What Does a Fulbright Specialist Do?

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The Fulbright Specialist Program links U.S. academics and professionals and their counterparts at host institutions overseas. Qualified academics receive grants to engage in collaborative two- to six-week projects at host institutions in over 100 countries. International travel costs and a stipend are funded by the U.S. Department of State Bureau of Educational and Cultural Affairs. Participating host institutions cover grantee in-country expenses or provide in-kind services.

Communication sciences and disorders professionals are among those who participate in the program. In this post, I (Robert Goldfarb) and my colleague Florence Ling Myers recount our experiences in it.

Florence was a specialist in education and worked at the University of Hong Kong in 2011 for two weeks. She received approval for the five-year placement on the specialist roster. I was a specialist in applied linguistics/TEFL at Universidad Pedigogica Nacional in Bogotá, Colombia for six weeks, with the latter half of the commitment completed online after returning to the United States.

Our experiences were different enough to provide a sense of what a prospective Fulbrighter can expect.

Florence’s experience: Fluency disorders and returning to my roots

My mission in going to HKU was to reinforce the importance of fluency disorders in the family of speech-language pathologies. I gave workshops to students and professionals on cluttering, cluttering/stuttering, and stuttering. I met with academic and clinical faculty and reviewed curricula. Of particular interest was learning the problem-based learning paradigm used by faculty. The pedagogical philosophy is that students need to acquire critical thinking and problem-solving skills, to pose clinical hypotheses based on independent library research and come up with evidence-based therapy approaches for various case studies.

I had the pleasure of co-mentoring a senior thesis in stuttering. The student was bright, responsive and competent. HKU is definitely a high-power university, with great expectations for faculty and graduate students to publish in premier journals.

I also had a personal mission: to return to my roots and give back to my motherland. I escaped to Hong Kong as a refugee from mainland China in 1949 with literally nothing but the reassuring hands of my mother. I took not so much a “slow boat from China,” but a creaky leaky junk under the blackened nocturnal skies from Canton. I now wonder if I had been an illegal child alien. My dad was already in the United States to earn his doctorate in physics from the University of Missouri. Much has changed in Hong Kong since the 1940s, yet there is still this undefinable yet undeniable human spirit—to survive and thrive—among the people there.

Having been in the United States for nearly 60 years, I, too, have changed, though there is still very much a Chinese core in me. Whether or not one is from the East or West, the common bond that motivated me to return to my homeland as a Fulbright Specialist was a passion for cluttering and stuttering, and to instill this passion in the next generation of speech-language pathologists in China.

Robert’s experience: Helping with research methods/professional writing

I committed to teach two intensive graduate courses in research methods and in academic writing to advanced students working on thesis projects. In preparation for the visit, I arranged for my publisher to send some relevant books I had authored, and added others I thought might be useful. In addition, I prepared course packs in English and Spanish (with the help of a graduate student from South America) regarding local idioms. I learned, for example, that people in Colombia expressed something very positive as “the last Coca-Cola in the desert.”

Students also received feedback on their research projects in various stages, from proposals to data collection. Another commitment was a keynote address, called the Foro Fulbright, to local universities and other Fulbright scholars in the country. The students and young faculty were all bright, hard-working and dedicated, but their exposure to research design and international perspectives was provincial. Most students and faculty were open and eager to learn what the global academic community had to offer.

Not all experiences were positive. I was given Thursdays off, because it was known as “riot day,” when vigilantes stormed local universities. Sure enough, on the first Thursday of my visit and the Wednesday of the second week, I was ordered out of the office I shared with colleagues as vigilantes bombed the institution for hours. These events were followed by riot police storming the university. The tear gas they discharged lingered in the air for days.

Finally, on the Sunday before I left for home, I was robbed by a policeman while walking to the supermarket. The executive director of Fulbright Colombia called it a perfect storm of crime and civil unrest, and approved my decision to teach the remainder of my courses online.

Ongoing ties

Our students continue to keep in touch. I have helped several students write master’s theses of which they could be justifiably proud, and the thesis that Florence co-mentored was published the following year in the International Journal of Speech-Language Pathology.

Working as Fulbright Specialists allowed us to interact with colleagues and students abroad, while serving our country as ambassadors of scholarship. While there were some unwelcome experiences for me, we have many positive memories. We encourage you to apply to be on the roster, but note that you will need a bodyguard in some countries.

 
Robert Goldfarb, PhD, CCC-SLP, is professor of communication sciences and disorders at Adelphi University. He is an affiliate of ASHA Special Interest Groups 2, Neurophysiology and Neurogenic Speech and Language Disorders, and 4, Fluency and Fluency Disorders.

Florence Ling Myers, PhD, CCC-SLP, is professor of communication sciences and disorders at Adelphi University. She is an affiliate of ASHA SIG 4.

Get Some Book Drive Know-How

July 25 (2)

 

In low-income neighborhoods, one book for every 300 children? In middle-socioeconomic status neighborhoods, 13 or more books for every child? I read this jarring statistic and had an epiphany. As a university professor, mother of a school-aged child, and part-time itinerant public school speech-language pathologist, I wondered if there was a way I could help effect change for the low-SES children in my own area?

SLPs all over the United States battle with the problem of students who present with cognitive, linguistic, and executive functioning deficits related to being from low-SES backgrounds. Sometimes these students have genuine, underlying language impairments and qualify for language interventions, but many times they are typically-developing language learners whose language deficits stem from their low-SES status and its accompanying disadvantages. As experienced SLPs, we all know that low literacy skills can have lasting and serious consequences. A shocking statistic indicates that in states such as California and West Virginia, prison cells are built based in part upon the number of third grade students who are reading below grade level. What could I do to help?

I decided to attack the problem of a lack of books for children in low-income homes. I started collecting new and gently-used children’s books in fall of 2008 for a graduate student’s thesis. We collected several hundred books, which she used, and then she graduated from our program. In April of 2009, my beloved mother, Beverly Roseberry, died of a heart attack. Mom had been a general education and Sunday school teacher. In the Philippines, where I grew up (my parents were missionaries), my mom always had books for my sisters and me despite the fact that we were quite poor. On one island we lived on, my mom even started a library for the Filipino children. She loved books, and made sure that my sisters and I did, too! I decided to keep the children’s book collection going in my mom’s memory. Today we have collected and donated more than 43,000 books to local children in under-resourced areas. There are 21 area agencies and organizations receiving our books as well as three elementary schools.

 

July 25

Third grade students at Whitney Elementary School receive books to keep and read during the summer.

It can be discouraging for SLPs who work with at-risk, low-SES children to address the seemingly insurmountable obstacles that these children face. One of these obstacles is the lack of access to age-appropriate reading materials. How can the average SLP gather children’s books to distribute to low-SES children to keep as their own? Here are some tips for being successful:

  1. Have a large, attractive, marked box in a central location that is easy for people to get to
  2. Make the collection time-limited (e.g., 1-2 months)
  3. Have a short flier explaining why books are being collected and who they will be shared with. On the flier, have a contact person with contact information (like an email).
  4. If possible, donate the books locally to groups of children that your audience of donors cares about. For example, the books collected by the Orangevale Rotary go to the Orangevale Food Bank. Books collected by moms in Davis go to Head Starts in Davis. People are most enthusiastic if books stay local and connected to them somehow.
  5. Be sure to pick up the books on a regular basis. Don’t let that box overflow and make a mess!
  6. Challenge your group to collect a certain number (e.g., 100-500 books). People love a numerical goal.
  7. Keep reminding people—announcing the book drive one time will not be sufficient.
  8. At the end of the book drive, celebrate with a treat! Share information about where the books went. If possible, share pictures of children who have received the books.

I have had several undergraduate students in our program gather between 300-800 books just by asking their friends. Members of service organizations such as the Rotary often like to take on a project such as a book drive. Churches are another great source. My own church, Bayside, has donated more than 5,000 beautiful books!

Most of all, remember: people love to donate books for a good cause. I have found that many, many people have children’s books sitting around in their homes gathering dust; however, the people are so sentimentally attached to the books that they cannot just give them to a faceless organization. Having a person specifically attached to the book drive—a face to identify with—helps people become more willing to part with books that hold precious memories. If you are the “face” of your book drive, most people will be very generous in their donations.

A book drive has several major advantages: 1) low-income children benefit greatly from having their own books, and their literacy skills improve; 2) your friends get to clean out those closets, and 3) you get the joy of seeing children own their own books—for many, these are the very first books they have ever owned. Collecting and donating children’s books is something I will do for the rest of my life, and I have been privileged to have tremendous support from my students, church, family, and friends. Good luck!

Celeste Roseberry-McKibbin, Ph.D., CCC-SLP, is a professor in Sacramento State University’s Department of Speech Pathology and Audiology and also works directly with students ages 3-18  as a speech-language pathologist in the San Juan Unified School District and has writes a blog about her book drive. She can be reached at sacbookdrive@gmail.com.

ASHA Schools 2013: Putting Your Best Foot Forward

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I needed to find some bandages. Even though it was Friday morning of my fourth ASHA Schools Conference I had somehow conveniently forgotten how even the most seemingly comfortable shoes can feel like torture devices after a day of running and I had forgotten to bring bandages. Luckily the very nice concierge listened to my tale of woe and, instead of making me walk five blocks to the nearest drug store, gave me four bandages from the hotel’s super secret hidden first aid kit. Bingo—I was set.

I don’t wear fancy shoes very often (and usually new shoes for me means new running shoes) but every now and then I’ll splurge on a pair that promises pizzazz and comfort. Hence my silver platform pumps that were actually cleverly disguised “wellness shoes.” Yowza. Off I went to the Long Beach Convention Center.

In the ballroom for the opening plenary: So far so good. Everyone is busy getting their materials and buzzing around saying hi to friends and colleagues. The opening speaker, Murray Banks, infused the audience with his energy and passion for teaching. Once named the Teacher of the Year in Vermont and a recipient of the Outstanding Educator Award from the American Alliance for Health, Physical Recreation and Dance, Murray told the audience that they, as SLPs, were charged with a special mission for each student—to connect with them, no matter how difficult. “Each day,” he said, “remember to look in the mirror and tell yourself ‘It’s show time!’”

The morning sessions were good—really good. I wanted to go to both Sylvia Diehl’s presentation on autism and executive function where the audience learned why “visual supports are the bomb!” and Patti Prelock’s session where she helped the audience identify steps to make an effective integrated team to support students with severe disabilities. I had to divide my time and (of course) they were located at opposite ends of the conference center. I could feel my feet becoming one with my shoes but in a good way. Each speaker emphasized the importance of looking at each child and really learning what was behind the behaviors and to the goals.  In other words, improve a life one story at a time.

Meanwhile I was beginning to take note of the shoes conference attendees were wearing as they, too, ran from session to session. I had already fielded several questions about how comfortable my shoes were, so I was curious about others’ choices. If I had to say there was an overall theme, it was comfort. But that didn’t keep some from wearing heels, straps, and sometimes even flowers on their feet.

It was in Wayne Secord’s Friday afternoon session I gained some insight into the conference’s attendees’ shoe choices. Secord presented the results of a questionnaire that he had presented to each state’s top two speech-language pathologists (each state determined the qualifications and chose one from the schools and one from health care). The idea was for the answers to this questionnaire to illuminate what sets these great speech-language pathologists apart. The presentation was fascinating and some of the characteristics Secord pointed out resonated with me:

  • They remember their priorities
  • Not afraid to take risks
  • They understand the big picture
  • They never got too comfortable in their jobs

And then I started thinking about some of the shoes I was seeing.  They weren’t just comfortable, they were athletic and purposeful. They weren’t just fun, they were creative. They weren’t just borderline uncomfortable, they were a way to not get too comfortable. So, in fact, the very members who were attending this conference and racing to go to all the sessions they possibly could, were, in a way, embracing and displaying the characteristics identified to place them in the top in their profession. I met so many wonderful people at this conference and was reminded once again what a special breed it takes to be a school-based speech-language pathologist.

Going forward into the conference on Saturday and Sunday, the race continued as there was so much to see. People were running to catch Vivian Siskin’s session on Avoidance Reduction Therapy for children who stutter; others clamored to see Bonnie Singer’s instructional strategies for academic writing; and there was practically a stampede of members vying to hear Judy Montgomery share vocabulary strategies to support the Common Core State Standards. I did notice, however, that the number of high heels had greatly diminished by Sunday.

After one of the afternoon sessions I decided to check out the exhibitors in the Exhibition Hall. Among the many vendors of books, speech software and literacy programs, I came upon Kathie Kenaston who was representing the Fairbanks, Alaska, school district and trying to recruit SLPs to come to Alaska. A former California girl, Kathie has lived in Alaska for more than 20 years and loves it. I asked her how recruitment was going and she said that it’s slow but steady.

“Going to Alaska isn’t for everyone, but it’s perfect for the right person. I’ve seen people embrace it but I’ve also seen people not be able to handle it,” she said. “When I’m talking to someone about it I can usually tell if they’d like it by their shoes.”

Look for more ASHA Schools Conference 2013 coverage online in the upcoming August issue of The ASHA Leader.

Kellie Rowden-Racette is the print and online editor for The ASHA Leader. She can be reached at krowden-racette@asha.org.

 

 

 

Collaboration Corner: Being Included

July 18

 

This is a story of why inclusion works. This story is about the sincerity of a fifth grade class, who like most 11-year olds moving to middle school, are full of excitement and angst. They had been together since kindergarten. When they were in fourth grade, a new student arrived. Abby (not her real name) entered their classroom as sweet student full of spunk and delight. A child with Downs Syndrome and autism, Abby is non-verbal. While in school, she learned how to use PECS, some signs, and her Dynavox. Most of all, she developed a fierce attachment to her peers, teachers and school community.  The feeling was mutual. When she was absent, her friends would ask how she was doing. Her peers pulled her into their games and conversations, whether by using sign, or learning to use her communication systems. An outside observer would never  have guessed that Abby was relatively new to the class or her school.

Which is why, two days before fifth grade graduation, when Abby didn’t come to school, her classmates became worried. They discovered that just a few days earlier, Abby had fallen and broken her leg, and would miss her graduation.

And that’s when the good stuff happened. The class decided to make Abby a get well video, and sang Twinkle, Twinkle, Little Star, a personal favorite that she often asked for when in class. Her elated parents called the school. According to her parents, Abby sat in her leg cast, watched the video, and beamed.  She smiled and waved at the video while her friends wished her get well and sang.

Then the school organized a graduation ceremony. Given her injury and sensitivity to sound and large crowds, the school arranged a smaller graduation, just with her fifth grade class. We all hoped that Abby would be well enough to make it that following Monday.

Monday arrived. With fans blowing, and classrooms sweltering 90 degrees, Abby came into school by wheelchair. Even though the class had graduated a week earlier, they wanted Abby to experience the same excitement they did at their own graduation. The staff cued up Pomp and Circumstance, and the class filled in the bleachers with Abby in line. My friend and colleague gave a graduation speech dedicated to not just Abby, but to the whole class. She spoke of how this class that grew up together readily embraced a new student to their class. How their acceptance reflected sincerity found in communities of people that care for one another. They learned how to reach out to her, and she taught them how to become a friend and advocate.

The ceremony concluded with the class singing and dancing to, Head, Shoulders, Knees and Toes, Abby’s favorite song. Then, for the second time in a week, the students received their diplomas, congratulations and a handshake from the principal and staff. As she rolled up and took her diploma, the class gave an enthusiastic (but silent) cheer for Abby.

As the class emptied the bleachers row by row to the song, Time of your Life, Abby began to cry. Maybe it was the activity, or the noise, but it almost seemed that on some level, Abby knew that this was the end (or the beginning) of something special.

The values posted on the front of our school building our simple: Be kind and respectful to everyone and everything. Include everyone.

Role models are what we need most in inclusion. Congratulations to the class of 2013, you sure are the best. Thanks for reminding me why I got into this career in the first place.

 

Kerry Davis, Ed.D, CCC-SLP, is a city-wide speech-language pathologist west of Boston. 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.

On the Other Side of the Table: Receiving the Diagnosis

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As a professional working with communication disorders for 13 years, I find it second nature to complete evaluations and report results and recommendations to families. Due to my graduate training and a couple of wonderful professors—in addition to an understanding of assessment and treatment of speech/language impairments—I feel I came away with effective skills in counseling and empathizing with families in the face of an unexpected diagnosis.

It was not until recently, however, that I found myself on the other side of the table, watching my father go through neurological and cognitive testing and hearing the impending diagnosis: moderate Alzheimer’s.  Though I was confident he was showing clear signs of dementia prior to the evaluation, as I sat with him during the exam, it was difficult, yet eye opening, to watch him struggle through simple language and memory tasks that previously would have been so easy for him.

Even more eye opening was his own unawareness of the problem, his inability to understand the reason he was seeing a neurologist in the first place, and the fact that most of his responses were incorrect, though he thought he nailed them!

At home with my mother, more eye openers came very quickly.  Though I primarily work with children, I have always been a big advocate for family and parent training, and I have sought to educate and include parents and family members as much as I can in the treatment of my clients. I have learned that my skills—what comes naturally to me, how I engage with children, how I intuitively attempt to promote speech and language at every turn—are not skills I can assume that parents and caregivers possess, and this understanding has helped me shape my family/parent education model.

With adults, however, I haven’t always thought in those terms.  I have come to realize that I tend to assume that adults, especially educated adults without impairment, should know how to engage with other adults who have cognitive-communication impairments.

It took me by surprise that my mom did not possess the understanding or the skills to handle my father’s memory lapses, lack of retention, confusion, reduced reasoning skills, and disorientation to time, place, and people.  The changes that are needed in their current home environment and in my mom’s interactive style with him appear obvious to me, and I can immediately “frame-switch” with him, changing the way I respond, react, reassure and redirect due to his current deficits. My mom, however, doesn’t know where to begin. Though she is an intelligent and very caring person, she appears stuck in the relational style she has always had with him, demonstrating by her words and actions that she expects from him the same sharpness and clarity of mind.

There is no overt denial of his condition, but there appears to be what I’m calling a “relational denial.”  She knows his cognitive function is progressively deteriorating, but she does not know how to modify her way of interacting with him. She cannot even identify that her expectations have not changed. The take-home point that has been solidified for me is this: One of the most important and effective roles I have as a speech-language pathologist serving adult populations is caregiver education and training.  I realize this is not a breakthrough discovery in the field of speech-language pathology, but I believe many of us do not spend enough time giving caregivers the tools and strategies to help themselves and their loved ones.

Even though my mom and I talked openly, honestly and lovingly about the needed changes, she could not readily implement them. Switching her frame of mind and subsequent actions and reactions has required much intentional modeling and repetition on my part. It has required identifying how she automatically responds and reacts, then identifying what a more effective way to respond and react would be to reduce her own frustration and his.

One discussion session would not have been enough.  A set of handouts or a brochure would not have been enough. Recommending a good book on Alzheimer’s would not have been enough.

This experience has caused me to evaluate not only my views on caregiver education and training for adult populations but also my investment in a hands-on family education model that is thorough, caring, and thoughtful. Families and caregivers desperately need our expertise in practical ways to effectively cope and help their loved ones!

 

Ana Paula G. Mumy, MS, CCC-SLP,  is a trilingual speech-language pathologist who provides school-based and pediatric home health care services in Colorado Springs, Colo. The author of various continuing education eCourses, leveled storybooks and instructional therapy materials for speech/language intervention, she also offers resources for SLPs, educators and parents on her website The Speech Stop.

Kid Confidential: What Reactive Attachment Disorder Looks Like

July11

 

Over the last few years, I have become aware of an increase in the number of referrals to assess children diagnosed with Reactive Attachment Disorder. Whether this is a coincidence or an indication of statistical increase in incidence of RAD, I cannot say.  What I can tell you is how clinically interesting and extremely frustrating these cases can be.

What is RAD?  According to Nancy Thomas, author of “When Love is Not Enough: A Guide to Parenting Children with RAD-Reactive Attachment Disorder,” RAD,  originally termed “attachment disorder” prior to 1979, is defined as a condition where an individual has difficulty forming lasting relationships and lacks the ability to be genuinely affectionate toward others.  In addition, persons with RAD do not learn to trust others and do not appear to develop a conscience.  This is believed to be caused by abuse or separation (physical or emotional) from one’s primary caregiver during the first three years of life which translates to an internally suppressed rage.  If untreated, children with RAD grow up to be adults who cannot truly ever feel love.  It is suggested that many of these adults will eventually be labeled as sociopaths or psychopaths.

According to Thomas, the following are a list of some signs that put infants at high risk for RAD in the first year of life:

  • Constant crying or a weak crying response
  • Tactile defensiveness (after 8 weeks, flinching or startling)
  • Poor clinging or holding on
  • Resistant to cuddles (may seem “stiff as a board”)
  • Lacks strong sucking response
  • Lacks eye contact and tracking skills
  • Demonstrates developmental delays
  • Does not exhibit a reciprocal smile
  • Doe not demonstrate “stranger anxiety”; appears to be indifferent to strangers
  • Will exhibit self abusive behaviors (head banging, etc.)

 

What can parents do to facilitate bonding with their infant?  Thomas makes several suggestions in her book.  Here are just a few of them:

  • Breastfeed if at all possible; hold bottle, never prop it up
  • Use a sling or carrier to carry the infant front facing toward the child’s mother for 4-6 hours daily
  • Baby massage, 20 mins/daily while smiling and using a high voice
  • Rock and hold infant with good eye contact while singing and taking using “motherese”
  • Sleep with or near parents at night
  • Nap skin to skin on dad’s chest

As these infants may be referred to speech-language pathologists due to feeding problems, we may be the first professionals to see these children.  So I believe it is important for us as professionals and parents to learn the warning signs and make the appropriate referrals as needed.

The following are signs and symptoms of RAD in children found in Thomas’ book:

  • Child is superficially engaging and charming
  • Lacks eye contact on parents’ terms
  • Demonstrates affection with strangers indiscriminately
  • Not affectionate on parents’ terms (no cuddling, etc.)
  • Appears “accident prone” in that the child is destructive to self, others and objects
  • Exhibits cruelty to animals
  • Steals
  • Lies about obvious things (outlandish lies)
  • Lacks impulse control; hyperactive frequently
  • Developmental delays (“learning lags”) due to being in a state of anger and frustration affecting ability to learn
  • Lacks cause and effect thinking
  • Lacks conscience
  • Exhibits abnormal eating patterns (not eating and/or gorging)
  • Has poor peer relationships
  • Seems to be preoccupied with fire, blood/gore, violence
  • Persistent nonsense chattering and questioning
  • Very demanding or inappropriately clingy
  • Exhibits abnormal speech patterns for the purpose of controlling situation
  • Attempts to triangulate adults against each other
  • Tells of false allegations of abuse
  • Feel entitled
  • Parents appear angry/hostile

 

What type of therapy works for children with RAD?  According to Thomas’ attachment therapy is a must. A good attachment therapist will work with the parents and child to create an attachment.  He/she will NOT allow the child to manipulate and triangulate them against their parents.  Additional therapies that can be of use in conjunction with attachment therapy are:  holding therapy, Neurofeedback or EEG biofeedback, EMDR (eye movement desensitization and reprocessing), Theraplay, Therapeutic horseback riding, specialized art therapy, music and sound therapy (Tomatis, Somonis), massage, nutritional supplements, and Psychodrama.

 

As SLPs, we may have children who have been or have yet to be diagnosed with RAD referred to us due to the “abnormal speech patterns” they tend to use.  The difficulty is in determining the true communication abilities of these children.  According to Thomas, little research supports effectiveness of speech services for children with RAD as communication is often times not truly affected.  Therefore, our role becomes more of a referral source either to a child psychologist for diagnostic purposes or to an attachment therapist for possible treatment.

 

Case Study, “Johnny”, 3 years old, seen in early childhood special education classroom setting:

 

Speaking from personal experience, I too was duped with the first child I ever suspected to have RAD.  Although, he was not diagnosed prior to my evaluation, I had come believe RAD was a strong possibility after many, many hours of collaboration and consultation with his early childhood special educator.

 

For confidentiality purposes let’s call this child, Johnny.  Johnny was reported to be a “difficult” child at home, requiring his mother’s constant attention, exhibiting extreme anger during typical play and sharing situations, highly impulsive, and very much enjoyed using language for the purpose of interrupting the classroom and manipulating adults.  As I was not familiar with this child prior to the evaluation, the only information I had were parent complaints of behavior at home.  When speaking to his mother, I was surprised to see that as Johnny tried to snuggle up to his mom in front of me, she would roll her eyes and push him away.  I didn’t understand then, that this reaction was because she knew he was attempting to manipulate me, showing me he was the loving child and his mother was the “bad guy.”  I didn’t know then, that his mother had spent years with little to no sleep because he insisted on sleeping on a cot at the bottom of his parents’ bed at night and woke up every night pretending to sleep walk.  I didn’t know then that Johnny would use a very high pitch and what I can only describe as “baby talk” when he wanted to seem sweet and affectionate all while trying to get something he wanted from someone.  I didn’t know then that this child would demonstrate the most rage and anger I had ever seen in a 3-year-old.  I didn’t know then, that the language he was using during my evaluation was his way of manipulating me.

 

After a few months, it became quite clear that the expressive language deficits Johnny exhibited during the initial assessment were not an accurate view of his true abilities.  In fact, although considered typically developing, he appeared to have higher receptive language skills than he portrayed during testing as well.  Academically, when Johnny would slip up a bit and show us what he really knew, he demonstrated good rote counting skills, early identification of some letters, and understood concepts of sorting and patterning with ease.  However, he had significant difficulties with peer interactions.  At this time, I attempted to change my strategies and help with his social skills by focusing on verbal expression of feelings of anger/frustration and using cognitive problem solving skills to determine appropriate behaviors during peer interactions in order to reduce hitting, grabbing, and physical contact with peers.

 

Yet, it wasn’t until the day, during a school assembly, Johnny picked his nose so long that he was gushing blood, did I realize he did not seem to register pain like you and I do.  As his teacher was unable to leave the rest of the classroom in the assembly without her, I took Johnny back to the classroom bathroom to clean up. Of course this was a day the school nurse was not in so I was on my own.  As he approached the bathroom, I watched as he stood up on the stool, looked in to the mirror and proceeded to smear his blood all over his face and arms while smiling in the mirror.  He did not see me watching him.  I’ve never seen a 3-year-old act like this.  It was in that moment, I became a true believer that he could very well be a child with RAD.

 

Unfortunately, Johnny and his family moved out of state prior to ever getting an outside evaluation to determine or rule out RAD.  And as you can imagine, the therapy strategies I attempted failed to carryover to functional play situations, although in the therapy room, he seemed to say all the right things (incidentally another sign that he might have had RAD).

 

I share this story with you because I know how easily one can be mislead and manipulated by a child.  Although I know I cannot diagnose RAD but based on the above signs and symptoms, Johnny exhibited 15 out of 22 of them and in my humble opinion, RAD was a very good possibility.

 

As they say, hind sight is 20/20, and I feel I am still learning long after Johnny is no longer on my caseload.  If I could turn back the clock there are two things I would have done differently.  Firstly, once I knew Johnny and saw him for who he truly was, I would have told his mother with sincerity that I believed her when she was telling me about his behavior problems at home.  Secondly, I would have pushed harder for her to follow through with a psychological evaluation prior to their move out of state.

 

At the end of the day, for the few months that I worked with Johnny, I learned to question everything I thought I knew about child development and language acquisition.  I learned to keep looking, consulting, collaborating and never give up trying to find the source of the problem.  Even if clarity came to us as a multidisciplinary team too late, I find that I will always be grateful to Johnny for the lessons he taught me and how he has personally made me a better diagnostician, therapist, collaborator and yes, even a better parent to my own son.

 

RAD can be a very confusing and trying disorder to understand.  We as professionals can work with a child for a very long time before we realize all the signs and symptoms are really pointing to something other than communication deficits.  However, as long as we never give up trying to help, as long as we continue to consult, collaborate, and research we may just be able to help these children by referring them to the correct professional.

 

 

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.

What Every Beginning SLP Wants to Know

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Your course work is over.  Your campus supervision went well but now you are out in the “real world.”  You know about normal development.  You have read up on various language and speech disorders but now what?

During my more than four decades of work, I have found that the answers to the questions I get asked are not in textbooks. They are in the trenches of experience. Clinicians do not want to know when children eliminate fronting or when irregular past tense develops; they can look up things like that.  They want to know about the nitty-gritty of conducting a session.

Today an extern was asking a child to say, “I want the bus,” and he would not respond.  I stopped her and asked her what it was she wanted him to do.  She looked perplexed because this sounded like an odd question when it was so obvious that she wanted him to repeat the sentence.   Noticing her look, I then asked her what she was trying to “accomplish.”   She said she wanted the child to request.  Well,  if the child could repeat her sentence, he obviously had the structure, “I want the train,” and if he was whining, reaching for the train and saying “train,” then he had mastered requesting. So what was it that she really wanted him to do? What was it that she thought he couldn’t do?

When questioned about the child’s skills, the extern said that the child could say, “I want….” in various contexts and that he could label “train,” so she wanted him to use the structure of “I want the train” to get the train. What she was trying to accomplish, without knowing it, was having the child use the skills he already had. She was not teaching him to request. She wanted him to “use his words.”

Carryover is an integral part of therapy, but you cannot force a child to speak or to “use his words.”  This is a battle you will not win.  You can continue to ask him to repeat, withholding the toy until he says what you asked him to say.  But what purpose does that serve other than frustrating everyone?

To aid compliance, we set up a scenario in which there were two different toys in close proximity—so close that the child’s pointing did not make clear which toy he wanted.  Taking the toy he wanted was acceptable, but the extern continued to ask, “What do you want?” even when the child just took the toy.  As he took the toy, the extern would say, “Oh, you want the train.”  The extern then requested a toy she wanted by saying, “I want the ….” and taking it from her pile of toys.  She continued to arrange toys in such a way that pointing did not help the child get what he wanted, and when he whined, she ignored it. She just requested the toy she wanted and took it.

The extern set up play situations where she was able to ask, “What do you need now?” The child began to say the name of the toy he wanted.  With continued modeling, he said a reasonable approximation of, “I want the train” by the end of the session.  Exuberant praise and the acquisition of the toy were very reinforcing, and the child used the “I want” approximation a few more times during the session.  It did not become a “talk or else” situation. It was a situation where speaking made it easier for the child to get what he wanted.  The intervention was given context and the end product was the child’s obtaining what he wanted by requesting it.

The main point here is to know what you are doing, what you are trying to accomplish, and what is that you are doing that is at cross purposes to what you actually want.  And to not make speaking a challenge for the child or a condition for playing, but to demonstrate that speaking facilitates communication.

I was a beginning SLP once, know the frustrations, and want to help. If you have other not-in-the-textbook questions you’d like answered,  pose them below in the comment spaces so that I might address them in future blog posts.

Irene Gilbert Torres, MS, CCC-SLP, chair of ASHA’s Multicultural Issues Board, is a clinician in New York City. She concentrates primarily on infant and preschool evaluations and supervision of graduate students. She is an affiliate of ASHA Special Interest Groups 11, Administration and Supervision; 14, Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations; 16, School-Based Issues; and 17, Global Issues in Communication Sciences and Related Disorders.

The Blame Game

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Although researchers are gradually learning more about stuttering and its cause/s, there is still a lot that remains a mystery. With “the unknown” comes room for parents to try and fill in the gaps with their own guesses as to what caused their child to begin stuttering. One of the questions I most often hear from parents is “Is it something I did?” The answer is a resounding “No!”

What We Know

According to the Stuttering Foundation, there are four factors that most likely play a role in the development of stuttering. It is hypothesized that a combination of these factors may result in a child with a predisposition for stuttering.

1. Genetics: Approximately 60 percent of people who stutter have a close family member that stutters as well. In addition, recent research by Dr. Dennis Drayna has identified three genes as a source of stuttering in families studied.

2. Neurophysiology: Brain imaging studies have indicated that people who stutter may process language in different areas of the brain than people who do not stutter.

3. Child development: Children with developmental delays or other speech/language disorders are more likely to stutter. (Note: By no means, is this implying that all people who stutter have delays in other areas. There is simply an increased likelihood of stuttering in children with developmental delays and language disorders.)

4. Family dynamics: High expectations and fast-paced lifestyles may play a role in stuttering.

Family Dynamics?? I Thought I Wasn’t the Cause??

You’re not! There are plenty of “fast-paced” families out there that do not have children who stutter. However, there are certain environments that may exacerbate disfluencies in a child who already has the increased propensity to stutter. This does not mean that you have to lower your expectations for your child or take them out of their extra-curricular activities. However, there are some changes that may help. Although I advise parents not to tell a child to “slow down” or “relax,” I do suggest slowing your own rate of speech and inserting more pauses. This decreases time pressure and models a more relaxed way of speaking. Indicate you are listening to your child with eye contact and by trying to set aside some time during the day that they have your undivided attention. Try your best to reduce interruptions. This can be easier said than done so don’t beat yourself up over this one, especially when there are siblings involved! On days that your child is having particular difficulty, reducing questions and language demands (i.e. “Tell grandma what we did yesterday.”) is a good idea. Let them initiate when they want to talk. Keep your expectations high, but give them a break on rough days!

If I’m Not To Blame, Then Why Does My Child Stutter More at Home And Around Me?

Although this is certainly not true of all children, many of my clients have stated that their child stutters more at home. Contrary to what most parents would believe, this is usually a positive thing and not a sign that they are doing something wrong. What these parents are witnessing is “open stuttering.” Open stuttering occurs when a child (or adult) speaks freely and without hiding, avoiding or “going around” words that they worry they may stutter on. Instead of feeling accountable for this increase in disfluencies, parents should be praised for creating a supportive environment that has allowed their child to be themselves and has encouraged their child to express themselves whether or not they stutter. At school or around peers your child may not stutter as frequently, however this may be a result of avoidance behaviors such as switching words or opting to speak less. These avoidance behaviors can be exhausting and frustrating. Home should be a place for your child to take a break from “avoiding” and say exactly what they want to say, when they want to say it (even if it means taking a little longer to come out!).

But What About The Techniques My Child Is Learning In Speech?

The strategies your child is learning with their speech-language pathologist are extremely valuable in giving them a way to regain some control over their speech, especially when entering a difficult speaking situation (i.e. reading aloud, oral presentation, introducing themselves, etc.) However, when it comes down to it, it is up to them when they choose to use their speech tools. They should be praised when they practice or use their techniques but also praised for open stuttering. It may not be easy, but resist the urge to feel (or express) disappointment when your child stutters. Instead, be proud that when they begin to stutter they are choosing to continue to speak and be heard.
Brooke Leiman, MA, CCC-SLP, is the Fluency Clinic Supervisor at National Speech Language Therapy Center in Bethesda, MD. Brooke hosts a blog dedicated to informing people on stuttering and stuttering therapy at www.stutteringsource.com. She can be contacted at Brooke@nationalspeech.com.

Summertime Speech and Language Activities for Toddlers

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It’s summertime. The days are longer, the kids are out of school, and everyone wants to be outside. But for toddlers receiving speech treatment, the warm weather needn’t mean a lapse in between-session stimulation of speech and language skills. In fact, the outdoors offers ready-made opportunities for play, and thus for rich speech interaction.

As speech-language pathologists well know, children learn through play—as a natural part of their development. And it can also be fun for adults. What better time for parents to let out their inner child than the dog days of summer?

Here are some fun things I suggest that parents do to develop and build on their toddlers’ current speech and language skills:

  • Take a walk with your toddler through your neighborhood, downtown, or local park.  Talk about everything you see, such as cars, trees and birds, while using simple language.  For example you can say, “Look at the little red car.  It’s going fast.”  You can also have your toddler identify common objects you name by gesturing or pointing toward that object.
  • Blow bubbles outside.  Have your toddler request “more” or “bubble” to get you to blow more bubbles.  If he/she is beginning to put words together have him/her say, “more bubble” or “want more bubble.”  He/she can also repeat “pop” or “pop bubble” when popping the bubbles.  If pronunciation is an issue, have him/her say “buh” or “buh-buh” for bubbles or “pah” for pop until he can say the word correctly.
  • Swim with your toddler at your community pool.  Work on receptive language skills (what your child understands) by having him/her perform simple actions on command in the pool such as jump, kick, and run. Target expressive language skills (what your child says) when jumping in and out from the side of the pool by having your toddler repeat words such as “go,” “in” and “out.” Pool time is also a great opportunity to work on identifying basic body parts such as eyes, nose, mouth, feet and hands.
  • Finger paint in the backyard.  Name the colors as your toddler paints them. Have him or her recognize colors by showing you specific colors as he/she is painting.  Have your toddler verbally name the colors if possible.  Draw basic shapes, such as circle, square and triangle as you’re painting with your child.  Again, have him or her recognize the shapes by pointing and, if possible, verbally saying their names.
  • Parents and SLPs can find a list of 25 toddler summer activities—and find a free Toddler Speech and Language Kit—on my blog, Talking With Toddlers. The bottom line is be creative and take it outside this summer!

 

Rebecca Haas is a pediatric speech-language pathologist and mother to identical twin toddlers in Jackson, Miss.  She works with First Steps, Mississippi’s early intervention program, and also sees clients in her private practice Talking With Toddlers, Ltd. This post is adapted from her blog, Talking With Toddlers.