’s right, social network sites and online forums can support your professional development, all from the comfort of your living room.

When I bring this up to my colleagues or friends, many groan… it’s one more thing, and how can you possible learn anything in 140 characters? Consider this:

  • One-third of public school speech pathologists travel between two or more schools (Edgar and Lugo-Rosa, 2007), thereby complicating the ability to meet face-to-face with colleagues
  • Professional development is meaningful when it is learner-centered, and by choice (Morewood, Akrum & Bean, 2010).

Virtual discussion forums can provide:

  • Opportunities to globally network with colleagues (Davis, 2012). More than just sharing hyperlinks and lesson plans, chatting with interdisciplinary teams and other educational staff, has broadened my perspective as a practitioner.
  • Online forums foster a chance to reflect (Davis, 2012). I have learned from the #slpchat colleagues, the #slpeeps, #spedchat folks, and the #edchat folks enormously. Many of these groups hold regular chats either every week or at least once a month.
  • Access information, or ask a question whenever you want (Dunlap & Lowenthal, 2009). Anyone with a smartphone can troll Twitter, or participate in an online discussion, any time of the day.
  • Access the only information that you need (Davis, 2012). Social network sites are completely dependent upon the user. This make finding information learner-centered, and not a boring, mandated, policy-driven affair.
  • A way to feel connected and supported (Hur & Brush, 2009). Sometimes getting out of your own workplace can help you regroup after a tough day.

So go ahead, dabble a little. Then advocate for yourself. Talk to your administrators. Write it into your professional development plan. Use the hyperlinks in this blog the and references listed below to support your case. Social network sites can be an affordable, meaningful tool for learning. For all the push to individualize learning for our students, doesn’t it make sense to do the same for those who teach them?

 Dr. Kerry Davis is a city-wide speech-language pathologist in the Boston area. Her areas of interest include working with children with multiple disabilities, inclusion in education and professional development. The views on this blog are my own and do not represent those of my employer. Dr. Davis can be followed on Twitter at @DrKDavisslp.

References:

DuFour, R., & Eaker, R. (2010). Revisiting professional learning communities at work: New insights for improving schools. Bloomington, IN: Solution.

Hur, J. W., & Brush, T. (2009). Teacher participation in online communities: Why do teachers want to participate in self-generated online communities of K-12 teachers? Journal of Research on Technology in Education, 41(3), 279-303. Retrieved from http://www.iste.org/learn/publications/journals/jrte.aspx

 Morewood, A. L., Ankrum, J. W., & Bean, R. M. (2010). Teachers’ perceptions of the influence of professional development on their knowledge of content, pedagogy, and curriculum. College Reading Association Yearbook, (31), 201-219. Retrieved from http://www.aleronline.org/

 

 

Yes, DSM-5 Changes SLP-Relevant Disorder Categories: What You Need to Know

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The speech-language pathology community has been abuzz for months about the pending release of the new Diagnostic and Statistical Manual of Mental Disorders because of expected changes to autism spectrum disorder and other communication disorders involving SLPs.

And indeed, the fifth edition, issued by the American Psychiatric Association last month, significantly changes ASD and several other SLP-relevant categories—and also unveils the new social (pragmatic) communication disorder.

As most SLPs well know, DSM is the standard classification of mental disorders used in clinical and community settings in the United States and other countries. The new edition is available first in print, with an electronic version to be offered later this year. See highlights of the changes to DSM-5 on the American Psychiatric Association’s website.

Here are some of the major changes in the category of Neurodevelopmental Disorders that are relevant to the work of speech-language pathologists:

 Intellectual disability (Intellectual developmental disorder)

  • Replaces the term “mental retardation” with “Intellectual disability (Intellectual developmental disorder).”
  • Relies more on adaptive functioning rather than on specific IQ scores.

Communication Disorders

Changed from expressive and mixed receptive-expressive language disorders to include:

  • language disorder
  • speech sound disorder
  • childhood-onset fluency disorder
  • social(pragmatic) communication disorder

Autism spectrum disorder (ASD)

  • Eliminates pervasive developmental disorder and its subcategories (autistic disorder, Rett’s disorder, childhood disintegrative disorder, Asperger’s disorder, pervasive developmental disorder-not otherwise specified). Instead, children meeting the criteria will be given a diagnosis of “autism spectrum disorder” with varying degrees of severity.
  • Omits criterion related to the development of spoken language.

 Specific Learning Disorder

  • Combines diagnoses of reading disorder, disorder of written expression, mathematics disorders, and learning disorder not otherwise specified.
  • Recognizes the need to use a variety of culturally and linguistically appropriate assessment tools and strategies and does not require use of a standardized measure.
  • Does not include oral language.
  • No reference to modalities of language.


Changes in the section on Neurocognitive Disorders pertinent to the speech-language pathology field include the following:

  • Dementia is considered a major neurocognitive disorder.
  • A less severe cognitive impairment is considered a mild neurocognitive disorder.

We were fortunate to have SLPs involved in developing some of the diagnostic criteria in DSM-5. Amy Wetherby was a member of the DSM-5 neurodevelopmental workgroup and chaired a subgroup on communication disorders. Mabel Rice, Nickola Nelson and I worked on this group. ASHA responded during the three public comment periods.

Now that the new edition is out, ASHA has assembled a DSM-5 response team coordinated by me and composed of Janet McCarty, Andrea (Dee Dee) Moxley, Froma Roth and Monica Sampson. We are developing resources to guide members and consumers on the changes, including at least three articles in upcoming issues of The ASHA Leader. The articles will include:

  • A comparative analysis of what ASHA recommended and what DSM-5 includes, with clinical implications for SLPs.
  • Coding implications for reimbursement.
  • Case studies to demonstrate how the changes will affect people with speech, language, communication and cognitive disorders.

ASHA also will communicate with consumers about what the DSM-5 might mean to them through podcasts, media interviews and other dissemination vehicles. A critical message we want to convey is that SLPs will continue to provide needed services, which are based on assessment of communication strengths and needs, and not on specific DSM-5 diagnostic labels.

ASHA would like to know how you think the changes in DSM-5 will affect your clinical practice. We also are seeking case studies that demonstrate impacts of the changes for a future Leader article. Please contact Diane Paul at dpaul@asha.org.

Diane Paul, PhD, CCC-SLP, is ASHA’s director of clinical issues in speech-language pathology.

Summertime Prep for the School Cafeteria

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Summer!  Ten luxurious weeks of spitting watermelon seeds, munching on veggies straight from the garden and crafting the perfect s’more over the campfire.  As an SLP who focuses on feeding challenges in children, summer food skills are foremost in my mind this time of year.  However, once a week in the summer, my little clients and their families will focus on preparing to eat in the school cafeteria.  Before you know it, it will be mid-August and those little munch bugs will joining their friends at elementary school, or perhaps all-day kindergarten. For kids who are about to go to their very first day of school, it also means their very first day in a school cafeteria, and that can be quite overwhelming, especially for a child in feeding therapy.

Many kids are truly scared of the school cafeteria. In fact, one little boy I worked  with called it “the Café-FEARia.” Imagine a 5-yea- old, on his first day of school, as he tries to negotiate a sea of kids filing into the school lunchroom, attempting to locate his lunch box among 20 others piled into a giant bin and ultimately squeeze into a tiny place to sit at the assigned table. Now, unlatch that brand spankin’ new lunchbox (how does that latch work, anyway?) and peer inside … the clock is ticking … your little munch bug now typically has 20 minutes left to eat, clean up and get back in line with his class; not the most relaxing lunch for any kid.

 

Introduce Weekly Lunchbox Dinners

Feeding therapy is more than just learning the mechanics of biting, chewing and swallowing.  Generalizing skills to multiple environments is essential.  For kids transitioning to school lunch, introduce once a week “lunch box dinners” where the entire family pretends to eat in the school cafeteria.  At the entrance to the kitchen or dining area, one parent stashes a large bin, just like the kids will find at school.  Each member of the family has their own distinct lunchbox thrown into the bin, along with a few “old” random empty lunchboxes so kids can practice digging down to the bottom to find their own.

 

Once everyone is seated at the table, the child can practice the fine motor skills of unzipping zippers, unfastening Velcro® flaps and opening up containers.  Choose a lunchbox that is easy to open and holds all the food in one container.  It saves precious time!  My favorites are Easy Lunchboxes® and Yumbox® , both simple to open and perfect for cutting the food into bite sized pieces.  I call it “grab and gab” food.  Speaking of “gab,” many of my feeding clients also are working on pragmatic skills with their peers, especially when they are in unfamiliar situations.  As an SLP, I teach the parents to practice this little script: “I’ve got ____ in my lunch!”  In all my years of sitting in school lunchrooms and listening to young kids, it’s ALWAYS the first thing they say to each other.  It’s their traditional conversation starter, usually accompanied by them proudly holding up the celebrity food – the star of the lunchbox. I can attest that I hear just as many kids enthusiastically say “I have fruit today!” as “I have (fill in any junk food here) today!”  Try for  the veggies … it’s really okay … it’s just as cool to have vegetables cut up into stars or other fun shapes so they can announce, “I have CUCUMBER STARS today!”  Better yet, get the kids involved packing the lunches and creating fun shapes so they can exclaim “I made carrot triangles for lunch!”  FunBites® are child safe tools for doing just that.  They may not eat them that day, but they will be comfortable with carrots in their lunchbox, and that’s the first step to trying a new food in a new environment.

 

Once the meal is over, everyone latches their lunchbox and puts it back in the bin, just like at school.  The final piece of advice I offer to families is this: The most important word in the phrase family dinner is “family.”  Enjoy this time!  Happy Summer everyone!

Melanie Potock, MA, CCC-SLP treats children birth to teens who have difficulty eating.  She is the author of Happy Mealtimes with Happy Kids and the producer of the kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is approved by ASHA and includes both her book and CD.  She can be reached at Melanie@mymunchbug.com.

Healing the Stuttering Self

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It’s a question so simple, so common, yet so terrifying to someone who stutters:

“What’s your name?”

It’s the first chance to make an impression on someone, and you’re forced to perform the most difficult of tasks because there are no words to switch. Your name is your name. And sometimes it can be hard to say.

The “D” sound was problematic in my name because it began with a plosive. I blocked on the D, and built up so much muscular tension in my tongue tip that the word would get stuck. The more nervous I was, the more tension would develop. This happened hundreds of times throughout my life, each instance chipping away at my self-esteem and adding to my anxiety in social situations.

Facing that question is difficult for me even now, at the age of 44, long free of the burden of caring what others think of me. Even though I am a fully-licensed speech-language pathologist, the question,“What is your name?” still triggers an immediate response of fear, paralyzing my throat and stopping my breath. Sometimes, if I’m caught in the moment, unaware that my name will be asked, I can get it out easily, without thinking twice about it. My fluency is automatic now. However, it’s different when I’m anticipating that I will have to say my name—when my fear of speaking has the time to surface.

Stuttering runs in my family. I began to stutter at around four years of age.

At first, I don’t recall having any difficulty with my speech. I remember sharing a thought with my first-grade teacher one day, the content of which was not significant enough to recall. But I remember the feeling of spontaneously talking because it was one of the last times I would speak freely at school, or anywhere. My stuttering got progressively worse as I began to struggle against it.

The teasing started in second grade, when I was mimicked by classmates, and even my own friends. I would hear laughter when I struggled to get the words out when reading aloud in class. One time in third grade, I was teased about my stuttering by a girl in my class. I cried so hard that other kids came over to see what was wrong with me, thinking that I must be physically hurt because I was wringing my hands in anger.

On the first day of home economics class in my first year of high school, I was unable to say my name during the usual introductions. Every day after that, the table of football players mockingly chanted my name every time I walked into class. By my third year in high school, I spoke so infrequently that I was often asked, “Do you ever talk?”

I had gone through the Precision Fluency Shaping Program when I was 12. I remember the machine I had to speak into to learn gentle onset of voicing. A green light would illuminate when I got it correct. I did hundreds of drills with that machine. I also learned how to take a diaphragmatic breath and to prolong the first sound or syllable of a word. All these techniques finally gave me the tools to speak fluently, but they never dealt with the underlying fear of speaking that had built up over the years. Saying my name was always difficult.

As a graduate student in speech-language pathology, I was mostly fluent, but I still had episodes of stuttering. My fluency disorders professor told the others that I had “exquisite gentle onsets.” I was offered the job of answering the telephone in the department office as a way to practice my fluency techniques. Unfortunately, I had to say “department of communication disorders” when I picked up the phone. I blocked on the D sound, and soon realized that accepting the job was a huge mistake. There were professors and students in and out of the office, so it was hard to concentrate on my fluency techniques.

I had so much difficulty that I began having anxiety attacks. I was made to go into speech therapy, but not allowed to discontinue the job if I wanted to remain in the program. The pressure was too great, the stakes too high. Somehow I got through the semester, but I developed such a fear of the ringing phone that it was three years before I was able to answer the phone even in my own home.

As I learned about the causes and mechanics of stuttering in my course of study, I became aware of the feeling of discoordination between my breath and the muscles in my mouth. I increasingly gained control over my speech with the knowledge of the disorder, but the fear never went away. Since I never processed the fear, I suppressed it.

Now, when the fear grips me, it’s not fear of certain sounds or words, as it was when I was a child. It’s the fear of speaking itself. It’s not a simple discoordination that needs to come under conscious control by employing fluency techniques. The fear goes straight to my vocal chords and locks them.

What I’m finding helpful in those instances, is to take a diaphragmatic breath through my nostrils and exhale gently, then begin vocalizing. If I can do this, the words come out more easily. Another tactic I employ when I know I will be asked to say my name is visualizing myself doing it easily and successfully, over and over, before I actually go into the situation.

To process the feelings that have built up about stuttering, I have begun to examine some of the more damaging experiences from my past and think about them. I replay the situation in my mind, feeling the emotions that were present, then I imagine what I would say to my younger self in that moment. By reframing memories in this way, I can begin to heal them and let them go.

Most importantly, when entering a speaking situation that I suspect may be challenging, I tell myself, “I can do this.” This is what people who struggle with their fluency need to hear. They need to know that stuttering need not define them, and that the ability to gain control over their speech is within their grasp.

Donna L Marland, MS, CCC-SLP, is a pediatric speech-language pathologist who spent many years providing services in public schools. She specializes in language and fluency disorders in her private practice.

Kid Confidential-Behavior Disorders and Language Impairment in School-Age Children

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In January, I read an article published in ASHA’s SIG 16 Perspectives December 2012 issue by Alexandra Hollo from the Department of Special Education, at Vanderbilt University in Nashville, Tenn., titled “Language and Behavior Disorders in School-Age Children: Comorbidity and Communication in the Classroom.”  She brought up some really good points that I think we, as SLPs, need to keep in mind when discussing, assessing and treating children who are labeled with behavior disorders.

Hollo discusses how often times children labeled with EBD (emotional and behavioral disorders) also have undiagnosed LI (language impairment).  According to this article, “Four out of five students with EBD are likely to have an unidentified language deficit,” which may result in children resorting to physical communication rather than effective use of expressive language to resolve issues.  In fact, it is estimated that 80.6 percent of students with EBD also have LI however, more than 50 percent of those LI diagnoses remain unidentified.  If staff members fail to recognize the child’s inability to functionally communicate, negative feelings and interactions between the student and staff members may result, which in turn negatively affects academic achievement. What is known about children with EBD is that they “have the most negative short- and long-term outcomes” (Hollo, 2012).

So what does EBD look like in children?  Well Hollo explains the two subcategories of EBD according to the DSM-IV, difficulties with internalizing and externalizing.  Deficits in internalizing include emotional withdrawal behaviors such as depression, anxiety or mood disorders.  Academic trends for these students with internalizing problems include high rates of absenteeism and low academic achievement.  Deficits in externalizing include disruptive behavior as in ADHD, ODD or conduct disorder.  Students with externalizing deficits tend to be more easily identified and receive services possibly due to the fact that their behavior is disruptive in the academic setting and can more easily be determined to interfere with learning.  Academic trends for students with externalizing issues:  disruptive behavior tends to interrupt and/or terminate instruction and therefore affect learning.  More importantly, it was stated that although students with EBD do perform similarly to those with other disorders on standardized tests, their academic performance tends to be BELOW that of other students with disabilities.

In addition to academic deficits, children with EBD also demonstrate deficits in language and social skills.  These children more often exhibit expressive language deficits rather than deficits in receptive language, and they tend to use simplified language within the classroom environment resulting in teachers grossly overestimating the student’s expressive language abilities.  It is important to note that based on Hollo’s research, the CELF and TOLD were the only two language tests that were able to consistently identify LI in children already diagnosed with EBD.

 

Socially, children with EBD tend to have negative teacher interactions, are often times rejected or victimized by peers, and struggle with use of effective conversational skills due to difficulties in initiating and maintaining friendships, problem solving deficits, and difficulties cooperating and collaborating with peers and adults.  In addition, students with EBD tend to be impulsive and struggle with the use of “inner dialogue” to effectively reason prior to responding to their emotions within various situations.  Their ability to control their emotions, follow directions, and transition between activities, classes and subjects is also affected.

Why is this information important for us as SLPs to know?  Well we must first be educated on the comorbidity between EBD and LI to effectively screen, assess, and treat these students.  We also have the responsibility to train staff members on the child’s communication and social skills deficits so as their behaviors may not be misconstrued.  We as SLPs can be instrumental in implementing linguistic supports for these children which include direct (i.e. teaching emotional language, using self-talk for regulation and problem solving skills, provide opportunities to practice negotiations with peers, etc.) and indirect instruction (i.e. collaborate with staff, train teachers on effective communication styles, teach use of slow rate of speech, etc.).  In addition, we can work with behavioral specialists to follow and enforce the behavioral supports that are deemed necessary to help students with EBD be successful in their daily environments.

So the next time you are in your weekly RTI meeting discussing a “problem child” or a “shy, quiet student,” pay attention, and keep in mind that EBD does not look the same in every child. Some behaviors may in fact be linked to language deficits.  Only we, as SLPs will be able to make that determination effectively in order to ensure students receive the services and support they require.

Note:  This entire article was not discussed in detail here.  I discussed the information I felt was important based on my personal clinical experiences.  I refer you to Hollo’s complete article in the December 2012 SIG 16 issue for further information and details.

Maria Del Duca, M.S. CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona.  She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name.  Maria received her master’s degree from Bloomsburg University of Pennsylvania.  She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues.  She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ.  Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech.  For more information, visit her blog or find her on Facebook.

Kuhl Constructs: How Babies Form Foundations for Language

thumbsup_127461614Years ago, I was captivated by an adorable baby on the front cover of a book, “The Scientist in the Crib: What Early Learning Tells Us About the Mind,” written by a trio of research scientists including Alison Gopnik, Andrew Meltzoff and Patricia Kuhl.

At the time, I was simply interested in how babies learn about their worlds, how they conduct experiments, and how this learning could impact early brain development. I did not realize the extent to which interactions with family, caregivers, society and culture could shape the direction of a young child’s future.

Now, as a speech-language pathologist in early intervention in Massachusetts, more cognizant of the myriad of factors that shape a child’s cognitive, social-emotional, language, and literacy development, I have been absolutely delighted to discover more of the work of Kuhl, a distinguished speech-language pathologist at The University of Washington. So, last spring, when I read that she was going to present “Babies’ Language Skills” as one of a two-part seminar series sponsored by the Mind, Brain, and Behavior Annual Distinguished Lecture Series at Harvard University, I was thrilled to have the opportunity to attend. Below are some highlights from that experience and the questions it has since sparked for me.

Who is Patricia Kuhl and how has her work reshaped our knowledge about how babies learn language?

Kuhl, co-director of the University of Washington’s Institute for Learning and Brain Sciences, has been internationally recognized for her research on early language and brain development, and for her studies on how young children learn. In her most recent research experiments, she’s been using magnetoencephalography (MEG)—a relatively new neuroscience technology that measures magnetic fields generated by the activity of brain cells—to investigate how, where and with what frequency babies from around the world process speech sounds in the brain when they are listening to adults speak in their native and non-native languages.

Not only does Kuhl’s research point us in the direction of how babies learn to process phonemes, the sound units upon which many languages are built, but it is part of a larger body of studies looking at infants across languages and cultures that has revolutionized our understanding of language development over the last half of the 20th Century—leading to, as Kuhl puts it in a 2000 paper on language acquisition she wrote for the Proceedings of the National Academy of Sciences, “a new view of language acquisition, that accounts for both the initial state of linguistic knowledge in infants, and infants’ extraordinary ability to learn simply by listening to their native language.”

What is neuroplasticity and how does it underlie child development?

Babies are born with 100 billion neurons, about the same as the number of stars in the Milky Way. In “The Whole Brain Child,” Daniel Siegel and Tina Payne Bryson explain that when we undergo an experience, these brain cells respond through changes in patterns of electrical activity—in other words, they “fire” electrical signals called “action potentials.”

In a child’s first years of life, the brain exhibits extraordinary neuroplasticity, refining its circuits in response to environmental experiences. Synapses—the sites of communication between neurons—are built, strengthened, weakened and pruned away as needed. Two short videos from the Center on the Developing Child at Harvard, “Experiences Build Brain Architecture” and “Serve and Return Interaction Shapes Brain Circuitry,” nicely depict how some of this early brain development happens.

Since brain circuits organize and reorganize themselves in response to an infant’s interactions with his or her environment, exposing babies to a variety of positive experiences (such as talking, cuddling, reading, singing and playing in different environments) not only helps tune babies in to the language of their culture, but also builds a foundation for developing the attention, cognition, memory, social-emotional, language and literacy, and sensory and motor skills that will help them reach their potential later on.

When and how do babies become “language-bound” listeners?

In her 2011 TED talk, “The Linguistic Genius of Babies,” Kuhl discusses how babies under 8 months of age from different cultures can detect sounds in any language from around the world, but adults cannot do this:

So when exactly do babies go from being “citizens of the world,” as Kuhl puts it, to becoming “language-bound” listeners, specifically focused on the language of their culture?”

Between 8-10 months of age, when babies are trying to master the sounds used in their native language, they enter a critical period for sound development. Kuhl explains that in one set of experiments, she compared a group of babies in America learning to differentiate the sounds “/Ra/” and “/La/,” with a group of babies in Japan. Between 6-8 months, the babies in both cultures recognized these sounds with the same frequency. However, by 10-12 months, after multiple training sessions, the babies in Seattle, Washington, were much better at detecting the “/Ra/-/La/” shift than were the Japanese babies.

Kuhl explains these results by suggesting that babies “take statistics” on how frequently they hear sounds in their native and non-native languages. Because “/Ra/” and “/La/” occur more frequently in the English language, the American babies recognized these sounds far more frequently in their native language than the Japanese babies. Kuhl believes that the results in this study indicate a shift in brain development, during which babies from each culture are preparing for their own languages and becoming “language-bound” listeners.

In what ways are nurturing interactions with caregivers more valuable to babies’ early language development than interfacing with technology?

If parents, caregivers and other children can help mold babies’ language development simply by talking to them, it is tempting to ask whether young babies can learn language by listening to the radio, watching television, or playing on their parents’ mobile devices. I mean, what could be more engaging than the brightly-colored screens of the latest and greatest smart phones, iPads, iPods, and computers? They’re perfect for entertaining babies. In fact, some babies and toddlers can operate their parents’ devices before even having learned how to talk.

However, based on her research, Kuhl states that young babies cannot learn language from television and it is necessary for babies to have lots of face-to-face interaction to learn how to talk. In one interesting study, Kuhl’s team exposed 9 month old American babies to Mandarin in various forms—in person interactions with native Mandarin speakers vs. audiovisual or audio recordings of these speakers—and then looked at the impact of this exposure on the babies’ ability to make Mandarin phonetic contrasts (not found in English) at 10-12 months of age.

Strikingly, 12 laboratory visits featuring in-person interactions with the native Mandarin speakers were sufficient to teach the American babies how to distinguish the Mandarin sounds as well as Taiwanese babies of the same age. However, the same number of lab visits featuring the audiovisual or audio recordings made no impact. American babies exposed to Mandarin through these technologies performed the same as a control group of American babies exposed to native English speakers during their lab visits.

Kuhl believes that this is primarily because a baby’s interactions with others engages the social brain, a critical element for helping children learn to communicate in their native and non-native languages. In other words, learning language is not simply a technical skill that can be learned by listening to a recording or watching a show on a screen. Instead, it is a special gift that is handed down from one generation to the next.

Language is learned through talking, singing, storytelling, reading and many other nurturing experiences shared between caregiver and child. Babies are naturally curious; they watch every movement and listen to every sound they hear around them. When parents talk, babies look up and watch their mouth movements with intense wonder. Parents respond in turn, speaking in “motherese,” a special variant of language designed to bathe babies in the sound patterns and speech sounds of their native language. Motherese helps babies hear the “edges” of sound, the very thing that is difficult for babies who exhibit symptoms of dyslexia and auditory processing issues later on.

Over time, by listening to and engaging with the speakers around them, babies build sound maps, which set the stage for them to be able to say words and learn to read later on. In fact, based on years of research, Kuhl has discovered that babies’ abilities to discriminate phonemes at 7 months old is a predictor of future reading skills for that child at age 5, as noted in a Harvard Crimson article on Kuhl’s Harvard lecture series.

I believe that educating families about brain development, nurturing interactions, and the benefits and limits of technology is absolutely critical to helping families focus on what is most important in developing their children’s communication skills. I also believe that Kuhl’s work is invaluable in this regard. Not only has it focused my attention on how babies form foundations for language, but it has illuminated my understanding of how caregiver-child interactions help set the stage for babies to become language-bound learners.

Sarah Andrews Roehrich, MS, CCC-SLP, works in early intervention at the ThomAnne Sullivan Early Intervention Center in Lowell, Mass.

Note: This post was adapted from an original version published by E/I Balance, a community blog on mental health research, set up by the Conte Center at Harvard University.