Welcome to Health Care POV | sign in | join
Speech in the Schools

Deconstructing Describing
May 24, 2016 10:16 AM by Teresa Roberts

Let’s start with a virtual field trip to the zoo to watch the hippos eating watermelon, using multimedia.

With YouTube, we can bring entertaining videos of zoo animals to therapy sessions. The hippos, with their mouths wide open awaiting a large, whole watermelon, give us a way to build our describing skills.

We can start with a basic noun phrase that has an article (the) and a noun (hippo): “the hippo”. Here is our short sentence: “The hippo is eating watermelon.” Now we can grow our noun phrase element-by-element using guided questions.

Quantity: How many of the hippos love watermelon?
•    Quantifier: All of the hippos love watermelon!

Specificity: Which hippo has his mouth open?
•    Demonstrative adjective: That hippo has his mouth open.

Numerical term: How many hippos are eating watermelon?
•    Number: Two of the hippos are eating watermelon.

Negation: How many hippos are sleeping?
•    Negative: None of the hippos are sleeping.

Characteristics: What does the hippo look like? Is he big or small? Is he grey or brown?
•    Adjectives: The big, brown hippo is eating watermelon.

Every time we add details to provide additional information, we are expanding the noun phrase, the syntactic complexity of the sentence, and the specificity of our descriptions. Describing doesn’t end there. Some of the best elements come after the noun phrase as post-noun modifiers.

Environment: Where are the hippos? They’re at the zoo.
•    Prepositional phrase: The hippos at the zoo are eating watermelon.

Location: Where are the hippos standing? They’re by the fence.
•    Prepositional phrase: The hippos by the fence are eating watermelon.

Characteristics: Tell me about the hippo’s teeth. Let’s count his big teeth. We can see eight big teeth.
•    Prepositional phrase: The hippo with eight big teeth is eating watermelon.

We can even embed an entire clause into our noun phrase. All we need to do to transform our prepositional phrases into relative clauses is to add a relative pronoun (that) and a verb. With a relative clause (also called an adjective clause), a whole sentence is used to describe the noun.

•    The hippos that live at the zoo are eating watermelon.
•    The hippos that are standing by the fence are eating watermelon.
•    The hippo that has eight big teeth is eating watermelon.

When you embed a clause, you combine two ideas. Two sentences become one sentence:
“The hippo has his mouth open” + “The hippo is waiting for watermelon” becomes “The hippo that has his mouth open is waiting for watermelon.”

Now let’s add in our first elements: “That one big, brown hippo at the zoo that has his mouth open is waiting for watermelon.”  We produced a sentence with 17 words, multiple elements, and an embedded clause.

We can model the gradual building of elements through repetition of a simple sentence with one addition at a time. Our describing skills are more complex than color, shape, size, etc. We can embed a whole idea to share what we know about the subject.

1 comments »     
Articulation: Social Belonging and Safety
May 17, 2016 9:09 AM by Teresa Roberts
How do you decide if a child needs articulation therapy? My colleague and I discussed different factors.

Does it sound like the child has an accent?
A mother shared with me that everyone thinks they’re from another part of the country.
Their son’s articulation disorder sounds like an accent. Whenever they meet people who have met their son first, they have to explain that they are really locals. What is the significance of sounding like you belong to your own speech community? Shouldn’t children have the right to represent their regional identity through their speech?

Do the errors affect language development?
Difficulty producing sounds that represent early developing grammatical morphemes and semantic relationships could affect expressive language growth.
•    Inflectional morpheme ‘-s’ uses the sounds /s/ and /z/ for plural forms and third person singular present tense forms.
Listen to the difference to the ending of “cats” and “dogs”. Even though we use the grapheme (letter) ‘-s’ for both sounds, we say “catsss” and “dogzzz”. The same thing happens with the verbs “walks” and “sings”. Even though we write “s”, we say “walksss” and “singzzz”. Either voiceless /s/ or voiced /z/ is used depending on the voicing of the vowel that comes before it.
•    Derivational morpheme ‘-er’ allows you to turn a verb into a noun, such as “dance” to “dancer”, or “teach” to “teacher”. We use ‘-er’ to compare “big” to “bigger”. We use ‘-est’ with a consonant cluster for the superlative, the “biggest”.

Are the errors on highly used sounds?
Some of the most commonly used consonants are /r/, /s/, /n/, and /t/. Given that these sounds appear in the most number of words, errors in their production affect speech intelligibility.

Are the errors odd or unusual?
Sometimes children produce atypical distortions. A bilateral lisp, made by spreading the lips and keeping the tongue flat, makes /z/ into a buzzing hum. Productions that don’t sound like speech sounds are highly noticeable to listeners.

Does the child have anatomical or motor muscle difficulties?
Any structural difference or functional difficulty has the potential to cause compensatory patterns that may become maladaptive and fossilized (resistant to change).

Can you say your name correctly?
•    Safety: Stating your own name accurately is a safety issue if you are lost or separated from a group. Producing your name correctly reduces your risk in an emergency situation.
•    Social: introducing yourself to make new friends requires stating your name
•    Psychological: we have self-identify tied to our names

Does the child have medical needs?
•    A young boy, who had asthma, was playing outside at recess. Sensing the need for his inhaler, he asked a teacher if he could go into the classroom to get it. The adult did not understand his speech and assumed that he wanted to go to inside for an inappropriate reason. Fortunately, other children intervened to explain the situation. The inability to state a physical or medical need is a potential safety issue.

Individuals are unique. Making decisions about when a child does or does not need services involves considering multiple factors. What factors would you want a clinician to consider for your own child?





0 comments »     
Spelling /r/
May 4, 2016 8:09 AM by Teresa Roberts
How do you say, “Squirrel”? Does your pronunciation truly match the spelling of “squirrel”?

A bright student and I were practicing the postvocalic /r/ sound in “first”. I re-spelled the word (incorrectly) as “ferr—st” to show how it’s pronounced with an emphasis on the underlying vowel and a prolongation of the /r/. “Even though it has an ‘i’ in it, we say, ‘er’, like in ‘her’, or ‘fur’.” We began to generate a list of others words that had the “er” sound, which led to an interesting discussion about /r/ and spelling.

This student has been working on the vowel /r/ sound for “er” for a little while. The “er” sound is often difficult for clients to produce because the underlying vowel is “uh”, like the two vowel sounds in the word “above”. This “uh” vowel, like in “duh”, is produced with the articulators (lips, tongue, and jaw) in a relatively neutral position – almost like your mouth at rest. If you just open your mouth slightly and make a sound, you’ll probably get “uh”. To make “er”, we have to add /r/ to a relaxed mouth position.

We started a list of words that rhyme with “er” and were astonished at the spelling variations.

•    “er” sound with “ir”: stir, girl, chirp, first, etc.
•    “er” sound with “er”: her, paper, dinner, etc.
•    “er” sound with “ere”: were
•    “er” sound with “ear”: pearl, earth, heard, etc.
•    “er” sound with “or”: worst, worry, world, doctor, etc.
•    “er” sound with “our”: journey, courage, etc.
•    “er” sound with “ur”: fur, nurse, purse, turn, etc.

If clients rely on spelling, it may be difficult for them to determine the underlying vowel for postvocalic /r/ words. Our orthographical system does not directly correspond to our phonological system. Approximately 44 phonemes (sounds) are represented with 26 graphemes (letters) combined in various ways.

Sometimes there are letters that we don’t even say. We tried the word, “February”.

“Do you know that most people don’t say ‘brew’ in the middle of ‘February’? They just say, ‘you’.” I explained. We then re-spelled “February” as “feb—u—air—ree”.

Articulation therapy may benefit from a focused exploration of sound-letter correspondence for /r/ and /r/ influenced vowels. We know that we don’t produce a /w/ sound for “write”. For conscientious, older students who are strong readers, their ability to use spelling to help them produce /r/ words may be highly misleading. Our spelling system does not consistently indicate which one of the underlying /r/ vowel sounds will be used. Generally, we have six /r/ influenced vowels: fear, fair, fur, far, four, fire. The “er” sound alone can be represented with seven different spelling combinations.

The student told me that “squirrel” is hard for him to say. We re-spelled the word as “sk—werr—ul”.

“I wish it was spelled that way,” he said.

“So do I,” I concurred.

You Might Also Like...

Software Uses in Speech-Language Therapy

SLPs and educators must select the most appropriate modes of instruction for learners.

New Options in Speech Therapy Software

The ultimate goal is not to replace the need for therapy, but rather to enhance its effectiveness.

iPad Use for Children With Apraxia

Parent and SLP observations exploring the impact.

All About Apps Resource Center

Speech-language pathologists take their practice to a whole new level thanks to SLP apps.

0 comments »     
Steps of Communication
April 29, 2016 8:29 AM by Teresa Roberts
Did you ever catch your friend’s eye from across the room at a crowded event and let her know that you were ready to leave? Briefly tilting your head to the side and a quick glance toward the door can represent an entire sentence.

We exchange thoughts and ideas through gestures, facial expressions, body postures, and physical proximity. Non-linguistic communication may often be just as important as spoken words.
 
We use conventional gestures to share familiar ideas, such as pointing or rolling one’s eyes. Coding and transmitting ideas non-verbally is actually a complex process. Communicating an intention with gestures and facial expressions, without speaking at all, requires multiple steps:
 
Generate an intention: decide what you want to communicate
 
Plan: decide how you will communicate your message
 
Gain attention
  • You can watch your partner until they look at you
  • You can wave at your partner
  • You can move a little closer to your partner (lean forward)
  • You can tap your partner lightly on the shoulder
Give your message: combine your gestures and facial expression to convey your intention and share your message

Check for understanding: watch for your partner’s response
  • If your partner doesn’t understand you, you can repeat the gesture or try a new gesture
  • Validate your partner’s correct understanding of your message: nod, smile, etc.
We can teach the sequential steps involved in a non-verbal communicative exchange as a game.  We can model and demonstrate the multiple steps required for each stage of the interaction with cue cards that use words and/or pictures. 

Each card has the command “No talking” and/or an icon of an X across the mouth to remind players that the message has to be shared non-verbally. The entire exchange will take place without talking at all:
  • Let your partner know that you think it’s hot in here
  • Let your partner know that you think it’s cold in here
  • Let your partner know that you are hungry
  • Let your partner know that you are thirsty
  • Let your partner know that you like their shoes
  • Let your partner know that you like their shirt
  • Let your partner know that you need a pencil
  • Let your partner know that you want to play a game (like Rock, Paper, Scissors)
  • Let your partner know that you want to know what time it is
When we communicate, we observe the behaviors of our partner to gauge their understanding of our message and if there is a communication breakdown. Individuals with speech and language disorders may have difficulty with pragmatic judgments of listener responsiveness, and limited perseverance to overcome misunderstandings. 

Showing the turn-taking steps in an interaction without using spoken language may provide a fun way to recognize the roles and responsibilities of both the sender and the receiver.

You Might Also Like...

Autism Resource Center

Autism information for SLPs, including features, multimedia, blogs and more.

SLP Scope of Practice

Continued expansion suggests growing professional opportunities.

Patient Handout: Early Signs of Autism in Infants

This patient handout can help parents discern the earliest signs and jumpstart therapy.

Speaking of Autism: Across Contexts And Ages

This blog focuses on approaches and strategies helpful within therapeutic settings such as early intervention and in schools.

 

0 comments »     
Politics of Mastery Charts
April 19, 2016 11:35 AM by Teresa Roberts

Do you have an emotional response to consonant mastery charts for age of acquisition for speech sounds? I do. Just the mere mention of late mastery of sounds makes me bristle.

Do you use the Poole study from 1934 or the Templin study from 1957[1] as a means to determine whether or not a child is demonstrating an articulation delay? The 1934 Poole study examined 65 children ages 2;6-8;6 at the University of Michigan, and mastery was defined at 100% accuracy for consonants in initial, medial, and final position in words. The 1957 Templin tested 480 children ages 3-8, and mastery was defined at 75% accuracy for consonants in initial, medial, and final position in words.

In the Poole study, /r/ and /s/ were not considered mastered until 7; 6. In the Templin study, both were considered mastered by ages 4;6.[2] There is a three-year difference in mastery between these two studies. (Neither of these studies was specifically designed to serve as a form of eligibility criteria for the provision or the denial of special education services and therapeutic intervention.) 

This past week I met with a new student and his family. The student was a second grader, age 7;8. He had recently transitioned from another school district. He had difficulty producing /l/ and /r/. His mother shared that she had advocated for services at his prior school and was told that his errors were typical. She had become concerned and had sought a medical evaluation for his speech.

I tested the student and found him eligible for services. He was friendly and eager, and readily attempted all tasks presented. When his mother asked me why no one had helped her son before, I said, “Everyone has different opinions.” There was nothing else I could say, because educational agencies form “opinions” by extrapolating certain elements of data for specific purposes that are then used to determine policy.

What if we conducted action-based developmental research on other factors?

- Age at which beginning intervention requires the least amount of services in order for child to achieve goals

- Age at which child is most stimulable to intervention (modifying articulatory movements)

- Age at which maladaptive compensatory patterns become fossilized (highly resistant to intervention)

- Age at which speech articulation affects perceptual skills (ability to differentiate between targets, approximations, and errors)

- Age at which speech sound disorders affect socialization and peer relationships

- Age at which speech sound disorders affect literacy development

- Age at which family, staff, or student are initially concerned about intelligibility 

In this case, the student presented with a mild restricted lingual frenulum (tongue tie), an anatomical and structural difference that may affect his development of speech production for /l/ and /r/. Waiting for a normative age of mastery may not have been appropriate, as underlying lingual range of motion was atypical, but we can talk more about tongue tie later…

Question mastery charts and their appropriateness to policy. 

References 
1. Prather, E.M., Hedrick, D.L. & Kern, C.A. (1975). Articulation Development in Children Aged Two to Four Year. Journal of Speech and Hearing Disorders, 40, 179-191
2. Bauman-Waengler, J. (2016). Articulation and phonology in speech sound disorders: A clinical focus (5th ed.). Boston, MA: Pearson.

You Might Also Like...

Autism Resource Center

Autism information for SLPs, including features, multimedia, blogs and more.

E-Book: All About Autism

Download an e-book focusing on challenging behaviors for individuals with autism.

Patient Handout: Early Signs of Autism in Infants

This patient handout can help parents discern the earliest signs and jumpstart therapy.

Speaking of Autism: Across Contexts And Ages

This blog focuses on approaches and strategies helpful within therapeutic settings such as early intervention and in schools.

 

0 comments »     
Benefits of Insecurity
April 12, 2016 3:00 PM by Teresa Roberts

Confidence is widely regarded as an important trait for success, and insecurity is often considered a liability.

Recently, a colleague who is transitioning to a new team shared her fears with me about her position change. She will soon be working alongside Occupational Therapists and Physical Therapists to serve children who use Augmentative and Alternative Communication. Many of the children have complex medical needs and the position requires coordinating services across multiple professionals.

“I feel like an imposter,” she confided to me, implying that she didn’t feel qualified for the job. The imposter syndrome describes when people with strong skills do not appear to believe in their own abilities. I know her and I know her work. She is qualified for the position, and it will also require her to expand her knowledge base.

After reassuring her that most professionals feel uneasy when they change settings and begin working with new clients, I told her that a little insecurity is actually a good thing. Insecurity can make us better clinicians. Insecurity often occurs when we are not sure how to proceed. When we are unsure, we may take deliberate steps to increase our understanding.

Self-doubt may be a form of self-reflection. If we entered every clinical situation with such a heightened sense of confidence, that we didn't question our own decision-making, then how would we learn new things? We might even inadvertently make incorrect assumptions about the course of treatment. Obviously, too much insecurity can be debilitating, but too much confidence can be detrimental. A balance of just enough insecurity to recognize our current limits may prompt self-improvement.

READ MORE FROM THIS AUTHOR

When we have moments where we feel like an imposter, we may be recognizing that we have areas that need growth. We are acknowledging that we have more to learn. Our field encourages life-long learning, which is another way of saying that we have a life-long lack of knowledge. The manifestation of disorders, disabilities, and constellations of needs in communication and swallowing that exist within the entire human condition is too broad for any one person to ever reach expertise.


Insecurity is a shadow form of humility, which may be an asset as we interact with clients and families. Self-improvement may come from recognizing present limitations, followed by a purposeful plan of action for positive change. We can welcome threads of insecurity to enter our practice in the form of functional questions:

•    How was I prepared for this client’s needs?
•    How was I unprepared for this client’s needs?
•    How did I interact with the family?
•    How could I change my interaction style to foster improved rapport?
•    What additional information do I need to access?
•    What resources could help me?
•    What is the expertise of the other professionals around me?
•    How can I learn more about the scope of related professionals?
•    What new research is available pertaining to this client’s needs?

Skilled services may include the instability that comes from seeing strengths along with current weaknesses. Insecurity can be a force that challenges us to be better.

You Might Also Like...

Disclosing Disability

What healthcare workers need to reveal in a job interview.

Hearing Loss in the Workforce

A clear solution for an invisible challenge.

More Than a Label

Does classifying people with developmental disabilities as severely intellectually disabled deny them opportunities?

Bilingual Care

Bilingual SLP certificate programs are imperative when providing services to a growing population of multicultural clients.

0 comments »     
Hearing Two Phonemes
April 5, 2016 10:37 AM by Teresa Roberts

A child who is substituting /w/ for /r/ makes progress producing /r/. He is now using /r/ in initial position in words. Surprisingly, he is also now substituting /r/ for /w/. He is producing “right” correctly, but now he is no longer saying “white”.

My colleague shared this story with me and explained how she needed to provide specific directions to the child, e.g., “It’s OK for you to still say /w/. ‘Wing’ starts with the /w/ sound. You can still pucker your lips for the /w/.”

What happened? We could simply assume that the child overgeneralized production of /r/. Perhaps it is much more complicated. Substitution of the /w/ phoneme for the /r/ phoneme may have altered his phonemic inventory. One sound, /w/, represented two distinct phonemes /w/ and /r/. Untreated speech sound errors may have the ability to affect a child’s phonological understanding.

We each have a phonemic inventory, which is the total number of phonemes that we use contrastively. This means that we recognize that when one phoneme changes, the meaning of the word changes. “Rich” is not the same as “which”. One phoneme change in the minimal pair means that we have said two different words. For a child who is using one sound for two phonemes, this contrast may be lost.

A teacher shared that one of the students was writing “thun” for “sun”. She was concerned that articulation had affected spelling. Speech sound production had likely affected more than spelling, it may have altered the child’s phonological development.

READ MORE FROM THIS BLOGGER

In articulation therapy, we often begin with ear training to help the child differentiate between target sounds and substitutions or distortions. Children often have difficulty recognizing when they have produced the target sound correctly and the closeness of their approximations.

Parents and caregivers may also report that they are unable to hear the difference between their child’s errors, approximations, and correct productions, e.g., “It’s just how he talks. I don't hear it anymore. ”How many years of substituted productions would it take for a child to become unable to hear the difference between phonemes? How many years of substituted productions would it take for a parent/caregiver to become unable to hear the difference in their child’s speech?

We listen for meaning. As typical communicators, the message is more important than how the speech sounds were produced. We generally focus on the content of what was said, instead of how it was said. Children with articulation disorders and their families are likely listening for meaning to the extent that they may lose the ability to hear production.

Extended ear training exercises and contrastive pairs may be essential for many more children with articulation errors than we realize. We could question if more years of inaccurate production leads to increased risk of phonological involvement. We can advocate for children by sharing the benefits of initiating articulation therapy with young children to prevent possible phonological disorders, which could, in turn, affect literacy development.

You Might Also Like...

Pediatric Earmolds

Getting the right fit is often a case of child distraction-and sparkles.

The Best Toys for Children with Hearing Loss

Consider the good ol' days of playtime, and a few factors to help decide on a purchase.

Teleintervention for Hearing Loss

Collaborative program overcomes barriers to services for infants and toddlers with hearing loss.

Pediatrics Resource Center

Columns, blogs, webinars, jobs and more: the latest pediatric speech therapy resources at your fingertips.

0 comments »     
What is Speech Worth?
March 29, 2016 9:15 AM by Teresa Roberts

Speech sound production and articulation are often treated casually in comparison to their fancy partner, language. The complexity of language and the mysterious relationship between language and cognition tend to overshadow the finely timed coordination of motor movements for speech clarity. Speech, however, isn’t an unimportant subdomain of communication.

Speech, itself, is incredibly powerful. We live in societies that use spoken language as the primary communicative modality.

Speech is socialization. Speech enables us to communicate with others. We establish emotional bonds, engage in reciprocal conversation, share knowledge, and express emotions.

Speech is acceptance. There are societal expectation for speech clarity and intelligibility. Clear speaking skills may provide a speaker with opportunities, advantages, and privileges (social, academic, employment, etc.). People who have significant speech sound disorders may be mistakenly perceived to be of lower intelligence. The original meaning of “dumb” was “mute” (unable to speak). Teasing and bullying may exist. Microagressions may be present in the form of potentially offensive questions, e.g.:

 “What’s wrong?”, “What happened to you?”, or even “Where are you from?” when your speech production makes it sound like you have an accent from another region.

READ MORE from this Blogger 


Speech is identity. Our speaking styles mark our allegiance to our communities. We use our speaking styles to show elements of who we are:
•    Regional and dialectal affiliation: geographically-based accents
•    Gender-coded speech of societally-determined binary male/female traits
•    Generational speaking styles: age of group belonging
•    Prestige: societally-coded styles indicating affluence and education

Speech is control. Using words to communicate allows for agency – the ability to exert influence on other people.
•    By speaking, we define traits and characteristics that shape another person’s thoughts and perceptions.
•    Our requests for assistance prompt others to come to our aid.
•    Verbal orders and demands prompt others do things for us.
 
The ability to speak the way that you want to speak, and to sound the way that you want to sound, shouldn’t be taken for granted. As clinicians, we may not necessarily understand the fundamental connection between speech and identity, as our speech typically matches our self-identity.

Experiential and simulation activities may help build our awareness and a renewed sense of value to speech. Try this: hold your tongue tip behind your lower front teeth and don’t move it. Start to talk. Your tongue range of motion has been limited and you are likely using the blade (flat, mid-section of your tongue) to produce sounds. You may even have saliva starting to pool on the interior sides of your mouth. Your speech will sound different. Now use this speaking style in public, ordering at a restaurant, meeting a new person, etc. Let me know how it goes and how you felt.

You Might Also Like...

AAC

Adapting technology to meet communication needs for more people.

Communication & Tangible Symbols

Tangible symbols are key in the development of higher levels of communication.

Inside an ALS Residence

Boston is home to the first long-term care facility designed specifically for people living with ALS.

AAC Mentoring

At school and via Skype, a mentor eases early AAC challenges for a student and his team.

 

0 comments »     
Degree of Professionalism
March 22, 2016 1:59 PM by Teresa Roberts
I would like to award you an honorary degree in professionalism. You worked hard for this degree. You studied and learned every day of your career, gaining insight from daily clinical, family, and staff interactions. You have specialized skills specific to clinical practice that you acquired through hard work and dedication.

As practitioners, we have obtained high levels of achievement both clinically and interpersonally. Perhaps it’s time that we acknowledge our own merits and expertise. If there were a higher education degree in professionalism, it could encompass the following knowledge, content, and skills areas:.

Interpersonal communications
•    Child and family studies
o    Operate as change agents regarding issues, polices, and needs that affect children, adolescents, and families
•    Intercultural communication studies
o    Theories and applications in cultural and linguistic diversity

Data analysis and documentation management
•    Educational measurement and performance standards
o    Norm referenced and criterion referenced measures
•    Methodological issues
o    Programmatic evaluation of service delivery

Clinical research and application
•    Theories and application of efficacious intervention
o    Clinical topics and issues across disorders, developmental stages, and needs
•    Evidence-based practice
o    Peer-reviewed research, client values, and clinical skills

Inter-professional collaboration
•    Professional and staff knowledge of quality services
o    Design and implementation of inter-professional teams
•    Cross-disciplinary intervention systems
o    Coaching and mentoring

Organizational systems
•    Organizational behavior and strategic communication
o    Ethical and legal considerations
•    Educational psychology
o    Theories and initiatives in teaching and learning

Learning exists in formal academic settings and in professional work settings. The role of professional requires study, observation, reflection, application, and self-evaluation. Each day that we work, we are increasing our clinical and professional understanding. The ability to serve as a positive influence supporting children, families, and staff, within a larger organizational structure, is deserving of recognition. There is pride and value in clinical practice.

Imagine your own commencement ceremony in your own work setting as you and your colleagues recognize the power of professional expertise.

“I hereby confer the honorary degree of professionalism with all the rights, honors, and privileges, which throughout the world pertain to that degree.”

“And Congratulations! You earned it.”

You Might Also Like...

ADVANCE for Healthcare Careers

A critical resource for your professional development.

The Next Step

An ending is always a new beginning.

10 Resume Myths

The single most important document that one uses to market oneself.

5 Best Practices for Landing a Job

The reality is healthcare jobs will be in high demand for many years to come.

0 comments »     
Recovering From an Angry Email
March 16, 2016 2:06 PM by Teresa Roberts
I received an unfriendly email message from a colleague. The message started nicely with kind words, but ended with criticism and complaints. I felt stung. The whole situation was a misunderstanding and I had not even caused the problem.

“I’m innocent,” I wanted to proclaim. “It wasn’t my fault. We didn’t even know that there could be a problem.” Multiple emotions confused my thinking in a mixture of sadness and indignation. We didn’t have all of the information at the time and were acting with the best intentions.

As adults, the playground refrain “words will never hurt me” has a new significance. Instead of becoming immune to insult, we know that words have power and are capable of causing emotional distress. Our words affect the trajectories of our personal and professional relationships.

I emailed back a short and polite apology. I said that I was sorry and made assurances that the team understood the factors, and that the situation would not be repeated.

It takes time to process and recover from difficult interactions. An initial human response is to interpret events personally, although most of the time, they aren’t personal. We have hectic days, extensive obligations, and on-going demands. We’re all doing the best that we can to keep up with the pace of work.

•    Sometimes when people are mean, it is because they are experiencing their own emotional states (tired, overworked, frustrated, etc.) and it truly has nothing to do with you.
•    Being unkind may indicate a measure of trust because it may show that a person has enough faith in the relationship to be a little bit rude without fear of rejection.
•    Rudeness may come from a perception of lack of control. People may feel powerless about other factors in their lives. A moment of emphatic, direct, and insensitive language may be a way for them to experience a sense of autonomy.
•    Some people have difficulty expressing what they need. They may find it hard to say “no” initially, and then find it easy to protest after they are overextended.
•    Sometimes anger is displaced. You may not be the actual target. A person may be upset by another party, such as a parent/caregiver, administrator, etc., and be unable to show it.  

If you have been treated insensitively, I’m sorry. I understand that it feels bad. We all deserve better. When there are repeated patterns of inconsideration, we may need to change our work environment and/or self-advocate. We work on teams providing services and supports for clients with complex needs. We partner with families who are experiencing significant stress regarding the growth and development of their children. It’s our job to care for each other, too. In our daily work we can be role models of respectful interactions. We can sincerely thank each other for the hard work that we do, and we can forgive those occasional times when we are less than polite.

0 comments »     
There’s a Zombie on Your Lawn
March 8, 2016 7:51 AM by Teresa Roberts

“There’s a zombie on your lawn.” This catchy refrain is from the theme song for the video game “Plants vs. Zombies.” Even though I’m not personally a fan of zombies, it’s easy to see how zombies have become part of the current cultural landscape for children. I held out as long as I could before I finally invited zombies into therapy using pictures from the video game.

In “Plants vs. Zombies”, animated smiling sunflowers, pea plants, corn, and other vegetables fight zombies who are heading across the front lawn toward your house. The drawings in the video game are relatively cute and the zombies don’t look too scary. I haven’t played the game, but I learned about the premise, the rules, and the characters from the students.

We co-created our own zombie games using Google images for the different characters, which we printed and laminated:

•    Zombie/plant barrier game: Students colored checkerboard patterns on green paper to make lawn game boards. Each student was given a lawn game board and a small set of zombies and plants. We used tri-fold presentation displays as barriers so that we couldn’t see each other’s game boards. Students would take turns designing the layout and giving specific directions to the group, e.g., “Put the zombie with the brown jacket in the top right corner of the lawn.”

•    Zombie/plant bingo: We made four different nine square bingo/lotto boards with matching cards. The students took turns drawing a card and describing it to the group, e.g., “It’s a sunflower with two heads and three leaves.”

•    Zombie/plant 20 questions: One student picks a character card and we take turns asking questions to guess which character it is, e.g., “Is it a plant?”, “Is it a flower?”, “Is it winking?”

READ MORE FROM THIS BLOGGER

There are discrete attributes for each character based on their appearance and their actions:

•    Zombies: color and state of articles of clothing, accessories, and uniforms denoting occupations and preferred hobbies, e.g., “The zombie who is wearing a red and white football jersey and a helmet,” or “The zombie who is jogging and has shorts on.”

•    Sunflowers: color of face, facial expression, number of faces, petals, and leaves, e.g., “The sunflower with two faces that are both light brown,” or “The sunflower that has three leaves.”
•    Plants: type of vegetable, color, size, facial expression, trait/power, number of leaves, e.g., “The small frozen blue pea plant with four leaves”

Our games addressed multiple goals:
•    Semantics: descriptors/attributes, categories, comparatives, basic concepts (directions/locations)
•    Syntax: elaborated noun phrases, question forms
•    Pragmatics: turn-taking, asking questions, providing information

And the reason that I finally agreed to use zombies in the first place was because of the /s/ and /z/ sounds in the words “plants” and “zombies”, as the student who liked to sing the theme song was working on tongue tip alveolar placement for /s/ and /z/.

You Might Also Like...

AAC

Adapting technology to meet communication needs for more people.

Communication & Tangible Symbols

Tangible symbols are key in the development of higher levels of communication.

Inside an ALS Residence

Boston is home to the first long-term care facility designed specifically for people living with ALS.

AAC Mentoring

At school and via Skype, a mentor eases early AAC challenges for a student and his team.

 

0 comments »     
We Do Care
February 29, 2016 4:51 PM by Teresa Roberts

A few years ago, I attended a restorative listening community event, which brought together parents/caregivers, general education teachers, special education service providers, and administrators. I wasn’t sure what to expect as I entered a large hall filled with round tables. Seating was organized so that each table contained members of the different constituent groups. Restorative listening is part of restorative justice, designed to unite disparate parties through the sharing of perspectives. Each person is encouraged to speak their truth while everyone listens.

At my table, a parent spoke first. She had a young daughter who had Autism Spectrum Disorder and behavioral challenges. She talked about how her daughter’s kindergarten teacher “really got it” and understood the supports that her daughter needed, but subsequent teachers had not connected with her daughter and didn’t support her. She commented that the special education team didn’t do nearly enough for her daughter. She listed the things that they should have done and should be doing right now.

A general education teacher shared next. She described her classroom and how she supported students with special needs. I couldn’t focus. My mind was still processing everything the mother had said. I was thinking about how I might try to collaborate with her if her child was on my caseload. I was also worried about the special education team that did serve her child and wondered if I might know any of them.

I wanted to explain that we wanted to do more. We all wanted to do more, but there were many constraints (time and staffing, competing responsibilities, district policies and mandates), and that as human beings with busy lives, we simply couldn’t work every evening and every weekend. I tried to organize my thoughts to show that we did care and that it was never that we didn’t care.

Suddenly, it was my turn, and everyone at the table was staring at me. To my shock and surprise, I didn’t speak at all but began to cry – not like crying in the movies where an actress sheds a solitary tear that slowly slides down her cheek. This was real life blubbering with my nose running and gulping breaths of air. I stopped eventually, after other people at the table had found a box of tissues and somebody had offered to hug me.

When I finally could speak, I said, “You have no idea how hard it is to know what you want to do and to be unable to do it because of the constraints of the system. I am not allowed to recommend a single thing to you for your daughter because anything I suggest could make the district liable to provide it. I want to do more, but sometimes it’s not allowed and sometimes there is not administrative support to provide more. We do care and we are trying.”

As speech Language Pathologists, we care about the students we serve. We work hard to support students, families, and staff. We can all take opportunities to advocate and to let everyone know our truth, even when it hurts.

READ MORE FROM THIS BLOGGER

You Might Also Like...

Software Uses in Speech-Language Therapy

SLPs and educators must select the most appropriate modes of instruction for learners.

New Options in Speech Therapy Software

The ultimate goal is not to replace the need for therapy, but rather to enhance its effectiveness.

iPad Use for Children With Apraxia

Parent and SLP observations exploring the impact.

All About Apps Resource Center

Speech-language pathologists take their practice to a whole new level thanks to SLP apps.

0 comments »     
Sounds, Syllables and Stress
February 22, 2016 4:36 PM by Teresa Roberts
Spelling is misleading. The orthographic system does not reflect all aspects of pronunciation. Word stress, syllable breaks, articulatory placement, and co-articulatory processes affect speech production. In General American English, 80% of words in conversation have stress on the initial syllable. Stressed syllables are typically produced more loudly, with a higher pitch, and held for a longer period of time. Unstressed vowels may be reduced or neutralized to the “uh” sound (called “schwa” in phonetics).

Producing a word with more than one syllable requires recognizing syllable breaks and the relative level of stress of each syllable. Sound production is shaped by the surrounding sounds in co-articulation. Each word can be analyzed at syllable and speech sound level. The words “dinner” and “dessert” show the contrast of stress.

“dinner”: Stress is on the first syllable, like “DINN-er”. Even though it is spelled with two middle consonants, we only say one consonant, “DIN-er”, as opposed to “DIN-ner”

The underlying vowel in the first syllable is the same vowel as in the word “it”. The lips are in a slightly spread position.
•    “DIN”: Lips are slightly spread throughout the entire first syllable because of the underlying vowel. Tongue lifts to the alveolar ridge for /d/, drops momentarily, and then lifts again to the alveolar ridge for /n/.

The second syllable is unstressed.
•    “er”: Lips return to a neutral and relaxed position. Underlying vowel is “uh”, as in “duh” with r-coloring added. This sound may be especially difficult because the /r/ is more subtle (less emphasized) in the unstressed position.

“dessert”: Stress is on the second syllable, like “de-SERT”, which is a less common stress pattern. Spelling does not match the sounds, because /s/ is pronounced as /z/, and the first vowel may be reduced.

Two different vowels are acceptable in the first syllable:
•    “di-ZURT”: “di” sounds like the start of “dip”, and vowel rhymes with the vowel in “it”
•    “duh-ZURT”: “duh” sounds like “uh”, and vowel rhymes with the vowel at the end of “llama”

The second syllable carries stress.
•    “ZURT”: Underlying vowel is “uh”, like in “dug”. It is the same vowel /r/ as in “fur”, with  the lips in a neutral (relaxed position). You can hear how “fur” rhymes with “zur”.

The second syllable ends with a consonant cluster blend. To produce “dessert” as “duh-ZURT”, the lips remain in a neutral (natural) state throughout the entire word. Both vowels have relaxed lip positioning. The tongue does the majority of the work:
•    “duh”: Tongue tip elevates to the alveolar ridge for /d/, and then returns rapidly to a mid-level position for the vowel “uh”.
•    “ZURT”: Tongue tip elevates to the alveolar ridge for /z/. Tongue returns to mid-level position for “uh” and is retracted as r-coloring is added. Tongue produces final /t/ with slightly retracted placement (just a tiny bit behind the alveolar ridge) based on the retraction from the preceding “er” sound.

Word and sound level analyses allow us to monitor client lip positioning to ensure that it matches the underlying vowel. Understanding stress helps us explain and model where emphasis is placed within a word. As speakers we are continually preparing for the next sound we will say, while our articulators are finishing the current sound. Appreciating the complexity of articulation fosters focused instruction.

You Might Also Like...

AAC

Adapting technology to meet communication needs for more people.

Communication & Tangible Symbols

Tangible symbols are key in the development of higher levels of communication.

Inside an ALS Residence

Boston is home to the first long-term care facility designed specifically for people living with ALS.

AAC Mentoring

At school and via Skype, a mentor eases early AAC challenges for a student and his team.

 

0 comments »     
On Butterflies and Families
February 16, 2016 8:17 AM by Teresa Roberts
In the early days of my career, I was at an IEP meeting waiting to present goals for a kindergarten student with multiple needs. He was an enthusiastic young boy with mild coordination difficulties, who frequently bumped into furniture and other children. He had language and learning delays, and slightly imprecise articulation. His grandmother was his legal guardian and she was at the meeting to discuss goals for his kindergarten year.

The grandmother appeared wary and distrustful; as she grilled the teacher on how many years of experience she had teaching. She drummed her long nails on the table during breaks in the conversation. I was nervous. This was one of many meetings with the families of students who attended a specialized kindergarten program.

When it was my turn to present, I launched into an explanation of how speech and language goals aligned with classroom curriculum. I described sequencing goals by using the caterpillar to butterfly metamorphosis from the classroom. There were colored pictures of cocoons and butterflies on the walls of the classroom because this was the current classroom theme.

The grandmother looked at me and said, “My family doesn’t care about butterflies.” I was shocked and startled. A series of thoughts entered my head: “Who doesn’t care about butterflies?” “Why wouldn’t you care about butterflies?” “I like butterflies.” Suddenly, in a moment of clarity I realized that it had nothing to do with butterflies. In her own way, the grandmother was saying to me, that I hadn’t recognized what was important to her and her grandson. When I spoke again, I floundered. I thought about how the student loved to wear sports shirts and talked about sports. I amended my example and described sequencing goals for sports and outdoor activities. It wasn’t a lot better, but I had made an attempt.

This event changed my practice because I no longer present any information without asking the family about their own concerns and preferences first:

•    How is your child’s speech and language at home? How does your child sound to you?
•    What are some of your child’s favorite activities? What are some of your family’s favorite activities?
•    What do you think would help your child to be able to express himself better?
•    I’m thinking of goals around X, how does this sound to you?
•    In the classroom we are doing X, how does this sound to you?

I neglected to tell you something. The grandmother and her grandson self-identified as African-American. What she actually said to me was dialectal: “What do a Black family care about butterflies?” She wasn’t just telling me that I hadn’t taken the time to personalize the treatment for her grandson. I also hadn’t taken the time to collaborate with the family, and to honor and respect them. Sometimes the clinical drive to share our own ideas of what we think will help a child causes us to overlook the fundamental need to connect with the family first.

You Might Also Like...

Autism Resource Center

Autism information for SLPs, including features, multimedia, blogs and more.

E-Book: All About Autism

Download an e-book focusing on challenging behaviors for individuals with autism.

Patient Handout: Early Signs of Autism in Infants

This patient handout can help parents discern the earliest signs and jumpstart therapy.

Speaking of Autism: Across Contexts And Ages

This blog focuses on approaches and strategies helpful within therapeutic settings such as early intervention and in schools.

 

1 comments »     
Lip Position and Vowel R
February 8, 2016 9:19 AM by Teresa Roberts
Vowels have lip, tongue, and jaw positions. Lip positions vary from highly spread (almost smiling) to rounded (puckered) positions. When you say “cheese” for a photo, you are producing the “ee” vowel, which puts your lips in the most spread position.

Many children master consonant /r/ (pre-vocalic, e.g., “run”, “right”, etc.) before r-colored vowels (post-vocalic /r/). Producing the glide /w/ with puckered lips, in place of the liquid /r/ with neutral lips, is a common early phonological process. Residual lip rounding may continue when producing rhotic vowels.

Rhotic vowels follow the same lip, tongue, and jaw positions as their underlying vowels. There are typically six rhotic vowels: fear, fair, fur, four, far, fire. In speech sound disorders, residual lip tensing and puckering may be visible in both the top and bottom lip, or just the top lip. Any lip rounding will change the resonating and acoustic properties of the underlying vowel – it will sound slightly distorted.

When eliciting vowel /r/ sounds, watch the client’s lip and jaw movements to see if they match the underlying vowel. In 5/6 rhotic vowels, there should not be any added tensing, puckering, rounding, or mouth opening. We can teach our clients the underlying lip and jaw shape of each vowel, so that they can monitor their articulators using a mirror.

Fear: Underlying vowel is close to “ee”, as in “see”. Lips should be spread (light, friendly smile). Jaw is nearly closed with only a minimal opening. Tongue is a in a high position in the mouth. As we move from “ee” to “ear”, our lips may stay slightly spread or return to a neutral (relaxed) position.

Fair: Underlying vowel is close to “ay”, as in “hay”. Lips are slightly spread (light, friendly smile). Jaw opens midway. Tongue is in a mid-position in the mouth. As we move from “ay” to “air”, our lips may remain slightly spread or return to a neutral (relaxed) position.

Fur: Underlying vowel is close to “uh”, like “duh”, or “duck”. Lips are in the most relaxed position (resting position when lips are closed). Lips open slightly without changing position. Lips and tongue primarily remain passive while the mouth opens midway. This is a challenging sound because you maintain neutrality of the lips and tongue, and then use only the tongue to add the rhotic element. Many clients use excessive lip movement for the “er” sound, which distorts the production. Watch how the lips are frozen in place in “uh, uh, uh”, and sliding from “uhhhh” to “er”

Four: Underlying vowel is like in the East Coast dialect “coffee”. This vowel is round! This is the only vocalic /r/ with a rounded lip shape. Mouth is open midway, tongue is in mid-position in the mouth, and lips are puckered.

Far: Underlying vowel is “ahh”, like “hot”, or when the doctor says, “say ‘ah’”. Mouth is in its most open position; lips are typically in a neutral or slightly spread position while jaw lowers. Tongue is in the lowest position in the mouth. Tongue moves from “ah” to “are”, while the lips remain neutral or spread lightly.

Fire: Underlying vowel is a diphthong with two sounds, like “eye”, that ends with an “ee” sound. Mouth starts in an open position and moves to near closed position. Tongue starts in a low position and moves toward a high position. Lips are spread (smiling).

Isolating and maintaining the underlying lip, tongue, and jaw positions will help our clients recognize when residual, early patterns of lip rounding are still occurring.

1 comments »     

Search

About this Blog


    Speech in the Schools
    Occupation: School-based speech-language pathologists
    Setting: Traditional and specialized K-12 classrooms
  • About Blog and Author

Keep Me Updated