Collaboration Corner: 5 Take-Aways to Support AAC, Apps and Language

TEchnology and augmentative and alternative communication

This past month, my colleague Sean Sweeney (AKA @speechtechie) and I had the opportunity to join forces and write about AAC, apps and literacy development. Our article will be in the next issue of SIG 12: Perspectives in Augmentative and Alternative Communication.

This gave us a great opportunity to discuss how AAC users can benefit from apps to enhance treatment outcomes. Here are five highlights:

Feature matching is important: When choosing AAC or apps for learning, the tool must meet the needs of the user. For AAC, this includes the size, layout and physical accessibility of features to maximize independent use. For apps, this includes Sean’s FIVES criteria, which examines the context, appropriateness, accessibility and therapeutic considerations for learning. Just like any other tool in your kit, if it isn’t a good match then opportunities for communication or learning are potentially lost.

Make CORE align with the CORE: Using generative language formats, including core and fringe word vocabulary, benefits the student two-fold: building in opportunities for language growth throughout the day, while also meeting those pesky Common Core Standards. For example, a first grade ELA standard CCSS.ELA-Literacy.L.1.1.c, “Use singular and plural nouns with matching verbs in basic sentences.” Using core vocabulary allows the student to meet this standard through basic sentence construction activities. A first grader may enjoy learning this through the “Collins Big Cat” series, a free app that reads stories out loud and then has the option of the student recording his voice (or in this case, synthesized voice). The app also has a more interactive component, which allows the student to build scenes and narrate his own version of the story.

Apps and AAC are powerful together: Students love the interactive nature of apps. “Toca Hair Salon” is a highly interactive hair salon studio allowing students to describe how they are going to cut, color or otherwise coif the animal or person of choice. Another simple app, “Pogg,” is a cute alien that hops, sings and performs other actions, all at your student’s direction during a session. Beyond paper flashcards, the apps give students immediate reinforcement, so then work feels less like work.

Separate communication tools from other tools: If you are going to use apps and AAC at the same time, one practical solution is to use separate tools. Toggling between apps and AAC is cumbersome, and slow session momentum. In addition, having separate systems prevents the user from confusing a communication device with other technology, which is an important distinction. If your tools look the same, change the colors of the cases. If you have students that like to surf and press that home key, enable guided access so that only the AAC app is available.

Model, model, model through apps and AAC: Finally, apps provide the opportunity to model AAC live, and in unpredictable ways. You have more opportunities to explore and learn together. Don’t have curling iron as a fringe vocabulary item when using your “Toca Hair Salon” app (it’s not there, believe me)? Show your student how you can give clues to what you mean and talk it through using what is available on your AAC: “Let’s see, it’s a tool, it’s hot and it makes your hair curly…what is it?

There’s your abridged version and takeaways…log in to your SIG 12 portal for more info, and to get CEUs….ASHA renewal is right around the corner!

 

 

Reference

Sweeney, S. & Davis, K. (2014). In press. Reading, writing and AAC: Mobile technology strategies for literacy and language development. SIG 12: Perspectives in Augmentative and Alternative Communication. American Speech Language and Hearing Association.

 

 

Kerry J. Davis, EdD, CCC/SLP is a speech-language pathologist in the Boston area. She holds a special interest providing services to children and adolescents with complex communication profiles, including AAC. Davis is a volunteer SLP and consultant to Step by Step Guyana, a school for children with Autism in South America.

 

“Use Your Speech Tools!” Why Your Child Who Stutters May Not Be Using His Strategies

Stuttering Tools

When a child who stutters demonstrates the ability to change his speech during a treatment session, it seems obvious that he’d want to use the same strategies to improve speech outside the session as well.  Children, especially teenagers, rarely want to stand out in a way that stigmatizes them, provokes questions or increases the chances of teasing.   So the question arises, “Why aren’t they using their tools?!”

Speech and stuttering modification techniques are often learned quickly and easily within the treatment setting.  However, SLPs and parents often feel discouraged when these tools seem to disappear as soon as the client gets to his car.  Is it laziness on the part of the child?  Is it the fault of the family for not following through with home assignments?  Is the SLP not teaching the best strategies?

Instead of placing blame, consider the following three reasons a child may have difficulty generalizing his skills:

Reason # 1: These Techniques Are Too Hard! 

Making changes to one’s speech becomes exponentially harder when you introduce factors that often are not present in the session, such as interruptions, time pressure and feelings of embarrassment or shame associated with stuttering. Learned escape/avoidance behaviors and increased language demands may make it very difficult to use these tools.  Suddenly, what felt like an easy decision to use a new technique, becomes complicated by the person’s desire to be heard in a large group of chatty peers or by the need to formulate an excuse about why he doesn’t have his homework.

How Can I Help?

Children will be more likely to use speech/stuttering strategies if they are first introduced in safe and supportive environments (i.e. home, session room).  To help with this, create a hierarchy of speaking situations and use it to guide where the client practices the strategies.  If a child who stutters is not yet using speech tools in certain situations such as the classroom, it is probably because of where that situation is on his hierarchy. Work with your clients to determine where they would like to use their strategies , while also identifying those situations where they would prefer to concentrate on things other than using their tools.

Reason #2: These Techniques Make Me Sound Weird! 

There are several techniques that may be taught to a child who stutters. Some strategies involve prolonging the initial sound to ease into or out of a word with less physical tension or struggle.  Other techniques include inserting more pauses into speech.   All speech tools require a child to alter their speech in a way that is still different from how his friends sound.  Children may report that they have similar negative thoughts and feelings about using these strategies as they do about their stuttering.  This may play a role in why they are choosing not to use speech strategies outside their sessions.

How Can I Help?

Just as you might spend time trying to help reduce negative reactions to stuttering, you might also spend time desensitizing clients to hearing themselves use strategies through voluntary stuttering assignments.  Children can also benefit from improving their ability to handle listener reactions. This can be addressed by participating in role-playing activities that help the child create “scripts” for responding to curiosity/teasing.  For example: “Why do you sound like that?” “Sometimes I stretch my sounds like that to help me get out of a stutter.”  The more comfortable the child feels with his strategies and ability to respond to questions about his speech, the more prepared he will be to use these techniques outside the session.

Reason #3: These Techniques Aren’t Worth it!  

A cost-benefit analysis can be useful when trying to understand why a child may choose not to use speech/stuttering strategies.  At the surface, it may appear that there are many benefits of using strategies which include increased fluency and improved overall communication. However, SLPs and parents must be careful to consider the costs, as well.  Costs may include increased effort, difficulty concentrating on the content of message, the risk of showing more stuttering and the potential that the strategy doesn’t work.

How Can I Help?

Have discussions with clients about what they perceive as potential costs versus benefits of using strategies in a variety of different speaking situations.  As the child becomes more accepting of stuttering and is better able to tolerate both his feelings about stuttering and listener reactions, physical tension and struggles associated with speaking will decrease.  As this happens, tools become easier to use and costs may not feel so high.

The bottom line 

There are several strategies that may help reduce stuttering frequency and severity.  However, you often can’t offer these tools without first considering and incorporating goals that target how the client thinks and feels about his speech both while stuttering and while using tools.

Brooke Leiman, MA, CCC-SLP, is the Director of the Stuttering Clinic 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.

 

 

Tales From Apraxia Boot Camp

bootcamp
In August of this year, I was selected to be a part of The Childhood Apraxia of Speech Association of North America’s 2014 Intensive Training Institute, otherwise known as “Apraxia Boot Camp.” Twenty-four speech-language pathologists, including myself, trained with three mentors–Ruth Stoeckel, Kathy Jakielski, and Dave Hammer–at Duquesne University over four days. In its third year, the goal of the boot camp is to spread a high level of knowledge about Childhood Apraxia of Speech (CAS) assessment and treatment throughout the United States and Canada. This conference accomplished that and so much more.

This experience was different than any other continuing education seminars that I have attended. We did not listen to speakers discuss CAS. Instead, Ruth, Kathy and Dave became our mentors. This was powerful. They moderated discussions on evaluation and treatment approaches. We reviewed research papers and had long debates on the principles of motor learning. We highlighted and critiqued therapy methods for those brave enough to show videos of themselves. We problem solved and brought up more questions than we knew were possible.

In smaller groups, our mentors provided insights and personal perspectives on how they work. In this intimate setting, we felt comfortable asking questions and sharing our experiences. The mentors shared constructive criticism along with thoughtful suggestions. In all, they made me think, reflect and question everything I do. Why do I give that test? Why do I treat that way? What is the research behind it? They encouraged us to become critical thinkers.

As therapists, we often get used to using the same materials and therapy techniques we learned in graduate school or during our early experiences. Those methods are not always effective with every child we treat nor are they all proven effective with evidence based-research. Specifically, children with CAS require different therapy techniques than other children with articulation or phonological delays.

Ruth, Kathy and Dave provided valuable information in a small, engaging setting. Their mentoring and passion for CAS has inspired me and I hope to pass along this valuable information to others through mentoring, improving my competency in treatment and diagnosis of CAS, and, in the end, helping children to communicate.

Based on my experience, I’d recommend asking yourself a few questions when selecting your next continuing education event:

  • What am I passionate about? Is there a child or an area of speech pathology that truly inspires me?
  • How will it improve my skill set?
  • How will it help me better serve my clients?
  • Who is doing the most current, researched-based evaluation or therapy techniques?
  • How will it further our profession?

 

Amanda Zimmerman, MA, CCC-SLP, is a pediatric speech-language pathologist in Columbus, OH. She can be reached at azimmerman@columbusspeech.org.

In Appreciation: Sylvia Onesti Richardson

Richardson SylviaSylvia Onesti Richardson, president of the American Speech-Language-Hearing Association in 1973-74  and a passionate advocate for children with language and learning disorders, died in her home on Friday, October 24. A Tampa resident since 1980, she was 94 years old.

Throughout her career, Richardson strongly advocated for children with learning disabilities and speech-language disorders: In 1949 she established at Boston Children’s Medical Center the first speech-language clinic in any children’s hospital in the United States. She also created the Child Study Center and became involved in the use of Montessori educational methods for children with learning disabilities while at the University of Oklahoma. In Cincinnati, she was a founding member of the Hamilton County Diagnostic Center for Children with Learning Disabilities and the founding editor of Children’s House magazine. In 1970, she was invited to the White House Conference on Children and in 1977, was appointed to the President’s Commission on Mental Health. She was also Chair of the National Joint Committee on Learning Disabilities from 1997 to 1999, and a member for 30 years.

Richardson received her training in pediatrics from the Montreal Children’s Hospital and the Boston Children’s Medical Center and was also an ASHA-certified speech-language pathologist  and certified Montessori primary teacher. Richardson had numerous academic appointments, culminating in Emeritus Clinical Professor of Pediatrics at the University of South Florida, where she began teaching in 1981.

Richardson has contributed much to the literature of her field with more than 100 publications including the book, “Something’s Wrong With My Child: A Parent’s Book About Children with Learning Disabilities,” 1973. She also received numerous honors, including the 1964 Oklahoma Woman of the Year.

Richardson’s professional accomplishments are only a part of her remarkable life. She was an active member of the Athena Society, and especially their Young Women of Promise Award program, which has been renamed in her honor. She was a strong supporter of the arts, especially the Straz Center for the Performing Arts, and she loved to attend performances there.

She is survived by her brother, Silvio Onesti; her sons William and Christopher; and her grandchildren: Lucas, Michael, Eva, Will, Anna and Sophia. These grandchildren were Richardson’s pride and joy. She attended many graduations from high schools and colleges, and this past June saw Lucas get married.

A memorial service was held Saturday, November 8, in Tampa.

In lieu of flowers, memorial contributions may be made to the International Dyslexia Association, 40 York Road, 4th Floor, Baltimore, MD 21204.

Teens and Feeding Therapy:  An SLP’s Top Five Tips!

Making trying new foods fun for teens.

Making trying new foods fun for teens.

As a pediatric feeding therapist, it’s not unusual for me to get a call from a mother who says “My kid’s 14 years old and still eats only six foods. He’s so picky!  I thought he would grow out of it.”  True, with patience and consistent strategies, some kids do indeed grow out of the picky-eater stage, typically at its peak aro

und age three. But if the child had underlying motor, physiological or sensory challenges that stalled the developmental process of learning to eat a variety of foods, it’s not unusual that selective eating behaviors will prevail into the teenage years.  I approach treatment with teens in a similar manner as my younger clients while respecting one important fact: They are teenagers!

Here are my top five tips for interacting with teens while building trust and confidence, plus making feeding therapy successful (and fun!) for both of you:

#5  Use Cool Games:  I always incorporate games into feeding practice.  Learning to try new foods is HARD, at any age.  Including games in the process of biting, chewing and tasting keeps anxiety levels low and still allows learning to take place.  Using games as a means of distraction, such as eating while playing independently on an iPad, does not allow for conscious learning.  Instead, try using games that are reciprocal in nature and where each player’s turn lasts no more than ten seconds.  If your client is working on learning to drink a smoothie, perhaps he might take a drink, get a turn, etc.  Try Blockus, UNO Blast or  Connect-4 Launchers, all interactive and exciting games. Plus, they are easy to clean, which is important in feeding treatment.

#4 Create Your Own Games: To quote a bit of teenage lingo, find out what the teenager “is obsessed with” and create games around that obsession. Does she love three-toed sloths?  Pull up the best sloth videos on YouTube and create a Jeopardy game around them, hiding each video under categories like  “Kristen Bell for One Hundred Please.”   I once had a client who knew every Movie Production Logo in Hollywood.  His mother sent me pictures of ten favorite logos and I laminated two copies of each.  During feeding therapy in his home, we would spread out the laminated pictures all over the kitchen floor and after each bite, try to toss a penny onto a picture.  Get a match, and you get a point.  Another client of mine was obsessed with paintball, but I wasn’t about to do feeding therapy in a paintball bunker.  Instead, I brought my Discovery Toys Marbleworks® and with each bite we added one piece, eventually building intricate contraptions and using the paintballs as marbles.

#3 Ask WHY: Once I get to know a teen, I always ask this question: “Is there a special reason you want to learn to try new foods?” One teen told me that he wanted to ask his girlfriend to Prom, but was afraid that he couldn’t take her to a fancy restaurant for dinner.  “I don’t think they serve pizza there, and that’s all I know how to eat.” That was eye-opening for me!  Now I know his motivation and we have a timeline for success. When there is no motivation, that’s a problem.   It’s common for a teen to reply: “I don’t want to learn to eat anything new – my Mom is making me.”  This is the time to help a teen FIND motivation.  “How’s wrestling going?  Did you know you need protein to build more lean muscle? What types of protein would you like to learn to eat: nuts, hamburger or vegetable protein?”  One of my clients had been consisting on  four strawberry Pediasures mixed with whole milk every day for over three years before starting therapy. He used to eat some solid foods, but over time began to limit his intake until he was food jagging on Pediasure.  He didn’t see a problem, because he liked the way he could gulp down a Pediasure and rush outside during break time to play basketball with his friends. That worked for him because it enabled him to avoid social eating in the cafeteria, which made him very anxious.  I suspected that the high dairy content was making him constipated, thus decreasing appetite.  Let’s face it: A teen is not likely to tell ME about his constipation.  But, I called his pediatrician and requested that they have the constipation talk during the upcoming sports physical.  Once his doctor explained that he would no longer have to struggle with bathroom issues, which was a huge source of embarrassment for him, the teen was open to tasting some new foods.  Feeding therapy, especially with teens, goes best when we focus on the whole child and learning what’s important in his unique world.

#2  Teach positive self-talk: So many older kids engage in negative talk about food because it stops parents from serving it.  Over time, those negative comments become a habit that for lack of better term, is a form of self-brainwashing.  While it’s important to acknowledge a teen’s feelings if he says “I can’t – I’m scared I’ll gag,”  it’s just as important to help him talk positively about eating.  I explain it this way:

I want you to talk to your own brain the way you would talk to your best friend.  If your best friend had practiced with his soccer coach to take a goal kick in soccer but was feeling anxious when it came time to attempt it, he might turn and whisper to you, “I can’t – I’m scared that I’ll miss.” You’d probably tell  him “You’ve practiced with coach and you have the skills to do it!  It’s OK to be nervous – you can still make that goal!”  He needs to hear that from you.  Well, your brain needs to hear the same positive talk from you when you talk about food.  It’s OK to be nervous and it’s OK not to like the taste of it.  We’re just beginning to learn how to how to eat this new food and we are practicing it.”

And this SLP’s #1 Tip? Give Them the Script: Teens may not always have the most descriptive vocabulary, except to narrow taste and texture down to “gross.”   Give them the language and discuss what terms like savory, buttery, creamy truly mean.  A reference list of 345 terms to describe food can be found here.  Plus, it helpful to use comparison phrases such as “It’s similar to tiny dots of corn, but it’s called polenta” in order to build familiarity with a food they’ve experienced in some manner, such as corn.  If the most interaction they’ve had with corn is just staring at it, that’s OK!  Stare at the polenta.  Make it a kitchen science experiment and discuss all the properties of polenta if you need to.  Give them the words that build visual familiarity with polenta: “yellow cornmeal”, “hulled”, etc.  Talk about how it can be baked, fried, grilled or stirred into a porridge.  Interact with it – get to know it.  Now you’ve got a teen whose introducing his brain to polenta by saying: “Polenta is cornmeal, which is made from something I’m familiar with: corn.  I think it looks best when it’s fried, because I like fried foods.” He’s OPEN to the concept of Polenta because he has the terminology to describe it and understand the properties. As you progress from visual interaction to tactile exploration, provide terms that describe the feel of polenta such as “gritty” and “course.” Eventually, you’ll be discussing the same feel in the mouth.  As all SLPs know, language is empowering.

What other strategies do you have when helping teens interact with new foods?  Please list them in the comments section, thank you!

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.

Trick or Treating Voice Disorders: 3 Reasons Why It’s Not So Scary

singingcloseup

Hopefully the least scary thing to happen to you this Halloween season is getting a voice client on your caseload. (You think, I had a class on voice disorders once…maybe? You pull out your voice resources. Ew–that’s what the vocal folds look like? Ew–that’s what a vocal fold lesion looks like? Those are TEP’s? Yikes. I’ll stick with my articulation and language clients thank you very much.)

I hear from clinicians all the time, in person and on the web, that they are frightened to even attempt providing therapy to a voice client. Even with all the wonderful new technology and apps available, is it really as bad as walking through a haunted house while clowns lunge towards you?

Taking a step back, I remember that every person with a CCC-SLP trailing his or her signature was not thrust into this profession in the same way I was. I already knew a thing or two (or so I thought) about the voice and was ready to begin my college career as a singer. Alas, this was not in the stars for me as I had a vocal cyst requiring voice therapy and surgical removal. There was no way I was catching up to my same-aged peers with vocal performance degree aspirations to graduate on time. My voice teacher sat me down (I think I may have actually been standing in a voice lesson) and told me the words that would (for the next few years at least) be as frightening as that haunted house clown…”You have to find a new career path.” I was shocked, hurt and lost.

After lifting my chin and changing majors, I decided I wanted to help others in the same situation as me. I would use my vocal upbringing, my musical skills and my unique perspective to become a go-to voice clinician. It wasn’t until graduate school that I actually began to understand how my vocal mechanism worked. I studied video after picture after diagram of the larynx, its muscles, and the vocal folds. Slowly, and after 2 years of singing rehabilitation, I began to learn to love singing again and I now am thankful for that seemingly harsh (but necessary) redirection. My dream had changed,  but I became a better performer because of it.

Treating clients suffering from voice disorders requires just as much creativity as treating any language or articulation disorder. It requires out-of-the-box thinking when a particular technique doesn’t work. Which brings me to my first reason voice therapy is not so scary.

REASON NUMBER 1: You are allowed to change your strategy mid-session. I change techniques all the time when I sense the client is frustrated or if the client is unable to achieve a target sound production after a good amount of trying. This is a learned skill and requires humility. I learned this lesson the hard way back in school as I prepared a therapy lesson for one of my first few child clients. I spent hours preparing the “perfect” board game on the computer only to get to therapy the next day and the child was bored to tears playing it. Ego-0, Kid-1. But really, if coordinating respiration, phonation and resonance with Stone & Casteel’s Stretch and Flow or Confidential Voice Therapy (techniques that require increased airflow as the main component in unloading the vocal mechanism) is too difficult for the patient, switch to Resonant Voice Therapy (a technique that uses forward-focused feeling and sound to improve subsystem coordination). If it is not working with the patient seated, have the patient stand and bend over into rag-doll. Use a mirror. Use a tissue. Use a hand. Use your IPHONE to record. Any of this feedback could be the ticket to a successful intervention, so here is the second gem.

REASON NUMBER 2: Odd and strange techniques are encouraged. Sometimes, the weirdest one results in a break-through. If you are confident in your techniques, the patient will be too. As I continue to provide voice therapy to patients, they look at me less and less as though I have 3 heads when I ask them to put a straw in their mouths, bend over and hum Yankee-Doodle. This is because I have seen the outcomes and know that the seemingly silly activities I have patients do in session really provide tangible improvement. This confidence is translated in how I present a task. Some say, “Fake it till you make it.” I say fake it, but make sure you know what you’re faking. You are going to have to feel uncomfortable to make yourself great. Just remember to include the 3 main components of voice therapy in your treatment planning: “Improving Vocal Hygiene, Decreasing Phonotrauma, Coordinating Subsystems.” That’s it. Voice disorders seemed so much more complicated at one time, didn’t it? As a community of SLP’s and AuD’s, we support each other with therapy ideas. I witness daily on my social media perusals where a weary SLP is calling an SOS for a difficult case. We help each other out, so here is the final tidbit.

REASON NUMBER 3: Community means community resources. There is never a dumb question on any list-serv or forum I have ever been a part of. I witness graduate students getting answers from seasoned professionals. I once was scared of the “greats,” but they are people just like me and just like you who just want patients and clients to improve. It is humbling to step back and admit you need to “use a lifeline.” I think this is not a sign of weakness, but of strength as a resourceful clinician. If we can expect honest feedback, we can provide the best care, and isn’t that what it’s all about? See, not so scary!

And in lieu of trick-or-treat candy, here are a few resources that are just as yummy:

Improving Vocal Hygiene

Eliminating Vocal Abuse/Misuse

Coordinating Vocal Subsystems

Hopefully now you are armed with some new information on the voice. Don’t be afraid to make mistakes and get messy. (Magic School Bus anyone?) Voice therapy is not nearly as scary as that large pile of paperwork on your desk…(That deserves a Halloween costume…)

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She provides voice, swallowing and speech therapy in her own private practice, a tempo Voice Center, LLC. She also lectures on the singing voice to area choirs and students. She belongs to ASHA’s Special Interest Group 3-Voice and Voice Disorders. She keeps a blog on her website at www.atempovoicecenter.com. Follow her on Twitter @atempovoice or like her on Facebook at www.facebook.com/atempovoicecenter.

 

A Misleading Account of Research on Stuttering Treatment for Young Children

stutter

A recent ASHA Leader article by Peter Reitzes on treatment for preschoolers who stutter makes claims to the efficacy of some treatments that are both misleading and not evidence based – at least as far as published research is concerned.  Reitzes refers readers to a study by Franken, Kielstra-Van der Schalk and Boelens (2005) that claims to have shown no difference between the results or outcome of the Lidcombe Program and a Demands and Capacities treatment approach.  That study, as Bothe, Davidow, Bramlett and Ingham (2006) reported in their systematic review of research on the treatment of stuttering, is fundamentally flawed, making the results uninterpretable.

A study by Jones et al. (2005) evaluating the Lidcombe Program, did so by comparing children who stutter that were treated by Lidcombe with a control group that did not receive treatment. Another study by Yairi, Ambrose, Paden and Throneburg (1996) made it clear that preschool children (especially those who have been stuttering for less than 15 months) have a very high rate of untreated recovery. Consequently, any treatment evaluation using that age group needs to be compared with an untreated control group so as to show that its beneficial effects exceed those that would occur without treatment.  In the case of the Franken et al. (2005) study there was no untreated control group.  Hence, Bothe, et al. (2006) concluded that “Franken et al.’s data are difficult to interpret without a no-treatment control group to confirm that their application of either treatment was actually effective” (2005, p. 331).  In fact, that is a very charitable comment because the data are not just “difficult to interpret” – they are impossible to interpret! There is nothing in this study that would show that any speech performance improvements (from Lidcombe or Demands and Capacities) exceeded those that might have occurred without treatment.

There is even more to be concerned about in the Reitzes article.  He describes a presentation by Franken at the 2013 NSA conference of another study that also compared Lidcombe Program with a Demands and Capacities treatments. This study (Franken, 2013) used a larger cohort (n =199; 3-6 years) and reported findings similar to those reported by Franken et al. (2005).  It was claimed that after 18 months there was no significant difference between the groups in terms of stuttering frequency and percentage of children recovered.  But this study simply repeats the design error identified by Bothe et al. (2006): yet again there was no untreated control group.  The importance of controlling for a natural rate of recovery is also underscored by the report that many of the study’s children may have been stuttering for between 6 and 15 months when they entered the study. It is now almost indisputable that a high rate of untreated recovery characterizes children in this bracket (Ingham & Cordes, 1999). The argument that some might raise that running an untreated control group would amount to unethically withholding treatment is not an excuse or defense. There are many alternative research designs that can offset this problem (see Kazdin, 1998). And if one is concerned about ethics in research, how can it be argued that it’s ethical to draw unwarranted conclusions about the effects of treatments for preschool children who stutter that are based on research designs that cannot support those conclusions?

The fact that the Bothe et al. (2006) review was not mentioned among the sources or references for this article is puzzling.  Either Reitzes was unaware of this critique of the Franken et al. (2005) study, or for some reason chose to ignore it. Or perhaps he is unaware of the high rate of natural recovery in this population and thus did not understand the threat that that fact posed to the usefulness of the Franken and colleagues’ findings. Nonetheless, readers should not be ignorant of the deceptive message conveyed within his article.

Roger J. Ingham and Janis Costello Ingham are professors in the Department of Speech and Hearing Sciences at the University of California, Santa Barbara. Roger Ingham is an affiliate of ASHA Special Interest Group 4, Fluency and Fluency Disorders.

 

References

Bothe, A.K., Davidow, J.H., Bramlett, R.E., & Ingham, R.J. (2006).  Stuttering treatment research, 1970 – 2005: I. Systematic review incorporating trial quality assessment of behavioral, cognitive, and related approaches.  American Journal of Speech-Language Pathology, 15, 321-341.

Franken, M-C. (2013). Comparing a Demands and Capacities Model approach and the Lidcombe Program for preschool stuttering children: The RESTART randomized trial (Abstract). NSA Conference Presentation, Scottsdale, AZ.

Franken, M-C., Kielstra-Van der Schalk, C. J., & Boelens, H. (2005). Experimental treatment of early stuttering: A preliminary study. Journal of Fluency Disorders, 30, 189-199.

Ingham, R.J., & Cordes, A.K. (1999). On watching a discipline shoot itself in the foot: Some observations on current trends in stuttering treatment research. In N. Bernstein Ratner and E.C. Healey (Eds.), Stuttering Research and Practice: Bridging the Gap (pp. 211-230). Mahwah, New Jersey: Lawrence Erlbaum.

Jones, M., Onslow, M., Packman, A.,Williams, S., Ormond, T., Schwartz, I., et al. (2005). Randomized controlled trial of the Lidcombe Programme of early stuttering intervention [Electronic version]. British Medical Journal, 331(7518), 659.

Kazdin, A.E.  (1998). Research design in clinical psychology (3rd ed).  Boston MA: Allyn and Bacon.

Reitzes, P. (2014). The powered-up parent. The ASHA Leader, 19, 50-56.

Yairi, E., Ambrose, N.G., Paden, E.P., & Throneburg, R.N.  (1996). Predictive factors persistence and recovery: Pathways of childhood stuttering.  Journal of Communication Disorders, 29, 51-77.

 

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

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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.

How to Prepare to Speak at ASHA Convention for the First Time

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This year I will be presenting at the ASHA Convention for the first time. The first time I attended an ASHA convention was last year in 2013. I enjoyed the sessions I attended and set a goal to speak at an ASHA convention sometime during my career. Thanks to partnering with amazing SLPs across the country I was able to  propose five sessions for the 2014 convention. Even though I felt that each proposal was an exciting topic, I did not expect all five to be accepted as talks (or get accepted at all). But that is exactly what happened. My first time speaking at the ASHA convention, I will be involved in five sessions. Due to scheduling conflicts, I will be speaking at only four of the sessions (see below for details). So how am I going to prepare for this? Here are three things:

 

1. Stay organized. Juggling the preparation for five sessions is not easy, so organization is key. I am reducing repetitive and inefficient work by only working on presentations at specific times. To respect my fellow presenters, I am communicating when I will be able to complete individual tasks. I schedule my presentation work sessions based on established deadlines.

Working with many co-presenters (all across the country) means many emails about our presentations. I created a file folder in my email for each presentation. I file each email in the presentation’s folder. This keeps everything together in case I need to refer back to details such as deadlines, ideas, to-do lists, and plans.

I have coordinating file folders in Google Drive for document storage (e.g. proposals, slide deck drafts, my presentation notes, etc). All the documents for each presentation are kept together. Since it’s all in the cloud, I won’t leave it behind.

 

2. Reduce inconveniences. The worst part about conventions and traveling for training for me is food. I have Celiac disease and other food allergies. Convention halls aren’t the best venue for finding gluten free, healthy food. Last year I spent $20+ on lunch, when I bought a sandwich with no bread or fries (because they were fried in the same fryer as gluten) and put the meat on top of a salad. I essentially bought 2 lunches to create one lunch (and I was still hungry).

So this time, I am doing myself a favor and anticipating a busy schedule and poor food options. I found a company that will make premade meals and deliver them to my hotel (for a lot less than $20). My hotel room has a fridge, so I will keep the premade meals in the fridge and bring lunch with me. I will not waste time on long lines or risk  getting sick.

 

3. Prepare for fun. The ASHA convention isn’t my first speaking engagement as an SLP. I have been speaking about dementia and ethics in healthcare to my fellow SLPs, other healthcare professionals, students, and family members via webinars, courses, video conferences, etc. I keep doing it because it’s fun! I thoroughly enjoy creating a presentation for a specific audience to help them reach their goals. My career has evolved into spending the majority of my time in an education role. For a former teacher, this is a very welcome evolution.

 

The pre-presentation nervousness comes, but reminding myself that each speaking opportunity is an opportunity for fun and to inspire better dementia treatment and elder care relieves my jitters quickly. I am thankful for each and every opportunity, including the several at ASHA’s convention this year. See you there!

 

Rachel Wynn is one of four guest bloggers for ASHA’s convention in Orlando and will be speaking at the following sessions:

 

Friday, November 21, 2014

  • Clients at risk for suicide: Our experiences and responsibilities (Session Code 1310) 8:00-10:00 a.m.
  • Get out of that box! Four creative mold-breaking models of private practice (Session Code 1441) 3:30-4:30 p.m.

 

Saturday, November 22, 2014

  • Social media for SLPs: Leveraging online platforms to connect and advance your practice (Session Code 1704) 1:00-2:00 p.m. (Not presenting due to scheduling)
  • Dementia 101 for students and new clinicians: Changing lives through a functional approach (Session Code 1720) 1:00-2:00 p.m.
  • Productivity pressures in SNFs: Bottom up and top down advocacy (Session Code 1755) 2:30-3:30pm

 

Rachel Wynn, MS, CCC-SLP, specializes in eldercare, and, as the owner of Gray Matter Therapy, provides education to therapists, healthcare professionals, and families regarding dementia and elder care. She is an affiliate of ASHA Special Interest Group 15 (Gerontology) and an advocate for ethical elder care and improving workplace environments, including clinical autonomy, for clinicians.

Finding Strength, Resilience and Speech-Language Pathology—as a Future Clinician and Current Client

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Life is full of challenges; age does not play favorites. I think the key is how we handle those challenges. That is where courage, resilience and strength come into play.

Since starting undergraduate courses at the University of Central Missouri, Warrensburg, in August 2012, I faced a number of challenges—residence changes, job changes, health challenges, and school challenges. I remember rolling into the fall semester in 2013 feeling exhausted, stressed and wondering if I would make it. I was trying to put some space between my long-time boyfriend and myself. He moved across the street from me after a fire where we used to live.

I was still working about 30 hours a week, attending school full time, and preparing to start graduate school in January. The final challenge was his unexpected death from a heart attack the day before the last week of fall classes in 2013. Over the next two weeks, I made it through classes, finals and a funeral.

At 52, I have experienced my share of obstacles and stressful events, but this put me into a tailspin. I am one of the strongest women I know and my obstacles are usually short walls. I made it through the spring semester, but that first summer semester knocked me back onto my heels, mentally and physically, and I could not climb over that wall. I learned then how much support I had in the school faculty, staff and my classmates.

During that summer semester, I lost my focus. I felt buried under the mountains of clinic paperwork, a research paper and challenging coursework. My clinical evaluations were not positive, and I was floundering. That is where I pulled my courage from deep inside myself and turned to the faculty and my friends for help.

Reaching for help is hard, because sometimes the answers are not what we want to hear. My supervisors got me back on track and helped me stand up on my own two feet. I had to take a long, hard look in the mirror and face the person they saw. At the final case conferences, I asked them some direct questions, which is how I not only became a clinician this fall, but also a client. As a former U.S. Army sergeant, and as someone with a strong personality, I fit in well in some venues, but I needed help to be successful in other venues—like the speech-language pathology field. That is where the strength came in. I am self-aware, and willing to look at myself, but I had to admit I needed help with my pragmatic skills.

My clinician is wonderful, and together, we are discovering how to work on my pragmatic skills. My clinician created a scaled list of questions about how I communicate, and we used that to get feedback from my teachers and supervisors. The answers knocked me back a bit, but I accepted their feedback with grace and maturity.

We are working on my personal interaction skills, my resume, and even my social media postings. The interventions are working as my teachers and supervisors notice a difference in how I communicate. I am having a successful semester and my mid-semester conferences resulted in two A’s and a B.

Being a client is different from being a clinician. I am convinced it takes courage and strength to come into a professional clinic and lay oneself open to change. Change is hard. Change is not always fun. Sometimes change is painful.
While attending graduate school, I turned 52, and in November my first grandchild will be born. So many changes, so many opportunities lie ahead for me. This field of speech-language pathology is ripe with opportunities for older students. As nontraditional students, we have faced challenges and experienced things that younger students will not experience for a while.

Sometimes our life experiences mirror those of our clients, giving us the ability to be empathetic and genuine in our care. I am looking forward to this next chapter in my life. I will face any other challenges with courage, resilience and strength, because that is what I do.

Teresa Shane is a speech-language pathology graduate student at the University of Central Missouri in Warrensburg, Missouri.