ASHA Schools 2013: Putting Your Best Foot Forward

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

 

On the Other Side of the Table: Receiving the Diagnosis

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

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

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

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

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

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

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

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

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

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

 

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

Yes, DSM-5 Changes SLP-Relevant Disorder Categories: What You Need to Know

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The speech-language pathology community has been abuzz for months about the pending release of the new Diagnostic and Statistical Manual of Mental Disorders because of expected changes to autism spectrum disorder and other communication disorders involving SLPs.

And indeed, the fifth edition, issued by the American Psychiatric Association last month, significantly changes ASD and several other SLP-relevant categories—and also unveils the new social (pragmatic) communication disorder.

As most SLPs well know, DSM is the standard classification of mental disorders used in clinical and community settings in the United States and other countries. The new edition is available first in print, with an electronic version to be offered later this year. See highlights of the changes to DSM-5 on the American Psychiatric Association’s website.

Here are some of the major changes in the category of Neurodevelopmental Disorders that are relevant to the work of speech-language pathologists:

 Intellectual disability (Intellectual developmental disorder)

  • Replaces the term “mental retardation” with “Intellectual disability (Intellectual developmental disorder).”
  • Relies more on adaptive functioning rather than on specific IQ scores.

Communication Disorders

Changed from expressive and mixed receptive-expressive language disorders to include:

  • language disorder
  • speech sound disorder
  • childhood-onset fluency disorder
  • social(pragmatic) communication disorder

Autism spectrum disorder (ASD)

  • Eliminates pervasive developmental disorder and its subcategories (autistic disorder, Rett’s disorder, childhood disintegrative disorder, Asperger’s disorder, pervasive developmental disorder-not otherwise specified). Instead, children meeting the criteria will be given a diagnosis of “autism spectrum disorder” with varying degrees of severity.
  • Omits criterion related to the development of spoken language.

 Specific Learning Disorder

  • Combines diagnoses of reading disorder, disorder of written expression, mathematics disorders, and learning disorder not otherwise specified.
  • Recognizes the need to use a variety of culturally and linguistically appropriate assessment tools and strategies and does not require use of a standardized measure.
  • Does not include oral language.
  • No reference to modalities of language.


Changes in the section on Neurocognitive Disorders pertinent to the speech-language pathology field include the following:

  • Dementia is considered a major neurocognitive disorder.
  • A less severe cognitive impairment is considered a mild neurocognitive disorder.

We were fortunate to have SLPs involved in developing some of the diagnostic criteria in DSM-5. Amy Wetherby was a member of the DSM-5 neurodevelopmental workgroup and chaired a subgroup on communication disorders. Mabel Rice, Nickola Nelson and I worked on this group. ASHA responded during the three public comment periods.

Now that the new edition is out, ASHA has assembled a DSM-5 response team coordinated by me and composed of Janet McCarty, Andrea (Dee Dee) Moxley, Froma Roth and Monica Sampson. We are developing resources to guide members and consumers on the changes, including at least three articles in upcoming issues of The ASHA Leader. The articles will include:

  • A comparative analysis of what ASHA recommended and what DSM-5 includes, with clinical implications for SLPs.
  • Coding implications for reimbursement.
  • Case studies to demonstrate how the changes will affect people with speech, language, communication and cognitive disorders.

ASHA also will communicate with consumers about what the DSM-5 might mean to them through podcasts, media interviews and other dissemination vehicles. A critical message we want to convey is that SLPs will continue to provide needed services, which are based on assessment of communication strengths and needs, and not on specific DSM-5 diagnostic labels.

ASHA would like to know how you think the changes in DSM-5 will affect your clinical practice. We also are seeking case studies that demonstrate impacts of the changes for a future Leader article. Please contact Diane Paul at dpaul@asha.org.

Diane Paul, PhD, CCC-SLP, is ASHA’s director of clinical issues in speech-language pathology.