Meet the Author Sessions at ASHA 2017 Convention

MEET THE AUTHORS AT ASHA!

SCHEDULE:

Thursday, November 9

11:00 – 12:00 pm: Celeste Roseberry-McKibbin and Priya James, co-authors of Comprehensive Intervention for Children With Developmental Delays and Disorders (10 book set)

1:00 – 2:00 pm: Wendy Papir-Bernstein, author of The Practioner’s Path in Speech-Language Pathology: The Art of School-Based Practice

2:00 – 3:00 pm: Raymond H. Hull, editor of Communication Disorders in Aging

3:00 – 4:00 pm: Françoise Brosseau-Lapré, co-author of Developmental Phonological Disorders: Foundations of Clinical Practice, Second Edition
Friday, November 10

10:00 – 11:00 am: Debra Abel, editor of The Essential Guide to Coding in Audiology: Coding, Billing, and Practice Management

11:00 – 12:00 pm: Erna Alant, author of Augmentative and Alternative Communication: Engagement and Participation

12:00 – 1:00 pm: Anthony DiLollo, co-author of Clinical Decision Making in Fluency Disorders, Fourth Edition

1:00 – 2:00 pm: Margaret Lehman Blake, author of The Right Hemisphere and Disorders of Cognition and Communication: Theory and Clinical Practice

Saturday, November 11

10:00 – 11:00 am: Christina Gildersleeve-Neumann, co-author of Phonetic Science for Clinical Practice (textbook and workbook)

11:00 – 11:30 am: Ryan W. McCreery and Elizabeth A. Walker, co-authors of Pediatric Amplification: Enhancing Auditory Access

Personal Attitudes about Professional Wellbeing

By Wendy Papir-Bernstein, author of The Practitioner’s Path in Speech-Language Pathology: The Art of School-Based Practice

Within our profession—whether student, professor, researcher or practitioner—we connect with people from a diversity of fields.  Have you noticed how some seem happier than others?  They excel at their work and communicate a sense of enthusiasm, passion and professional fulfillment. It shows on their faces and use of body language, their social interactions, and of course through their work.  Researchers from the field of positive psychology tell us that happiness, whether personal or professional, is driven by the same themes:  we want to make a difference, we want to be useful, we want to connect with something greater than ourselves, we want balance in our lives, and we want community (Haidt, 2006).  It all seems pretty basic and yet it can be our greatest challenge.

One reason may be that we sometimes think of ourselves as consummate caregivers, and this culture of self-sacrifice is naturally carried over into our work setting.  I remember the moment many years ago when I first thought this idea.  I was on a plane, traveling out of the country.  The flight attendants spoke about safety regulations, demonstrated oxygen masks, and I thought I knew the drill well.  This time, however, I really heard it for the first time.  When they explained how important it was for you to put on your own oxygen facemask first—before helping anyone else with their own—I understood and took it to heart.  After returning to work, I made some immediate changes with priorities and strategies for my own self-care.

Bottom line—our work reflects our personal attitudes about our own wellbeing, as much as it does about the wellbeing of our patients, clients, and students. In fact, these attitudes are an integral component of clinical expertise, and will drive the success of our practice.  The significance of “personal attitudes and qualities” has recently been expanded in both ASHA’s 2014 clinical competency standards as interaction and personal qualities, and in the 2015 revision of standards for accreditation of graduate programs as professional practice competencies (ASHA, 2014; 2015).  Attitudes provide the framework and the context for what happens within the clinical and educational processes, and are thus the most critical “tool” in the profession. As it has been discussed within the medical profession, the most valuable part of the stethoscope is the part that rests between the ears.  And so, prescriptions for our own self-care and wellbeing must be at least as important as care for the people who receive our services (Traux & Mitchell, 1971).

What do we mean by professional wellbeing? While wellbeing is difficult to define and measure, we do know that it involves maintenance of equilibrium easily offset by life’s challenges.  It is sometimes linked to Aristotle’s idea of “eudaimonia”, the belief that the overarching goal of all human actions is to flourish (Bradburn, 1969).  Martin Seligman, another leader in the positive psychology movement, developed a theory about the building blocks for a life that flourishes, which he coined PERMA: positive emotion, engagement, relationships, meaning and accomplishment (2011).  All of this contributes to a feeling of success.  Wellbeing has been compared to quality of life, which is defined by The World Health Organization (WHO) as “an individual’s perception of their position in life in the context of the culture and value systems in which they live in relation to their goals, expectations, standards and concerns” (WHO, 1997).

Paths, roads or ways are metaphors for the possibility that there is a connection between all we are and do.   Our chosen path is the practitioner’s path, where our work becomes about who we are as well as about what we do.  As we think about building, supporting, traveling and ultimately manifesting our path—we create a sense of passage within phases of our professional life that fosters balance, self-care, and reflective practices. As we approach the inevitable forks on our professional paths, let’s reflect upon the values we live by, the qualities and attitudes we embody, and the examples we model for others.  Nothing becomes more valuable than establishing our own set point for wellbeing, and building strategies for maintaining that sacred balance between our personal and professional self.

References

American Speech-Language-Hearing Association (2014) Standards for the Certificate of                  Clinical Competence in Speech-Language Pathology. Retrieved from                  http://www.asha.org/Certification/2014-Speech-Language-Pathology-                               Certification-Standards/

American Speech-Language-Hearing Association (2015). Proposed Revised Standards                 for Accreditation of Graduate Education Programs in Audiology and                                 Speech-Language Pathology. Retrieved from
http://caa.asha.org/wp-content/uploads/Accreditation-Standards-for-                                 Graduate-Programs.pdf

Bradburn, N. (1969). The structure of psychological well-being. Chicago, IL: Aldine.

Haidt, J. (2006). The Happiness Hypothesis. New York, NY: Basic Books

Seligman, M. E. P. (2011). Flourish – A new understanding of happiness and well-being                 – and how to achieve them. London, England: Nicholas Brealey Publishing.

  Traux, C. B., & Mitchell, K. M. (1971). Research on certain therapist interpersonal skills                  in relation to process and outcome. In A. E. Bergin & S. L. Hartfield (Eds.),                  Handbook of psychology and behavior change. New York, NY: Wiley.

World Health Organization. (1997). WHOQOL Measuring Quality of Life. Geneva,                           Switzerland: World Health Organization.

One of the best things you can do for your clients with right hemisphere brain damage

By Margaret Lehman Blake, PhD, CCC-SLP
Author of The Right Hemisphere and Disorders of Cognition and Communication: Theory and Clinical Practice

It can be difficult to know what to do with clients who have right hemisphere brain damage (RHD): how to assess them, what to treat, how to treat, etc. It’s not surprising, because (a) there is less collective knowledge within the field and (b) there are limited opportunities to acquire the knowledge that does exist. As for the amount of knowledge, aphasia was “discovered” and named the 1860s. In contrast, the impact of RHD specifically on communication and language has only been recognized since the 1960s, so we are behind by a century! As for the opportunities to acquire the knowledge, the problem starts in graduate school. While a majority of graduate programs have stand-alone courses on aphasia, RHD is typically covered as one of several topics/etiologies in a cognitive disorders course. I would venture that a majority of graduate programs have an expert in aphasia on faculty, while only a minority of programs have anyone interested in RHD. It is equally difficult to find continuing education about RHD after graduate school. In the past three years at the ASHA Convention there have been only between 6 to 9 presentations on RHD each year. In contrast, the number of presentations about aphasia has ranged from 177 to 269.

There is not enough room here to provide tips and advice for how to tackle all of the disorders associated with RHD, so I’ll just mention the one that I think is the most critical: talk to families. While SLPs likely talk to families of all of their patients/clients, it is especially important when working with someone with RHD. The purpose is two-fold: first to get information about how the patient has changed following the stroke, and second to provide information and resources to the families.

Getting information from the families about how (and if) the patient is different is essential. When it comes to pragmatics, there is no clear cut-off between being “normal” and being “a bit odd” as a result of brain damage. Add to that cultural differences in how people communicate (both verbally and non-verbally), and it may be nearly impossible in some cases to determine if someone has a pragmatic deficit or not. For example, just the other day I was assessing a man with RHD for a research project. In the small talk at the beginning of the session, I found out that he was originally from Wisconsin, so I asked him what brought him to Texas. He replied, “a 1972 Chevy truck”. If the exchange ended there, and I had no information about his personality from his family, I could have thought, “Aha! Typical RHD, he’s overly literal in his interpretations” and decide that I might want to target pragmatics in therapy. But the exchange did not end, and he followed up that response with an appropriate explanation of a change in jobs. Additional information from his family regarding whether or not that kind of response was a typical pre-stroke behavior would allow me to make a more appropriate decision about therapy goals.

The second part of talking with families is to provide education. They need education about the variety of problems that may occur and who they can contact for help. While families may get information about unilateral neglect from neurologists, SLPs are the ones who can educate families about pragmatics and communication. SLPs are the ones who can explain how RHD can affect theory of mind, cause a person to no longer accurately interpret another person’s intended meaning, understand their point of view, or become more egocentric and self-focused. SLPs are the ones who can explain that changes in theory of mind and emotional processing may result in changes in empathy. SLPs are the ones who can explain that appreciation and use of humor might change after RHD. SLPs are the ones who can explain that deficits in problem-solving and reasoning can affect communication, such that a person may not be able to notice or fix a communication breakdown, or figure out that the breakdown was mostly their fault. SLPs are the ones who can explain how prosody, facial expression, and body language are critical to communication, and that all can be affected after RHD. And most importantly, SLPs are the ones who can explain that they can treat these deficits.

Educating families about RHD is especially important because some deficits may not become apparent until the patient goes home. For example, an egocentric perspective and limited empathy for others might be considered normal for anyone in the hospital after a life-changing event such as a stroke, so it may not be identified as a deficit until the patient goes home and his spouse observes a lack of empathy in everyday situations. A patient also may seem to have a blunted sense of humor that in acute care may not seem unusual given the situation, but it may become really obvious when she goes home and her husband can’t joke with her like he used to, or conversations just aren’t “normal”.

When these kinds of changes become apparent, most families won’t think, “I should ask for a referral to a speech therapist”, because the person’s speech generally is fine. SLPs need to provide that link for them when they have the chance, so that when the deficits become apparent, the families will know where to go for help.

Despite the limited number of evidence-based treatments, I believe that SLPs can provide effective treatments to adults with RHD. Our knowledge about pragmatics and cognition can go a long way in addressing the deficits that limit participation in activities important to our clients. We just might increase interest in RHD, which would lead to more research, more experts in the field and more opportunities to learn about the problems, which in turn would spark more interest, lead to more research, and on and on.

Lesson Plans — An SLPA’s foundation for an effective therapy session. Now that I have one, how do I implement it?

Jacqueline_BrylaKraemer_CWSLPA

By Jacqueline Bryla, co-author of Clinical Workbook for Speech-Language Pathology Assistants

Responsibilities of a Speech-Language Pathology Assistant are many and can vary.  One key component within the scope of practice for a Speech-Language Pathology Assistant (SLPA) is to follow documented treatment plans or protocols developed by the supervising Speech-Language Pathologist (SLP). For a new SLPA this can be tricky and requires some experience in order to provide an effective therapy session for their clients and students.

Presenting a Lesson Plan

A guideline will make your clients and students aware of what they will be learning or practicing during the therapy session in addition to keeping them engaged and on task. An SLPA can share the lesson or treatment plan by telling their clients or students what they will be learning.  Providing a visual schedule by outlining the therapy tasks on a tabletop white board (i.e., warm-up; 5 minutes, articulation practice; 15 minutes, homework/carryover assignment, reward) can also be very effective for providing expectations of the therapy session time. Adding icons or photos to illustrate the task can be helpful for those who are not yet readers. Depending on the goals and objectives for the students, an SLPA might spend a portion of therapy time working on an articulation goal (i.e., medial /s/ in sentences) and the rest of the session on a specific language goal (i.e., concepts).  Considering how to incorporate multiple student goals or objectives within a therapy session will come with quality guidance from the supervising SLP as well as practice and experience. Providing a clear agenda for your clients and students at the beginning of the therapy session will be extremely helpful for you and your students to stay on task.

Engagement

When appropriate, offering choices for student and clients can set the stage for a productive therapy session. Allow your students to choose to work on one sound before another (i.e., /s/ or /l/), or to choose a board game or token piece that might be used during the session (i.e., Candyland, Snail’s Pace Race, red or blue token) or to use an articulation card deck or an app (i.e., Little Bee Speech Articulation Station, Smarty Ears Articulate It). Knowing and understanding your students’ interests will aide in keeping them engaged during the therapy session. Some students thrive on verbal positive feedback (i.e., you’re doing great, that was an awesome try), others will likely stay engaged by being allowed to have a little control by choosing the activity and yet others will need some additional motivation by earning a short timed reward at the end of the session or during the session (i.e., using a fidget, receiving a sticker or stamp). Seeking guidance from, in addition to observing, your supervising SLP provide treatment sessions can be helpful in this area.

Tool Box and Resource Efficiency

Become familiar with the materials available to you for therapy. Is there a closet full of games and therapy items at your disposal (i.e., an iPad with apps, articulation card decks, language or pragmatic resources)? Taking time to read the game directions and instructions of use or viewing an app tutorial prior to the therapy time will allow for a more efficient therapy session by allowing an SLPA to instruct their students and clients from the start. Being prepared and familiarizing yourself with materials reduces the opportunities for clients and students to veer off task. Always keep in mind that an SLPA must perform only those tasks assigned by the supervising SLP. Many therapy sessions are only 30 minutes, to provide a quality session for clients and students preparation is of the utmost importance.

Conclusion

There is no one way to describe or predict each therapy session scenario. A lesson plan may not work as well as you expected or go as planned. Do not get discouraged; this is an opportunity for you to learn what may work and what may not work. Being prepared and following your supervising SLPs guidelines will allow you to have the most productive therapy session, one that allows your students to work toward their goals and objectives.

Love, Talk, Read: Early Intervention Strategies for Infants and Toddlers At Risk for Language Impairment

Celeste_Roseberry-McKibbinRoseberry-McKibbin_ILSSLIB_2e

By Celeste Roseberry-McKibbin
Author of Increasing Language Skills of Students From Low-Income Backgrounds: Practical Strategies for Professionals, Second Edition
and co-author of the forthcoming Comprehensive Intervention for Children with Developmental Delays and Disorders Practical Strategies (10 book set)

Statistics have documented the precipitous rise of children diagnosed with Autism Spectrum Disorder (ASD), language impairment, and other atypical developmental profiles. For example, according to the Centers for Disease Control and Prevention (2016), 1 in 68 children today is diagnosed with ASD. Many times, these children do not receive intervention until they are 4 years old or even older. Recent research has documented very exciting outcomes that can occur when these at-risk children receive early intervention, which can start as early as 6 months of age. Speech-language pathologists can help caregivers begin, very early in their children’s lives, to implement strategies that improve their language outcomes. The strategies can be summed up in three words:  love, talk, read. Let’s start with love.

Love

Relationships are the cradle of all learning. Babies and young children above all must feel attached to their caregivers through love, attention, and bonding. It is critical, in the early weeks and months of life, for caregivers to respond immediately and with love when a baby cries. Immediate responses help infants to bond with caregivers and trust their world. Leaving babies to “cry it out” teaches them that the world is not a safe place, and can create a shaky foundation upon which to build later language interaction. Thus, immediate responsiveness to a baby’s cries is a foundational building block of later language.

Talk

We have all heard the oft-repeated advice, “Talk to your baby.” This is true, and talking to babies and young children is crucial to their developing language. However, research has shown that it is actually parent responsiveness to the baby’s initiations that is even more predictive of early language development (Center on the Developing Child at Harvard University, 2016; Ozonoff et al., 2009; Tamis-LeMonda et al., 2001). When a baby looks at something, for example, the parent can follow his “line of regard” and establish joint attention, where the parent and baby are focusing on the same thing. So when the dog walks into the room and the baby’s eyes land on the dog, the parent can say, “Oh, you see Angel. (pointing to dog) That’s right, Angel just came in.” When the baby points, the parent can look at what the baby is pointing to and comment—“Oh, you are pointing at the red balloon. The balloon is pretty!” When babies make sounds, the parents can respond with immediate imitation and add new sounds as well.

Ozonoff et al. (2009) conducted a study with parents of infants (6–15 months of age) suspected of having ASD. Parents were coached to create pleasurable social routines to increase their children’s opportunities for interaction. Parents used toys and words to attract their babies’ attention, and also imitated their babies’ sounds and intentional actions. The treatment consisted of 12 one-hour sessions with the infant and parent, followed by a six-week maintenance period with biweekly visits and follow-up assessments at 24 and 36 months of age. The study’s results showed that in contrast to a control group whose parents did not receive coaching, the children who received the intervention had significantly more ASD symptoms at 9 months of age, but significantly lower autism severity scores at 18 and 36 months of age. By age 3, the group that received the intervention had neither ASD nor developmental delay.

When the baby begins to say words at around 12 months of age, parents can extend their utterances. Extensions have proven to be some of the most powerful ways to increase children’s language skills.  So, for example, if the child points to the dog and says “doggy!” the parent can say, “Yes, our doggy Angel just came into the room and she is wagging her tail.” If the child says “more juice,” the parent can say, “You are thirsty, and more juice is available. Here you go!” When parents add words and new meaning to children’s utterances, semantic and syntactic skills grow. The best part is that this can be done in any language, even if the caregiver is nonliterate and has little extra time. Extensions can easily be added to families’ daily routines with no extra expenditure of time or money.

Read

Parents can share books even with babies, reading and pointing out pictures. Simple books with colorful pictures are ideal. If parents do not read, they can talk about pictures on the pages. Parents can label pictures and actions in the pictures, saying things like, “Look—there is Thomas the Tank Engine! (pointing to Thomas). Why is he happy? (pause) Oh, he is happy because Percy the Train just came up to him and wants to play.” Babies and some young children will not answer questions, but parents can ask the questions, pause for a few seconds, and then answer the question themselves. This shows the developing child that, eventually, turn-taking is expected. Routines such as this help establish joint attention, reciprocity, and eventually conversational turn-taking. Daily sharing of books with babies and young children establishes pre-literacy skills, which are critical building blocks for later literacy.

Summary

For infants and young children who are at risk for language impairment and other developmental issues, caregivers can focus on three simple strategies: love, talk, read. Research shows that early intervention, beginning in infancy, can have exciting and dramatic results in terms of helping children achieve successful language and life outcomes.

For more information, visit http://lovetalkread.com.

 

References

Center on the Developing Child at Harvard University. (2016). Serve and return. Available at http://developingchild.harvard.edu/science/key-concepts/serve-and-return/

Centers for Disease Control and Prevention. (2016). Autism spectrum disorder. Available from https://www.cdc.gov/features/new-autism-data/index.html

Ozonoff, S. et al. (2009). How early do parent concerns predict later autism diagnosis? Journal of Developmental and Behavioral Pediatrics, 30(5), 367–375.

Roseberry-McKibbin, C. (2013). Increasing language skills of students from low-income backgrounds: Practical strategies for professionals (2nd  ed). San Diego, CA: Plural Publishing, Inc.

Tamis-LeMonda, C. S., Bornstein, M. H., & Baumwell, L. (2001). Maternal responsiveness and children’s achievement of language milestones. Child Development, 72(3), 748–767.

For Aspiring Singers, Ignorance Is Never Bliss!

Jan_Bickel Bickel_VT2E

By Jan E. Bickel, DMA, author of Vocal Technique: A Physiologic Approach, Second Edition

Singers must understand how to maintain their vocal and overall health in order to keep vocal production at the high levels required of them. In order to achieve this understanding, singers need in-depth knowledge of the anatomic and physiologic function of the complete vocal instrument, a pedagogically well-trained voice teacher, and the knowledge that they can reach out to a team of voice professionals (voice teacher, otolaryngologist, speech-language pathologist, and possibly others) who understand vocal technique and pedagogy as well as voice science and medicine. It is particularly important for aspiring singers to know they have a professional team ready and appropriately trained to help when vocal difficulties arise. The aspiring singer’s trust in this team of professionals must be established at the earliest levels of vocal training. If an aspiring singer is afraid to seek help from the voice teacher, otolaryngologist, and/or speech-language pathologist, valuable time will be lost in vocal development, damage to the vocal instrument may occur, and the aspiring singer may decide to choose another career path. It is imperative that speech-language pathologists and otolaryngologists have some training in vocal pedagogy if they wish to accept singers or aspiring singers as clients, and that voice teachers have a functional understanding of voice medicine and voice science. Ignorance is the quickest path to voice disorders for the aspiring singer.

I wrote Vocal Technique – A Physiologic Approach with the intention of appropriately educating and providing a strong foundation for aspiring undergraduate singers, whether their desire was to enjoy singing as amateurs, or perform as professional singers. In my teaching of undergraduate students, I found these young singers frequently able to produce very beautiful vocal sounds, but having little or no knowledge regarding how their vocal instrument functions when speaking and singing. Most of these singers seemed to have no idea what to do or whom to turn to when their voices were not functioning well. In addition to having a clear concept and understanding of the anatomy and physiology of the vocal instrument, they need to understand how to maintain that instrument on a daily basis; i.e. vocal hygiene, breath management, vocal exercises, careful attention to speaking voice production, and determining what might be detrimental to maintaining healthy vocal folds and bodies. I use Vocal Technique – A Physiologic Approach to teach undergraduate voice classes, initial voice lessons, and again in the vocal pedagogy course in the senior year. I find that students who fully understand the information presented within the book progress much more quickly in the voice studio, and I rarely find them in vocal distress.

Excellent singing requires appropriate posture, refined breath management skills, efficient phonation and resonation techniques as well as the ability to articulate in multiple languages without disturbing the vocal production. Professional classical singing requires perfect phonation; i.e. a clear and resonant tone quality, the ability to create a variety of tone colors, excellent dynamic control, accurate pitch, and the ability to infuse the vocal tone with many appropriate emotions. This means the aspiring singer must have the discipline and dedication to become a vocal athlete with the creativity and imagination of the best professional actor. Learning to sing well enough to perform for the public requires much more than the average person can even imagine. Singers cannot afford to be ignorant about any aspect of their profession if they are to be successful.

There are issues beyond vocal technique that can cause a very well-trained singer to have difficulty with his or her voice – respiratory infection, acid reflux, allergies, inability to “support” the voice appropriately because of bodily injury or illness, interruption in sleep pattern, stress, aging, dehydration, fatigue, and many more. A singer must know intimately his or her voice and how it functions when healthy so that when it is not functioning normally, he/she is fully aware and comfortable reaching out for support from the appropriate professional. A voice teacher can be of great assistance in many cases, but sometimes a singer needs to see a laryngologist, a speech-language pathologist, or a vocal specialist for proper diagnosis and treatment. The demands of professional singing necessitate excellent health, physical conditioning, and careful use of the speaking voice as well as the singing voice, so the aspiring singer must learn how to maintain his or her instrument early in the learning process.

I posed the following question, among others, to 35 undergraduate and amateur singers participating in a choral ensemble and/or a freshman level voice class: “Do you think singers, in general, are reluctant to see an otolaryngologist (ENT) or a speech-language pathologist (SLP) for problems with their voices? 16 responded “yes,” 18 responded “no,” and one did not answer. Of the 16 who responded that singers are indeed reluctant, three had actually seen an ENT or an SLP for a vocal issue. One singer who said she had not seen an ENT or SLP wrote about having “muscle tension dysphonia,” which would seem to indicate that she actually had seen an ENT or an SLP for diagnosis, but did not want to acknowledge this visit. Another respondent wrote that he had “strain and discomfort when singing,” but had never seen an ENT or SLP. Of the respondents who answered that singers are not reluctant to see an ENT or SLP, only two had seen an ENT or SLP, while eight of the respondents made the following statements regarding their own vocal health: “trouble with speaking voice,” “lost voice completely,” “voice hurts when I sing,” “belting created vocal problems,” “laryngitis due to asthma, allergies and bronchitis,” and “unresolved tinnitus, causing problems with pitch matching.”  It follows that these singers might have been helped by a laryngologist or speech-language pathologist, but chose not to reach out to make an appointment.

When asked why an aspiring singer might be reluctant to see an ENT or SLP, the respondents made the following statements: “Singers think the problem is fixable by themselves,” “Fear of being told that there is irreversible vocal damage,” “It can be seen as embarrassing or you don’t want to admit you have a problem,” “Some singers simply resign themselves to discomfort or stop singing altogether,” “Singers feel they can resolve issues themselves by rest and homeopathic methods,” “They don’t want to admit there’s a problem because of the competitive nature of auditions. . . ,” “Perception is the ENT does not care about solving vocal problems for amateur singers,” “It is hard for a singer to admit there is something wrong with their vocal mechanism,” “Singers assume a referral means the voice is bad/sounds bad.”

When asked the same question, two professional singer/voice teachers responded with these comments: “I feel strongly that singers, myself included, are afraid to hear that something may be wrong. I also think that singing is a very expensive endeavor, and the thought of having to spend more money on doctor visits, or treatments, in addition to the cost of taking lessons, and coachings and paying tuition, or fees for applications and auditions, is daunting,”  “The ENT I saw did not at all quell my fears. He told me that I had polyps (which I later found out was not the case) and suggested that I start coming in once or twice a week to help rebuild my voice. I had such an uneasy, unpleasant feeling about it that I went maybe twice. He did some pathetic vocal warm-ups that didn’t teach me anything and sent me to work with an SLP down the hall. Likewise, those exercises felt silly and I never felt reassured that this was going to make me better in any way.” This singer later went to a laryngologist and an SLP, both specifically trained to work with singers, and the results were entirely different as stated: “He was very kind, performing a gentle procedure to examine my vocal cords. He printed out photos and explained very thoroughly what I was looking at . . . the SLP was very kind as well. Her exercises were thoughtful, helpful and specific. She gave me reasoning behind every one of them. I actually followed through and did them every morning.” This singer went on to complete a Master of Music degree in vocal performance and to sing several opera roles successfully and is now a professional actress. Clearly, appropriate preparation of the otolaryngologist and speech-language pathologist in working with singers is important. There is no place for ignorance in the area of vocal technique and pedagogy for these professionals if they wish to take on singers as clients/patients.

Aspiring singers spend much one on one time with their voice teachers, perfecting their technique, and learning to trust the voice teacher implicitly. This trust is built up over time, and is an essential part of the training of the singer. “Singing teachers are not only music educators, they are also guardians of their students’ voices. An astute teacher does not just help prevent vocal difficulties by providing a student with expert, healthy singing technique; he/she also is often the first person to detect a vocal problem and is usually regarded by the student as the source of all knowledge about anything vocal.” (Heman-Ackah et al., 2008)

 When a vocal issue arises, the voice teacher is usually the first to hear it in the singer’s voice, and the singer naturally trusts the voice teacher to “fix” the problem. When the teacher is unable to help the singer resolve the issue, the student begins to feel uncomfortable, worried, and even desperate. Their thinking follows the path – if my voice teacher can’t “fix” the problem, it can’t be fixed. I find that undergraduate student singers are particularly fearful of a referral to the laryngologist, even when I explain that this doctor is trained to diagnose and help resolve the vocal difficulty, not to criticize or place blame. I find that many singers find the idea of getting “scoped” to be quite frightening, even though I introduce this procedure in the freshman voice class, showing a video of a singer in the process. I want them to understand this is not painful and will help to diagnose the problem. Perhaps more importantly, for the aspiring undergraduate singer there is a clear social stigma attached to visiting a laryngologist, so if the singer does make an appointment, he or she will keep it a secret.

When the laryngologist refers a singer to an SLP, this seems to be even more difficult for the singer to accept. It says to the singer that it is his or her own fault that he/she has a vocal problem. If the SLP is not knowledgeable regarding vocal technique, and works with the singer as if he/she is the same as every other client who comes into the office for voice therapy, I will have a very difficult time convincing my student singer to continue with appointments as advised by the laryngologist. An SLP working with singers MUST have some training in vocal technique and vocal pedagogy and should be willing to work in ways that are familiar to the singer from voice studio work.

If there is a diagnosis of vocal nodules, even though the voice teacher may have suggested this might be the case, it is always a shock to the singer. The singer generally comes back to the studio depressed and feeling as though his or her singing life is over. Frequently, vocal nodules can be removed through careful vocalizing and establishment of healthy speaking and singing technique, but aspiring singers want an instant cure. Many will choose to do surgery, even when the laryngologist says it is not really necessary, so they can put this diagnosis in the past as quickly as possible. The singer does not want to consider the need to do preoperative speech therapy, surgery followed by vocal rest, postoperative speech therapy, and, finally, slowly bringing the voice back to the ability to sing with excellent technique. If the singer continues to speak incorrectly or without support the outcome, even after surgery, will not be good.

So, what I am proposing here is that voice teachers give their aspiring singers an excellent foundation in vocal technique – posture, breath management, phonation, resonation, etc., and carefully teach them about the anatomy and physiology of speaking and singing so they understand the importance of establishing an appropriate speaking pitch, not screaming at the college football game, not speaking over noise at the local club, singing music from the correct voice category, and so many other directives coming from the teacher. Voice teachers should insist that their students see videos such as the ones for which links are provided on the companion website for Vocal Technique – A Physiologic Approach, demonstrating the anatomic function of the larynx, lungs, diaphragm, and surrounding muscles. There are many YouTube videos demonstrating the use of the laryngoscope so that singers will know exactly what to expect when they visit the laryngologist’s office. In addition, voice teachers must coordinate with speech-language pathologists in their universities.

Speech-language pathologists need to understand and be able to demonstrate the diaphragmatic-costal breathing that a singer would use when projecting his/her voice in an opera house without a microphone. SLPs wishing to work with singers don’t need to be professional singers, but they must have a strong understanding of what is required for a singer to produce vocal tones worthy of the concert and opera stage, and it would help greatly for them to have formal training in vocal technique and pedagogy. I think this will change the way they interact with singers, and will certainly help gain the respect of their singer/clients. This should help to improve the communication between the two, and will keep the singer coming back to complete the therapy as prescribed. It will be important for SLPs working with singers to be able to use non-traditional forms of voice therapy that have a solid basis in anatomy and physiology. In order for speech therapy to be successful, the singer must be fully invested in the process, and the process must produce results quickly so the singer can get back to singing within a short period of time.  Because singers have developed higher than normal levels of vocal stamina, and phonation skills, they expect to be treated differently as a client of an SLP. If they are not, they will not comply with prescribed treatment and probably will not complete therapy sessions or exercises at home.

It is equally important for the otolaryngologist to understand vocal technique and pedagogy when accepting a singer as a patient. If the otolaryngologist understands the hesitation and fear that is present when a singer makes an appointment to see him or her, this will help the singer remain calm and accept the diagnostic procedure and the diagnosis and prescribed treatment suggestions. “As vocal athletes, singers require special diagnostic and treatment consideration when voice difficulty develops because they must maintain higher-than-normal levels of phonatory agility, strength, and stamina to repeatedly execute complex laryngeal maneuvers” (Zeitels et al., 2002). It seems best that it is a laryngologist, specialized in the care of disorders of the voice and larynx, who treats a singer, but this is not always possible. When it is not possible, the otolaryngologist must take extra care to understand how the singer thinks and uses the voice.

In addition, there must be open and complete communication among the voice teacher, the speech-language pathologist, the laryngologist, and the singer in distress at all times. As the singer generally has full confidence in his or her voice teacher, but perhaps not as much in the SLP and/or laryngologist, this communication will help the voice teacher to motivate the singer to do the appropriate exercises. If the speech-language pathologist has a good understanding of vocal technique and the mindset of the aspiring singer, this will open the door to communication and success. In this regard, two of the professional singer/voice teacher respondents to my questionnaire stated:

“I have raised concerns about my inability to speak or sing, or concerns about how     medicine will affect my singing voice. I understand that I don’t have a medical degree,   but I do know that my voice is largely responsible for my income, and my emotional       health. Concerns raised by patients should be addressed professionally and respectfully,”

Medical professionals and SLPs should “make sure you know how emotionally      connected we are to our voices. Singing is our life, an echo of our very soul. For our       singing voice to be in turmoil is as scary as telling a runner that they ruptured their          Achilles’ tendon. It’s a very big deal.”

Let’s make sure we all do our part in fully educating aspiring singers to the best of our abilities. Every singer needs to be as educated as possible about the anatomic and physiologic function of the vocal instrument in addition to the many other areas of study. Understanding these concepts fully will allow every singer to seek out an outstanding voice teacher, and will certainly help to remove fear and anxiety about reaching out to the laryngologist, speech-language pathologist, or a voice specialist when vocal problems arise. If the voice teacher, laryngologist, speech-language pathologist, and other voice professionals understand voice science, medicine, technique, and pedagogy to an appropriate extent, and communicate clearly with one another when working with a singer in vocal distress, the outcome will surely be a good one. If we communicate well with one another on a regular basis, we cannot help but replace ignorance with knowledge for our singers, clients, patients, and ourselves.

References:

Heman-Ackah, Y. D., Sataloff, R. T., Hawkshaw, M. J., Corln, V. D. (2008). Finding a voice doctor and voice care team. Journal of Singing, 64 (5), 583–592.

Zeitels, S. M., Hillman, R. E., Desloge, R., Mauri, M., & Doyle, P. (2002). Phonomicrosurgery in singers and performing artists: Treatment outcomes, management theories and future directions. Annals of Otology, Rhinology and Laryngology Supplement, 111(12), 21–40.

 

 

 

When a Client’s Behaviors Interfere with Delivery of Effective Treatment: Evidence-Based Behavioral Approaches

Christine_MaulMaul_BPCD

By Christine A. Maul, PhD, CCC-SLP, co-author of Behavioral Principles in Communicative Disorders: Applications to Assessment and Treatment

A 3-year-old child badly in need of one-on-one language stimulation clings to his mother and cries inconsolably whenever she tries to leave the clinic room. An adult being seen for elective accent reduction therapy asks numerous questions that increasingly consume valuable therapeutic time. An elementary school-aged child being treated for a fluency disorder with a token economy system coupled with response cost reacts with torrents of tears whenever a token is taken from her. All of these are cases of behaviors that interfere with the effective delivery of therapy, taken from real-life clinical situations. In all of them, the behaviors were reduced through behavioral techniques: for the 3-year-old, a modified version of extinction was applied; for the adult, questions were reduced using differential reinforcement of low rates of responding; and for the elementary school-aged child, a modification was made of response cost, which is often coupled with conditioned generalized reinforcement, such as a token economy.

Extinction. After consulting with the mother of the 3-year-old child with delayed language, it was decided that a modified version of the process of extinction should be utilized to decrease the child’s crying behavior. Extinction removes the reinforcing contingencies for a person’s undesirable behavior. Ideally, a clinician should work with a board certified behavior analyst (BCBA) to identify the exact reinforcing contingencies for a targeted behavior. In this clinical case, however, the clinician, in consultation with the mother, determined that the mother’s continued presence and the attention she gave the child in the clinic room was probably reinforcing the child’s crying behavior.
Therefore, for the next clinic session, the clinician arrived with a bagful of toys and books she hoped would be appealing to the child. The mother agreed to take the child into the clinic room and then leave. The expected tantrum behavior occurred. The clinician positioned herself in front of the door, blocking the child’s “escape” path, with her back to the child and began pulling out toys, one by one. The clinician played with each toy, remarking about how much fun she was having, but keeping her back turned toward the child. She engaged with each toy for only a brief amount of time, and, if there was no reaction from the child, she would exchange the toy she was playing with for another item. She did this with several items, none of which seemed to interest the crying child. Then she pulled out a pop-up book that made a “ding-dong” doorbell sound every time she turned the page and began reading it. The child continued to cry, but every time he heard the doorbell sound, he cried less and less, and began to approach the clinician. The sobs subsided more and more as he peeked around her back to look at the book. Finally, to the delight of the clinician and the mother observing through a one-way mirror, the child crawled into the lap of the clinician who gently started evoking one-word productions from the child through her storybook reading. The whole process took no more than 10 minutes, from the time the clinician turned her back to the time the child approached her, and the child went willingly into the clinic room for all subsequent sessions.

There are important things to remember if a clinician wants to try extinction, or this modified version of extinction. First, the process must be thoroughly explained to the parent, and the parent must be in agreement with the procedure. Second, the first time extinction is applied, an “extinction burst” is likely to occur, when the undesirable behavior escalates to even greater heights. When this happens, the procedure of extinction should continue to be applied; if not, all the client will have learned is how much of the undesirable behavior must be displayed before reinforcement is given. Third, extinction should never be used for physically aggressive or self-injurious behaviors.

Differential reinforcement of low rates of responding. In the case of the adult being seen for foreign accent reduction, the clinician suspected that the excessive question-asking behavior was probably negatively reinforced by providing escape from therapeutic tasks. Sometimes, maybe even often, clients find therapy to be aversive, and if a behavior puts off the hard work involved in therapy sessions, it is likely to increase.

The clinician decided that the rate of question-asking was so high, the most that could be done at first would be to employ a technique designed to reduce, but not entirely eliminate, the question-asking behavior. In differential reinforcement of low rates of responding (DRL), the client is warmly reinforced for performing an undesirable behavior at a lower rate. The clinician in this case explained to the client that the amount of time spent responding to her questions was seriously interfering with the effectiveness of treatment. She asked the client to limit her questions to only three per session. The clinician kept her responses to the questions very brief, and kept a tally of the number of questions asked during each session. If the client met her goal, the clinician warmly congratulated her and let her know how much her cooperation was appreciated. If the client had been a child, the clinician could have reinforced the reduced rate of undesirable behavior by offering a small prize at the end of the session; for adults, however, just warm acknowledgment of a job well done is usually enough.

Clinicians should be aware of the disadvantages of this technique. First, the technique will only serve to reduce a behavior. After the behavior has been reduced through DRL, further techniques will have to be employed to eliminate it. Second, a phenomenon known as generalized suppression of a behavior may occur. Consider the fact that asking questions is not an entirely undesirable behavior. People ask questions to seek out new information and to clarify that which is already known. If the client in the scenario provided eventually ceases to ask a reasonable number of well-considered questions altogether, generalized suppression has occurred.

Response cost and conditioned generalized reinforcement. A token economy system, such as the one employed by the clinician treating the school-aged child with a fluency disorder, is based on the behavioral principle of conditioned generalized reinforcement. People learn to work for conditioned generalized reinforcers that provide access to many other tangible reinforcers. In the natural environment, money is the most commonly sought after conditioned generalized reinforcer. In the clinic room, tokens such as poker chips, stickers, points, or happy faces can be given to a child to reinforce correct responses. The child can then exchange tokens earned at the end of the session for a prize in the clinician’s “treasure chest.”

A token economy can be even more effective when coupled with response cost, a corrective technique in which a token previously given for a correct response is taken away for an incorrect response. Children will usually work hard to keep the tokens they have earned, but sometimes, as is the case in the given scenario, a child may react emotionally when a token is taken away for an incorrect response.

Sometimes clinicians decide to simply cease administering response cost as a corrective technique when a child displays such emotional reactions. The clinician in this case, however, decided to adapt a slightly modified version of response cost. Each fluent response the child made was lavishly reinforced with three or four tokens, placed in a plastic cup. When the child exhibited a dysfluency, the clinician took one token out of the cup but did not remove it from the child’s view. Instead the clinician held the token over the cup, gave the child an expectant look, and encouraged the child to try again—“Come on, I know you can smooth it out!” Almost always, the child was able to produce the utterance fluently, and the token was plopped right back in the cup. Administering response cost in this way increased the child’s production of fluent utterances and eliminated undesired emotional reactions.

These are but a few examples of cases in which the application of techniques based on behavioral principles resulted in the reduction of undesirable behaviors that were interfering with the delivery of effective treatment. There are many other techniques that can be employed to decrease undesirable behaviors and to increase the desirable communicative behaviors SLPs seek to teach their clients. Much more detailed information regarding these and many more techniques, accompanied by protocols for session planning and recording data, are provided in Behavioral Principles in Communicative Disorders: Applications to Assessment and Treatment.

 

Cultivating an Awareness of Generational Differences for Effective Communication

By A. Embry Burrus and Laura B. Willis
Embry_Burrus
Laura_Willis
Authors of Professional Communication in Speech Language Pathology: How to Write, Talk, and Act Like a Clinician, Third Edition

Burrus_3e_PCSLP3E

Popular literature is filled with descriptions of the term, “generational differences,” and for good reason. There are distinct differences among individuals based on when they were born, and the political, social, and economic environment in which they have grown up. This post will address the various communication styles of individuals who are currently in the workforce. Although there are differences among the generations, according to the Center for Creative Leadership, there are also similarities; namely, most people have the same basic core values: “family, integrity, achievement, love, competence, happiness, self-respect, wisdom, balance and responsibility.”

The Millennial Generation, born between 1982 and 1994 (estimate), represents a cohort distinct from their parents of the Baby Boom generation (1945–1964 [estimate]), and their predecessors, Generation X (1961–1981 [estimate]). Millennials have been generally described as optimistic, team-oriented, high-achieving rule-followers. In addition, aptitude test scores for this group have risen across all grade levels, and with the higher aptitude has come a greater pressure to succeed. It is noteworthy to mention that Millennials are the most racially and ethnically diverse generation in U.S. history. As of 2012, individuals of Hispanic origin accounted for 26.9% of the 21-and-under population (http://www.census.gov), and Asians accounted for 25.6%. Interestingly enough, this generation has been described as more accepting of diversity than past generations.

Research has shown that children of the Millennial Generation were encouraged to “befriend” their parents, as well as their parents’ friends, and as teens they became comfortable expressing their opinions to adults; therefore, they are not hesitant to challenge authority, assert themselves, or ask for preferential treatment. Studies have shown that Millennials view strong relationships with supervisors to be a crucial factor in their satisfaction with their role as supervisee, and that they expect communication with supervisors to be frequent, positive, and affirming.

In today’s society, we are taught that to be successful, we need to be self-confident. Some of the characteristics assigned to the Millennials are that they are self-assured, assertive, and perfectionistic, which, when used constructively, can be very positive attributes. It is important that Millennials are aware that to members of the older generations, this can sometimes be misconstrued as overconfidence. If a supervisor or colleague perceives you to be overconfident, this could create a number of opportunities for miscommunication and misunderstanding. You do not want to communicate to others that you have more ambition than skill, or that you already “know it all” and therefore do not need or want their input. We often advise our students to be mindful that if they are perfectionists, they should not allow this to morph into fear of failure. We remind them that it is okay to admit that they do not know something, and it is much better to do so than to seem falsely competent.

Members of Generation X, the cohort immediately preceding the Millennials, were shaped by many factors. Generation Xers learned independence, autonomy, and self-reliance early in life. They were the first to be described as “latch-key” kids, and they often took care of themselves and their siblings. They grew up in a time when divorce was commonplace, and therefore ended up in single-family or blended-family homes. As a result, they have been described as being more accepting of themselves and others, and embracing of diversity. Members of this generational cohort have been described as valuing flexibility and creativity, as well as encouraging of individualism.

According to Jean Scheid (2010), “Gen Xers aren’t afraid of technology and love new gadgets, even if it takes a little longer than a Millennial to understand how it all works. Their communication style is one brief and to the point, and e-mail is their preferred method.” Gen Xers desire feedback from supervisors and do not hesitate to offer feedback in return. On the other hand, if not kept in the loop, they may become upset and feel left out.

The “Boomers,” as they are often referred to as, make up approximately 29% of the U.S. population and 50% of the workforce. The oldest members of the Baby Boom generation are now mostly retired, and in less than 15 years, one in five Americans (the youngest members) will be over the age of 65. Those who were born at the end of this generational cohort (1960–1964), however, are still a large part of the workforce and may still embody some general characteristics used to describe this group: focused on hard work, ambitious, competitive, and believers in equality.

To summarize, it is important to always show respect by communicating clearly and demonstrating that you acknowledge what your communication partner feels is important, regardless of position or age difference. This does not mean that individuals across the generations cannot understand each other, or learn from each other; it simply means that we must take into consideration that we may have different ways of looking at the same issue. Being part of a diverse workplace may be challenging to some, yet it can provide an environment that fosters rich personal as well as professional growth.

References

Deal, J. (2015). Ten principles for working across generations [Podcast]. Center for Creative Leadership. Retrieved from http://insights.ccl.org/multimedia/podcast/10-principles-for-working-across-generations/

Schied, J. (2010). Types of communication styles: Bridging the communication gap. Bright Hub. Retrieved from http://www.brighthub.com/office/home/articles/76498.aspx

U.S. Census Bureau. (2012). Current Population Survey, 2012 Annual Social and Economic (ASEC) Supplement. Washington, DC: Author.

 

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.

Book Review: Auditory Verbal Therapy: For Young Children with Hearing loss and Their Families, and the Practitioners Who Guide Them

AVT book - artwork -v8

Reviewed by Estelle Roberts, Speech-Language Therapist, Jhb Cochlear Implant Programme, Johannesburg, South Africa

Advances in technology have increasingly cast a spotlight on the possibilities for children with hearing loss, however severe, to learn to listen and use spoken language as their preferred mode of communication.   Auditory Verbal Therapy (AVT) has gained prominence as the intervention of choice for these families and their practitioners.  Auditory Verbal Therapy: For Young Children with Hearing loss and Their Families, and the Practitioners Who Guide Them provides a current, comprehensive and evidence-based text with appeal for a broad spectrum of professionals. The editors’ global experience reflects in, and influences the text, as does the work of 29 contributors, all international experts in their fields.

This is a substantive book:  seventeen chapters spanning 600 pages.  While this might initially seem daunting, the text makes for absorbing reading.  Much of the information is presented to encourage a fresh look at familiar topics. Throughout the text, the latest thinking and research is applied to AVT. In Chapter 2, hearing and listening are naturally paired with thinking and its accompanying research.  In Chapter 8, extensive and relevant information covering auditory processing, speech, language, emergent literacy and play is linked to developmental scales to provide diagnostic guidelines for practitioners.  Chapter 9 explores emergent literacy and provides compelling data that highlights the importance of early and effective access to sound for infants with hearing loss.  Very topically, it includes a balanced perspective on digital literacy.  For students and practitioners seeking practical knowledge in skill development, there are a number of ‘How to…’ chapters that have the potential to be used as ‘templates’ for acquiring skills or refining professional practice.

Unlike most texts, where the emphasis is directed at a particular group of practitioners, this inclusive text speaks to a broader audience within the field.  The material presented in chapters 4 – 7, covering audiology, hearing aids, implantable hearing technologies and assistive and access technologies, balances the next chapters, which provide greater depth for Auditory Verbal practitioners in particular. This balance between depth and breadth creates a must-have reference for the broader professional community interacting with cochlear implants.

The final chapter presents the voices of families from twelve countries as they reflect on their journeys with their children with hearing loss. Their reports, told from this powerful perspective, bear touching and convincing testimony to the global reach of AVT.

The lay-out of the book contributes to an ease of understanding that would be appreciated by parents, students and others not wholly familiar with the field.  Generous spacing, bulleting and frequently highlighted sub-sections creates a navigable reading experience and serves as a useful reference for those who prefer to use the text as a ‘dip-in’ resource.

Given its broad appeal to professionals and families, its presentation of extensive current, researched information and practical application to AVT, as well as its easy navigability, this resource may well replace existing texts to become the favoured ‘go-to’ resource for practitioners, students, families and the broader CI community seeking exploration and guidance in the field of AVT.