Clinical Aphorisms: Thoughts While Shaving


  1. Evidence-based practice must consider the clinical intangibles: Performance does not guarantee competency.
  1. Do not be afraid of silence—it is your best friend!
  1. The most potent clinical interventions are those that empower the family.
  1. Family-centered is just that: seeing the family as our client.
  1. Not doing is doing: More often than not, it is the most powerful doing.
  1. The most important clinical tool is the clinician: Every so often the “tool” needs a checkup and re-calibration.
  1. Having dependent clients benefits no one.
  1. Covert help is the best help: Miracle workers need not apply.
  1. The clinician’s need to be needed—in conjunction with perceived client helplessness—is a clinical death dance.
  1. Clinical success can best be measured by the degree that the client takes ownership of the disorder.
  1. Operate on the fringes of your competency: If you aren’t a bit scared, you aren’t learning anything.
  1. Communication is best accomplished when we engage both feeling and cognition.
  1. View the client through the eyes of compassion; when you do so, there is no blame.
  1. Listening to the client is often the only thing needed.
  1. Embracing our pain—by expressing it—is often the first step in healing.
  1. The greatest gift we can give our clients is a support group: It’s a powerful healing vehicle.
  1. The difficult client is often our best teacher.
  1. It’s only a mistake if you do it twice—competency is born of mistakes.
  1. Always remember what the Dali Lama said: “Everybody is seeking happiness.” It helps to get through the day.


David M. Luterman, AuD, EdD, is professor emeritus at Emerson College, author of many books on counseling people with hearing impairment and other communication disorders, and director of the Thayer Lindsley Program for Deaf and Hard of hearing Infants and Toddlers at Emerson College.



American Pharoah: Triple Crown Winner Uses Ear Plugs!

American Pharoah WEB May 2015 Barbara Livingston

American Pharoah sprinted to win the first Triple Crown in 37 years. His trainer, Bob Baffert selected brown ear plugs—rather than the typical white cotton used with other horses—that better match the bay colt’s coloring. Many race horses wear ear plugs.

Horses have a wider range of hearing sensitivity than humans. We typically hear from 20 Hertz out to 20,000 Hertz. Horses hear out to 35,000 Hertz. This means they hear a lot of sound not perceived by human ears.

Breeders carefully mate and breed thoroughbred horses to become highly valued racers that perform at exceptional levels. A horse needs a certain amount of alertness to perform at the top, however, galloping hooves, yelling jockeys, cracking whips and cheering fans create a cacophony of noise. Even urban noise such as rescue vehicle sirens on city streets nearby can be heard on the track.

This creates a sound environment that might increase startle responses and make the horse skittish. Because of the noisy environment and the need for a high level of performance, trainers condition them to run at their best with a ‘noisy crowd’ live audience and with unusual noise distractions down on the track.

Some thoroughbreds, like American Pharoah, find this excessive noise unsettling and confusing. They lose focus and become nervous, distracted and might not perform as expected. Ear plugs offer damping and filtering of noise to assist the horse to focus on the race. They are not worn as hearing conservation but rather as a way to calm the horse.

Interesting facts about American Pharoah:

  • Foaled February 2, 2012
  • Owned by Ahmed Zayat
  • Trained by Bob Baffert
  • Ridden by Victor Espinoza (for most races)
  • 12th Triple Crown winner in history
  • Name is misspelled, through an error in registration of the name but is now permanent. Pharaoh is the correct spelling
  • Both the correct and incorrect name spellings are registered so another horse cannot use the correct spelling.


Pamela Mason, MEd, CCC-A, is ASHA director of audiology professional practices.

The River School Emphasizes Integration of Kids With Hearing Loss


The River School—tucked along a tree-lined street in Washington, D.C.’s Northwest quadrant, alongside the Potomac River—specializes in the oral education of young children with hearing loss. But unlike other programs that silo and segregate deaf children from their typically hearing peers, the private school has developed an inclusive, mutually beneficial program that urges literacy and speech skills in both sets of students at the same time.

The ASHA Leader recently spent a sunny spring morning at the school. Here’s who we met and what they do.

On the other side

Jennie Massad has always had a personal connection to her job.

The preschool teacher wears a hearing aid for her moderate-to-severe hearing loss—an instant link to her students who also have aids or cochlear implants. But after the birth of her daughter, Amelia, and the diagnosis of Amelia’s hearing loss, Massad gained another connection to the River School—as a parent.

Massad’s worked at the school for eight years and appreciates the staff’s focus on the students and serving their needs. “[Amelia’s] teachers are aware of pushing language a little bit more and exposing her more,” Massad says, “where in the regular daycare, they’d be aware of it, but they may have a lot of other kids and it’s just not the top priority.”

With 11-month-old Amelia in the school’s infant program down the hall from her own classroom, Massad attends her daughter’s once-a-week treatment sessions, typical of most students with hearing loss. (Children 18 months or older participate in classroom programs, while the school takes babies as young as 6 weeks into its daycare.)

The school serves about 230 students—39 of whom have a hearing loss, according to Julie Verhoff, River’s audiology director—and employs a team of specialists to educate them. Each class includes a dedicated SLP to assist general educators like Massad, while audiologists offer support by troubleshooting issues with assistive technology. A handful of psychologists, therapists and other specialists fill out other offices.

And while it’s still a long way off for Amelia, students who complete third grade—the highest level of instruction offered at the River School—flow into mainstream public or private schools in the area, typically with ease.


Sounding it out with ‘Mouth Time’

On the April weekday morning of our visit, Fiacre Douglas sits on a carpeted floor, encouraging students to blow cocoa powder into the air.

Douglas is considerably older than your typical second-year speech-language pathology graduate student, but his enthusiasm for this new path shows in his interactions with students. As a student clinician at the River School this semester (the school calls him an intern), he’s been supervised by Samantha Wasilus—one of the school’s SLPs—and enjoys hands-on experiences in the classroom.

The cocoa powder—or “dino dust,” as Douglas and Wasilus call it to fit their current “back in time” theme—is one of today’s Mouth Time tools. Mouth Time, a River School innovation, takes place for 15 minutes a day in each class to help students develop literacy skills.

Sitting cross-legged in a semi-circle, the kids practice making a “ch” sound by placing their dino-dust–covered palms up to their lips. Each successful production receives a chocolate-y, chalky explosion as reward, followed by squeals of delight (and a meticulous lick of the hand for leftover specks). Later in the quick productive session, the children sound out words using symbols written on “dinosaur eggs.”

“What’s great about Mouth Time is that the kids all learn these symbols for the shape of their mouth, and how the words are formed, before they actually learn what the letters look like,” says Douglas, who recently completed his clinical placement and earned his master’s degree from George Washington University. “For the kids who have special needs for hearing, we’re making sure they’re hearing the word, they’re understanding the word and they’re learning it—as well as the other kids who don’t have those issues.”


Haley Blum is a writer/editor for The ASHA Leader. 


Free Custom Hearing Protection for Professional Musicians


Musicians performing at the Bonnaroo and CMA music festivals near Nashville—both of which begin tomorrow—will receive free custom ear plugs that allow them to hear the notes clearly just at a lower volume. The plugs normally cost around $200 a pair.

The Vanderbilt Audiology Clinic and MusiCares sponsor the program, now in its second year at Bonnaroo. In addition to fitting them with custom plugs, audiologists from Vanderbilt educate the musicians on how important it is to protect their hearing. They also teach them about long-term effects of not wearing ear plugs.

Read more about the free hearing protection program.

How to Encourage Hearing Protection: It’s All in the Attitude


A quick Google query tells us that “attitude” is a settled way of thinking or feeling about someone or something, typically one that is reflected in a person’s behavior.

Millie likes to go to the shooting range with family members. Her caring family makes sure to protect her hearing. (Millie is a rescue pup belonging to Christine Sanders, a senior in the Department of Communication Sciences and Disorders at Valdosta State University.) If only all parents understood the importance of hearing protection.

In 2009, I participated on a research team studying hearing protection use and attitudes of young adults toward exposure to loud sound. Our target population was college-age adults in the U.S. We compared results to a similar age group in Sweden. The data suggested that, by comparison with the Swedish sample, American young adults are less likely to view loud sound as a health hazard.

We live in a noisy world. Consider, for example, the fans of the Kansas City Chiefs who proudly proclaimed they broke the Seattle Seahawks record for the loudest outdoor stadium sound level record at 142.4 decibels (dB). By comparison, a jet fighter taking off from an aircraft carrier generates approximately 140 dB. It’s estimated that at 150 dB, the human eardrum ruptures.

Where does our craving for loud sound first develop? Music and speech share similar development characteristics. Consequently, we develop our taste for loud sound at an early age.

If we know that hearing loss due to noise exposure is 100 percent preventable, and attitudes toward health safety or risks are developed earlier in life, then we need to work harder to establish early awareness on the negative effects of loud sounds—ideally in preschool and lower elementary grades.

Unfortunately, most research and campaigns on hearing protection still focus on young adults. Researchers report a growing incidence of hearing loss among young individuals, particularly ages 12 to 19. By the time we survey young adults in college, attitudes regarding the potential danger of noise exposure have already been formed, perhaps five to 10 years earlier.

So, while college-age students are a convenient (and important) source of data, the information obtained from this age group probably reflects the consequences of attitudes most likely developed at a younger age.

In the spirit of Better Hearing and Speech Month, what can we do?

We should amplify our warnings to young people about noise-induced hearing damage. The use (and abuse) of tobacco, drugs, and alcohol get tons of exposure. And texting while driving is certainly a hot issue. However, the effects of noise exposure get little attention. Efforts do exist to inform parents and children, such as Dangerous Decibels and Listen to Your Buds. But they aren’t as widespread as messages on texting or drugs.

As professionals in the field of communications, we should:

  • Develop a mandate for instruction in health and physical education classes regarding the damaging effects of exposure to loud sound.
  • Increase hearing screening frequency at the K-12 level—an area that has in recent years retreated, not expanded.
  • Expand efforts to promote programs such as Dangerous Decibels and Listen To Your Buds to the level of safe driving classes in high school.

Healthier attitudes toward loud sound need to be developed earlier!


Ted L. Johnson, AuD, CCC-A, is an associate professor in the Department of Communication Sciences and Disorders at Valdosta State University. He is an affiliate of ASHA Special Interest Group 1o, Issues in Higher Education.