Top 12 Pearls of Wisdom For SLP Newbies

pearls

You’ve done it! Congratulations! Six years of school, countless clinical hours, and the Praxis. Now that it’s time to start your first job as a speech-language pathologist. Your first job will teach you all those things you didn’t learn in graduate school. After my first few years, I’ve reflected on the most important lessons I learned and here are the top twelve:

1. Be kind. Be kind to everyone! Everyday. Learn everyone’s names. Thank your secretaries, clerks, and custodians as many times as you can. Don’t underestimate the amount of help they will give you!

2. Go out of your way to connect with families. There are many reasons this is important. You won’t get the full picture of your student’s life if you don’t know something about their family and their life outside the school day. Your parents will be much more likely to buy-in to your homework plans and carryover if you’ve made a personal connection with them.  Lastly, you are taking care of their baby (the most precious thing to them in the whole word). If you’re working with their 3-year-old they will feel so much better if they know who the heck you are!

3. Don’t procrastinate. You’ll need help and there is no getting around that.  If you are writing an IEP at home at 9 pm for an 8 am meeting and then the printer doesn’t work, you won’t have time to make other arrangements.

4. Be a team player. Bite the bullet and volunteer to do things that take extra time. If you have a talent use it to help others. For example, whipping up visuals is super easy for me. Even when a student isn’t on my caseload, I often make up data sheets or visual posters to support students going through our RTI team. Your team will appreciate your talents and you will be able to ask your team to help you with their specific talents.

5. Think generalization from day one. Ask your student’s teacher what is the ONE thing you can work on to make the biggest difference in the classroom.

6. If you make a mistake, admit it, and find a way to solve it. Then don’t make that mistake again. You’re going to make mistakes, just be gracious when you do.

7. Ask for help, but do your own research first. Your co-workers and administrators will be willing to help as you get to know the paperwork. If you can do the research yourself and spend the time to try to solve problems yourself before you check in for help.

8. You aren’t done learning. Get involved with ASHA, blogs, conferences, whatever it takes. When a kiddo comes along and you haven’t seen that disorder before, get busy researching.

9. There’s nothing worse than being out of compliance or completing paperwork incorrectly. Your supervisors might not see how great your therapy is everyday, but the minute you’re out of compliance they will notice. The ‘take home message’… get organized early. Double check your dates and get with your teachers, clerks and intervention specialists. Get yourself organized before you get busy decorating that cute therapy office!

10. Advocate for all things speech and language in your buildings. You might even need to advocate for new ideas within the SLPs in your district. Speak up when you have a good idea, but remember that you’re new. Sometimes it pays to be quiet and listen to what seasoned SLPs have to say. They seriously know so much.

11. Document, document, and document. Remember, if you don’t document it, it didn’t happen.

12. You’re just one fish in the sea. Remember that when it comes to scheduling, therapy time, etc. everyone needs ‘time’ with the students. Work with your team. Just get over the fact that you think you’re done with your schedule the first time. It will change monthly if not weekly.

The best part of being a speech language pathologist is that you’re never done learning. You’ll get new interesting children added to your caseload, be challenged to use new technology, and collaborate in ways you never thought you would. By this time next year you’ll be able to make your own ‘top 12’ list of valuable lessons.

Jenna Rayburn, MA, CCC-SLP. is a school based speech-language pathologist from Columbus, Ohio. She writes at her blog, Speech Room News. You can follow her on facebook, twitter, instragram and pinterest.

ASHA’s Online Community Goes Mobile

mobilephones

I love my smartphone and iPad so much that my husband often makes jokes about my need to be with one of them at all times. No matter what I’m doing, one of these mobile devices is almost always in my hands. I think it all relates to my inability to do just one thing at a time.

So while we are watching MasterChef or The Next Food Network Star in the evenings, I am also keeping up on what is happening in the ASHA Community.

As with any relationship, there are habits or characteristics that are less than appealing about the other person. The pet peeve I have with my mobile devices is the constant need to use pinch-to-zoom maneuvers to read or navigate the browser. To avoid this, I usually download the app when there is one available for a particular website or service.

Until now, the only way I could surf the ASHA Community was with my mobile devices’ browsers. You can imagine my excitement when the ASHA Community Mobile App idea was formed—my hand was definitely raised to be part of the team working on that project! Well, the day has finally come. The new ASHA Community Mobile App is not only helping my relationship with mobile devices, it helps all ASHA members with these unique features:

  • Convenient. Read all the latest discussions from your subscriptions in a single feed.
  • Seamless. Reply to discussions and post new discussions without pinch-to-zoom maneuvers.
  • Searchable. Find your colleagues in the directory and easily add them to your personal contacts. With a couple of taps on your screen, you can send an e-mail or make a phone call to another ASHA member.
  • Latest news. Find ASHA’s Twitter feed and read this and other ASHAsphere blog posts directly in the app.

If you are as excited as I am, then you have already downloaded the app on all of your devices. Just in case, here are the steps:

  1. From your mobile device, click on the appropriate link below or visit your app store and search “ASHA Community.”
  2. Download the app.
  3. Log in with your ASHA username and password.

Get it on Google Play

You’ll see your name at the top of the navigation. Under your profile, you will see Discussions, People, Inbox, Announcements, and a list of communities to which you subscribe. The ASHA Community Mobile App will help you stay connected with other ASHA members and allow you to post questions to your colleagues on the go–or when you are sitting on the couch enjoying your favorite show.

Visit community.asha.org/mobile to learn more about ASHA’s new mobile app. If you have app-related questions, e-mail community@asha.org.

Jill Straniero is ASHA’s online collaboration manager. 

The School Cafeteria: Hurry Up and EAT!

Aug 22

 

Most parents tell me that their elementary school child has 20 to 25 minutes to enter the school cafeteria,  search for her lunchbox buried in a portable tub, find a place to sit, open all the containers, eat (oh, right, eat), then clean and pack up before the bell rings.  In an effort to ensure that their kids eat anything at all, well-meaning parents pack lunchboxes filled to the brim with typically, 7 to 8 different options!

Picture this: Your little first grader searches for spot in a sea of tables, newly found lunchbox in hand.  She squeezes in between her best friends, climbing up onto the metal bench, feet dangling, with her  little elbows resting on the much too high table top, just below her chin.  Most school cafeterias provide the same size seating for the entire school, whether the kids are 3 feet tall or towering 5th graders, about to move on to middle school.  Ever try to eat a meal on a narrow bench, your feet dangling and no back-rest?  It’s not easy.  By the time your child gets  the plastic bags opened, the juice box straw unwrapped and poked hard enough into the box that it squirts her in the face, all while holding up her other hand  to signal the teacher “Can you please open this lid?” well, another 5 minutes have passed by.  Meanwhile,  she’s excited to get out to recess, now just 15 minutes away.

As a feeding therapist, I visit lots of school cafeterias and have learned that parents and teachers have one priority: Getting kids to eat a nutritious lunch.  In contrast, kids have this priority: Talking to their friends.  How then, does a parent pack a lunch, especially for a picky eater or perhaps a child with special needs, that still allows their child some much needed “down time” to chat with friends yet fill their bellies quickly and nutritiously? Here are 3 strategies to do just that:

  1. Send one easy open container plus a drink.  I recommend EasyLunchboxes® BPA-free system, because the lid is easy for little fingers to pop off and instantly reveal 3 to 4 yummy choices.  Another favorite is the Yumbox®, where the single tray is divided into ½ cup portions designed for the key food groups: Fruit, Veggies, Grains, Protein and Dairy.  Both options are quick to open and not as overwhelming as a lunchbox filled to the brim with individual plastic bags, containers and/or drippy fruit cups with tricky foil lids
  2. Pack “GRAB and GAB” food.  Cut fresh fruit, veggies, sandwiches, cheese, etc. into small enough pieces that kids can grab a piece without gazing down and continue to gab with their friend across the table.  My favorite speedy gadget is FunBites® which instantly creates grab and gab bites, yet has no sharp edges.  It’s a fun way to get  kids in the kitchen making their own lunch the night before – once again,  get them involved and they are more likely to eat it later.  For some kids, cutting a sandwich into a larger, fun shape like a dinosaur, keeps the conversation and the eating on the same track.  But, for those kids who tend to just eat a sandwich and skip the other items, try cutting the sandwich into small pieces with a  FunBite® so the child alternates “grabbing”  a variety of foods, much like a mini-smorgasbord.  Remember, you don’t need to send a whole sandwich when sending half leaves room in little bellies for other key food groups.
  3. Include a power- packed smoothie  that you made the night before.  Freeze it directly in the cup (with a lid, of course) and be sure to include a wide straw.  By the time your child opens her lunch, the smoothie will be the perfect consistency, plus it helped to keep the lunch cold.  For elementary school age kids, refillable pouches are another option for healthy smoothie or puree blends.  One of my favorites is the adorable 4.5 oz. Squooshi™, which is freezer and dishwasher safe and free of all the “bad-for-yous” like BPA, lead and phthalate.  Recipes for kids of all ages can be found on the Squooshi website.  Another terrific option is to fill a Sili Squeeze with Eeeze™ food pouch and freeze it with the cap on. Please note that the manufacturer does not recommend storing the Sili Squeeze™ in the freezer for an extended periods of time, but states on their website that “Sili Squeeze™ is the perfect lunch box addition to keep your child’s lunch cool and will be perfectly defrosted for lunch time!”

One elementary school that I visited was graciously flexible to help one little girl eat better.  They provided a smaller table that fit her so that her feet could be on the floor (or try a box underneath little feet as a footrest). The table should be at sternum-height so your child can see her food and rest her arms for stability.  Smaller tables also reduce cafeteria noise and foster social skills thanks to smaller groups of kids sitting together.

Here’s a picture of that sweet little girl.  Note the easy “grab and gab” food in one (and only one) container.  See the rest of the food on the table?  That belongs to the two other kids seated across from her.

Aug22

Tell me about your kids’ cafeterias – the good, the bad and the delicious!  What can we do to help kids in school get more time and more options for a healthy lunch?


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 award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is  offered for ASHA CEUs and includes both her book and CD for each attendee.  She can be reached at Melanie@mymunchbug.com.

Distinguishing Cluttering from Stuttering

boyphone

Developmental stuttering affects 1 percent of the population and over 3 million people in the United States. However, there are other, lesser known fluency disorders that include neurogenic stuttering and cluttering. Telling the difference between stuttering and cluttering is often a point of confusion, so we take a closer look here at what, exactly, cluttering is—and the process of identifying and treating it.

The International Cluttering Association defines cluttering as “…a fluency disorder characterized by a rate that is perceived to be abnormally rapid, irregular or both for the speaker. These rate abnormalities further are manifest in one or more of the following symptoms: an excessive number of disfluencies, the majority of which are not typical of people who stutter; the frequent placement of pauses and use of prosodic patterns that do not conform to syntactic and semantic constraints; and inappropriate (usually excessive) degrees of coarticulation among sounds, especially in multisyllabic words. ”

So what does cluttering look and sound like?

1. Often people who clutter have what I (and many other speech-language pathologists) refer to as “machine-gun” speech. Their speech comes out in rapid bursts, which is described above as “irregular rate,” and may include pauses where it doesn’t feel appropriate.

2. A person who clutters may also demonstrate disfluencies that are unlike what we see in people who stutter. Some examples of disfluencies that are more typical of a person who clutters is excessive whole word repetitions, unfinished words and interjections (such as um and well). I have also noticed more atypical disfluencies, such as final part word repetitions (chair-air, bike-ike).

3. Coarticulation refers to when a person collapses or omits a syllable of a word (for example, “wuffel” for “wonderful”).

There is quite a bit of symptom variability, as well as co-existing conditions, that make this an even more confusing diagnosis. Below is a list of characteristics and co-morbid conditions that have been seen in people who clutter. (Note: Some people who clutter may have several of the below symptoms/co-existing conditions; some may have only one; and some may have none at all.)

  • Limited or no awareness of their irregular speech pattern unless someone draws their attention to it (very different from what we see in stuttering).
  • Sloppy handwriting.
  • Difficulty organizing thoughts; listeners easily get “lost.”
  • Learning disability.
  • Attention difficulties (i.e., ADHD).
  • Auditory Processing Disorders.
  • Asperger’s Syndrome/Autism Spectrum Disorder.
  • Stuttering (a person can clutter and stutter).

If you feel this diagnosis is hard to grasp, you’re not alone.  As a result, this condition goes largely misdiagnosed (as developmental stuttering) or undiagnosed (“I just speak too fast! I don’t have a “real” speech problem!”). For a helpful chart that breaks down the similarities and differences between stuttering and cluttering, see this brochure created by Kathleen Scaler Scott for the National Stuttering Association.

So what do you do if you think your child is cluttering?

Since this a relatively lesser known diagnosis, your best bet would be to find a speech- language pathologist who has experience working with fluency disorders. As you have learned, cluttering is a highly variable disorder. We cannot prescribe a “one size fits all” plan of treatment. There must be careful and continuous observation in order to create a treatment plan that is specific to the symptoms your child is displaying. Here are some common treatment objectives:

    • Self-Monitoring. One common characteristic among people who clutter is limited awareness of their own speech. It is important to heighten the client’s ability to monitor his or her disfluencies, rate, and/or mis-articulations. For a person who stutters, calling their attention to stuttering, although sometimes necessary, may initially cause an increase in disfluencies. However, for people who clutter, calling attention to their speech often helps them improve their rate and overall clarity (at least for a short bit).
    • Over-articulation. Another common characteristic among people who clutter is the collapsing or omitting of syllables. By practicing the over-articulation of sounds, it calls a person’s attention to all the syllables in a word, both stressed and unstressed. The speech of people who clutter may be monotone or “robotic.” Practicing over-articulation can be worked on in conjunction with exaggerating stressed syllables and inflection. Here is a useful video of an SLP discussing the speech of a child who clutters. This particular language sample highlights what it sounds like when a child collapses and omits syllables:http://youtu.be/2AFygz-bxwQ
    • Pausing and Phrasing. Using this technique,  a person practices inserting more pauses into their speech, with attention to the proper placement of these pauses. For younger children, I will have them place pauses every one to three words, but as they get older, more attention will be paid to inserting pauses based on proper phrasing. I often will transcribe a client’s language sample, to include both the words they say and the placement of their pauses. I will then have them mark up the paper with where the pauses should have gone. Having a visual representation of speech is a helpful way to identify when there are way too many words being said between pauses (machine gun speech). Pausing is another too used in teaching a people to slow their rate, which is much more effective and constructive when compared with saying “slow down.
    • Provide strategies for “typical” disfluencies. As noted above, some people will demonstrate stutter-like disfluencies in addition to their cluttering characteristics. In this case, standard stuttering techniques should be addressed. These include cancellations, pull-outs and the like. SLP discussing the speech of a child who clutters. This particular language sample highlights what it sounds like when a child collapses and omits syllables.

Brooke Leiman, MA, CCC-SLP, is the fluency clinic supervisor at the National Speech Language Therapy Center in Bethesda, Md. She is an affiliate of ASHA Special Interest Group 4, Fluency and Fluency Disorders. This blog post is adapted from a post on her blog, www.stutteringsource.com, which focuses on fluency disorders and their treatment.

 

Collaboration Corner: Teaching in South America

aug 15

 

This summer, Scotia Bank sponsored me to support the Step-by-Step School for Autism in Guyana, South America. All of the children have an autism spectrum disorder diagnosis, and a majority are functionally non-speaking. The school officially opened in 2011. Ten children attend the program, most stay from 8:30-12, and a few stay in the afternoon. My talented colleague, Dr. Jim Ellis, PhD, BCBA-D,  assesses the children as they come in, and writes up all of the ABA programs. As far as I know, he’s the only person in the city (more likely the country) that diagnoses children with ASD. He visits several times a year, brings supplies, and supports the staff through Skype sessions and video.

The school sits on the top floor of a car dealership. If you look closely, you can see a trampoline in the top right…which is their outdoor space.

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I think I underestimated the cultural adjustment. While the primary language is English, the dialect is Guyanese Creole, a form of Creole influenced by African and East Indian languages. A couple of days new families came in to meet with me at the school; luckily one of the head tutors was there to gracefully interpret and mitigate any language difficulties. Everything was different from what I was used to–the roads, the livestock wandering the street, the weather, the sound of generators. Not an ATM in site. I did love the mangoes I got to eat every day, and the neighbor next to the school had three beautiful (and loud) McCaw Parrots for pets, which were amazing.

Most of the families do not have enough money to pay tuition. The cost per child is $4,800 per year, which pays for the tutors’ salaries. Assistance is also given for snacks and  transportation costs if the families need help.  That’s right, tutors make about $480 per month, which is considered relatively high for teachers. And don’t think the cost of things is much lower… I spent 300 Guyanese dollars on a bottle of soda, which was about  $2.

In Guyana there are no speech-language pathologists per say, rather there are trained “rehab techs” that, after 18 months of training provide OT, PT and speech services to children and adults. The pay is so low, that qualified people simply leave, so there are simply no speech-language pathologists in the country.

Kudos to the tutoring staff there, aside from a few who have children with ASD, very few of the tutors have any teaching experience, let alone experience with autism, but they do remarkable work. They work around the power outages, flash floods getting to work, and that one morning where we didn’t have running water. The entire program is supported by donations from private citizens and businesses, so finding consistent financial support is a struggle. Despite these obstacles, the students are clearly benefiting.

I appreciated that the tutors welcomed me, a total stranger, into their school. In the mornings, I observed or worked with the students and tutors.  In the afternoons, I conducted training and workshops. A few of the rehab techs from the hospital came to the school, observed the tutors working with the students, and then stayed for training. The majority of my time was spent modeling how to use each student’s communication system, evaluating language, and coming up with communication and language goals.

First, however, the tutors needed a foundation. While I evaluated the students, I assessed the most practical things that the tutors needed to learn. It’s important to know why you are doing what you are doing, so lecturing at them wouldn’t be helpful (let’s face it, none of us really learn that way). Every day, I divided the seven tutors into groups, one group per table. Each table had slightly different materials, whether it be games or books. Every day, the tutors made therapy materials, and then role-played with their partners using the materials to support the games or books on their tables. Then they swapped tables and partners. This was important so they could naturally provide feedback to one another. So, in 10 days, the tutors focused on:

  • How to create communication books and use pictures to communicate (we made 10 in 10 days!)
  • Preliteracy activities: How to modify and present books to enhance language
  • How to use play to support language development
  • How to use Boardmaker® software
  • How to use an iPad to support language and social skills (iPads donated by the British High Commission)
  • How to use pictures and language to support transitions
  • How to use functional sign language to support language development
  • Typical language development for grades K-1

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Learning language through play

One statement that stuck with me, was one tutor who said she loved the sense of teamwork that she felt that week, every tutor pulling together to make materials for all students. Another commented how nice it was to play, and to see how the students responded. The students were amazing and so responsive to intervention.

So, I’m hooked. We will keep collaborating via Skype, and I’m sponsored for two more trips this year. And in August, I will go back to my public school with my newfound perspective of gratitude, and what can be possible.

For more information about the school, please visit the Step by Step Foundation, or feel free to contact me directly by posting to this blog.

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.