Speech-Language Pathologists Working in Early Childhood Intervention

By Kathleen D. Ross, MS, CCC-SLP
Author Speech-Language Pathologists in Early Childhood Intervention: Working with Infants, Toddlers, Families, and Other Care Providers

Misperceptions and questions surrounding the role of speech-language pathologists (SLPs) in various settings persist. Our title is not yet a common term within everyday households. Speech-language pathologists working in early childhood intervention are no exception to these persistent misperceptions. When SLPs are labeled as the “speech teacher” who corrects lisping, how can one possibly teach an infant to make sounds appropriately when they don’t yet make /s/? How can an SLP train a toddler to change his behavior when he has no idea that he’s responsible for his own actions and behaviors? Education and advocacy continue to be an integral part of an SLP’s role in all settings.

Early childhood intervention SLPs tend to go beyond some of the traditional roles. Part C of the Individuals with Disabilities Education Act (IDEA) presents a practical philosophy for working with infants and toddlers: coaching parents and caregivers to guide children to functional communication efforts within daily routines in natural settings. Guiding parents to utilize new interventions with their children within daily routines truly is best practice for this young age, who do not yet have the cognitive ability to easily generalize an isolated task learned in a clinic setting to other situations. An infant and toddler’s social world is typically small, with greatest focus on the family constellation and primary caregivers. Teaching in the moment with familiar trusted learning partners (the parents) is often the most adequate way to make the synaptic connections that create useful memories. This practical application manifests the functionality of a learned task almost instantaneously.

In early intervention, SLPs enter the lives of young children and their families to thoughtfully observe their natural interests and interactions, and to become involved in the relationships that are most central to the children. In this way, they are at ground zero if you will, at the heart of the developing child and family.

Adults recognize that infants enter the world as helpless beings, needing continual support and guidance to progress through each day. Infants seek relationships with loving adults who provide routine care and consistent positive responses to their every need. They expect and rely on those responses, developing rhythms and trust with the adults around them. But not all situations are the same, and for a variety of reasons, there are times when infants do not receive the care they need and, thus, cannot develop the daily rhythms and trust of others. SLPs become integral in coaching parents to understand and develop these rhythms with their young children. Parents learn to carefully observe and listen, then positively and consistently respond to their child’s needs. Parents and primary caregivers are guided to develop or alter behaviors with young children—shaping unwanted behaviors into positive functional skills.

Our early experiences affect who we become as adults. Acknowledging this as early interventionists allows us to unhesitatingly advocate for infants, toddlers, and families within IDEA’s Part C program. Recognizing the influence of personality, prior knowledge, birth and early experiences, and a child and family’s degree of tolerance for stresses and outside influences, is crucial for success. As SLPs, we give tools and strength to a child and family to effectively communicate their needs and wants in various situations.

Speech-language pathologists who understand the connections between social, emotional, cognitive, and communication growth—the developing whole child—will work judiciously and respectfully to collaborate with other service providers and the family to enrich the child’s life and create practical interventions. We know that young children thrive on familiar and caring positive relationships through the routines of the day. We support parents and caregivers to guide children to reach their potential as they become threeyear-olds, when they transition from Part C to Part B services, if eligibility continues. Through meticulous and developmentally appropriate evaluation to diagnosis, and maintaining ongoing assessment for up-to-date programming, we provide accurate treatment measures to match the child and family’s needs.

Each family constellation presents a unique dynamic for all service providers to consider. We need to fully comprehend how both children and families develop, and the dynamic nature of both in order to work diligently within unique parameters. Knowledgeable SLPs respect and work with cultural and linguistic differences in each family, understanding the invaluable nature of these circumstances, while also recognizing the controversial elements that may present. SLPs will provide best practice when we acknowledge these complexities, especially in the face of our own preconceptions. Each human possesses their own perspective of their world as an individual. Service providers who early on grasp the concept that diversity is what makes us human, will be most successful in working in human services.

Speech-Language Pathologists in Early Childhood Intervention: Working with Infants, Toddlers, Families and Other Care Providers by Kathleen D. Ross, aims to inform SLPs who are considering work in early intervention. The text is also intended for early interventionists and service providers who wish to know the specifics of working with infants, toddlers, and families, and collaborating with others in this specialty area. Scenarios are presented as practical application examples to reinforce concepts discussed.

The rewards within this level of care are boundless. Working with both the child and the family presents satisfaction at two age levels simultaneously. Early childhood intervention sets the base for developing communication success. Where there previously existed frustrations, we now send children and families forward with a solid base of competence to function positively within their daily lives.

Effective Mathematics Interventions

By Margaret M. Flores, PhD, BCBA-D, Auburn University
Co-author of Making Mathematics Accessible for Elementary Students Who Struggle: Using CRA/CSA Interventions

 

According to the National Center for Educational Statistics (2016), the 2015 National Assessment of Educational Progress showed that 18% of fourth grade students performed below basic levels of achievement, meaning that they did not demonstrate mastery of fundamental skills. Students’ mathematical difficulties begin with understanding numbers, basic operations and their novice conceptions lead to further difficulties with complex operations and fractions (Fuchs et al.; Jordan & Hanich, 2003; 2016). Students who struggle in mathematics comprise a diverse group which includes students with identified disabilities as well as students without disabilities (Powell, Fuchs, & Fuchs, 2013). There is a critical need for effective implementation of interventions that have been shown to be effective through research. One effective approach that can be adapted across mathematical concepts is the concrete-representational/semi-concrete-abstract sequence (Miller, Stringfellow, Kaffar, & Mancl, 2011; Witzel, Furguson, & Mink, 2012; CRA/CSA).

What Is CRA/CSA?

The CRA/CSA sequence in an instructional approach to mathematics that emphasizes conceptual understanding prior to procedural knowledge and fluency. There are three phases: concrete, representational/semi-concrete, and abstract. The concrete phase of instruction involves the use of objects to complete mathematical tasks or solve problems. During this phase, teachers explicitly teach concepts through the manipulation of objects. The representational/semi-concrete phase continues to focus on the development of conceptual understanding, but problems are solved using pictures and student-made drawings. Once students demonstrate understanding of the target mathematics concept at the representational/semi-concrete levels, they learn to solve problems using just numbers, the abstract phase. During the abstract phase, the focus of instruction is on procedural knowledge and fluency. The benefit of including the CRA/CSA sequence into mathematics interventions is that the concrete and representational/semi-concrete phases provide students with needed remediation in their understanding of whole numbers, the base ten system, operations, and rational numbers (fractions). The physical manipulation of objects, drawing, and visual aid of pictures fill in the gaps that exist in their prerequisite knowledge and understanding about mathematics. Another benefit of these physical and visual aids is that they assist students in making meaning of mathematical language and using language to explain their computation or problem solving.

CRA/CSA and Number Concepts

The CRA/CSA sequence has been shown to be effective in teaching young children and elementary students number concepts. Researchers used CRA/CSA to teach preschool students, with and without disabilities, counting skills. This included number sense in the form of visual counting or recognizing that four objects were represented by the numeral four without physically touching the objects (Hinton, Flores, Schweck, & Burton, 2015; Hinton, Flores, & Strozier, 2015). Elementary students also successfully learned how to count this way using CRA/CSA. In addition, Hinton and Flores (submitted) taught rounding skills using CRA/CSA. Using base ten blocks and drawings representing base ten blocks, students learned how to round numbers to the nearest ten and hundred. After abstract instruction using just numbers, students quickly and accurately completed rounding tasks. Mercer and Miller (1992) taught place value to elementary students with and without disabilities using CRA/CSA.

CRA/CSA and Basic Operations

Miller and Mercer (1992) and Mercer and Miller (1992) taught elementary students, with and without disabilities, basic operations using the CRA/CSA sequence. This included addition, subtraction, multiplication, and division. Using objects and drawings, students learned the conceptual meaning of each operation: addition is combining, subtraction is separating, multiplication is combining of groups that are the same size, and division is the separation of groups that are the same size. After instruction at the concrete and representational/semi-concrete phases, students learned a simple strategy to assist in computation using just numbers. This set of steps served as a reminder to (a) attend to the numbers and the operational sign, (b) remember that problems can be drawn if the student has not memorized the fact, and (c) write the answer. Students who participated in this large study become fluent in basic operations and their accuracy in computation increased significantly.

CRA/CSA Complex Operations

Researchers also used the CRA/CSA sequence to teach regrouping skills associated with addition, subtraction, and multiplication (Miller & Kaffar, 2011; Mancl, Miller, & Kennedy, 2012; Flores, 2011; Flores & Hinton, in press; Flores, Hinton, & Strozier, 2014; Flores, Schweck, & Hinton, 2014; Flores & Franklin, 2014). Difficulties faced by students within each of these studies were related to poor conceptions of numbers and the base ten system. The concrete and representational/semi-concrete phases of instruction involved the use of base ten blocks and drawings that bolstered students’ understanding of numbers and why regrouping is necessary in when adding and subtracting large numbers. These studies included students with and without disabilities and led to significant gains in accuracy and fluency.

CRA/CSA and Fractions

CRA/CSA has been shown as an effective way to teach rational numbers or fraction concepts (Butler, Miller, Crehan, Babbit, & Pierce, 2003; Flores & Hinton, submitted). Butler et al. studies the necessity of including a concrete phase within instruction. Students successfully leaned to make equivalent fractions, but those who used fraction blocks prior to drawings performed better than those who only received instruction using drawings. Flores and Hinton taught elementary students equivalency using CRA/CSA as well as comparison of fractions to decimals. At the concrete phase, students made fractions using fraction blocks as well as sets of objects. At the representational level, students shaded shapes and marked number lines. In both studies, concrete and representational/semi-concrete instruction allowed students to understand the proportional nature of fractions which led to their mastery of more complex concepts such as equivalence and relations to decimals.

Summary

The CRA/CSA sequence has been shown to be effective across a variety of elementary mathematics concepts. The materials needed are simple; base ten blocks and counters are readily available in elementary schools. However, it may be difficult for teachers to implement and replicate the research as journal articles are not written in ways that provide detailed descriptions of each lesson component. Therefore, in order to close the gap in mathematical achievement, there is a need for more user-friendly guides for implementation of the CRA/CSA sequence.

References

Butler, F. M., Miller, S. P., Crehan, K., Babbitt, B., & Pierce, T. (2003). Fraction instruction for students with mathematics disabilities. Learning Disabilities Research and Practice, 18, 99–111.

Flores, M. M., Hinton, V. M., & Strozier, S. D. (2014). Teaching subtraction and multiplication with regrouping using the concrete-representational-abstract sequence and strategic instruction model. Learning Disabilities Research and Practice, 29, 75–88.

Flores, M. M., & Franklin, T. M. (2014). Teaching multiplication with regrouping using the concrete-representational-abstract sequence and the strategic instruction model. Journal of American Special Education Professionals, 6, 133–148.

Flores, M. M., Schweck, K. B., & Hinton, V. M. (2014). Teaching multiplication with regrouping to students with learning disabilities. Learning Disabilities Research & Practice, 29(4), 171–183.

Fuchs, L. S., Schumacher, R. F., Long, J., Namkung, J., Malone, A., Wang, A., Hamlett, C. L., Jordan, N. C., Siegler, R. S., & Changas, P. (2016). Effects of intervention to improve at-risk fourth graders’ understanding, calculations, and word problems with fractions. Elementary School Journal, 116(4), 625–651.

Jordan, N. C., & Hanich, L. B. (2003). Characteristics of children with moderate mathematics deficiencies: A longitudinal perspective. Learning Disabilities Research & Practice, 18, 213–221. doi:10.1111/1540-5826.00076

Mancl, D. B., Miller, S. P., & Kennedy, M. (2012). Using the concrete-representational-abstract sequence with integrated strategy instruction to teach subtraction with regrouping to students with learning disabilities. Learning Disabilities Research and Practice, 27(4), 152–166.

Mercer, C. D., & Miller, S. P. (1992). Teaching students with learning problems in math to acquire, understand, and apply basic math facts. Remedial and Special Education, 13(3), 19-35. doi: 10.1177/074193259201300303

Miller, S. P., & Kaffar, B. J. (2011). Developing addition with regrouping competence among second grade students with mathematics difficulties. Investigations in Mathematics Learning, 4(1), 24–49.

Miller, S. P., & Mercer, C. (1992). CSA: Acquiring and retaining math skills. Intervention in School and Clinic, 28(2), 105–110.

Miller, S. P., Stringfellow, J. L., Kaffar, B. J., & Mancl, D. B. (2011). Developing computation competence among students who struggle with mathematics. Teaching Exceptional Children, 44(2), 38–44.

Witzel, B. S., Furguson, C. J., & Mink, D. V. (2012). Number sense: Strategies for helping preschool through grade three children develop math skills. Young Children 89–94

 

Communication Disorders in Aging

 

By Raymond H. Hull, PhD, Editor of Communication Disorders in Aging

Older adults are, in most instances, no different than younger ones other than the fact that they have grown older. They have the same personality they had when they were young; maybe it’s a little stronger, but is basically the same. They look the same except for some wrinkles and skin that may have begun to sag, and are maybe a little shorter due to the pull of gravity over the years.  Their voice will be the same except for the possibility of some change due to the aging vocal mechanism, so pitch may raise slightly, and they may speak a little louder due to a decline in their hearing. Their walking gait may slow just a little since they may not exercise as much as they used to and their joints might ache. They may be wearing reading glasses since there may be a change in their near vision. But, everyone is different, and some people age faster and more dramatically than others. When I was in my first year of graduate school, one of my classmates by the name of Bob was, at age 23, bald, with an ashen—somewhat prematurely wrinkled—face and had a voice that resembled that of an older man. In other words, he looked and acted “old”, at least to me. So, we are all aging differently. I like to think of myself as a younger/older person, but perhaps I am deluding myself into visualizing myself as such.

The one aspect of growing older that seems to be common is that disorders of communication are observed more frequently. Those are the result of stroke and other related diseases and disorders of the peripheral and central nervous system, Parkinson’s disease, hearing impairment, the influences of drugs and medications on their ability to communicate, and the various forms, or shades, of dementia. Further, environmental factors can have a greater impact on the ability of older adults to hear to a greater degree than younger adults.

Counseling must be adapted to take into consideration the age and status of the older adult as compared to the counseling strategies used with younger adults and children. And, if an older adult experiences a dramatic change in their ability to communicate with family and friends, the result can be even more devastating in light of the many other changes that frequently occur as a person ages. For example, the death of a spouse, difficulties with transportation, financial difficulties, restricted mobility due to physical decline, or the inability to hear, can all influence the ability of an older adult to take advantage of, and respond to, the services of the rehabilitation professional.

The book, Communication Disorders in Aging is designed to help people understand the process of aging, its impact on the human organism, the disorders of communication that are more frequently observed in older adulthood, and the impact of those disorders on them. Most importantly, it provides information on how to serve those individuals who experience the various disorders of communication that can affect them. I hope it helps you to understand the frustrations that approximately 32 million adults over the age of 60 experience as a result of various disorders of communication, and ways we can assist them. That is, in a world of people who may not understand the impact of those disorders on older adults, how best to communicate with them, and importantly, in the many places that are not meant for communication.

The book, Communication Disorders in Aging is intended for use in the academic preparation of all who will serve older adults in a variety of settings, including those in audiology and speech-language pathology, nurses who are preparing to become geriatric nurse practice specialists, those who are preparing to become gerontologists, psychologists, family practice physicians, geriatric medicine specialists, and others who serve or who are preparing to serve older adults.

However, due to the very practical nature of this book, it will also prove to be a wonderful resource for family members and other significant others who, in one way or another, serve older adults who possess disorders of communication. The information contained within this book is that which many persons who know or serve older adults request from me when I speak at conferences and conventions around the U.S., Europe, and Canada.

Raymond H. Hull, PhD, CCC-A/SP, FASHA, FAAA
Professor of Communication Sciences and Disorders, Audiology/Neurosciences
Department of Communication Sciences and Disorders
College of Health Professions
Wichita State University
Wichita, Kansas  67260-0075

Perspective-Taking for Neurotypicals

Stephanie_SandersSanders_FILTER

By Stephanie D. Sanders, MA, CCC-SLP, author of The FILTER Approach: Social Communication Skills for Students with Autism Spectrum Disorders

While creating The FILTER Approach, I took exhaustive measures to help students with Autism Spectrum Disorders (ASD’s) identify, comprehend, and explain essential social skills, while putting them into practice.  As I implemented this curriculum, it began a personal perspective-taking opportunity for me.  I noticed weaknesses within my own communication skills in specific situations. A perfect example is my inability to Listen to my family with technology distractions in view (thank you, Pinterest).  Demonstrating social errors as a neurotypical Speech-Language Pathologist (SLP) could likely justify a new DSM-5 diagnosis of “social skills hypocrite.”

The truth is that most of us have room for improvement socially and in considering the perspectives of those with social impairments.  Perspective-taking tasks usually present a challenge to individuals with ASD, due to Theory of Mind.  I’ve frequently referenced the idiom “put yourself in my shoes” with students during these activities. However, SLP’s can also struggle with taking perspective when driven by accountability for pragmatic language goals printed on a report. I become frustrated when my student resists the educationally relevant IEP goals that will undoubtedly transform him or her into a social skills superhero.  An epiphany soon occurred with a hint of witty wordplay.  My mission: try taking a new perspective on perspective-taking.

I began investigating:

  • How do those with social impairments perceive conversation?

I asked students individually, “Why are conversations important?”  The same response was consistently given, “To find out information.”  This perspective came across as task-driven, lacking any element of enjoyment.  Some interrogation sessions I’ve witnessed appear to be information-seeking at its finest.  In other instances, my students feel obligated to be the source of information.  They lecture peers regarding topics of interest, rather than seeking to find out information.  We’ve discussed how obsessive interests and “conversation hog” habits will cause one to miss the Target, socially.  I’ve also taught this concept in the middle school gifted-student classroom during monthly F.I.L.T.E.R. lessons.  Luckily, the “conversation hog” reference hasn’t triggered any speeches about swine or guinea pig fixations!

Other questions on my mind:

  • How are common rules of social language perceived?
  • What are the most stressful things about social situations?

My little brother Zach was diagnosed with an ASD at the age of thirteen and was my primary inspiration for “The FILTER Approach.” As part of this perspective-taking endeavor, I knew it would be beneficial to get Zach’s viewpoint on social rules.  I asked him to speak freely, without concern of giving a wrong answer.

Me: What do you think the expression, “Put yourself in his/her shoes” means?

Zach: It means you should consider the other person’s feelings.

Me: Exactly.  I want to put myself in your shoes to find out what conversation is like for you, having an ASD.  I want to know your perspective about some social rules in conversation.

Zach: Okay.

Me:  What do I mean when I tell you to “use your filter” in conversation?

Zach: It’s what you should or should NOT say in conversation.  If you always say what you’re thinking, then you could look bad as an employee, lose respect, and look unconcerned about feelings.

Me: Great explanation!  Now I want your perspective on some social rules from my book.  How do you feel about making eye contact and looking for Facial clues?

Zach: A little uncomfortable.  A symptom of people with Autism is sometimes having a hard time with eye contact.  I don’t want to give too much and it’s hard for me to know.

Me: Very true.  We’ve talked about glancing, which works.  You’ve done a nice job of avoiding inappropriate topics in person.  However, you and many other people might post strong opinions on Facebook.  Why do you think that is?

Zach: On Facebook, it’s virtual and like your own little world, so it’s not as real.  It’s uncomfortable in person because you’re actually with them.

Me:  I see what you’re saying.  Do you think it’s hard to Listen during a conversation with someone and why or why not?

Zach: It can be a lot of work. Sometimes I run out of things to say or my mind is off-topic while I’m trying to listen.  The conversation gets stressful if it’s too long and boring.  Sometimes, I think about something totally unrelated, like a conversation with someone earlier.

Me:  Staying focused probably does feel like a lot of work. Why do you think we should try to “hit the Target” socially and what did we talk about for your target?

Zach: We should make goals to be successful. I need to close my conversations with “See you later” and ask about someone else’s interests.

Me: Excellent. Is it awkward for you to End conversations with people at places like church or work?

Zach: Yes, because I run out of things to say.  It’s also difficult to end things at work when my shift is over.  I want to tell my manager I’m ready to leave, but he’s usually busy.  If I just leave, I might look disrespectful like I’m trying to get out of my job.

Me:  Later, we’ll make a plan for leaving work.  Is it difficult for you to Repair conversation mistakes you’ve made and have you used some of the Repair tools we’ve talked about?

Zach: I’ve used some.  Apologizing can be hard and it’s hard to admit you’re wrong.  I’ve asked, “Should I stop now?” when the person was being quiet. I also messaged, “Did I say something wrong?” two times to someone on Facebook who quit talking to me.  He never responded, so I didn’t ask anymore.

Me: I’m so proud of you for trying to Repair social mistakes.  You made a good choice to quit asking when the person on Facebook never responded.  At least you tried.

Me: Overall, what are the most stressful things for you in social situations?

Zach:  It’s stressful because:

  • I don’t know what the other person is thinking.
  • I don’t know if I’ve said something wrong.
  • I don’t know what will happen to that friendship (in the future).
  • It’s tough to start new friendships as an adult.
  • Losing a childhood friendship is discouraging and can’t be replaced.
  • I’ve become shy as an adult.

Me:  Thanks for sharing, Zach.  Therapists need to consider what it’s like for someone with ASD to follow these rules.  It has really helped me to hear your perspective.

From Zach’s outlook, it must be draining to worry about confusing social cues and potential negative outcomes.  If someone repeatedly struggles to use verbal and nonverbal social behaviors in conversation, then it could become a losing battle.  Isn’t it easier to retreat into a virtual world where at least all of the nonverbal challenges are removed?  Many of our students/clients with ASD’s could perceive communication as a lot of effort with little worth.

The challenge is to find pragmatic goals that are realistic, beneficial, and meaningful for our students/clients.  The perspectives of these individuals are usually disregarded as wrong with an immediate need for change. If I truly listen to the individual’s perspective, I can not only set an example of showing interest, but also ensure my therapy approach remains individualized.  I can clearly and personally define the advantages of practicing good social habits now in order to make future social success a possibility. Taking the student’s perspective increases my chances of enlisting him or her in therapy, which will result in a more socially responsible individual. Early investment in the views of my students could allow the opportunity to become an influence in rewriting a lifelong story filled with social struggles and disappointments.

Speech-Language Pathologists Climbing the Steps to Mastery

Lydia_Kopel

Speech-Language Pathologists Climbing the Steps to Mastery
By Lydia Kopel
Co-author of IEP Goal Writing for Speech-Language Pathologists: Utilizing State Standards

Facing the mountain
As a speech-language pathologist (SLP), you are forever tackling a huge mountain called language. There are peaks at the top that you are trying to help your students/clients reach. Do you ever find yourself working on a skill with a student/client who does not seem to be making progress? That peak didn’t seem so far away, but along the way, you encounter twists and turns, making it around one corner only to face an obstacle around the next bend. Frustrating, right? On the inside you’re screaming, “Why can’t he get this? How can I approach this in a different way? What am I doing wrong?”

You’ve set your goal(s) for this individual carefully choosing the target skill(s). But, did you think about prerequisite skills? Prerequisite skills are all the skills that lead up to the targeted skill; the building blocks. Every skill has several prerequisite skills; each prerequisite skill has prerequisite skills. With language learning there is a great deal of scaffolding – one skill builds upon another skill, builds upon another skill, and so on. Let’s look at an example related to the skill of the main idea.

To be able to identify the main idea when it is not stated in a text, one has to have success with many other language skills. These include being able to answer factual questions, determine important details from unimportant details, determine how the details go together in the sequence of events, and be able to draw inferences. Of course, each one of these skills has even more prerequisite skills! And it doesn’t end there!

Each target skill also has several steps to mastery. With the same example of the main idea, we probably shouldn’t expect that a 6th grade student will learn the prerequisite skills outlined above and be able to identify the main idea and supporting details from a grade level text in one year. It is more likely that additional scaffolding and instruction will be needed at various steps. The student may first need to identify a supporting detail when given a choice of three and given the main idea in a 5th grade text. Maybe then you can move them to identifying three details that support a given main idea in a 5th grade text. With further scaffolding, this student may move toward identifying the details in a 6th grade text when the main idea is unknown. Going through these prerequisite skills and steps to mastery can increase an individual’s success and decrease therapist and client frustration—making for a much smoother climb up that language mountain.

Peaks and valleys
We all encounter those individuals who have splinter skills.   They have some of the language skills in the developmental continuum but are missing others. There may be no specific order, no rhyme or reason, to what they can and cannot do. If we can tap into the skills that haven’t fully developed, we can help increase performance on the target skills that are lacking.

Let’s look at the semantic skill of compare/contrast. Perhaps you have a client who can label pictures of nouns and verbs. He can tell you the color, size, and shape of single pictured items. He may be able to use comparatives and superlatives. However, he can’t sort items by attribute, identify things that do not belong, or state category labels. His describing skills are limited because he breaks down when more than one item is pictured together in a scene and more than two descriptors are expected.  Would it be reasonable to expect this client to state how two or more items are the same or different? It seems like there may be numerous gaps in his semantic skills that would be imperative to the skill of compare/contrast.

Reaching the peak
As an SLP, do you have students/clients who are lacking some of the necessary prerequisite skills? Taking the time to figure out what prerequisite skills are needed can lead to success with the target skill(s).   Take a step back and work on the missing skills. Sometimes we need to go backward in order to move forward.

When setting goals, consider the amount of prerequisite skills needed and how fast you anticipate the student to progress. Is your anticipated target skill too high? Maybe you need to aim for a smaller peak. Maybe the goal needs to be one of the prerequisite skills. Take it one step at a time and you’ll soon find the individual standing at the peak.

Prerequisite skills, goal writing, and much more are discussed and outlined in the book IEP Goal Writing for Speech-Language Pathologists:  Utilizing State Standards. Check it out!

Please visit our blog Living the Speech Life and feel free to contact us at livingthespeechlife@gmail.com

Lydia Kopel and Elissa Kilduff

Living the Speech Life

Book Review: Auditory-Verbal Therapy reviewed by Helen M. Morrison, Ph.D., CCC/A, LSLS Cert. AVT

AVT book - artwork -v8

Auditory-Verbal Therapy: For Young Children with Hearing Loss and Their Families, and the Practitioners Who Guide Them, by Warren Estabrooks, Karen MacIver-Lux and Ellen A. Rhoades, Plural Publishing, 2016.

Reviewed by Helen M. Morrison, Ph.D., CCC/A, LSLS Cert. AVT

 

 

 

Auditory-Verbal Therapy provides a thorough, 21st century resource for professionals, families, and students. Each chapter is organized in a way that technical information is accompanied by suggestions for practical application, making it a likely “go-to” reference that will be consulted frequently.

The history of Auditory-Verbal therapy (AVT) described in the first chapter is comprehensive and much needed in order to ensure that the story of the approach is not lost to current and future generations of professionals and families. The book is clear about the principles of AVT, what it is and is not, all while demonstrating how AV therapy has evolved to apply evidence-based practices that meet the needs of today’s diverse families and children.

A highlight of the book is a systematic review of literature concerning AVT that utilizes the most current techniques and standards for scientific rigor to describe the state of evidence supporting the approach. The chapters that address audiological procedures and hearing technology are current and provide a basis for deeper reading of the topics discussed. The book addresses each of the knowledge domains that Auditory-Verbal therapists apply in practice, including comprehensive developmental milestones, emergent literacy, inclusion and specific strategies for parent coaching.

An important section of this book provides a rationale and framework for planning and implementing AVT sessions, followed by a series of case studies and lesson plans written by experienced AV therapists that apply this framework. The children and families in these case studies and lessons represent a range of ages, diagnoses, additional disabilities, and cultural/economic situations. The lesson plans at first glance may not seem like conventional lesson plans. They illustrate how important teaching within the conversational context is in AVT, beginning with initial greetings and entering the therapy room or home. Following the child’s lead and exploiting teachable moments are highlighted.

Finally, families from across the global community tell their own stories, demonstrating the universality of the approach. The families not only hail from many different countries, but they are each unique in their cultural and economic situations, types of hearing loss and the ages at which their children entered AVT. Many of the children in these families have challenges in addition to hearing loss.

This book is a must-have for anyone who works with children with hearing loss and their families. The information has value for professionals and families across the communication options that families might choose. This book is essential for professionals working to attain Listening and Spoken Language Specialist certification. It will guide their learning during their certification period and serve as a foundational source for examination preparation.

Nasal Emission Terminology Should be Evidence Based and Consistent with Physiology and Perceptual-Acoustic Characteristics

Nasal Emission Terminology Should be Evidence Based and Consistent with Physiology and Perceptual-Acoustic Characteristics (1)David J. Zajac, PhD, CCC-SLP, ASHA Fellow

Coauthor of Evaluation and Management of Cleft Lip and Palate: A Developmental Perspective

The term “cleft palate speech” has often been used to refer to hypernasality, nasal air emission, reduced oral air pressure, and compensatory articulations of speakers who exhibit velopharyngeal inadequacy (VPI). Hypernasality is defined as excessive resonance of the nasal cavity during production of vowels and voiced consonants. Nasal air emission refers to the audible escape of air during the production of high-pressure oral consonants, especially voiceless consonants. Reduced oral air pressure is the flip side of nasal air emission. When air escapes through the nose, some oral air pressure is lost. Thus, oral pressure consonantsespecially voiceless ones—may be produced with reduced oral air pressure and perceived as weak or reduced in intensity. Compensatory articulations are maladaptive gestures that are produced at the glottis or in the pharynx as a way to circumvent a faulty velopharyngeal valve. The use of glottal stops to replace oral stops is a classic example of a compensatory articulation. Hypernasality, nasal air emission, and reduced oral air pressure are passive (or obligatory) symptoms of VPI. This means that the symptoms occur as a direct consequence of incomplete velopharyngeal closure. Compensatory articulations, however, are active (or learned) behaviors and may not occur in every individual.

Although obligatory nasal air emission is a core characteristic of VPI, many confusing, overlapping, and inaccurate terms have been used to describe its perceptual manifestation. The literature is replete with terms such as audible nasal air emission, nasal turbulence, nasal rustle, and passive nasal frication. Because the velopharynx and nasal passage are complex anatomical structures— which may be significantly altered due to both congenital defects and surgical interventions associated with cleft lip and palate—the variety of terms used to describe nasal air emission should not be too surprising. Numerous other terms have been used to describe nasal air emission that is part of active (or learned) nasal fricatives and will not be discussed here. The reader is referred to Zajac (2015) for a discussion of active nasal fricatives as an articulatory error. Rather, this article will focus on terminology used to describe passive or obligatory nasal air escape.

A Brief History of Current Terminology

McWilliams, Morris, and Shelton in the first and second editions of Cleft Palate Speech (1984, 1990) described nasal air emission as occurring along a continuum. First, it could be visible but inaudible, detectable only by holding a mirror under the nostrils of a speaker to see fogging as a result of the air emission. In such a case, the nasal airflow is laminar, moving in relatively smooth fashion, and does not become turbulent, or noise producing. Clinically, visible nasal air emission typically occurs in speakers who have adequate but not complete velopharyngeal closure and normal resonance. Although visible nasal air emission should be noted when it occurs in a speaker, there are no treatment implications. Continue reading

Auditory-Verbal Therapy- Hearing, Listening, Talking, Thinking

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By Warren Estabrooks, M.Ed., Dip. Ed. Deaf, LSLS Cert. AVT, co-author of Auditory-Verbal Therapy: For Young Children with Hearing Loss and Their Families, and the Practitioners Who Guide Them

 

 

Globally, there is a great shift towards listening and spoken language for children who are deaf and hard of hearing.

Amazing auditory options, state-of-the-art hearing aids, and a variety of implantable hearing devices and the pursuit of excellent (re)habilitation by highly qualified practitioners working in partnerships with families, will hopefully become the standard of international health care and educational intervention for children with hearing loss around the world.

It is the work of therapists, teachers, audiologists, surgeons, social workers, and allied practitioners in health care and education to guide, navigate, and coach parents on their search for the treasure chest of spoken communication—to help them help their children discover the valued jewels of hearing, listening, and spoken conversation.  Practitioners everywhere form alliances of hope and trust with parents, and together we polish these precious gems until they sparkle and dance with life.

Why would one ever consider compromising when so much is possible?

We hope that one day we will look back and see an abundance of evidence-based outcomes, all barriers to equitable service gone, and a global focus on literacy with a deep understanding of powerful auditory access to the brain provided by state-of-the-art hearing technologies.

Renaissance man and mentor of many of today’s auditory-verbal practitioners, Dr. Daniel Ling, wrote that “auditory-verbal therapy… developed as a result of the natural outcomes of advances in knowledge, skills and technology.  As such advances occurred, new treatment strategies were devised to maximize their applications”.

Auditory-Verbal Therapy is now widely accepted because more children are acquiring, or have already acquired, the abilities to use spoken language, to interact more freely with other members of society, to obtain higher levels of academic education, and to have a more extensive range of careers, a greater security of employment and fewer limitations on the personal and social aspects of their lives” (Estabrooks, 2006).

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2016 Awards and Honors

We are thrilled to announce the winners of the 2016 Plural Publishing Research Awards given in honor of the late Dr. Sadanand Singh, Plural’s founder. These two scholarships are awarded by the Council of Academic Programs in Communication Sciences and Disorders and the honorees and their faculty sponsors will be acknowledged at the annual CAPCSD meeting award banquet, in San Antonio, TX on March 31.

At the MS/AuD level, the award went to Chelsea Hull of the University of Nebraska-Lincoln. Working with advisor Dr. Sherri Jones, Chelsea is researching the impact of Sound Field Amplification (SFA) devices, specifically the REDCAT amplification system, on student academic outcomes and teacher perspectives of this amplification system on academic improvement.

CAPCSD Scholarship Chelsea Hull

Chelsea Hull                                                         Au.D. Student                                             University of Nebraska-Lincoln

At the PhD level, the award was given to Nancy Quick of the University of North Carolina. Under advisor Dr. Melody Harrison, the focus of Nancy’s research is on investigating the impact of underlying linguistic sources of knowledge on spelling among children with hearing aids, cochlear implants and normal hearing, utilizing a multilinguistic analytic approach.

CAPCSD Scholarship Nancy Quick

Nancy Quick, M.S. CCC-SLP               University of North Carolina at Chapel Hill PhD Candidate in Speech and Hearing Sciences, Class of 2017

Congratulations Chelsea and Nancy on your achievements!


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Healing Voices

Healing Voices (1)By Leda Scearce, MM, MS, CCC-SLP author of Manual of Singing Voice Rehabilitation: A Practical Approach to Vocal Health and Wellness

Singing is a part of virtually every culture and is fundamental to our human experience. In the United States, singing is enormously popular, as evidenced by the vast number of people engaged in all kinds of singing activities. Over 30 million Americans participate in choral singing alone (Chorus America, 2009). Shows such as The Voice, America’s Got Talent, and American Idol illustrate how passionate we are about singing. From the amateur recreational singer to the elite celebrity, we sing as soloists and in ensembles, with instruments and a cappella, in classical and contemporary styles, on stage, in concert, and in the shower.

Every person’s voice is unique and identifiable, and our voices can be a big part of our identity and how we see ourselves in the world. This is especially true for singers, for whom the voice is not only intricately tied to self-image and self-esteem but also may be a source of income and livelihood, creative expression, spiritual engagement, and quality of life. For a singer, a voice injury represents a crisis. Because of the specialized needs of singers, it takes a team—including a laryngologist, speech-language pathologist, and singing voice rehabilitation specialist—to get a singer back on track following an injury or voice disorder. Singing voice rehabilitation is a hybrid profession, requiring in-depth clinical and scientific knowledge married with excellence in teaching singing.

Voice problems are rarely isolated in etiology—usually multiple factors converge to create an injury. These factors may include poor vocal hygiene, inadequate vocal technique, an imbalance in vocal load and medical problems (allergies and reflux are common in singers, but thyroid, pulmonary, neurologic, and rheumatologic conditions are among the illnesses that may affect the voice). The singing voice rehabilitation process must encompass all elements that may be contributing to the problem: medical factors, vocal hygiene, vocal coordination and conditioning, vocal pacing, and emotional factors. Continue reading