Thank you for trusting me and telling me about everything. I didn’t realize how difficult this fall has been for you. The problems you described are painfully familiar:
• Fundamental imbalances in the amount of tasks required within the time period allotted
• Insurmountable paperwork and documentation, and the sinking knowledge that you could easily fill all of your time with paperwork alone
• Lack of building level support due to insufficient understanding of Special Education processes and legal requirements
• Daily meetings before and after school extending the work day into the evening
• Suggestions for interventions that you should implement that appear as veiled accusations of an inability to provide a sufficient level of support for students
• Lack of respect and understanding for your training and expertise
• Subjection to the continual rotation of administrative policies and the whims of certain administrative personnel
• And more, because there is always more…
You told me what this is doing to you. You told me, with a quiver in your voice how you are affected:
• Lying awake at night making lists in your head about the tasks that you are expected to accomplish the next day
• Crying at work
• Recognizing that your continual stress level is affecting your ability to be emotionally present when you are at home with your family
• Fearing that you may be missing out on your own life because you are consumed by work
• Feeling inadequate because you work hard daily and are not able to accomplish all that is expected
• Questioning your ability to continue in this field, tinged with a thread of desperation about changing jobs, moving, changing careers, or changing anything…
You said quietly, “I think I’m burned out,” and in your distress, you lamented how much you had loved this field, this avocation, and this gift of communication that we share.
You still love this work – our fundamental clinical work. I could hear it when you told me about the students and we problem-solved tricky cases together. I sensed it when your expression changed and you smiled while sharing funny stories about student interactions. I know that you care deeply about the needs of your clients.
We work under federally mandated guidelines, which are interpreted at the statewide level, and implemented at the local level. We work within complicated, convoluted, and restrictive bureaucratic organizational systems. You are not alone in your experiences. Some of us might not talk about these challenges for fear of drowning in disillusionment.
Every year is a re-commitment to an organizational infrastructure in which we agree to abide by given mandates in order to provide therapeutic services to clients. We have all tried to make positive changes. Sometimes things change. Sometimes they don’t. We all wish that we could make it better. As you make a commitment to this school year, know that this is a choice.
We hugged when we said goodbye and we joked about compartmentalizing and disassociating. I hope that you know how much I value your friendship and how much I respect the work that you do.
When the right advice is given at the appropriate time, it improves lives. When off-hand, unsolicited advice is given, it may be a source of frustration. The concept of advice is to guide another person in making a decision or completing an action. As Speech Language Pathologists, we are often expected to provide advice and demonstrate expertise. We may inadvertently begin offering unsolicited advice to our colleagues, as well as our friends and family.
Sometimes advice isn’t about offering solutions, but about honoring thought processes. Early in my career, I worked in a wonderful, supportive program for children with high levels of needs. Sadly, this unique program was discontinued. I was confused and distressed. I talked to the school principal, seeking guidance and advice. As a new clinician, I had little knowledge of policy and funding issues. The principal said to me, “The fact that you care that this program is ending and that you see its value, shows me that you are a knowledgeable clinician.”
The principal didn’t lecture me about systems, revenue streams, or educational trends. She didn’t show me how much she knew about institutional practices. She let me know that there are times for advocacy and times for acceptance within one’s career, and within an organization. Most importantly, for me, she let me know that she believed in me. The underlying message that I heard, was that I was good at my job – that I was competent and capable
When we are given valuable advice, we remember it, because it changes our outlook and our self-perception. In our roles as experts, it is incredibly easy to slip into a state of offering advice continually – it just feels like it’s supposed to be our job, however a stream of recommendations isn’t always warranted.
Perhaps there are ways to give less advice in general and to start to offer the type of guidance that both teaches and inspires.
• Give specific advice only when it is directly solicited, e.g., “Can you give me some advice?”
• When you think that you have knowledge to offer, ask before you offer it: “I have some ideas about that, let me know if you want to hear them sometime.”
• Recognize the value of the question and the situation: “The fact that you are thinking about this issue shows that you are aware of a lot of the important factors.”
• Build the other person’s confidence: “Your concerns show me your dedication and commitment to providing quality services.”
• Inspire the other person to reflect and to act: “I think that you have might have some great ideas about how to start.”
Carefully timed and well-crafted advice allows others to shine and that is what is remembered. What advice has helped you in your career and what has made it memorable.
“Do you think that the student’s responses are affected by dialect?” I asked my colleague. We were discussing a student’s performance on a subtest that required generating original sentences given a picture and a stimulus word.
“What dialect?” she countered, “Trailer Park?”
After a momentary pause, I said, “I was thinking rural or mountain dialect.”
Linguist Max Weinreich stated that, “A language is a dialect that has an army and a navy.” Geopolitical forces, land, resources, and military, may determine what we consider to be a distinct language, and what we consider to be a dialect.
All dialects are valid systems of communication with sophisticated linguistic complexity equal to that of any language. No language or dialect is intrinsically better than another. Ranking and social standing of languages and dialects are societally constructed reflecting the speaking patterns and status of groups within a culture.
We all speak a dialect. There is no dialect-free speech. If we think that we don’t have a dialect, it is because our dialect closely resembles the established dialect of “General American English” (Midwestern dialect/newscaster dialect).
In linguistics, descriptive analysis is non-judgmental. It is a focused observation of speech and language describing observed usage. In contrast, prescriptive analysis is codifying and enforcing “correct” or “proper” ways of speaking based on pre-determined rules from the dialect with the current highest societal status.
As Speech-Language Pathologists, we are evaluative. We analyze and evaluate the communicative effectiveness of our clients. We often begin descriptively by recording, transcribing, coding, and analyzing client productions. These preliminary stages are followed by a swift shift to prescriptive, where we make comparisons between client productions and expected norms. We decide what is correct/incorrect, based on standardized testing guidelines, language sample methodologies, developmental norms, clinical judgment (experience with similar clients and demographic groups), etc.
Speaking the dominant dialect has privileges, such as access to opportunities and group inclusion. Communication goals are often based on the dominant dialect. It may be challenging to maintain the objectivity of descriptivism while engaged in prescriptive acts of conducting assessments and providing intervention.
• Analyze your own dialect and your feelings about its status in society.
• Compare your dialect to your clients’ dialects: notice similarities and differences.
• Think about your initial/instantaneous emotional responses and perceptions when you hear common dialects and accents.
o Do some dialects seem “better” than others?
• Ask yourself about the origin of these feelings.
• Discuss dialectal differences and social register with clients and families in neutral terms:
o “We have different ways of talking depending on where we are and who we are talking to.”
o “Your teacher might say it this way”, “Kids on the playground might way it this way”, “At home you might say it this way”, etc.
• Ask families about home dialects and how they relate to communication goals.
We bring our societal framework into our work. We can question how our own cultural factors affect interactions with our clients.
There's often a single moment in therapy when you recognize that the client now sees you as a trusted support. As clinicians, we measure clients' progress in skill development in many ways, including daily data collection, judgments of approximations, tallies and percentages of correct responses, levels of scaffolding and modeling, audio/video recordings, analyses at regular intervals, and more. Even with all of these valuable calculations, there is another important data point. We can measure the progression of trust.
In the middle of a recent therapy session, I suddenly knew that the client and I had established trust. I was working with a third grade student on his articulation of /r/. He was in middle of retelling events from class and given the context, the next word that he was about to say would be "reward". He didn't say, "reward" - he stopped talking and looked at me. He stopped himself mid-sentence and stared directly at me.
"You're right," I said, "there are two /r/ sounds. The first one sounds like ‘ree', then there's a ‘w' and the second ‘r' is like ‘ord'." I slowly said the word, separating the syllables and exaggerating the mouth positioning. The student imitated me. He then resumed his story as if nothing had happened.
We had been practicing the /r/ sound for a little over a month. At the beginning of therapy he had reported that he couldn't hear the difference between /r/ and /w/, or between different mid-central vowel distortions for vocalic /r/. We had been making steady progress with ear training, tongue positioning, and self-monitoring. This moment, however, was special. It was a milestone in therapy. It represented trust. The client recognized when he would have difficulty and trusted me to help him.
SEE ALSO: Treating the Family
Throughout the intervention process, clients may be moving through their own stages of understanding, as if their acknowledgement of the need for help with communication is its own version of the grieving process:
Clients may initially report that they don't have any communication challenges and we may spend early sessions discussing the importance of therapy. Recognizing and verbalizing that you have any difficulties is an emotional process that often requires vulnerability and a sense of safety. Subsequently looking to another person for help involves trust. Clients show us in different ways when they are ready to turn to us for guidance. Requests may be direct or indirect, and sometimes clients ask for help by not saying anything at all. Our awareness and perception of clients' progression of trust allows us to measure their level of understanding and their participation in the process. Development of trust alone indicates substantial progress.
- Initial awareness of challenges
- Readiness and comfort describing challenges to clinician
- Expression of desire for change
- Responsiveness to therapeutic techniques and strategies
- Prediction of areas of difficulty
- Seeking support from clinician
Imagine a contemporary trivia game show with teenage contestants pitted against each other to see who can find information the quickest. The host asks a series of factual questions across content areas (history, literature, science, music, etc.). Contestants type key words on their cell phones, which appear on large monitors placed above their heads for the audience to view. The winner is the one who is the most adroit at using a search engine to pinpoint the correct answer.
The ability to memorize has given way to the ability to search. A search engine is a database of web documents that are sorted using a mathematical algorithm to determine relevance. Search engine research requires an individual to determine the most salient characteristics of the fact needed, and the key words that the database will have pre-coded as relevant.
For example, in science class you learn that crickets tell the temperature, as the rate of crickets chirping mathematically corresponds to degrees. You can’t remember the equation and want to find it online. There are a minimum number of keywords needed to type (or speak) into a search engine to find the equation. You don’t need to compose a full question: “What is the equation for the rate of crickets chirping to temperature?” You need to generate two or three key words, or parts of words. The minimum for the crickets may be “cricket chirp temp”, which will provide you with the equation on the Farmer’s Almanac website (count the number of chirps within a 14 second time span and add 40 to get Fahrenheit).
SEE ALSO: Teaching With Mobile Technology
Specific skills are needed to find, evaluate, and share information using a digital medium. A student needs to complete a series of sequential tasks:
• Recognize the information required
• Formulate a question
• Identify the key words from the question
• Distill the key words to the minimum needed for search engine recognition
• Type the words into the search engine
• Scan a series of results
• Evaluate the top results for relevance (disregarding non-relevant results)
• Navigate to the webpage with the expected answer
• Scroll the webpage to locate the answer (ignoring non-relevant information)
Perhaps we could help students evaluate their own ability to locate information. We could provide cross-curricular questions and practice identifying key words. As a group, we could identify the minimum number of key words needed to determine the answer. Each student could offer key words. We could compare key word suggestions for similarities and differences and discuss interpretations of relevant concepts. We could test the key word combinations using a common search engine. Further lessons could target rapid scanning of webpages to locate information. We can address language goals of identifying key concepts and vocabulary, and locating relevant information digitally. There are numerous important lessons around the use of virtual mediums, including safety, authenticity, social media, etc. We can begin with the search.
A colleague told me that during the first Special Education staff meeting of this school year, an administrator pointedly asked her, "What is it that you actually do?" The principal was questioning team members about their individual roles and the services they provide for students. Members of the team were responding by listing curriculum kits and standardized intervention approaches.
As my colleague attempted to explain the fundamentals of articulation therapy and language therapy, she became distressed and uneasy. The principal stared at her and said dismissively, "That all sounds wishy-washy to me."
Education and Speech Language Pathology, like most disciplines, use a high level of jargon. People outside of the field will not have a sense of the breadth of services and supports offered. A complete description of the work that we accomplish across skill domains would be too extensive to provide an unfamiliar listener with a clear understanding.
We can answer questions about our work with a variety of examples distributed over time. Having a sentence that encapsulates one aspect of the field may help others understand how communication is inherent in learning and social relationships. Prepared sound bites may work like snapshots, giving another person a quick glimpse into all that we do. We can describe our activities in a succinct and confident manner.
- Provide services for the five domains of language: (1) semantics (vocabulary), (2) syntax (sentence structure), (3) morphology (word forms and grammar), (4) phonology (sounds), and (5) pragmatics (social language)
- Collaborate with Special Education teachers to use curriculum extension activities to increase skills in the language areas of semantics (vocabulary) and syntax (sentence formulation)
- Co-teach lessons with Special Education and General Education teachers targeting pragmatic (social language) skill development for peer interactions
- Offer literacy intervention in oral comprehension for students with language/learning needs
- Lead whole class lessons in kindergarten and first grade on phonological awareness
- Co-teach activities with the kindergarten and first grade teams for story narratives and sequential markers for story organization
- Teach students placement of the articulators of the mouth for correct sound production
- Partner with teachers and families for carryover activities to practice speech sound production
- Teach students techniques to shape rhythm and smoothness of speech production
- Teach students vocal health and hygiene fundamentals, and safe vocal use
Augmentative and Alternative Communication:
- Partner with students and staff to provide meaningful opportunities to use dedicated voice output devices for interactions throughout the school day
Autism Spectrum Disorder:
- Teach students social expectations, organizational systems, and conversational strategies for peer and academic situations
There are many more domains and examples to be shared. We can subdivide elements of our roles into manageable pieces, sharing tidbits throughout the school year. We are highly trained and we are specialized. We are able to speak with authority about the discipline of Speech Language Pathology. Every time the team meets, we can share just a little bit more about what we actually do.
Competition may be inherently divisive and alienating, as people are sorted into predetermined roles based on “winning” and “losing”. People handle competition in different ways, and some types of responses are more successful than others. Ideally, we gradually learn to manage our frustration when we don’t win a game. Recently, I was touched by one student’s empathy, and his attempts to resolve a situation when two of the other students in the group began quibbling about the game.
This student’s initiative prompted us to put together a short book about “How To Be an Awesome Game Partner”. We examined competition from three different angles, (1) mindset or cognitive framework of the concept of game, (2) resilience and positive self-talk, and (3) self-regulation and problem solving. How you view a specific situation may shape how you interpret the outcome of events. The ability to self-soothe and provide oneself with affirmations may be a key part of resilience and the ability to attempt new and challenging activities. Self-awareness of one’s own state of being and generating solutions to manage emotional states is part of self-regulation.
Students offered suggestions based on guided prompts.
Cognitive Framework: “What are different ways to think about what happened in a game?” and “What are different ways to think about winning and losing?”
• Remember it’s just a game. It’s not real life. It’s not like the “Hunger Games”.
• You gotta believe you’ll have a chance. If not today, then maybe another day, or maybe in a little bit.
• Sometimes people get lucky in a game so it’s not always fair.
• Think about the times that you’ve won before and know that you will win again.
• Think about things you’re good at.
SEE ALSO: Building Sounds One Block at a Time
Resilience: “What could you say to yourself to feel better?”
• You’re doing good.
• At least you did your best.
• Second place is good.
• You gave it effort.
• You’re still a winner inside.
Problem Solving: “What could you do if you get upset while you are playing a game?”
• Take a short break
• Take a walk
• Write it down
• Talk to the teacher about it
• Stop the game
As a group, and as a team, we created guidelines about how to view competition. The collaboration involved in the project established a sense of unity toward a common goal and a shared understanding. This new sense of community may have helped students feel that the entire game experience is a part of group belonging, instead of a solo act. As clinicians, we infuse multiple objectives within single lessons, with long-term goals around developing successful life strategies. Sometimes the lesson we had planned becomes less important than the lesson that emerges.
There’s always a small thread of sadness mixed in with the happiness when a client completes therapy.
Our relationships with students are temporary. Sometimes they last a few years, and sometimes they last a few months or less. Yesterday, a student who has been making excellent progress on her articulation asked me, “What happens when I’m finished with my R’s?”
“You don’t need to work on any other sounds. Your R’s will sound awesome all the time. You’ll be a rock star!” I replied.
I think that she was really asking me if we would ever spend time with each other again after she finished with her R’s. Perhaps she already knew the answer.
Students may move, our job positions may change, and hopefully, in many cases, students graduate from speech. As clinicians, we understand and accept that these relationships are transient and that is reflected in our very title of “Itinerant”. We work quickly to establish rapport, which means that we make a meaningful positive connection with another person (each client). We are skilled at developing the clinician/client relationship because we care and our feelings are genuine.
SEE ALSO: Summer Camps Address Speech and Hearing
There are many different ways to conclude these relationships and to say goodbye. Most of us celebrate the accomplishments of our clients, and the ending is marked as a new beginning. We make assumptions that many of our clients understand the nature of the short-term therapeutic relationship.
We often do not know what our time with clients has meant to us until much later, as we incorporate everything we learn from each session and each new client into our practice, steadily increasing our clinical skills. We may never have the opportunity to know what our time with our clients has meant to them and how it has affected their lives.
Should we begin clinical interactions with the awareness of the limited duration of the relationship?
• “I’m glad that we’ll be able to spend a little bit of time together to work on your sounds.”
• “It will be fun to play together for a few months to work on your speech.”
• “We can do a lot of cool stuff together during this school year (or while you are in X grade) to help you learn new words.”
Should we add closure rituals to the concluding sessions that honor the reciprocal nature of our work?
• “I’m going to tell you some wonderful things I learned from spending time with you. You can tell me what you learned, too.”
• “I loved spending time with you. I really thought that it was fun when we (add activity). What did you think was fun?”
• “It’s been great to see you every week. I’m going to miss your (add positive traits), and I’m glad that we got to hang out together.”
Saying goodbye in any relationship carries an emotional element, whether it is one of many goodbyes or part of a formative time period.
Even after all these years, there’s always a small thread of sadness mixed in with the happiness. How do you say goodbye?
“What would you do if you won a million dollars?”
A few years ago I was working with an entertaining group of fifth grade students who were practicing producing their speech sounds at the sentence and conversational level. We were taking turns answering social questions from a deck of cards. We turned over the card with the question, “What would you do if you won a million dollars?”
Each of the students shared their fantastical ideas about what they would do if they won the money, then one of the students turned to me and asked me what I would do. I suddenly realized that I wasn’t sure what I would do. Another one of the students smiled and announced to the group, “Well, she certainly wouldn’t be here with us!” and we all laughed.
I’ve often wondered about the student’s comment that I wouldn’t be working as a clinician if I received sudden riches. It’s common for people to daydream about a life without worry that appears to be promised with independent wealth. Waking up everyday and spending long hours balancing client contact, documentation and compliance paperwork, staff interactions, and organization/institutional practices, isn’t easy. Sometimes we see work as mainly burdensome and taxing, instead of seeing the beneficial reciprocal relationships that exist, as we are enriched through clinical interactions.
There are two ways to consider the idea of imaginary, newly found wealth that may provide insight into one’s own clinical values and career identity. Therapeutic services are often within the guidelines of a predetermined system, which is rarely as fully funded as it could be. In times of perceived scarcity, it may become easier to focus on limitations than on possibilities.
SEE ALSO: Metacognition & Success Mindset
Thinking about your work without any limitations may open up freedom of thought.
• What would you want to change about your job if you had the resources to make many more things possible?
• In what ways might you change your professional life?
• How could you improve your daily practice if you had unlimited resources?
Releasing ourselves from superimposed boundaries may help stimulate creativity and identify what we value. Our work includes aspects of altruism (public service), self-improvement (professional development), creativity (materials generation and intervention), interpersonal skills (client rapport), and much more. When we brainstorm about what we would do and what we would change if we had access to financial resources, we might learn where we want to put more of our clinical energies.
Another way of examining the question of what you would do if you won a million dollars is “How would you feel if you could never work as a clinician again?” Having the identity of a practitioner carries meaning. It may even be a source of pride. Our work is often difficult, but it is meaningful and important work. We believe in what we do. Even if we don’t win the million dollars, perhaps we have all already won the “Job Lottery” because speech language pathology is a fulfilling and stimulating career.
Some years ago, a student showed me how ‘sitting quietly’ doesn’t necessarily equate to ‘listening’. His teacher was concerned about his behavior during reading and his auditory comprehension skills. He was a friendly and gregarious student who was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and mild language/learning challenges.
We decided to role-play reading to find ways to help him. We rearranged a section of the clinic room, placing a group of stuffed animals in a semi-circle, replicating how the students sit on the carpet around the teacher while she reads. The student sat with the stuffed animals while I sat in front with a book.
We reenacted reading in two different ways:
“First I want you to show me what happens when you get in trouble during reading. Just pretend to do whatever you do before you get in trouble. It’s all pretend so we can figure out how to make reading better.”
I read a few pages from the book while the student squirmed around and whispered to the stuffed animals. He scooted closer to some of them, knocking them over and giggling. We stopped and I asked him if he had been able to hear the story. He said that he hadn’t been able to hear any of it.
“Now I want you to show me what happens when you don’t get in trouble during reading. Show me what happens when you are doing what the teacher wants you to do. It’s all pretend play right now so we can help make it better.”
I read a few pages from the book. The student sat with his legs crisscrossed and his back straight. He stared directly at the book, looking intently focused. After a few pages, I asked him if he had been able to hear the story. He said, “No.”
I asked, “Why didn’t you hear the story?” He said that he was working too hard to sit still to be able to hear anything. He reported that it took all of his energy and attention just to be quiet. He wasn’t able to attend to the story whether he was talking or sitting silently.
SEE ALSO: Dually Assessing Hearing Loss and Autism
I met with the teacher and the student’s mother. We had a new understanding of his effort and his insight. We decided to use an inexpensive portable personal sound amplifier (designed for adults with hearing loss) with him, which I purchased. The student wore headphones during reading and the teacher talked into the microphone. This stopgap measure helped him to focus on the teacher’s voice, as class-wide amplification systems are still not widely available.
We make assumptions that certain behaviors represent internal actions, as if we can judge another person’s cognitive processes by external physical manifestations. Classroom expectations include the continual processing of auditory information, which is often measured by how successfully a student is able to sit quietly. Sometimes our own framework of associations between behavior and thinking will not match the framework of our students. We can design ways to let students tell us about how their own outward appearance may or may not be associated with specific cognitive functions.
How we ask questions and the types of questions that we ask our clients may encourage success-based thinking patterns. Forward-thinking and future-based questions may help clients envision themselves meeting their goals. Being able to see oneself in the future is a metacognitive skill.
As clinicians, we believe that our clients are able to make gains. We have faith that they will make progress toward their communication goals. We use encouragement, praise, and positive feedback with scaffolded activities. Adding metacognitive questions may foster a success-based mindset.
David Rock’s book “Quiet Leadership” presents metacognitive strategies to elicit individualized thought patterns for behavioral change. He outlines question types to prompt a person to self-reflect and begin the internal process of problem solving. The underlying premise is that people have the capacity to generate their own solutions.
A fundamental aspect of the therapeutic process is behavioral change. Direct instruction is typically needed at the beginning stages of acquiring a new skill, however, we could quickly move toward metacognitive strategies, as clients are able to practice semi-independently. We use the term “generalization” to represent a client using a new skill across environments and communicative contexts. With generalization, the focus is on tracking the demonstration of the behavior. We could also consider the term “internalization”, which includes the ability to integrate a pattern into one’s life (establish a rapid neurocognitive pathway).
SEE ALSO: Thinking Language Environment
The following client questions are inspired by David Rock’s solutions-focused framework to allow clients to reflect on how they can help themselve
Articulation and Speech Sound Goals
- What do you need to do next time to make your sound?
- How can you help your tongue find the right place for your sound?
- How can you help your ears recognize when you’ve made the right sound?
- What activities do you think will help you practice your sound?
- What words do you think you want to practice next?
- What sounds do you want to learn next?
Language and Learning Goals
- What can help you learn new words?
- What do you need to do to help yourself remember new words?
- How can you practice making longer sentences?
- What activities do you think will help you organize your ideas?
- How can you come up with your own topic sentence?
- What do you think will make it easier next time? What kinds of things do you want to learn next?
Even early learners can begin the metacognitive process through questions using self-reflective preferences, “What did you like about the activity?”, and future-based thinking, “What do you think would make it easier (or more fun) next time?”
By adding more questions to encourage clients to consider their own learning, clients may be able to see that we have confidence in their ideas for growth, and their ultimate success in therapy.
Which of the following is not an easy way to ask a question?
d) Both (b) and (c)
My colleague and I worked with a friendly, middle school student, who had language-learning challenges. In the classroom, the students read classic and modern novels with regular quizzes (characters, setting, events, etc.). The teacher met with us to share her concerns. Although the student was generally able to understand the novels, he often failed the quizzes because he didn't understand the format of the questions.
Assessment measures frequently include varied question types. Even when the content and the knowledge measured remains constant; the question format affects the difficulty level:
• Inclusivity: Identify all items that fit within a specified group based on a shared characteristic.
o “Circle all of the animals.”
o “Which of the following are animals.”
• Exclusivity: Identify items, which would be excluded from a group. Determine the key trait of one group (inclusive group), and contrast the characteristics of the inclusive group with the characteristics of other items.
o “Circle everything except the animals.”
o “All of the following are animals except:”
• Negation: Negation, a form of exclusivity, is about recognizing shared category members and non-members.
o “Circle everything that is not an animal.”
o “Which of the following are not animals.”
SEE ALSO: Question Parents Carefully
With exclusivity and negation questions, there is only one added word that signifies non-belonging (except, not, never, etc.).
We wanted to increase the student’s understanding of negation questions. At the next session, I used picture cards of familiar entities/objects with high contrast, starting with “deer” and “boat”. We brainstormed characteristics for each item using a T-chart. For “deer”, we listed: “animal, tail, antlers, prey”, and for “boat”: “sails, lake, water, ride on it”. We made a field of two possible choices with specific traits for each choice.
Keeping the T-chart in front of us, we took turns asking questions in negative forms, following initial modeling: “I want one of the two cards. I’m going to ask you for the card I want in a tricky way. I’m going to tell you what I DON’T want, and then you will know which card I really DO want. Give me the one that does NOT have sails.”
We then moved to general knowledge questions, which used negation, presenting a hierarchy of question types with instructions about how to interpret each question:
• “Is a ball round?” – yes/no question
• “What shape is a ball?” – Wh-question with single word answer for a known fact
• “What shape is NOT the shape of a ball?” – Identify the known fact (round shape) and then generate an answer within the same category (shapes), which does not meet the criteria (shape of a ball).
Categorization, category members/titles, descriptors, and key traits, are common areas for language intervention. We frequently focus on inclusivity. We can expand categorization by teaching exclusivity, negation, and non-belonging. All of our early lessons about grouping shared items become the basis for answering higher-level complex questions. Answering questions correctly includes knowing what is wanted, as well as what is not wanted.
“My caseload is really diverse. About 25% of the students are African-American, 25% are Hispanic, 25% are Asian, and the rest are American.”
One of my colleagues offered this description of her caseload at a social event attended by other clinicians and university faculty. Did you notice anything interesting about the above statement? Perhaps you thought about the diversity of students that the clinician served. Maybe you wondered about the school’s community.
Sometimes word choices provide insight into our conceptual frameworks and the differences in how we each organize our own view of the world. People interpret statements based on many factors, including sensitivity to dominant majority and minority status.
One interpretation of the above caseload description is: About 25% of the students are African-American, 25% are Hispanic, 25% are Asian, and 25% are White.
Look closely, because this is not what was actually stated. It assumes that the term “American” is synonymous with “White”. Are these two words the same?
Another equally valid interpretation is: Students who are African-American, Hispanic, and Asian are not American. Only students who are White are American.
This was not overtly stated. The original statement categorized students into four groups: African-American, Hispanic, Asian, and American. Since the group “American” was separated from the other three culturally determined racial/ethnic groups, it appears as though these groups are not the same as the group that is considered “American”. They are not American. They are something else.
SEE ALSO Multicultural Care
Dr. Derald Wing Sue, of Columbia University, introduced the term “microggressions”. A microaggression may be a slight wording choice that separates or alienates an individual or group. Often a speaker is completely unaware of any negative connotations and may not overtly harbor any ill will toward anyone. The person committing the microaggression may feel innocent of any wrongdoing, however, the prevalence, frequency, and consistency of microaggressions may perpetuate privilege and power.
Disenfranchised, minority, and underrepresented groups recognize the subtle, likely unintentional comments and behaviors that signify separation. The word “American” is not a synonym for “White” and to use it as such divides people. This is only one of many ways that a person may, verbally or nonverbally, communicate a sense of non-belonging to another person.
Many people respond that usage of politically correct language is already too extreme, as though we have the inherent right to speak without consideration of how our words shape reality. I believe that my colleague cares about the students she serves and her school community. Somehow, through institutionalized, cultural practices, she has correlated the trait of “White” to the meaning of “American”.
It takes a great deal of courage to question the ramifications of how information is presented. When we question seemingly simple words, we advocate for ourselves, for the children we once were, and for the children who are in school today. Census data from National Center for Educational Statistics listed that 48.3% of public school age children were categorized as Non-White (African-American, Hispanic, Asian/Pacific Islander, and Mixed Race), and 51.7% were classified as White.
Perhaps one day, it will be easy for everyone to say that all of these children are American.
Many people are enthusiastic communicators who love to share stories and talk about their hobbies and interests.
I once worked with an 11-year-old boy who was creative, engaging, and entertaining. He had specialized interests and advanced skills in engineering. He loved to talk about his latest inventions – in a long, detailed, running monologue.
As much as people may have been interested in his projects, his tendency to continue without pausing affected his listeners. We worked on interrupting the monologue by adding questioning:
“Sometimes when you tell a story, you talk for a long time and nobody else has a chance to say anything. Maybe the person who is listening wants to participate too. There is a way for you to tell your story and still give other people a chance to talk. You can ask a question about something in your story and then you can go back to your story.”
I told him that I would be interrupting him all the time during his stories to point out times that he could ask a question. He started a story about something that had happened in class. After a few sentences, I stopped him and said, “I’m going to stop you now, because here’s a chance to ask a question.” His first questions were not fully developed. I think he said, “What’s a chair?” and then, “Do you have a chair?”
SEE ALSO: Perceived Rate of Speech
We talked about asking real questions. “Ask a question that you don’t know the answer to. You might learn something interesting about someone else. Maybe you even have something in common.” I reassured him that his story was still important, “You can just ask a quick question, listen to the answer, and then go back to your story.”
We moved toward using whispered cues. I would use a stage whisper to offer a question that he could ask. For the next story, he talked about his job mowing lawns and how he fixed an old lawnmower. I interrupted him within the first few sentences to whisper, “Ask me about my backyard.” He asked, “What’s your backyard like?” I responded truthfully and shared that it was so overgrown that my little dog gets lost in the high grass, which he found amusing. We talked about my yard for a moment and then I encouraged him to return to his story.
Over the next few sessions, we worked on recognizing a key concept from a sentence that he had just said that could be used to formulate a quick question. Before long, he was smoothly inserting sincere questions into his storytelling. Although it doesn’t always happen this successfully, it felt like letting him know that other people want to talk about the same thing as he does (even slightly tangentially) gave value to both his story and his listeners.
Conversations flow in and out of dialog and moment of monologues – swapping stories, commenting, and informing. Honoring the totality of the story while encouraging participation unites the speaker and the listener.
Last week I met a skilled clinician who had recently relocated, transitioning from running a private practice in an urban environment to working in a rural school district. After our conversation, she shared the following sentiment: “I was encouraged by your own strong feelings that school-based clinicians aren't second class therapists and shouldn't be viewed that way.”
The inherent desire for humans to categorize, sort, rank, and assign hierarchical meanings likely has neurological and sociological underpinnings. We may be biologically motivated to determine “best” from an array of choices, and “highest status” within a group. We teach students about semantic categories, superordinate/subordinate, superlatives/comparatives, etc. Ironically, we also appear to have sorted and ranked ourselves.
According to American Speech Language Hearing Association, approximately 53% of Speech Language Pathologists work in educational settings from Early Intervention through Adult Community Transition. Public schools serve children across socio-economic, racial/ethnic, ability/disability levels, and more. Federal regulations are designed to ensure the provision of services for individuals with special needs. Children’s needs range from mild speech sound disorders to complex medical conditions, and school-based clinicians serve children, who are medically fragile, living in hospital settings.
SEE ALSO: Summer Hearing Health
School-based clinicians do not necessarily choose an area of specialization and are required to research and design intervention for an ever-changing caseload. It is perhaps this sense that we are “generalists” that may cause us to be viewed with a jack-of-all-trades mentality, and its corresponding master-of-none.
It could be that the hierarchy of specialist to generalist comes from a physician-based model of tiers of elite level specialization. A medical provider who specializes may be perceived as more capable than a general practitioner. Some people may then view medically based clinicians who serve one population type as the most skilled. Valuing specialization is about valuing expertness. Specialists may have one single defined area of expertise. Sometimes this is the best match for a presenting need, and sometimes it isn’t.
What if school-based clinicians actually have multi-faceted expertise? Using the physician metaphor, school-based clinicians are a combination of both emergency room surgeons and family-based general practitioners. We handle any situation that appears before us. We may be the first provider who interacts with the client and family.
Traits of school-based clinicians include:
• High levels of flexibility
• Understanding of family and client needs/resources
• Ability to assess and provide therapy across the range of communication disorders
• Implementation of therapy in varied settings and delivery models
• Partnership with clients for functional and academic goals
• Collaboration with related professionals
• Consistency in completion of comprehensive documentation
• Research, data, and information gathering of current practices
• Adherence to state and federal guidelines and regulations
• Belief in the fundamental right for individuals to have access to communicate thoughts and ideas
If this list appears similar to a list for any other work setting, it should. School-based clinicians have complex and fast-paced days. We strive to ensure client progress. In some situations, we may feel affected by subtle assumptions about our worth and validity. Remember to believe in the value of your work and how you show your skill and training daily. We are all first class clinicians.