Collaboration Corner: AAC & AT: 5 Tips, Myths and Truisms

AAC

 

Look around at every stop light and you will see the soft addictive glow of smartphones. Minivans off for a family vacation are burgeoning with tablets and some other thumb-numbing form of entertainment.  For more particular consumers, any technology prefaced with an “i” will do.

For people with complex communication needs, tools for learning and speaking have become more affordable and accessible.  But this easy access is not without its challenges.

It’s true that augmentative and alternative communication (AAC) platforms have made it into the cool kid circles, but this can make it more confusing for families and therapists to make informed decisions. Beyond You Tube and Candy Crush, it is important to remember the why and how of AAC and assistive technology (AT). Here are some points to ponder before getting too bedazzled.

  1. “AT and AAC are the same thing.” Not so much. While AAC falls under the umbrella of assistive technology, it requires a specific skill-set. Just as “related service provider” or “allied health services” includes SLP services, I would not assume the job of my physical therapy colleagues and start recommending orthotic devices. Same with AAC and AT; both tools aid and assist, and include low tech (such as a pencil grip, picture schedules) and high-tech interventions (anything that plugs in). The difference here is who is involved: AT includes a wide range of professionals well-versed in making recommendations, from special education teachers to AT certificate holders. AAC does not. In AAC, the “C” stands for communication. It is within our scope of practice per ASHA guidelines. As far as I know, it’s not under the domain of other disciplines. Period.
  2. “I don’t get it, he has an ipad, he should be able to (fill in your random ability here).” A large reason for device “abandonment” is a mismatch between the tool and the user. As SLPs your job is to consult with other experts to make sure it fits the child’s needs in terms of accessibility; fine motor, vision, and positioning are just a few considerations. AT, particularly high-tech AT, requires additional considerations, with the primary focus being, does it aide and assist?
  3. “Everybody has one.” ‘Nuff said. Social pressure should not guide recommendations. AAC is prescriptive. I know it can be difficult, but stay strong and focused on what is appropriate and effective.
  4. “He is so good at using technology, so then why can’t he…?”  My 10 year-old can use keys to unlock the door, but I wouldn’t give him the keys to drive to the store and pick up milk. Technology is a tool. AAC is a tool that requires explicit teaching. SLPs and parents are teachers that guide the process. Here is where it is important for us to educate, model and educate some more. As evidence-based practitioners, we need to take data. Data guides us on what’s working to guide what needs to be changed. For my students with autism spectrum disorder, it has been so helpful working with, and learning from, certified behavioral specialists, and come up with a system that everyone can use.
  5. “She uses it at school, and home is a time to relax, not work.” Consider the social circles of communication partners described by Deanna Wagner and colleagues (2003):
    diagram(adopted from Wagner, Daswick & Musselwhite, 2003)

    Becoming a confident communicator means practice: practice at home, practice with friends and friendly acquaintances, familiar and unfamiliar people, and within the context of different places. Don’t aim for perfection. Just aim for opportunities to practice!

Kerry Davis EdD, CCC-SLP,is a speech-language pathologist in the Boston area, working with children who have significant communication challenges. She conducts trainings and workshops, and serves as a volunteer speech pathologist and consultant for Step by Step Guyana, a school for children with autism in South America. The opinions expressed in this blog are her own, and not those of her employer.

Making the Most of Summer Fun: Language-Based Activities for Children & Their Families

With summer just around the corner, many parents and teachers are already making plans for summer fun. Do you need ideas for speech-language activities during the summer break? Read on!  Here are my top suggestions for fun, language-based activities that target communication skills in memorable ways.

Take a walk – A walk that incorporates language skills can be as simple as a stroll around the block, or as complex as an afternoon hike to a scenic destination. As you walk, encourage conversation by asking open-ended questions or observations like, “I wonder what this is!”  Take note (out loud) of things that you see, hear, discover and enjoy, encouraging your child to do the same. You could also create a game or scavenger hunt for your walk, prompting your child to search for and label objects using a picture checklist:

Plan Day Trips – Take trips to local beaches, parks, museums or amusement parks. These excursions are not only fun, but they give your child the gift of developing background knowledge, or schema – an important database of personal experiences that become essential for reading comprehension. Providing your child with a variety of life experiences gives them a broader vocabulary base and fosters personal connections to text and stories. These connections will prepare children for higher level skills as they are introduced to new reading material and participate in group discussions. Day trips are also good practice for language formulation, planning and organization skills, and they offer many opportunities to reinforce conversational behaviors, language use and comprehension. Here are some select visuals that target these skills:

Take a Road Trip – If you are planning a vacation this summer, take advantage of the many built-in opportunities to develop communication skills. Trapped in the car for hours? Resist the urge to “autoplay” your ride with DVDs or handheld electronic devices. Why not target speech-language skills with games that kids love and will very likely remember for years? “I Spy,” license plate games or find-the-alphabet contests all target verbal skills and a variety of language concepts. You could also create a Seek-and-Find activity for your trip, like this downloadable version:

 Make a Treat – What activity is more rewarding than one that ends in a fun treat to eat? Simple recipes can target a variety of language skills and are a favorite with kids. Practice following directions, using descriptive concepts, sequential vocabulary and more with real tools and materials.  Here is a super easy treat I’ve made with my own children and students, with visual directions that allow for review after you are done:Go to the Movies – ‘The movies’ are not exactly the first thing that comes to mind when one thinks about fostering communication skills. How can sitting passively in a dark theater target speech-language goals? But let’s face it – many parents can become desperate to find an enjoyable activity for the kids on those stifling hot, lazy days of summer. Enjoying an air-conditioned theater for a two hour respite can be just what you and your child need. (For children with sensory issues that make trips to movie theaters a challenge, look for sensory-friendly movie times, like those offered in AMC theaters.) In addition to creating motivating content for future discussions and activities, movies also generate opportunities for language before and after your excursion. Decide with your child what you will seewhere and when you will see it. After the show, review with your child the movie plot, characters and sequential events. Ask questions like, “What was your favorite part? Why?” to help your child formulate and support their opinions. Offer your own opinion, too! Encourage critical thinking skills by asking “why”  “how” and “what if” questions. Some families I know even keep a log of movies they see throughout the year, giving each movie a rating after a family movie discussion.

Schedule Playdates – Effective speech-language therapy often includes group sessions to promote socials skills and to create opportunities that reinforce generalization of skills. Foster peer interaction, interactive play, functional communication and other skills by arranging a short playdate. Around two hours is a good length of time for a get-together, allowing ample opportunities for play, exploration and a small snack. Offer a few summer activities (bubbles, balls, sand toys, etc) and encourage conversation/interaction, but do resist the urge to organize their activities. Children need time to develop play with each other and discover what is motivating or fun in the moment.

Read, Read, Read – Reading with your child is one of the best activities you can do to promote language and literacy skills. Studies show that time spent reading with your child is the best predictor of overall academic success. The AmericanAssociation of School Librarians reported a study, (Wells, 1988) where researchers found that “the amount of experience that five-year-old children had with books was directly related to their reading comprehension at seven and eleven years old. Wells stated that of all the activities considered possibly helpful for the acquisition of literacy, only one—listening to stories—was significantly associated with later test scores.” Read more.

Not sure how to incorporate language into reading? The U.S. Department of Education outlines things you can do to help your child develop language and literacy skills. Read more.

Whatever your plans this summer, do take time to engage with your child in real ways using everyday activities. For more ideas/activities that target communication skills, please visit my speech-language blog at LiveSpeakLove.

(This post originally appeared on LiveSpeakLove)

 

Lisa Geary, MS,CCC-SLP, is an SLP working in the Baltimore County Public Schools in Baltimore, MD. She also recently establishing her own private practice to supplement her school-based position. Lisa enjoys a diverse student caseload, servicing preschool and elementary school students in general and special education settings. Lisa especially enjoys working with students on the Autism spectrum and with students using low-tech communication supports and/or AAC/AT devices. With personal interests in the application of technology and in the creation of speech-language resources, Lisa maintains a blog highlighting these efforts.

Better Hearing & Speech Month Roundup–Week 5

Second place winner of the BHSM Drawing Contest--by Paul Gammaitoni, Age 7

Sadly, Better Hearing & Speech Month (BHSM) has come to a close! So many great posts, articles, events, tweets and stories shared–the messages will undoubtedly resound well beyond this one month. Here are just a few of the many great posts we noticed from this last week of BHSM:

  •  The Kansas Speech-Language-Hearing Association produced five podcasts in honor of BHSM examining issues relevant to SLPs and audiologists.
  • Even the Department of Defense’s Hearing Center of Excellence got involved in highlighting the importance of BHSM, sharing plans to embark on a campaign to raise awareness about the dangers of noise later this year.
  • The Technology in (Spl) Education blog featured many SLP guest posts throughout May in honor of BHSM.
  • The Standford School of Medicine blog Hearing Loss Cure posted a great summary of  more BHSM efforts undertaken by various organizations, and reminded us of the importance of keeping the spirit of BHSM alive throughout the year.

Thanks again to all who commented on the week 1 , week 2 week 3 and week 4 roundup posts–please share any last BHSM blog posts and other resources in the comments.

 

Maggie McGary is the online community & social media manager at ASHA, and manages ASHAsphere.

Better Hearing & Speech Month Roundup–Week 4

2012 bhsm drawing winner

First place winner of the 2012 BHSM drawing contest--by Aiza Javaid, age 6

Closing in on the end of Better Hearing & Speech Month (BHSM) and it’s been amazing to see all the online buzz focused on hearing and speech! There have been hundreds of tweets, many blog posts, and equally many Facebook posts highlighting facts about BHSM. Here are just a few  of the many great posts we noticed from this past week:

Also, congratulations to the 2012 BHSM Drawing Contest winners! The drawing above was the first place winner, done by Aiza Javaid, age 6, from Aldie, Virginia.

Thanks to all who commented on the week 1 , week 2  and week 3 roundup posts–please continue to share other BHSM blog posts and other resources in the comments.

 

Maggie McGary is the online community & social media manager at ASHA, and manages ASHAsphere.

Better Hearing & Speech Month Roundup–Week 3


So many Better Hearing & Speech Month (BHSM) posts and so little space to share them all! Thanks to all who commented on the week 1 and week 2 roundup posts–it’s great to see so many actively engaged in promoting BHSM in innovative, fun ways.
Here are just a few of the many posts we’ve seen this past week:
  • Carole Zangari, Ph.D., CCC-SLP, is devoting this month’s strategy of the month posts to helping SLPs develop  PrAACtical Learning and Resource Networks.
  • Brenda Gorman, PH.D., CCC-SLP, reminds us that BHSM is a great time to spread the word about the CSD professions, on the Lingua Health blog.
  • The UHS-Pruitt Corporation website devoted this month’s Wellness Tips section to BHSM, focusing on hearing and hearing safety.
  • The National Initiative for Healthcare Quality highlights their infant hearing screening program in recognition and celebration of BHSM.
  • Not a blog post, but last week, Pat Ritter, Ph.D., CCC-SLP, Executive Director, The Treatment & Learning Centers and Greg Weimann, MBA, ASHA  Manager of Public Relations, conducted a live online chat for ASHA members that focused on marketing one’s services as part BHSM.  The questions ran the gambit from inquiries about the best ways to reach physicians and other referral sources to questions about starting a new practice, hours of operations, and even how to market an open house. Here’s an except from the chat:

Q: How would you market an open house? What would you suggest having at an open house besides staff/brochures/possible videos?

Greg: For the open house, I would invite the local media. Take pictures if media doesn’t come and send the photos. I would have food, demonstrations, videos and perhaps have patients that you have helped tell their stories.

Pat: Make the open house personal. Have lunch and chat about your services. This is best. You can have the brochures etc. to take away. Think of what you like, conversation, interaction a good feel. Market through flyers, letter and personal calls. We do these and with everyone so busy it is hard to get people to come. Personal invites are best OR give value. Do a one hour workshop that would draw people in and then talk about your practice for 10 minutes.

ASHA members can access the full archive of the online chat here.

Share your blog posts or other resources in the comments and we’ll continue sharing them each Thursday throughout May.

(The poster pictured above was included in the March 13, 2012 issue of the ASHA Leader. For more free BHSM resources like coloring pages, book marks, door hangers and more, visit the BHSM section of the ASHA website.)

 

Maggie McGary is the online community & social media manager at ASHA, and manages ASHAsphere.

 

 

Better Hearing & Speech Month Roundup Week 1

Happy Better Hearing & Speech Month! This May marks the 85th anniversary of Better Hearing and Speech Month (BHSM), a month dedicated to raising awareness about communication disorders and to promoting treatment that can improve the quality of life for those who experience problems with speaking, understanding, or hearing. ASHA offers many resources for BHSM, and with each passing year, more and more SLPs, audiologists, and others interested in CSD are using social media to share ideas for celebrating BHSM.

Twitter is a great way to hear what others are doing to celebrate BHSM. You can follow the #BHSM hashtag on Twitter or just bookmark this link and check it throughout the month to follow the conversations about BHSM on Twitter. We’ve also started a Better Hearing & Speech Month Ideas board on Pinterest, where we’ll be pinning/re-pinning resources and ideas we see throughout the month.

Each week throughout May ASHAsphere will be highlighting some of the blog posts and other resources we’ve found using these social media sources. Here are just a few of the many posts we’ve seen this week:

  • Christopher Bugaj, MA CCC-SLP, did his annual A.T. TIPSCAST podcast and accompanying blog post about language-based curriculum, dedicated to BHSM.
  • Dan P McLellan, CCC-SLP, did a post about BHSM in his new blog, Speechguy.
  • Stephanie Bruno Dowling, M.S. CCC-SLP, lists some BHSM resources on the Advance  Early Intervention Speech Therapy blog.
  • Canadian SLP Skye Blue Angus has a great May Month (Canada’s Speech and Hearing Month) photo of the day challenge on her blog, CREE-ZY, CRAZY SPEECHIE.
  • Lisa M. Geary, MS, CCC-SLP created printable information pages SLPs can share with parents, teachers and other educators, along with some other BHSM resources, on Livespeaklove.

Share your blog posts or other resources in the comments and we’ll continue sharing them each Thursday throughout May.

 

Maggie McGary is the online community & social media manager at ASHA, and manages ASHAsphere.

Auditory-Verbal Therapy: Supporting Listening and Spoken Language in Young Children with Hearing Loss & Their Families

Deep conversation

Photo by juhansonin

Approximately 95% of parents of children with hearing loss are hearing themselves (Mitchell & Karchmer, 2004), and trends indicate that many parents are choosing spoken language as the primary mode of communication for their children with hearing loss. In fact, some states such as North Carolina, are reporting that parents are choosing spoken language options for their children with hearing loss more than 85% of the time (Alberg, Wilson & Roush, 2006), especially when they know spoken language is a viable outcome for their child. And, these parents are typically selecting approaches that support listening and spoken language, such as Auditory-Verbal Therapy, without initiating visual communication systems.

With early identification and the use of advanced hearing technology, children with even the most severe or profound hearing losses can access audition and follow an intervention approach focused on achieving typical developmental milestones in listening, speech, language, cognition, and conversational competence. Parents’ communication choices are based on their long-term desired outcomes for their child. Once those decisions are made, professionals providing early intervention and habilitative services should support the parents’ choices and provide the necessary support and intervention to ensure, to the greatest extent possible, that the child achieves those outcomes.

Definition of Auditory-Verbal Therapy

The Alexander Graham Bell (AG Bell) Academy for Listening and Spoken Language, which is based in Washington, DC, governs the certification of Listening and Spoken Language Specialists (LSLS), the practitioners qualified to provide Auditory-Verbal Therapy. The Academy defines the practice of Auditory-Verbal Therapy as:

“Auditory-Verbal Therapy facilitates optimal acquisition of spoken language through listening by newborns, infants, toddlers, and young children who are deaf or hard of hearing. Auditory-Verbal Therapy promotes early diagnosis, one-on-one therapy, and state-of-the-art audiologic management and technology. Parents and caregivers actively participate in therapy. Through guidance, coaching, and demonstration, parents become the primary facilitators of their child’s spoken language development. Ultimately, parents and caregivers gain confidence that their child can have access to a full range of academic, social, and occupational choices. Auditory-Verbal Therapy must be conducted in adherence to the Principles LSLS of Auditory-Verbal Therapy” (AG Bell Academy, 2012).

The Principles of Auditory-Verbal Therapy: Defining Practice

The Academy has endorsed a set of principles that delineate the practice of Auditory-Verbal Therapy:

  1. Promote early diagnosis of hearing loss in newborns, infants, toddlers, and young children, followed by immediate audiologic management and Auditory-Verbal Therapy;
  2. Recommend immediate assessment and use of appropriate, state-of-the-art hearing technology to obtain maximum benefits of auditory stimulation;
  3. Guide and coach parents to help their child use hearing as the primary sensory modality in developing spoken language;
  4. Guide and coach parents to become the primary facilitators of their child’s listening and spoken language development through active consistent participation in individualized Auditory-Verbal Therapy;
  5. Guide and coach parents to create environments that support listening for the acquisition of spoken language throughout the child’s daily activities;
  6. Guide and coach parents to help their child integrate listening and spoken language into all aspects of the child’s life;
  7. Guide and coach parents to use natural developmental patterns of audition, speech, language, cognition, and communication;
  8. Guide and coach parents to help their child self-monitor spoken language through listening;
  9. Administer ongoing formal and informal diagnostic assessments to develop individualized Auditory-Verbal treatment plans, to monitor progress, and to evaluate the effectiveness of the plans for the child and family; and
  10. Promote education in regular school with peers who have typical hearing and with appropriate services from early childhood onwards.

The Listening and Spoken Language Specialist (LSLS):

Two Paths to Certification

The AG Bell Academy has designated two paths to certification for Auditory-Verbal practitioners: LSLS Certified Auditory-Verbal Therapist (LSLS Cert. AVT) and the LSLS Certified Auditory-Verbal Educator (LSLS Cert. AVEd). The LSLS certification is awarded to qualified professionals who have met rigorous academic, professional, post-graduate education and mentoring requirements, and have passed a certification exam. Typically, LSLS certified practitioners are licensed audiologists, speech-language pathologists, or educators of the deaf who have the required background, training and experience in listening and spoken language theory and practice with children with hearing loss and their families. For additional information about certification as a Listening and Spoken Language Specialist (LSLS), speech-language pathologists and audiologists should contact the AG Bell Academy at academy@agbell.org, visit the website ate www.agbellacademy.org, or call (202) 204-4700.

References

Alberg, J., Wilson, K., & Roush, J. (2006). Statewide collaboration in the delivery of EHDI services. The Volta Review, 106, 3, 259-274.

AG Bell Academy for Listening and Spoken Language (2012). 2012 certification handbook. Available at www.agbellacademy.org

Mitchell, R.E. & Karchmer, M.A. (2004). Chasing the mythical ten percent: Parental hearing status of deaf and hard of hearing students in the United States. Sign Language Studies, 4, 2, 138-163.

 

Dr. K. Todd Houston, Ph.D., CCC-SLP, LSLS Cert. AVT, is an Associate Professor in the School of Speech-Language Pathology and Audiology at The University of Akron. His primary areas of research include spoken language acquisition in children with hearing loss, strategies for enhancing parent engagement in the intervention process, Auditory-Verbal Therapy, and telepractice. He directs the Telepractice and eLearning Laboratory (TeLL), an initiative to evaluate clinical practices in the area of distance service delivery in Speech-Language Pathology.

 

iPhone 4S & Siri Personal Assistant : What’s in it for Speech Therapists and People with disabilities?

Siri for disability

Have you ever had trouble enjoying a day away from the house? The date was October 14th; my heart raced in agony and longing of home and this time it wasn’t because I missed my husband or dogs, it was because I was far away in California while my new brand new iPhone 4S sat patiently awaiting it’s techie mother back in Texas.

When the grueling heartache of the 14th was finally over, and the promise of finally seeing my new iPhone on the 15th, was a tangible dream, I rushed home from the airport to find my beautiful seek elegant iPhone 4S sitting on my table begging me to try out all of it’s new functions.

Some critics have been leery of the new iPhone being called the iPhone 4S, as opposed to the speculated “iPhone 5”, but the reality is that I do not care about what name it was given because it is definitely a huge upgrade from my previous phone iPhone 4; it is faster and it comes with a personal assistant! To paraphrase Shakespeare, “a rose by any other name would smell as sweet”. I won’t be crying about nomenclature decisions when I have a handful of awesomeness at my fingertips, and that awesomeness starts with Siri.

Siri, is the name given by Apple to its voice activated personal assistant on the iPhone 4S; I named mine Jane. For those of you who do not own an iPhone 4S yet, Siri allows you to dictate almost anything and it will do its own research to get you the answers. You can speak what you want and Siri will transform your speech into text. Siri is quite impressive and I can only imagine where this technology is going and all of the future possibilities.

You can watch Apple’s video ( in which they show a person with visual impairment using Siri).


I was, however, wondering how “Jane”(AKA Siri) would respond to people with speech disabilities such as individuals who stutter, who have cerebral palsy or articulation delays.  I decided to test out Siri and here are my results:

Siri and foreign accents:

I am Brazilian, and I learned English 6 years ago, so my Portuguese accent is still here and I don’t think it is going anywhere. So, testing out Siri + Foreign accents was not an obstacle to me! ;-) I have to say I am quite impressed with Siri’s ability to understand my speech (almost as good as my husband’s speech). Siri had an accuracy rate of about 97% with my speech! Impressive! I noticed it had the biggest trouble when I tried to speak specific proper nouns such as street names and people’s names.

Faking accents:  I am also really good with trying to imitate other accents, especially accents that are much more marked than mine. Again, I am impressed! I dictated a complex sentence and Siri was about 80% accurate. I can see that the major issues can be recognizing the vowel, which often leads to transforming the word into something completely different.

The possibilities: I wonder if Siri could be implemented for accent reduction by alerting the user when specific vowels/ consonants are not pronounced as the standard English accent just like Rosetta Stone Language learning software. This would open up the possibilities for several apps that can give instant speech feedback.

 

Siri for people with speech impairments:

Stuttering:

I tested Siri using a variety of different types of stuttering moments. Here are the results I got from it:

Syllable repetitions: I tried “wh-wh-wh where are you?” ; Siri interestingly completed the syllables “Wh” and made it into a “what”: here is what was typed on my text: “What what what where are you.”

Word repetitions: Siri types everything you say, so if a person repeats the word three times Siri will just accept that as a meaningful repetition.

Prolongations: Siri does much better with prolongations than with syllable repetitions. I prolonged the “I” in “I love you” for 3 seconds and Siri was great! It understood the message “ I love you”.

Blocks: Siri respond to blocks just as pauses, which is great; it does not account for any of my attempts to imitate a block.

Interjections:  I used the interject “hum” three times in a sentence; out of those three times Siri ignored two times and substituted the third by “him”.

Articulation delays/Phonology:

Siri and the “r”: Siri does NOT like the substitution of “w” for “r”; it interprets as a completely different word. I said the following phrase “ The red/wed rabbit/wabbit went to play”, here is what I got typed: The wed web it went to play”.

I tested Siri at the word level for several specific articulation/phonological errors:

Gliding:

Street/stweet: sweet

Final consonant deletion:

Hai(hair): head

Helme(helmet) : helmet

Ketchu(ketchup): cat

Siri does much better at the phrase level than at the word level; because I believe it tries to get information from the following word to make sense of a phrase. For example:

I spoke “haven’t” without the “t” and I got the word “ Hey” ; then I said “haven’t seen” without the “ t” and Siri was able to compensate for my final consonant deletion well.

Fun with Siri: I wondered how Siri would respond to my dogs’ bark. Well, it interpreted my dogs barking to “where where where where”. I wonder is that is what they are really saying. Maybe Siri is the new dog translator!?? I can only wish and hope for that in a future iOS update.

 

(This post originally appeared on GeekSLP)

 

Barbara Fernandes is a trilingual Speech- Language pathologist, a geek  and an app developer. She is the founder and CEO of Smarty Ears Apps , a company that creates apps for speech therapy. Barbara is also the face behind GeekSLP TV, a blog and video podcast focusing on the use of technology in speech therapy. Barbara has also been a practicing speech therapist both in Brazil and in the United States. Barbara has created over 21 applications for the mobile devices for speech therapists.

Recommending Monolingualism to Multilinguals – Why, and Why Not

Multilingual christmas lights in Barcelona


Photo by Oh-Barcelona.com

In cases of suspected or confirmed clinical disorder among bilingual/multilingual children, one common recommendation is to have the children “switch to one language.” This advice comes both from monolingual SLPs, who are trained in and for monolingual settings, and from multilingual SLPs, including those working in multilingual contexts. I would like to offer a few thoughts on the practical feasibility of this advice, the reasons that may motivate it, and whether those reasons match what we know about multilingualism and speech-language disorders.

Recommending monolingualism to multilinguals seems to draw on a conviction that multilingualism either causes or worsens speech-language and related disorders or, conversely, that monolingualism either blocks or alleviates them. Speech disorders (such as stuttering), language disorders (such as SLI), and developmental disorders (such as autism) do affect language, in that linguistic development relates to physical, cognitive, social and emotional development. But language development can be typical or atypical regardless of the number of languages in a child’s repertoire. Speech-language and developmental clinical conditions affect multilinguals and monolinguals alike, which means that there is no correlation between multilingualism, or monolingualism, and disorder. In the absence of a correlation, there can be no legitimate conclusion that using one language vs. using more than one has predictable effects upon disorder. The unwarranted conviction that number of languages is a relevant factor of speech-language disorder rests on a number of beliefs, as follows.

First, the belief that healthy linguistic and related development can only be achieved in a single language. Multilingual children naturally develop linguistically in all the languages that they need to use for everyday purposes. Cognitive, social and emotional development follows suit, through each of the contexts in which the languages of a multilingual are relevant. Multilinguals, big and small, use each of their languages in different ways. This is in fact why they are multilinguals: if a single language served all their purposes, they would be monolinguals.

Each of the languages of a multilingual naturally reflects the specific uses that it serves, and each will develop accordingly, at its own pace. If a child uses, say, one language with mum, another one with dad, and yet another one in school, each language will naturally show evidence of mum-related, dad-related and school-related accent, vocabulary, grammar and pragmatics. Having different words or a different number of words in each language, for example, or preferring to use one language rather than another for specific topics or with different people, is typical of multilingualism, not a sign of atypical linguistic competence. A less developed language of a multilingual is therefore not a symptom of a clinical condition such as ‘language delay’, but reflects instead less use of that language than of another. If there are concerns about the development of a particular language of a multilingual, the child may be appropriately referred to a language tutor, not to an SLP.

Second, the belief that using more than one language results in diminished proficiency both in each language and in other proficiency. This belief draws on subtractive views of the human brain, which have it as a computer-like processor featuring limited storage capacity, organised into computer-like modules and processing modes. On this view, ‘brain space’ allocated to each language disrupts other brain space, by encroaching upon it in ways similar to zero-sum situations, where the gains and losses of one ‘module’ exactly match the losses and gains of another, respectively. Computer analogies of the human brain gained popularity by the middle of last century, but current findings about inherent brain plasticity prove their inadequacy to model brain organisation, activity and power.

Third, the belief that using one particular language in one setting will promote development of that language in other settings. The recommendation to switch to one language often means ‘switch to exclusive use of the mainstream language at home.’ Even in cases where it might be viable to change or amend the home language practices in which a child has been brought up, switching to a mainstream language at home, or making it the only home language, will not necessarily impact uses of that language elsewhere, for example in school. The converse is also true: academic uses of a language, say, do not automatically transfer to home uses of the same language, because these uses belong to different registers.

“Register” is a term used in linguistics to describe the differential ways in which we all use our languages to fit specific contexts and specific people. Monolingual children (and adults) switch among the registers that they have learnt to be appropriate at home, in school, at work, or with peers, juniors and elders. Multilinguals do likewise: they switch register in each of their languages, in order to match the participants and the context of an interaction in a particular language, and they switch language, again where participants and context so require. The ability to switch uses of language appropriately constitutes proof of linguistic competence, because it shows understanding of how different registers and/or different languages serve different purposes. A home language, or a home register, develops for home-use purposes, which do not and cannot match academic and other uses of it. The way to promote development of languages or registers in a specific context is to use them in that context.

Finally, the belief that language disorder is best addressed through a single language of intervention. The mainstream language favoured by recommendations of monolingualism often coincides with the language of education, that the child may, in addition, happen to share with the clinician. This raises the question of whether the recommendations are indeed meant to favour monolingualism, or to favour monolingualism in a particular language, the language in which assessment instruments are likely to be more readily available. Whichever the case may be, current research on clinical work with multilingual children shows that intervention which targets the whole of a child’s linguistic repertoire increases both the chances and the pace of recovery. Addressing linguistic repertoires for purposes of intervention makes good overall sense, in that language disorders affect the whole of a child’s linguistic repertoire, regardless of the number of languages involved. Diagnosis must take the whole child into account, so that intervention can start from where the child’s abilities are, whether these abilities are monolingual or multilingual.

Depending on the context of specific interactions, typical monolinguals and multilinguals alike make proficient use of their linguistic repertoires, which means differential use of linguistic resources. The whole linguistic repertoire of a monolingual child translates into resources drawn from a single language, but the whole linguistic repertoire of a multilingual child does not. Beliefs and convictions to the contrary, such as the ones sketched above, rest on a misconception of monolingualism as “norm” of language use, which has spawned related misconceptions that take proficiency in a single language for linguistic health, and lack of proficiency in a single language for symptom of language disorder. Being multilingual involves differential proficiency in more than one language, whose interplay with social, cognitive and emotional development can only be ascertained from observation of the child’s abilities in each appropriate context.

The take-home message that I would like to leave here is that multilingualism is neither a disorder nor a factor of disorder. In cases of suspected or confirmed clinical disorder among bilingual/multilingual children, switching to a single language will not address the disorder. It will simply create a monolingual child with a disorder.

 

Madalena Cruz-Ferreira, PhD in Linguistics and Phonetics (University of Manchester, UK), researches multilingualism and child language. One section of her book Multilingual Norms addresses multilingual clinical assessment. Her blog Being Multilingual deals with the use of several languages at home, in school and in clinic.

Is the iPad revolutionizing Speech Therapy? From an SLP & App Developer

(This post originally appeared on GeekSLP)

It seemed like just an ordinary day back in November of 2009, when I was playing with my iPhone and I was thunderstruck with an epiphany to create apps for speech therapists. As the iLighbulbs flashed above my head I envisioned an app that would provide therapists with the ability to select specific phonemes and have all their flashcards stored on their iPhones. For some people an idea like this can feel farfetched, but for me, a self-professed geek, having already designed several websites from a young age and understanding html very well, learning what it would take to put my ideas in action was not an obstacle that I would let get in my way. With non-stop dedication, and night after night working tirelessly, my first app –and the very first app for speech therapists– was born; like a proud mother, I still remember that precise joyful moment on January 2nd of 2010.

The app was called Mobile Articulation Probes (now renamed Smarty Speech), and it was on sale on iTunes for $29.99; and I was elated and ecstatic. Still feeling the momentum of creating something so new and useful I signed up for a booth that very same month for the Texas Speech and Hearing convention happening in March, and I could not wait to see the faces of excitement from my fellow SLPs when I showed them what my app could offer them in therapy.

But I didn’t take five seconds for myself to breathe between January and March as I was working non-stop on creating five other apps (WhQuestions, Age calculator, yes/no, iTake Turns, iPractice Verbs). I was a woman on a mission. I could feel the difference these apps made in therapy rippling through my veins and I wanted to see every aspect of therapy utilize the potential of this powerful device. Despite the fact that maybe 10 to 20% of TSHA attendees that year owned an iPhone or iPod touch, it appeared nobody had even ever considered using it for therapy! Oh, I forgot to say: all this happened before the iPad (yes, there was life before iPad).

I loved seeing the reaction of my fellow SLPs when I showed them what the app could do. A lot of people instantly recognized it was a deal: 450 flashcards organized by sounds with data tracking capabilities. This would probably cost us around $200 if we buy paper flashcards (not to mention that they don’t come with data tracking capabilities). Other attendees were apprehensive at such a change, they thought it was too expensive. The reality was this: most iPhone apps I knew cost less than $1, so I could see where they were coming from. No matter if they loved it or not, one thing was universal—their eyes bulged wide open with amazement as if they were looking at an alien, and more often than not that look of surprise turned to a smile when they saw this “alien technology” for therapy was on something they might already own—an iPhone. Today– a little over one year- -that app on its original state would be considered outdated.

I believe that at that time if you searched the key word “Speech therapy” on the app store probably 80% of apps there were developed by me. 😉 – Well, there were probably only eight apps available.

In May of 2010 the iPad was released and at the same time I saw the need to let users know about the amazing possibilities of the iPad. Although great strides had been made in accepting the iPhone and iPad as a tool for use in therapy, there seemed to be a lack of general education on using it as a therapist tool. Questions continually swirled around the web and at conventions: what happens if I delete the app? Can I use my iPhone app on my iPad? What is a universal app? Can I use the apps on my computer? That’s when GeekSLP was born. My first video–done with dark lighting, and not much planning–taught viewers that it IS possible to run iPhone apps on iPads. Today, only one year later, GeekSLP has had over 55 thousand views!

Many people have difficulty separating me as a developer and me as an app reviewer/educator/blogger of  tech for SLPs. While Smarty Ears is a company that is behind me in the development of apps, I still felt the need to do things independently from the company, such as teach about other apps that I like and about implementing technology. GeekSLP & Smarty Ears are like cousins with completely different purposes. GeekSLP gives free information (it is a free app) that can benefit almost all educational technology users by giving them tips on utilizing their iDevices, while Smarty Ears is pushing Speech Therapy and education forward by creating apps.

When I started blogging and video podcasting only a couple (and I mean TWO or so) SLPs were doing it- -especially with a focus on technology; today we have tons of blogs that want to discuss and review apps. Is this the “SLP APPidemy”?

Yes, the iPad is a revolution to our field. However, would it really be a revolution without the apps or without the people who created them?

If you search the key word “Speech Therapy” on your iPad you will see that we have 55 iPad apps for SLPs. I have created 14 of them. I have created a total of 25 apps between iPhone, iPad and Android apps! Five more in the works. I am currently collaborating with my fellow SLPs from Twitter, which has led me to start publishing apps for other SLPs with ideas like mine.

If you search the keyword “physical therapy” you get only 23 apps, and only four when you search “occupational therapy”; likewise you only see 14 when you search “counseling.” You may ask yourself: is the iPad having the same impact on these professions?
I believe the iPad is an enormous success partly due to the nature of our work: play based learning. Also because we have been stuck in the stone age with our materials: flashcards? Worksheets? But also because the apps are available; I applaud all SLPs who have created apps for us.

Today the iPad is seen as the number one therapy box for many therapists. It is also the number one topic many speech therapy groups discuss online. I have provided trainings all over the country and been invited to at least 10 state conventions for this year (and invitations for 2012 are also filling my mailbox) to teach people about the amazing power of technology and apps.

It has been an amazing year for my profession and for me and I see that we are moving towards a more environmentally friendly and engaging therapy set up. It was about time! After 15 months developing apps for SLPs, giving training all over the world on the use of apps and iPad, I still always look forward making new geek friends online, presenting, and creating apps that make a difference.

 

Barbara Fernandes is a trilingual Speech- Language pathologist, a geek  and an app developer. She is the founder and CEO of Smarty Ears Apps , a company that creates apps for speech therapy. Barbara is also the face behind GeekSLP TV, a blog and video podcast focusing on the use of technology in speech therapy. Barbara has also been a practicing speech therapist both in Brazil and in the United States. Barbara has created over 21 applications for the mobile devices for speech therapists.