Attacking Social Interaction Problems Across the Lifespan

Featured

Autism: Attacking Social Interaction Problems

Autism: Attacking Social Interaction Problems by Betholyn F. Gentry, Pamela Wiley, and Jamie Torres-Feliciano

By Pamela Wiley, Ph.D., co-author of Autism: Attacking Social Interaction Problems

In my private practice, we are often asked by our funding sources when our children with ASD will no longer need social skills instruction. I often feel a sense of “indirect or subtle” pressure to discontinue our service and declare that a child is socially competent and basically cured of what is essentially the hallmark feature of ASD: impaired social interaction. However, given what I know and have observed with this population it is difficult both ethically and morally to do so.

As professionals we know that social skills are the foundation for getting along with others. We also know that there are social skills milestones which develop along a continuum. For example, one of the early skills focused on for our young children is “how” to make friends and join groups. Many are successful and with parental support during the preschool years engage in playdates and develop friendships with their typically developing peers. However, around 8 or 9 years of age the terrain shifts and children reportedly become more discriminating and scrutinizing as they select their friends. Labels such as nerd, cool and loser become important in the selection process. Our children with ASD often fall into the category of nerd.

As a result, many of them experience rejection and bullying and are left confused and hurt when their only friends abandon them. Social skills continue but our focus evolves to include discussions and skill steps to facilitate their understanding of “who” should be their friend and “how” our friends make us feel and accepting loss and changes in life. The need for social skills training into middle school and beyond can have a profound effect on the quality of life for these children.

High school brings yet another level of complex social interactions and negotiations especially when dealing with the opposite sex, changes in hormone levels, sexual maturation, and peer pressure.

The final phase is the transition process from high school to college and the world of work. The need for continued social skills training is essential and should address core clusters of skills critical for promoting independence and fulfilling lives: vocational, independent, and personal development. Social skills taught may include relationships and how to discriminate between a friend, a colleague, and an acquaintance, the importance of good hygiene, executive functioning, workplace conversation, nonverbal communication, unwritten social rules, and workplace idioms such as “hit the ground running” to name a few.

Based on decades of working with this population and the long-term relationships experienced with many of the children and families in my practice and more importantly the positive outcomes we have achieved, in response to the question, how long should children with ASD continue with social skills treatment, my short answer is, “Across the Lifespan.”

That having been said, based on the positive comments and requests from our colleagues following several ASHA presentations on social skills, my colleague and I have developed a series of social skills workbooks, Autism: Attacking Social Interaction Problems to cover the lifespan of children with ASD from 4 years to adulthood.

Our books contain clear and concise objectives and instructions on how to introduce and implement the lessons. Our approach is fun yet structured and each unit builds on previously learned skills to assist in the generalization of information across boundaries and contexts which include home, school, and the community while incorporating parent and teacher input.

Our newest additions are the teen and prevocational books which are fresh and relevant to today’s youth and include the use of social media and issues facing young people today such as sexting, texting, and TMI. The goal is to assist our students to develop a full range of interpersonal social competencies that can help them ultimately achieve acceptance in the workplace and develop a meaningful existence.

To learn more about our series of workbooks, visit Plural Publishing at www.pluralpublishing.com or our website www.speakla.com.

Tinnitus: In the Brain of the Beholder

Marc_Fagelson    Baguley_PTINN    David_Baguley

 

By: Marc Fagelson, BA, MS, PhD and David M. Baguley, BSc, MSc, MBA, PhD

Co-editors of Tinnitus: Clinical and Research Perspectives

Most audiologists and patients understand tinnitus to be the perception of a sound that is not connected in any way to an environmental event. For some patients, the sound produces minimal discomfort and is noticeable only a fraction of the time. Other patients are not so fortunate, and their tinnitus may persist and prove distracting when they are in the presence of other sounds or when they try to communicate. A relatively small proportion of patients with tinnitus, still probably more than 10 million people worldwide, have bothersome tinnitus that consistently reduces their quality of life and affects most routine activities. Such patients often respond to tinnitus as though its presence merits the attention and concern consistent with that demanded by a sound that is recognized as a threat. These patients illustrate some of the more confounding elements of tinnitus: it is a sound experience that may produce, or be associated with, powerful emotions and physiologic responses consistent with those demonstrated in fear-avoidance research.

A person’s experience with tinnitus may be complex and multi-faceted. Some patients link tinnitus to traumatic events, perhaps those that triggered the tinnitus onset. Other patients report psychological conditions such as anxiety and depression appear to exacerbate tinnitus and may be reinforced by tinnitus-related negative associations. Often, tinnitus severity is dictated not by the sound, but by the patient’s interpretation of and response to the sound. In this regard, the power of tinnitus to exert influence over a person’s life is in the eye, or ear, of the beholder.

Tinnitus interventions, then, may be viewed as proceeding along parallel tracks: abolishing or attenuating the sound may be the target of a treatment strategy, or the patient’s response to tinnitus may be the target of a management strategy. Both approaches are considered in detail, and with many examples, in Tinnitus: Clinical and Research Perspectives. Continue reading

The Ineffectiveness of Checklists in Diagnosing Childhood Apraxia of Speech (CAS)

Margaret_Fish  Fish_HHTCASE2E_low res

By Margaret Fish, MS, CCC-SLP, author of Here’s How to Treat Childhood Apraxia of Speech, Second Edition

Sorting through evaluation findings for young children with complex speech sound disorders can be confusing and challenging. As SLPs we strive to complete thorough evaluations and make sense of our evaluation findings to achieve an accurate diagnosis; however, many of the characteristics of CAS overlap with other types of speech sound disorders. Certain key characteristics from a CAS checklist such as inconsistency, atypical prosody, groping, or vowel errors may raise red flags for a diagnosis of CAS, but these characteristics alone should not predetermine the diagnosis until a thorough analysis of the child’s speech productions is completed.

Following are case studies of two children recently seen for consultations. Both children had an incoming diagnosis of CAS, but only one child was given a definitive diagnosis of CAS at the conclusion of the consultation. The other child demonstrated a number of characteristics commonly associated with CAS, but after careful examination of the child’s speech, the underlying nature of the challenges was not consistent with the core impairment of CAS that ASHA (2007) describes as the “planning and/or programming (of) spatiotemporal parameters of movement sequences.”

Case Study 1.

Mark, age 3 years, 7 months, had recently received a diagnosis of CAS by a diagnostic team at a local hospital. The diagnosis was based primarily on the following factors:

  • Reduced speech intelligibility (judged to be 50% intelligible)
  • A nearly complete repertoire of consonants and vowels
  • Inconsistent productions of the same word
  • Occasional vowel errors
  • Atypical speech prosody

Because of Mark’s limited speech intelligibility, inconsistency, vowel errors, and prosody differences, it was understandable how a diagnosis of CAS was made, as these characteristics often are associated with a positive diagnosis of CAS. Indeed, the use of a checklist of CAS characteristics alone could lead a clinician to conclude that Mark had CAS.

Continue reading

How to Work with Interpreters and Translators

Henriette_Langdon  Langdon_WWIT  Terry_Saenz

By Henriette W. Langdon, Ed.D., FCCC-SLP and Terry I. Saenz, Ph.D., CCC-SLP, authors of Working with Interpreters and Translators: A Guide for Speech-Language Pathologists and Audiologists

Our world is increasingly heterogeneous. English is no longer the only language spoken in the United States, England, or Australia. French is not the only main language spoken in France and neither is German the only language spoken in Germany. Immigration caused by political and economical changes has dispersed many people to other countries in the world in search of better opportunities. Consequently, communication between these individuals and residents of the different countries is often disrupted due to the lack of a common language. This challenge has existed throughout humankind, but it seems that it has increased in the last century or so. There have always been people who knew two languages that needed bridging, but now this urgency is more pronounced. The need for professionally trained interpreters was first noted following the end of WWI when the Unites States was first involved in world peace talks alongside many nations with representatives who all spoke a variety of languages. This historical event eventually led the League of Nations to the foundation of the École d’Intèrpretes in Geneva, Switzerland in 1924. Since that time, many other schools that train bilingual interpreters to participate in international conferences have been established. The AIIC [Association Internationale des Interprètes de Conférence (International Association of Conference Interpreters)] Interpreting Schools directory lists a total of 87 schools worldwide: http://aiic.net/directories/schools/georegions. The reader can gather information on which specific language pairs are emphasized in the various training schools; for example, Arabic-English; French-Spanish, Chinese-English, and so forth. Thus, interpreting for international conferences is a well-established profession today, offering specific training and certificates. However, interpreting is necessary not only for international conferences, but also to assist in bridging the communication in everyday contexts such as medical or health, judicial, educational (schools) and the community at large. Training and certification in areas such as medical and judicial have slowly emerged and are available to those who need them in various states throughout the United States. Legislation has been the primary force in the establishment of certificates in the areas of medical and legal interpreting. However, training in other areas where interpreting is needed such as education, and our professions, speech pathology and audiology, are notoriously lacking. There are some situations where medical interpreters can assist speech-language pathologists (SLPs) and audiologists in a hospital or rehabilitation center, but even those interpreters may not have the specific terminology and practice or procedures to work effectively with our professionals. Working with Interpreters and Translators: A Guide for Speech-Language Pathologists and Audiologists is a second revised and expanded edition on this topic that provides SLPs, audiologists, and interpreters who collaborate with them some concrete tools and strategies on how best to conduct interviews, conferences, and assessments when the client and/or family does not speak English fluently.  The proposed process is based on information gathered from other interpreting professions. The research, and some personal interviews with audiologists in particular that were conducted to assemble this information, indicate that the process is conducted haphazardly at best.  The literature available on the collaboration between SLPs and interpreters indicates that both parties are not secure about procedure and must learn how to work together by trial and error. Often the SLP does not trust the interpreter and the interpreter does not follow suggested procedures, such as failing to interpret all that is being said, conducting a side conversation with a parent during a meeting, and giving the child unnecessary cuing during testing (if tests are available in the child’s language, which is primarily Spanish). Literature on working effectively with audiologists is almost nonexistent; therefore, the first author resorted to several personal interviews with audiologists, a specialist of the deaf and hard of hearing, and professors of audiology throughout the country. Often individuals who perform the duties and responsibilities of the interpreter and who are hired to do this job are not fully bilingual; they may speak the two languages, but may not be able to read or write the language they are using to interpret. These interpreters are often not respected, are not treated as professionals, and their pay is very low.

Continue reading

ASHA 2015 Preview

The 2015 ASHA Convention starts November 12 in Denver and is shaping up to be one of the largest ever. If you are attending this year’s meeting, please stop by our booth (#804) for the following:

  • Save 20% with free shipping!
  • Connect with experts at one of our Meet the Author sessions (schedule to be announced November 11)
  • Browse our new textbooks and request a review copy for your course
  • Meet with Valerie Johns, Executive Editor, about any ideas for a new book

Attend the session, then buy the book!
We have many new books debuting by authors that are presenting at ASHA 2015 on their book topics.

Session Title: Drawing from Different Settings: A Panel Presentation on School-Based Swallowing & Feeding
Presenter(s):  Emily Homer (presenting author); Lisa Mabry-Price (presenting author); Kim Priola (presenting author); Gayla Lutz (presenting author); Donna Edwards  (presenting author); Lissa Power-deFur (presenting author)
Day: Thursday, November 12, 2015 Time: 10:30 AM – 12:30 PM                                     Book title(s): Management of Swallowing and Feeding Disorders in Schools and Common Core State Standards and the Speech-Language Pathologist: Standards-Based Intervention for Special Populations

Session Title: Assessing the Validity of Remote MAPping for Children With Cochlear Implants
Presenter(s): Emma Rushbrooke (presenting author); Louise Hickson; Belinda Henry; Wendy Arnott
Day: Thursday, November 12, 2015 Time: 11:00 AM – 11:30 AM
Book title(s): Telepractice in Audiology and Evidence-Based Practice in Audiology: Evaluating Interventions for Children and Adults with Hearing Impairment 

Session Title: Trauma & Tinnitus
Presenter(s): Marc Fagelson (presenting author)
Day: Thursday, November 12, 2015 Time: 1:30 PM – 2:30 PM
Book title: Tinnitus: Clinical and Research Perspectives 

Continue reading

Managing the Expectations of the Common Core State Standards

Lissa_Power-deFur      PowerdeFur_CCSS

By Lissa A. Power-deFur, author of Common Core State Standards and the Speech-Language Pathologist: Standards-Based Intervention for Special Population

Speech-language pathologists (SLPs) in school districts across the country have returned to school, often with the new (or renewed) obligation of addressing the “Common Core” (or the “Career and College Readiness Standards” as the Common Core State Standards [CCSS] is referred to in some states.) The SLPs’ reactions are likely to include the following:

  • With all the students on my caseload, how can I possibly do something else?
  • This is just another education fad; it’ll pass in a couple of years.
  • From what I hear about these standards, they aren’t applicable to the students on my caseload.
  • I’m focusing on the IEP goals, they are most important for my students.

These are common reactions, reflecting the current challenges and pressures of working as an SLP in the schools. However, it is important that all SLPs working with children, whether in schools or other settings, understand that the CCSS is now the lens through which educators must view the achievement of all students, including students with speech-language impairments. The education standards movement has been in place for over two decades, with states first adopting their own standards and developing assessments to measure student achievement of those standards. More recently, the National Governors’ Association (NGA) and the Council of Chief State School Officers (CCSSO), with funding from the Bill and Melinda Gates Foundation, used teams of educators, business professionals, and policy-makers to develop the Common Core State Standards. Released in 2010, 43 states have adopted the CCSS. The Standards serve as the basis for state assessments developed by two consortiums, the Partnership for Assessment of Readiness for College and Careers (PARCC), and the Smarter Balanced Assessment Consortium.

As SLPs study the CCSS, they will find that the Standards encompass a hierarchy of language skills from phonological awareness to the ability to understanding diverse perspectives, from comprehension of discipline-specific vocabulary to syntactic complexity in speech and text. The CCSS emphasize oral language and phonological awareness in the primary grades, as kindergarteners must demonstrate skills in counting, pronouncing, blending, and segmenting syllables in spoken words. The CCSS expect secondary students to use oral communication effectively to present findings and support their evidence clearly and concisely using a style appropriate to the audience and task. In the vocabulary area, students must demonstrate such diverse skills as mastery of morphology for understanding meaning to becoming adept at understanding euphemisms, hyperbole, and paradox. Students’ skills in the conventions of Standard English develop from early skills in using nouns, verbs, adjectives, and adverbs to secondary level skills in using parallel structure in their oral and written communication.

The CCSS provide an excellent vehicle for SLPs to use to support collaboration with their education partners. As SLPs communicate with teachers, the CCSS provides a common vocabulary to describe student expectations and performance, thereby facilitating the education team’s focus on needed language and communication skills. A typical child on the SLP’s caseload will have difficulty acquiring standards from prior grade levels. The CCSS can serve as a resource SLPs can use in explaining the effect of children’s speech-language impairments on their ability to master specific standards. By using the language of the CCSS in describing students’ performance, the SLP’s ability to communicate with teachers and administrators about the challenges the child is and will be facing is enhanced.

SLPs will find that an analysis model facilitates their ability to integrate the standards into their intervention planning. A 5-step model builds upon SLPs’ extensive knowledge of the language and metalinguistic skills and leads to development of collaborative direct and classroom-based intervention activities. In step 1, SLPs work collaboratively to identify the standards needed for success. SLPs will analyze the CCSS, identifying the specific expectations that will rely on the student’s language and communication skills. Due to the magnitude of the CCSS, this task quickly becomes overwhelming. Therefore, SLPs are urged to follow the practice of their education partners—creating teams to review the standards. By working with colleagues, SLPs can focus on the areas that relate to their expertise. For example, SLPs with specialization in fluency can review the standards for expectations for oral communication and presentations. SLPs with a passion for literacy can focus on these standards. Another approach would be for SLPs to focus on all standards or the grade levels they serve (or the grade levels their students have just left and will be moving into). Not only does teamwork minimize the workload, it enables the creative generation ideas that flow from a collaborative group of professionals. The Plural book, Common Core State Standards and the Speech-Language Pathologist:  Standards-based Interventions for Special Populations, provides SLPs with examples of the language and communication expectations of the standards.

The model’s second step focuses on detailed identification of the language and communication skills needed for success. This analysis addresses phonology, morpho-syntactic, semantic, and pragmatic and metalinguistic skills. The SLPs will find standards that require competency in speech sound production and fluency as well. This is another task completed well by a team of SLPs, reducing the workload and facilitating the brainstorming and analysis. The result will be a comprehensive understanding of the standards.

Step 3 shifts the attention from the standards to individual students. The SLP will complete a thorough analysis of a student’s current skills and needs. Data sources include standardized assessments, observations of the child in the classroom, classroom work samples (e.g., narratives, spelling tests), and probes of specific skills. Many of these items will be found in the Present Level of Academic Achievement and Functional Performance (PLAAFP) of the child’s Individualized Education Program (IEP). However, SLPs will find that they will want to generate skill-specific probes to understand the nuances of the child’s needs as they plan for intervention.

At this point, the SLP’s focus shifts to consideration of the expectations in the child’s classroom. The SLP will use information from observations to identify the language of the classroom communications, especially directions, texts, and instructional activities. A specific focus on morphological-syntactic constructions and vocabulary will enable the SLP to focus on specific skills the child will need for success. If multiple SLPs have children in this same classroom, this can be a joint activity.

The final step is to design intervention. Children’s academic success relies on their ability to apply the language and communication skills developed under the guidance of the SLP into real-world settings (i.e., the classroom). Therefore, the intervention should be a combination of direct intervention and collaborative classroom-based intervention. This combination of approaches allows for a specific focus on skill attainment, followed by application of that skill. The SLP may find it particularly valuable to participate in classroom center activities, working with specific children and facilitating their mastery of skills through collaboration with other students. This step relies on a collegial working relationship with the child’s classroom teacher(s), with time for planning to enable both professionals to identify which skills they will focus on and the nature of interventions.

The use of a stepwise model for analyzing the standards and applying this information to the strengths and needs of a specific child enables the SLP to tailor intervention to what matters for children—academic success. It is only through the SLP’s comprehensive knowledge of the academic standards and analysis of the specific linguistic expectations of the standards that students with language and communication difficulties can successfully meet the academic demands of 21st century schools.

About the Author 

Lissa A. Power-deFur, PhD, CCC-SLP, ASHA-F, is a professor in the communication sciences and disorders program at Longwood University in Virginia. Among the courses she teaches is public school methods, which focuses on supporting children’s mastery of the language expectations of the Common Core State Standards. In her clinical role at Longwood, she has collaborated with local school districts for service delivery. She received her bachelor’s, master’s, and doctoral degrees in speech-language pathology at the University of Virginia. She is a Fellow of the American Speech-Language-Hearing Association (ASHA) and the Speech-Language-Hearing Association of Virginia, and regularly volunteers for the profession. Dr. Power-deFur has served as a state education advocacy leader and as a member of numerous education-related committees at ASHA. She is the ASHA 2014–2016 vice president of standards and ethics in speech-language pathology. Additionally, she received The ASHA Leader Outstanding Service Award for her 2011 article on special education eligibility.

 

 

Brain-Based Listening and Spoken Language: The Focus of the Third Edition of Cole and Flexer (2016)

Elizabeth_ColeCarol_Flexer

By Elizabeth B. Cole and Carol Flexer, author of Children With Hearing Loss: Developing Listening and Talking, Birth to Six, Third Edition

Spoken language is acoustically based. When the expectation is that a child will learn spoken language, hearing loss presents a critical spoken language-information-accessing obstacle to the child’s brain. When, through the miracle of modern technology and expertise, the audiologist provides the child’s ears with appropriately selected and programmed hearing aids or cochlear implants, the child’s brain now has access to the acoustic information encoded in spoken language. Looking at it this way, for the child who is learning spoken language, untreated hearing loss presents not only an ear problem, but also a brain access problem. Luckily, given sufficient acoustic access to spoken language in meaningful, varied-but-repetitive contexts, the child’s brain learns to make sense of the auditory input and learns to understand and produce spoken language. That process can be described in just one sentence, but is far from simple. The process of helping a child with hearing loss learn to listen and talk fluently requires a great deal of time, commitment, and sustained effort from all those who care for the child.

In recent years, there has been a veritable explosion of information and technology about testing for and managing hearing loss in infants and children, thereby enhancing their opportunities for auditory brain access. The vanguard of this explosion has been newborn hearing screening. As a result, in this day and age, we are dealing with a vastly different population of children with hearing loss, a population that we’ve never had before in our history. With this new population whose hearing loss is identified at birth, we can facilitate access of enriched auditory/linguistic information to the baby’s brain. The miracle is that we can prevent the negative developmental and communicative effects of hearing loss (such as delayed speech, language, reading and social skills) that were so common just a few years ago. With these babies and young children, we can now work from a neurological, developmental, and preventative perspective rather than a remedial, corrective approach. As we implement brain-based science, the effects on the field of hearing loss are truly revolutionary.

The following are some suggestions for families and practitioners who want to grow the baby/child’s brain for listening and spoken language. Many of the suggestions describe things that any devoted parent would likely do with a child. Beyond the technology, what is different for the parent of a child with hearing loss is the requirement for constant vigilance for decreasing noise and distance, and the requirement for sustained effort at increasing appropriate and meaningful verbal interactions with the child. These are the so simple, yet so difficult, keys for successfully laying the spoken language foundation that the child needs for the rest of his or her life. The authors take their hats off to all of the thousands of parents who have internalized all of the strategies and accomplished just exactly that!

  1. Your child must wear his or her hearing aid or cochlear implant every waking moment and every day of the week—“eyes open, technology on” (even when bathing or swimming, use technology that is water resistant/proof). The brain needs constant, detailed auditory information in order to develop. The technology is your access to the brain and your child’s access to full knowledge of the world around him or her. If your child pulls off the devices, promptly, persistently, and calmly replace them.
  2. Check your child’s technology regularly. Equipment malfunctions often. Become proficient at troubleshooting.
  3. The quieter the room and the closer you are to your child, the better you will be heard. The child may have difficulty overhearing conversations and hearing you from a distance. You need to be close to your child when you speak, and noise in the environment (especially from nonstop TV or other electronics) needs to be greatly reduced or eliminated. Keep the TV, computer/tablet, and CD player off when not actively listening to them.
  4. Use an FM system at home to facilitate distance hearing and incidental learning. An FM system can also be used when the child is reading out loud to improve the signal-to-noise ratio and to facilitate the development of auditory self-monitoring. Place the FM microphone on the child so that he or she can clearly hear his or her own speech, thereby facilitating the development of the “auditory feedback loop.”
  5. Focus on listening, not just watching. Call attention to sounds and to conversations in the room. Point to your ear and smile, and talk about the sounds you just heard and what they mean. Use listening words such as “You heard that,” “You were listening,” and “I heard you.”
  6. Maintain a joint focus of attention when reading and when engaged in activities. That is, the child should be looking at the book or at the activity while listening to you so that he or she has a chance to gain confidence in his or her ability to listen and understand without watching.
  7. Speak in sentences and phrases, not single words, with clear speech and correct grammar using lots of melody. Speak a bit slower to allow the child time to process the words, but be careful not to exaggerate your mouth movements. Many adults speak faster than most children can listen.
  8. Read aloud to your child daily. Even infants can be read to, as can older children. Try to read at least ten books to your baby or child each day. You should be reading chapter books by preschool.
  9. Sing and read nursery rhymes to your baby or young child every day. Fill his or her days with all kinds of music and songs to promote interhemispheric transfer. Singing is a whole brain workout!
  10. Constantly be mindful of expanding your child’s vocabulary. Deliberately use new words (in appropriate phrases and sentences) with the child for objects, foods, activities, and people as you encounter them in the environment during daily routines.
  11. Talk about and describe how things sound, look, and feel.
  12. Talk about where objects are located. You will use many prepositions such as in, on, under, behind, beside, next to, and between. Prepositions are the bridge between concrete and abstract thinking.
  13. Compare how objects or actions are similar and different in size, shape, quantity, smell, color, and texture.
  14. Describe sequences. Talk about the steps involved in activities as you are doing the activity. Sequencing is necessary for organization and for the successful completion of any task.
  15. Tell familiar stories or stories about events from your day or from your past. Keep narratives simpler for younger children, and increase complexity as your child grows.

Above all, love, play, and have fun with your child!

cole

Please read Dr. Cole and Dr. Flexer’s Children With Hearing Loss: Developing Listening and Talking, Birth to Six, Third Edition for detailed information about audiology, technology, parent coaching, and listening and spoken language development.

7 Tips for Landing Your First SLP Job

Guest post by Erica L. Fener, PhD, vice president, strategic growth, at Progressus Therapy

There has never been a better time to be a speech-language pathologist (SLP). According to the U.S. Department of Labor (2014), SLP jobs will grow at a rate of 19% between 2012 and 2022, which translates to an additional 26,000 jobs over the course of the decade. The median pay in 2012 was $69,870 per year, and the current number of jobs—more than 134,000—indicates plenty of opportunity, even before projected growth.

If you just finished graduate school in this field, congratulations! Now all you have to do is ensure you find the right job to begin building your long-term career. Consider these seven tips to help you land your first SLP job:

1. Apply for Your Temporary State License
Every state is different, but most require you to hold a temporary license before becoming an SLP clinical fellow—the first step to being a full-time SLP. Depending on your state, you may be able to apply for the license during your degree program. Your professors can help you figure out how.

2. Land a Professional Clinical Fellowship
Your clinical fellowship year (CFY) is a crucial step on the path to working as a full-time SLP. The purpose of the CFY is to transition from theoretical knowledge to practical application. The experience you gain will be invaluable, if it is the right kind.

The American Speech-Language-Hearing Association (2015a) recommends choosing a setting that provides a full range of speech pathology services, rather than one that solely performs screenings, and treats you as a member of the staff. Also, aim to do your CFY in a setting that you would eventually like to work in, such as a school or a nursing home, so that you will get the training you need to be successful in your future career.

3. Complete Your Fellowship
Successful completion of the clinical fellow requires you to work at least 35 hours a week for 36 weeks, totaling 1,260 hours. You may also work part time, at least five hours a week, until you hit the total. Note that your mentor must be a verified SLP, which you can check through the ASHA Certification Verification page (ASHA, 2015b).

4. Reflect on Your Experience
After you complete your hours, it is time to move forward and look for a real job, which requires reflection. This step might seem a little overwhelming, but thinking through your experience can make a world of difference in your professional career. What did you like? What would you prefer to avoid? How did the setting suit your nature? The answers to these questions will help you determine where you apply.

5. Start Searching for a Job
In rare cases, the setting where you completed your fellowship may choose to hire you. Typically, however, you should not expect your mentoring facility to offer you a job. If it does, wonderful, but you must be prepared to look for work elsewhere, so it is time to start the job search. Check out career fairs and job boards, look online, and utilize your network for prospects.

6. Look Outside the Box
Not all SLP jobs will be specifically labeled as such. Some might be called “speech therapist” or “speech-language pathologist and children’s therapist.” If you are working with older people, your duties might be split between speech-language pathology and physical therapy. The specific job you land depends on your setting and your skills. To get a better idea, do your research and review job boards to see what types of jobs are available.

7. Nail the Interview
In your interview, be personable and honest about your experience and your desires. If you are worried about it, read a few articles detailing some tricks for performing well in the interview. According to Business Insider (2014), these can be as simple as warming up your hands, mirroring your interviewer’s body language, and reading facial cues. Your expert knowledge, good humor, and attention to detail will eventually land you the job you are looking for.

Now that you have that job offer, it is time to take a little break and celebrate—but not for too long, of course. Soon enough it will be time to pack your supplies and start your new career as a professional SLP, helping improve the lives of others.

References

American Speech-Language-Hearing Association. (2015a). ASHA certification verification. Retrieved from http://www.asha.org/eweb/ashadynamicpage.aspx?site=ashacms&webcode=ccchome

American Speech-Language-Hearing Association. (2015b). Selecting a clinical fellowship (CF) setting. Retrieved from http://www.asha.org/certification/SelectingCFSetting/

Business Insider. (2014). Retrieved from http://www.businessinsider.com/psychological-interviewing-tricks-2014-9

U.S. Department of Labor. (2014). Speech-language pathologists. Retrieved from http://www.bls.gov/ooh/healthcare/speech-language-pathologists.htm

About the Author

Erica L. Fener, PhD, is vice president, strategic growth, at Progressus Therapy, a leading provider of therapy employment, including school-based therapy and early intervention services. Progressus Therapy connects speech-language pathologists with schools across the United States.

Insight into the Significance of Supporting Caregivers from Dr. Payne’s New Book

Joan_Payne Payne_SFC

By Joan C. Payne, PhD

Author of the new Supporting Family Caregivers of Adults With Communication Disorders: A Resource Guide for Speech-Language Pathologists and Audiologists

In the United States, there are nearly 44,443, 800 family caregivers over the age of 18 who are caring for someone aged 50 years and older (Alzheimer’s Association, 2011; National Alliance of Caregivers in collaboration with AARP, 2009). Family, or informal, caregivers are family members and friends who provide unpaid care and advocacy for a chronically ill or disabled person for 20 hours a week or more. As such, family caregivers are the nexus between the formal health care system and the community for many individuals. Family caregivers, also called informal caregivers as opposed to those who are paid to render care, are vital extensions of the health care system. Without them, many persons discharged from acute and rehabilitative hospitals would not be able to care for themselves. The efforts of family caregivers are so important to the health, positive mental outlook, and indeed, survival of care recipients that their services are invaluable and predicted to be needed more and more as the 21st century continues.

This is why I am so excited about my book! Supporting Family Caregivers of Adult with Communication Disorders. A Resource Guide for Speech-Language Pathologists and Audiologists represents the first time that caregiver issues and resources have been organized and put in one place for the benefit of health professionals and the families of their patients. Much of my passion for the topic of caregivers comes from my remembering how stressful caregiving was because I really did not know what to do 20 years ago even though I had advanced degrees in speech-language pathology. The purpose of putting this information in one place where it is readily accessible is to empower speech-language pathologists and audiologists and other health professionals to support family caregivers of adults with disorders of communication and swallowing.

Caregiving is a deeply personal and intensive enterprise. Many caregivers report that they have appreciated the time to forge more intimate and caring relationships with their loved ones. At the same time, a significant body of research indicates that caregiving is also costly in terms of time, effort and financial sacrifice. Many caregivers are placed in the primary role of helping others without adequate resources with which to provide the best care. Caregiving can be so stressful that caregivers can themselves develop diseases and disabling conditions which affect their caregiving and those who depend upon them. For some, the stress can be so crippling that some caregivers are forced to abandon providing care altogether, or they become terminally ill.

To that end, each chapter addresses the issues of caregiving of adults with communication and swallowing disorders. Chapter 2 gives an overview of statistics on family caregivers, caregiver responsibilities for care, the economics of family caregiving, and concepts of caregiver burden, strain and stress. In addition, information on the effects of caregiving on physical, mental and emotional health of those who provide care is also provided. Caregiving has been recognized as an important national resource. There are laws that protect and support caregivers at the local and national levels, and Chapter 2 also includes national and state legislation that supports family caregivers when they deliver care. Chapter 3 describes the diversity of caregivers and how culture and tradition prescribe who will care for disabled adults as well as how caregivers use both internal and external resources. There are important differences in how caregivers perceive and accept caregiving responsibilities across ethnic and cultural groups. These differences have implications for how caregivers manage when the responsibilities becomes stressful. There are also some differences in how caregivers may accept and comply with counseling and referrals. Chapter 4 discusses basic characteristics of various brain-based diseases and disorders that affect communication and swallowing with a focus on how these disabling conditions affect communication and swallowing disorders and to assist caregivers in minimizing communication breakdowns.

Chapter 5 is developed from the perspective of audiologists and includes basic information on hearing loss, auditory processing disorders, balance disorders, cochlear implants and hearing aids, as well as the impact on caregivers. Included in this chapter is information on helping caregivers with hearing aid upkeep. A major portion of the chapter is devoted to assistive and augmentative technologies which audiologists can use to educate caregivers of adults with hearing loss who can benefit from these devices. Perceptions of burden, strain and stress interfere with a caregiver’s ability to provide quality and sustained care.

Chapter 6 describes assessments that measure caregiver strain, burden, stress and coping with caring responsibilities. Chapter 7 introduces concepts of education and counseling caregivers within the clinical setting and within the scope of practice. Educating and training caregivers can be helpful in improving communication and providing a continuum of therapy outside of the clinical setting. Although speech-language pathologists do not provide counseling in many areas of need, resource information is provided that can be shared with caregivers that will empower them to find answers to their most important questions, like respite or hospice care, elder law, and insurance. Chapter 8 provides information on other health care professionals and their areas of expertise. It is designed to inform speech-language pathologists and audiologists about the most appropriate professionals to whom caregivers should be referred when they need counseling in specific areas outside of the scope of practice.

Chapter 9, the final chapter, describes a case of a newly-wed husband who suffers a stroke and how his stroke affects his wife and their relationship. Without support from health professionals, his wife flounders in her caregiving role. Their story ends tragically, but questions are presented to guide clinicians to avoid missing caregiver needs.

It is hoped that this book will serve as a resource for health professionals and students in speech-language pathology and audiology and that it will become part of the toolkit for assisting caregivers. It is also the intent that this resource book will be helpful to those who are involved in caregiving now and in the future.

References

Alzheimer’s Association (2011). Alzheimer’s disease facts and figures. Retrieved from http://www.alz.org/downloads/facts_figures_2011.pdf

National Alliance for Caregiving and AARP (2009). Caregiving in the U.S. Retrieved from http://www.caregiving.org/data/Caregiving_in_the_US_2009_full_report.pdf

About the Author

Joan C. Payne, PhD, is a Fellow of the American Speech-Language-Hearing Association (ASHA) and is a professor of communication disorders at Howard University in Washington, DC, where she has been a member of the faculty for more than 40 years. She is nationally and internationally recognized for her work in neurogenic language disorders from an ethnobiological perspective and is the 2014 recipient of the Scholar-Mentor Award from the National Black Association for Speech-Language and Hearing.

Fundamentals of Clinical Decision-Making Analysis for SLPs and Audiologists: Evidence-Based Approach

Statistical Methods and Reasoning for the Clinical Sciences: Evidence-Based PracticeDr. Satake Photo

By: Eiki B. Satake, PhD, author of Statistical Methods and Reasoning for the Clinical Sciences: Evidence-Based Practice

Over the past decade or so, interest in evidence-based practice (EBP) has steadily increased in many clinical fields—a movement that has emphasized the importance of providing empirical evidence to support various therapy interventions. To succeed in meeting the goals of EBP, clinicians must rely on more than intuition and clinical experience. In addition, they must be well versed in the methods of research and statistics to accurately evaluate and apply evidence that seems to support a particular intervention. As Guyatt et al. (2002) noted, the ability to critically appraise research literature and apply such findings is an essential skill for scientifically based treatment. Yet, my observations suggest that this concern is often neglected in graduate training programs as well as by many clinical practitioners and researchers. Furthermore, in this EBP era, all clinical professionals, not only clinical researchers but also clinical practitioners, are almost required to have the substantial knowledge of (1) how to measure the strength of clinical evidence accurately, and (2) how to interpret and report the findings. These are the essential components of EBP that will lead to improvement of one’s scientific literacy.

Scientific literacy is fundamental to the understanding of research methodology as well as the statistical assumptions and techniques used for the analysis and interpretation of data. In the absence of such understanding, it will be impossible for professionals to stay abreast of a rapidly flowing and ever-changing stream of information related to the study and treatment of speech, language, and hearing disorders. What is ultimately at stake is the credibility of the field to function as an independent discipline that presumably prides itself on contributing to a fund of knowledge leading to scientific advancements, not only in its own specialty areas but also for its contributions to the arena of the health science specialties at large. In the absence of such credibility, we will practice “unethically” by failing to provide the best possible services for the people we serve.

So, how does a clinician determine whether or not she is making an accurate, reliable, and credible EBP-oriented diagnosis and improves scientific literacy? One effective way is to learn how to evaluate the results of a diagnostic test accurately to find out the presence (or absence) of a particular disorder.

According to Hawkins (2005), EBP consists of the following four major steps: 1. Formulate a clear clinical question from a client’s problem; 2. Search the literature for relevant clinical articles; 3. Evaluate or clinically appraise the evidence for its validity and usefulness; 4. Implement useful findings into clinical practice. So, let us apply Hawkins’s principle to the diagnostic screening test process.

Despite the many applications of diagnostic test findings, the primary objective of any such test is to detect a particular disorder or disease when present. A good diagnostic test normally identifies people who have the particular disorder or disease of interest and excludes people who do not. To accurately measure the outcomes of a new test or a screening test, results obtained from it are generally compared with some other established test(s) viewed as the gold standard in yielding valid results. Even though such tests may not prove to be 100% accurate, they serve as the standard against which the merit of a new test can be judged. A logical question to ask is “If a test judged as the gold standard is doing a good job in accurately diagnosing a particular disorder or disease, why not use it in all cases?” The answer is that the gold standard for diagnosis can be time-consuming, expensive, and more difficult to perform. For this reason, a screening test is often used as an option during initial testing to decide who should be given a more definitive evaluation and who should not. Thus, an audiologist might give an audiometric screening test to decide when a more complete audiometric evaluation might be warranted. There are several major probabilities that constitute a screening test for determining the accuracy of the results. They are, namely, as follows:

  1. Prevalence of a disorder (denoted by D): P (D+) = Probability that the disorder (or disease) is present, whereas P (D−) = Probability that the disorder is absent.
  2. Test Results (denoted by T): P (T+) = Probability that the test is positive, whereas P (T−) = Probability that the test is negative.
  3. True Positive: P (D+ and T+) = Probability that the disorder is present and the test result is positive. People with the disorder are correctly identified as test positive.
  4. False Positive: P (D− and T+) = Probability that the disorder is absent but the test result shows positive. People without the disorder are falsely labeled as test positive.
  5. True Negative: P (D− and T−) = Probability that the disorder is absent and the test result is negative. People without the disorder are correctly identified as test negative.
  6. False Negative: P (D+ and T−) = Probability that the disorder is positive but the test result is negative. People with the disorder are falsely identified as test negative.
  7. Sensitivity of a test: It is defined as the probability that the test result is positive (T+) given that the disorder actually exists (D+). Symbolically, it is written as:
    Sensitivity of a test formulaIf a test has high sensitivity, it will have a low false-negative rate, that is, the probability that a subject who tests out as negative but who is actually positive, denoted by P (T− | D+). In such a case, the test result will seldom indicate that the disorder is not present when in fact it is present.
  8. Specificity of a test: It is defined as the probability that the test result is negative (T−) given that the disorder actually does not exist (D−). Symbolically, this is written as follows:
    Specificity of a test formulaA test that has high specificity is one that has a low false-positive rate, denoted by P (T+ | D−), meaning that it will seldom predict the presence of a disorder that does not exist.Although test sensitivity and specificity are important preliminary steps in constructing a diagnostic screening test, these indices alone have limited application to actual diagnosis and clinical decision making. More specifically, although these values may be used to estimate the accuracy of a particular diagnostic test, it is the predictive values of a test that actually have practical/clinical values in detecting a disorder or disease. In the case of measures of sensitivity and specificity, in contrast with predictive values, the disorder or disease status is already known. However, as noted previously, what a clinician really wants to obtain is whether or not a disorder or disease actually exists based on the test result of a diagnostic screening test. Only the predictive values allow for forecasting actual clinical outcomes (EBP) based on test results. There are two major components of predictive values of a diagnostic screening test, namely, predictive value positive (PV+), and predictive value negative (PV−). In short, PV+ and PV− can be viewed as a calculus of evidence to further explore the accuracy of a screening test in a more precise manner.
  9. Predictive Value Positive (PV+): It refers to the probability that a disorder or disease exists when the test result is positive (T+). Symbolically, this is expressed as follows:Predictive Value Positive formula
  10. Predictive Value Negative (PV−): It refers to the probability that a disorder or disease does not exist when the test result is negative. Symbolically, this is written as follows:Predictive Value Negative formula

All probabilities defined above are summarized in Table 1 shown below.

TABLE 1: Probability Estimates of Test Results

Table 1: Probability Estimates of Test Results

Additionally, in communication disorders, clinical practitioners often look at the results of clinical trials they are investigating and are interested in the association (or relationship) between a treatment and an outcome. In some cases, they may find a strong association or, in another case, there may be no significant association. When clinical investigators try to show the degree of association between two events (control versus experimental, treatment A versus treatment B, etc.), they need to know how to measure the strength of association based on what they observed. To answer the question pertaining to measuring the strength of association, we often use such advanced measures as relative risk, absolute/relative risk reduction, and odds ratio.

In summary, the clinical professionals in the field of SLP and audiology have not quite caught up to the level that medical professionals have achieved in terms of EBP statistics education. At the time of my writing, EBP education has become well established as a component of both undergraduate, graduate, and postgraduate medical education. So, why not us? Now is the right time to check our scientific literacy skills and promote better understanding of EBP statistics to a much larger extent, so that all clinical researchers and practitioners in our field are able to interpret the results and make a diagnosis more accurately.

References

Guyatt, G. H., & Rennie, D. (2002). User’s guide to the medical literature: A manual for evidence-based clinical practice. Chicago, IL: AMA Press.

Hawkins, R. C. (2005). The evidence based medicine approach to diagnostic testing: Practicalities and limitations. The Clinical Biochemist Reviews, 26(2), 7–18.

Satake, E. (2014). Evidence-based statistics for clinical professionals: What really prevents us from moving forward. Keynote presentation at the annual research symposium of LSU-School of ALLIED Health, New Orleans, LA.

Satake, E. (2014). Statistical methods and reasoning for the clinical sciences: Evidence-based approach. San Diego, CA: Plural Publishing.

About the Author

Eiki Satake, PhD, is an associate professor of mathematics and statistics at Emerson College in Boston, Massachusetts. He has conducted several research seminars and short courses on evidence-based statistics at national and international academic conferences. His research interests include Bayesian statistical methods and probabilistic approaches to evidence-based practice. He has also written numerous scholastic articles and instructional textbooks on statistical methods and statistics education. His most recent textbook, Statistical Methods and Reasoning for the Clinical Sciences: Evidence-Based Practice, provides practitioners with the scientific literacy needed to understand statistical methods in order to increase the accuracy of their diagnoses.