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

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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.

 

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

Warren_Estabrooks

 

 

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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AudiologyNOW! 2016 Author Signing Schedule

AudiologyNOW! attendees – Meet our authors and connect with experts in the field! Stop by the Plural booth (#301) for the following Meet the Author sessions: 


Thursday, April 14, 11:00 am – 12:00 pm
Meet Marc Fagelson, BA, MS, PhD 
Co-editor of Tinnitus: Clinical and Research Perspectives

Marc Fagelson   Tinnitus


Thursday, April 14, 3:00 – 3:30 pm
Meet Mark DeRuiter, MBA, PhD and Virginia Ramachandran, AuD, PhD
Authors of Basic Audiometry Learning Manual, Second Edition 

Mark DeRuiter   Virginia Ramachandran   Basic Audiometry Learning Manual, Second Edition


Friday, April 15, 11:00 – 11:30 am
Meet Ruth Bentler, PhD, H. Gustav Mueller, PhD, and Todd A. Ricketts, PhD
Authors of Modern Hearing Aids: Verification, Outcome Measures, and Follow-Up  

Ruth Bentler   H. Gustav Mueller   Todd A. Ricketts  Bentler_MHA.jpg

Congratulations to Ruth Bentler, 2016 recipient of the Jerger Award for Research in Audiology. 


Friday, April 15, 1:00 – 2:00 pm
Meet Anne Marie Tharpe, PhD
Co-editor of Comprehensive Handbook of Pediatric Audiology, Second Edition

Anne Marie Tharpe   Comprehensive Handbook of Pediatric Audiology

Congratulations to Anne Marie Tharpe, 2016 recipient of the Marion Downs Award for Excellence in Pediatric Audiology. 

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

Tinnitus: In the Brain of the Beholder

Marc_Fagelson    Baguley_PTINN    David_Baguley

 

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

Co-editors of Tinnitus: Clinical and Research Perspectives

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

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

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

How to Work with Interpreters and Translators

Henriette_Langdon  Langdon_WWIT  Terry_Saenz

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

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

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ASHA 2015 Preview

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

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

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

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

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

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

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Managing the Expectations of the Common Core State Standards

Lissa_Power-deFur      PowerdeFur_CCSS

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

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

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

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

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

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

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

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

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

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

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

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

About the Author 

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

 

 

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

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

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

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

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

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

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

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

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

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

TABLE 1: Probability Estimates of Test Results

Table 1: Probability Estimates of Test Results

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

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

References

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

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

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

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

About the Author

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