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

Margaret_Fish  Fish_HHTCASE2E_low res

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

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

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

Case Study 1.

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

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

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

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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.

 

 

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

Elizabeth_ColeCarol_Flexer

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

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

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

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

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

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

cole

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

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

Joan_Payne Payne_SFC

By Joan C. Payne, PhD

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

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

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

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

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

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

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

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

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

References

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

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

About the Author

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

Reflecting on Autism Awareness Month: Why Is Awareness Important?

Zenko, Catherine

By: Catherine B. Zenko, MS, CCC-SLP

During the rush of activities on April 2nd for World Autism Awareness Day, a journalism student interviewed me to discuss upcoming events at our center and to learn more about Autism Awareness Month. One of the first questions she asked me was, “Why is awareness so important for autism?” It seems like such a simple question, but when I had to put into words why I do what I do every day to promote awareness, it took me a moment articulate the importance of awareness. My response sounded something like, “Ideally, the more people know and understand what autism spectrum disorder (ASD) is—how individuals think, process, and learn differently—the more understanding they will be when they see a person on the spectrum acting ‘out of the ordinary.’”

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, autism spectrum disorder consists of deficits in two domains: (1) social communication and (2) restricted, repetitive, and stereotypic interests and activities (APA, 2013). ASD presents in a myriad of ways, thus inspiring the expression, “once you’ve met one person with autism, you’ve met ONE.” Generally speaking, people with ASD have difficulty communicating: some cannot use speech to communicate; some use a combination of speaking, sign language, pictures, or augmentative/alternative communication (AAC); and some speak too much, not understanding the social rules that a conversation involves two people and both people get to talk. Understanding spoken and written language is also difficult and takes more time to process for most people on the spectrum.

The DSM-5 outlines the diagnostic characteristics of the domain of restricted, repetitive patterns of behavior, interests, or activities as the following: repetitive speech, motor movements, or use of objects; inflexible adherence to routines and/or ritualized patterns of verbal/nonverbal behavior; restricted, fixated interests (intense focus); and hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of environment (APA, 2013). All of the diagnostic criteria translate into people who:
• Are literal interpreters of language and concrete thinkers;
• Have difficulty processing all of the sensory information around them and can have both gross- and fine-motor challenges;
• Are visual learners;
• Have a strong sense of logic that is black and white, not much (if any) room for gray;
• Prefer routines and become extremely upset when a routine is disrupted and are sometimes compelled to finish a task they have started, even when the allotted time has expired;
• Have difficulty taking the perspective of others which makes them appear egocentric;
• Are detail-oriented but have trouble seeing the big picture;
• Have difficulty with attention, starting with joint-attention and engagement with others as well as trouble shifting their attention away from their intense interest area (Janzen & Zenko, 2012; Quill, 1997; Rydell, 2012; Zenko & Hite, 2013).

I like to view autism spectrum disorder more like a difference rather than a disability. The term “neurodiversity” is gaining steam lately and illustrates that just because people on the autism spectrum think and learn differently, they are not disabled. One of Temple Grandin’s most famous quotes embodies this idea of “different, not less.” One social media campaign currently trending is #AutismUniquelyYou. This campaign highlights and celebrates each individual with ASD’s unique personality, instead of lamenting it. Another great campaign is #MakeATinyChange that encourages people to make a difference in the lives of individuals with disabilities through any one of 25 small changes.

There have been several stories circulating this month about how a small gesture of openness and understanding can make a huge difference. One that stood out was a story by ABC News about a man who put away his work and played with a little girl with autism sitting next to him on a plane. The man did not understand why “playing Ninja Turtles with the little girl was a big deal,” but to her mother—who was so relieved when her daughter was met with kindness and acceptance, not pity and annoyance—it meant the world.

Circling back to the question of why awareness is so important, if more people take the time to learn how someone with autism thinks and experiences their surroundings, the more people may embrace the neurodiversity, rather than shy away from the differences and get to know some truly interesting people.

References
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, DC: American Psychiatric Publishing.

Janzen, J. E., & Zenko, C. B. (2012). Understanding the nature of autism: A guidebook to the autism spectrum disorders (3rd ed.). San Antonio, TX: Hammill Institute on Disabilities.

Quill, K. A. (1997). Instructional considerations for young children with autism: The rationale for visually cued instruction. Journal of Autism and Developmental Disorders, 27(6), 697–714.

Rydell, P. J. (2012). Learning Style Profile for children with autism spectrum disorders. Retrieved from http://itunes.apple.com

Zenko, C. B., & Hite, M. P. (2013). Here’s how to provide intervention for children with autism spectrum disorder: A balanced approach. San Diego, CA: Plural Publishing.

About the Author
zenko_hhtpicasdCatherine B. Zenko, MS, CCC-SLP is a Florida-licensed speech-language pathologist who has worked with individuals on the autism spectrum for over fourteen years. She is an adjunct lecturer at the University of Florida Dept. of Speech Language Hearing Sciences since 2008 teaching a graduate-level Autism and Augmentative and Alternative Communication (AAC) course and has worked at the University of Florida (UF) Center for Autism and Related Disabilities (CARD) since 2000. While at CARD, Catherine has helped hundreds of individuals with ASD, their families and educators by providing consultation or training opportunities on a myriad of topics relating to best practices and ASD. In addition to her work at CARD, Catherine has co-authored Here’s How to Provide Intervention for Children with Autism Spectrum Disorder: A Balanced Approach, a timely resource for speech-language pathologists working with children on the autism spectrum as well as graduate students preparing to work with this demographic.

Writing Tips from Plural Authors

Have you ever thought of writing a book in your field? We know that writing a book is no small undertaking, so as part of our 10 year anniversary celebration we enlisted the help of our knowledgeable authors Celeste Roseberry-McKibbin, PhD, Lynn Adams, PhD, CCC-SLP, and Lise Menn, PhD, to share advice on writing a best-selling book! Here you will gain some insight into the inspiration, motivation and hard work that goes into a best-selling Speech-Language Pathology and/or Audiology textbook and professional book.

1. What insight or tips would you offer to a first-time author who is writing a professional development book or textbook in the Speech-Language Pathology and/or Audiology field?

CRM: It is very important to make sure that your contribution is original—something that meets a need in the field. I never write a book that competes exactly with something currently in print. I always make sure that my book is unique, original, and has a perspective that no other book has. The questions I also ask are: who would want to buy my book? Why would they spend money on it? What value does it bring to them? What problems does my book help them solve?
It is so important to think about meeting the needs of your audience. As authors, we have our passions and enthusiasms. Who shares them?

LA: JUST START WRITING…..that is the hardest part!!

LM: Have a colleague in a related but different field read through your book to make sure it’s understandable to someone who doesn’t already know the subject matter.

Go back to the original published sources – amazing amounts of old material are easy to get on-line, and you’ll find that you get fresh insights from reading the classic papers instead of relying on the usual summaries. What you take away from a paper that you read for yourself might be quite different from what everyone else has said about it.

Create or find new examples instead of re-using the standard ones that everyone else uses. You might discover something in the process, too. Continue reading

Interprofessional Education: Future Directions in Pre-professional Instruction

Child and Adolescent Communication DisordersMARIE R. KERINS

By: Marie R. Kerins, EdD, CCC-SLP, Loyola University Maryland
Editor of Child and Adolescent Communication Disorders: Organic and Neurogenic Bases

Interprofessional Education (IPE) is becoming a more recognized model for educating pre-professional students entering the healthcare or education workforce. It is quickly gaining momentum in institutions of higher education as a means of addressing some of the fragmentation observed in the healthcare industry and in the schools, both of which strive to produce positive and lasting outcomes for the individuals and communities they serve. Working collaboratively mends fragmentation, reduces duplicative efforts, and effectively addresses client/student needs. The World Health Organization (WHO) has endorsed IPE and defines it as a period when “two or more professions learn about, from, and with each other to enable effective collaboration and improve [health] outcomes” (WHO, 2010, p. 7). Formalizing IPE through published guidelines from organizations such as the Interprofessional Education Collaborative (IPEC) has helped renew interest in interdisciplinary and collaborative practices that have been around for quite some time but have not been systematically or formally taught in higher education settings. While the WHO and IPEC are geared more toward international health care practices, professionals working in schools have also joined in the conversation and are adopting the language of IPE. One goal of IPE is to develop a practice ready workforce where professionals can immediately implement knowledge and skills they have practiced while training in an integrated and interdisciplinary manner. Evidence is mounting to support interprofessional care (see Reeves, Perrier, Goldman, Freeth, & Zwarestein, 2013; WHO, 2010). IPE and collaborative practice will become an established manner of service delivery to improve patient/student care, if we can embrace interprofessional education as a shared vision with an understanding of the benefits of this new collaborative curriculum.

Collaborative Internship Experience: Speech-Language Pathologists and Reading Specialists

Continue reading

Handbook of Central Auditory Processing Disorder Reviewed

Handbook of Central Auditory Processing Disorder, Volume 1, 2nd Edition

Peer review of Handbook of Central Auditory Processing Disorder: Auditory Neuroscience and Diagnosis, Volume I, Second Edition edited by Frank Musiek, PhD, CCC-A and Gail Chermak, PhD, CCC-A.

Review by Herbert Jay Gould, PhD, Associate Professor, School Communication Sciences and Disorders, The University of Memphis

The addition of several new chapters to the Handbook of Auditory Processing Disorders Volume 1 is a significant enhancement and expansion of the first edition. The general layout and writing is consistently high quality throughout the book. Several chapters and areas of discussion are particularly valuable to the reader’s basic understanding of CAPD.

The initial section on auditory neuroscience has excellent chapters by Jos Eggermont on central auditory system development and by Phillips on central auditory neuroscience. These two chapters provide a strong basic science underpinning to the remainder of the book. Dr. Eggermont’s chapter ties the anatomic and electrophysiologic activity of the system to the normal behavioral measures of basic signal processing and speech perception of the developing nervous system. The extraordinarily long time course of this system’s maturation exemplifies the difficulties of separating a slowly maturing, but normal system, from a significantly disordered one. Continue reading