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.”
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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.
As clinicians, many of us do not have a societally recognized form of disability. We have the privilege of able-ness. Our work ensures daily contact with individuals who may be identified by society and/or may self-identify as individuals with a disability.
Even though providing therapeutic services is our calling, we are still only able to see life events from the viewpoint of ability. We make assumptions and hypotheses about what it could feel like to have communication challenges, but we can’t truly know how we would react in the same situations.
On recent Friday night, I was fortunate to be able to attend the premier The Way We Talk, a documentary about stuttering by Michael Turner. He narrates his journey to understand stuttering with footage from his life and travels, as he challenges his personal beliefs and feelings. He describes how he moves from a place of never mentioning stuttering out loud to anyone, to filming a documentary on the subject.
Prompted by a question from his friend about what it feels like to stutter, the filmmaker explores his family history, his childhood, and the national and international stuttering community. He talks with a geneticist in Washington, D.C., who explains the 80% heritability rate for stuttering, and initiates a conversation with his mother, who also stutters, about how she felt raising a child who stutters.
The movie features Glenn Weybright, a speech language pathologist, and person who stutters. Excerpts of therapy sessions and interviews with clients provide a glimpse into teaching the tools to manage stuttering, and the frustrations of not being able to speak fluently, quickly and spontaneously.
SEE ALSO: Finding School-Based Stuttering Resources
In the documentary, Turner meets with children at Camp SAY: Stuttering Association for the Young, a summer camp for children and adolescents who stutter. He also travels to Japan where he attends a local stuttering support group, which shows how cultural views of disability may include honoring the gift of imperfection. There are poignant moments where the film captures the honesty and bravery that are part of growth and change.
Turner was at the film premier and received a standing ovation. A man in the audience, a person who stutters, thanked him for giving voice to his thoughts. This man and his wife were expecting their first child, and he had been dwelling on concerns about the possibility of having a child who stutters. He was inspired by the movie and expressed renewed hope and joy. Another audience member asked about the theme of vulnerability throughout the film, reminding us of the societal pressures for ableism, and the desire to hide any perceived flaws.
Hearing firsthand about what it feels like to be considered as having a communication disorder reinforces the idea that, for many of us, we are still outsiders. The shared community is the community of individuals we serve. We have the honor of being welcomed into this community through our work. Personal accounts give us insight. Promoting and sharing stories of how we view ability and disability may change societal views for all of us.
In the early days of my career, I apprenticed with a clinician who specialized in Augmentative and Alternative Communication (AAC). She was highly skilled and in tune with her clients, who used forms of AAC to communicate. One day, a young girl arrived for her therapy appointment. The girl wore ankle/foot orthotics on both legs and had a stilted gait. The therapy room had a charming child-sized table with matching small chairs.
While the clinician and the girl’s mother were involved in a conversation about the girl’s ongoing medical appointments, as well as the girl’s desire for more independence, the little girl made her way to the table and chairs. She appeared to hold on to the back of one of the chairs as a support. She attempted to sit down in the chair, but somehow inadvertently tipped the chair backwards and tumbled to the floor. Almost as if in slow motion, you could see a series of emotions cross her face, from surprise, fear, sadness, and frustration, to anger. She started to cry.
The clinician and the girl’s mother rushed to help her. The clinician switched the chair to an adaptive chair. Then, in an instant the clinician grabbed a single-switch voice output device and recorded the sentence, “I hate that chair!” She spoke the words loudly and emphatically. She placed the voice output device on the table and pressed the button. You could hear the words clearly and the emotional content of the message in the recording. The clinician offered the voice output device to the girl.
SEE ALSO: iPad Use for Children with Apraxia
The little girl pushed the button repeatedly. You could hear the message over and over, “I hate that chair! I hate that chair!” The little girl smiled and then started to laugh. The clinician partnered with the girl by smiling and commenting on the chair, “I hate that chair, too! It’s a silly chair.”
As a new clinician, I was in awe of this incredible moment exemplifying the power of providing an expressive modality to an individual. The child was suddenly able to communicate her thoughts. This episode formed the basis for a belief in the fundamental right of communication. As I’ve continued to work as a clinician, I’ve realized that this situation was also about the right to be heard.
As individuals, we often have strong emotions. We learn to find ways both to express these emotions, and to share them with an audience who understands us. As clinicians, we provide communicative intervention, and we may also be the audience. We can help a person feel “heard” and understood. Individuals with communication disorders may have many different challenges with sharing their thoughts and ideas. With every therapy session and every interaction, we have the opportunity to provide support with expressive output and also to validate the merits of each message. We provide legitimacy to every comment, from saying that you are angry at a chair, to deep and complex ideas. Communication is the expression and the audience – and we can provide both.
As dedicated professionals, we work long hours, possibly staying late to finish just one more thing. In providing supports to others, sometimes we may not think of our own needs.
Exhaustion is an interesting phenomenon. It may be a slow process. We may not realize that we are nearing exhaustion until we are completely fatigued. Perhaps you have been working at an untenable speed for months. Our jobs are complex and require heightened attention and analytical skills – completing high-level cognitive tasks while balancing interpersonal relationship with clients and colleagues. As service providers, our focus is often outward, as our care and concern are centered on our clients.
Amidst the rush of demands, do we ever lose touch with our own ability to monitor our emotional and physical states? We may begin to overlook signs from our bodies that we need support. When we accomplish complex projects on a regular basis, we may start to hold ourselves to rates of completion and standards of perfection that are not achievable. We may even become critical of ourselves instead of recognizing when we are overextended. What if we were able to talk to ourselves as both clinician and client?
SEE ALSO Avoiding the Breakdown Lane
As clinicians, we regularly conduct unbiased analyses of a client’s emotional state, attention, cognitive reserves, temperament, energy level, etc. We review and subdivide the tasks and demands within a client’s daily environment in order to design a plan to foster success in communication and learning tasks. We are compassionate and realistic. We combine counseling with detailed task analysis. We assess clients’ strengths to maximize opportunities for growth. We do important work for our clients, and we can do this important work for ourselves too.
As a clinician, you can talk to yourself:
• “Tell me about your average day?”
• “What kinds of things do you do?”
• “Who do you talk to?”
• “What kinds of things do you talk about?”
• “Who are your friends at work?”
• “How long do you work?”
• “What are the easiest things that you do?”
• “What are the hardest things that you do?”
• “What is the most fun thing that you do?”
• “What are you really good at doing?”
• “What activities make you feel happy?”
• “Do you ever have any difficulties?”
• “What kinds of help do you have if there is a problem?”
• “What do you think could help you if there was a problem?”
• “How have you been feeling?”
• “What kind of help do you need?”
Separate yourself into two roles: clinician and client. You are a clinician and you can use your clinical skills to determine what you need. Give yourself time to ask questions in a thoughtful and interested manner – the way that you would interview a client. Pause after each question, and encourage further comments by waiting. Then, as a client, be open and honest in your responses. You can share details about daily expectations and reflect on both your skills and the demands of your work. Return to your role as a clinician and provide unbiased responses. We know how to support others. We occasionally need to use these same tools to be supportive of ourselves.
It may take a great deal of bravery to try something new – something that you don’t know how to do, something that feels foreign or strange. When we ask our clients to produce sounds in different ways, we are asking them to experience unfamiliar motor movements. When we shape progressive approximations of targets, we ask our clients to make sounds that they are not currently producing by forming a new movement pattern with their articulators.
Recently, a client had an unexpected breakthrough in his production of /r/. He is an outgoing 10-year-old, who has been working on acquisition of rhotic vowels. He tended to produce a variety of derhotacized central vowels, “uh-ah”, “ow-uh”, “eh-ah”, etc. He is personable and likes to engage others. We were talking about plans for summer vacation. He was responding to questions while intermittently making funny sounds with silly voices.
Suddenly, I heard a perfect production of “summer”, in a slightly silly voice. I was astonished. I asked him about it and he said that he was imitating the character Yoshi from the Super Mario video game. Apparently imitating Yoshi required a change in tongue placement, as he likely had his tongue retracted for the entire word, which made the final /r/ fully realized and clear. I was overjoyed and told him what had happened, “When you say, ‘summer’ in your Yoshi voice, your ‘r’ is perfect!”
We froze the mouth position for the /r/ in “summer” for his Yoshi voice. We used a mirror and a flashlight so that he could see his tongue placement. We practiced producing /r/ with an open mouth to help him recognize the extent of retraction and to minimize any residual lip rounding. We practiced the same tongue placement without the silly voice. He was then able to produce final “-er” easily (using his everyday voice).
SEE ALSO: Summer Camps Address Speech and Hearing
Obviously, teaching articulation therapy by imitating video game voices is not likely to be a viable method for remediation on any regular basis, however, the entire episode made me wonder about the use of impersonation and the willingness to be silly. Learning something new often involves making mistakes – a lot of mistakes. We can become discouraged, shy, self-conscious, or defeated when we don’t feel successful. Experimenting with silly voices and new and funny sounds, without fear of judgment or a desire for perfection, could allow for greater freedom in finding new positions for the articulators.
When we are being goofy, we laugh at ourselves, because we are not actually making mistakes; we are just trying out funny things. Doing something strange becomes expected as part of the activity. Humor helps us relax. It’s easier to be daring and to do something that you’ve never done before when you know that it’s going to be fun or amusing. Maybe we can start a few of our sessions with some silliness, because making different sounds is a form of comedy, too. Making silly voices, made-up words, and funny facial expressions and mouth postures might just lead us to feeling freer in our willingness to try that new sound.
As speech language pathologists, we are highly trained at observing and listening. We recognize and identify client productions that deviate from normative targets. We listen for errors and sort errors by type, degree, and frequency to plan remediation. Our testing methods enable us to pinpoint specific areas of difficulty and design intervention to provide multiple opportunities to practice correct productions. Our very job title is disorder-based, as pathology is comprised of morphemes representing the study of disease.
Perhaps we don’t necessarily use our heightened observational powers to highlight client skills and positive traits as much as we could. What if we shifted our perspective and started recognizing and analyzing strengths, too? Every day, we see and notice specific communicative behaviors. We have the ability to show clients, staff, and families the specific positive traits that foster interpersonal interactions and academic development.
SEE ALSO Stuttering Therapy for Teens
Within every therapy session, it is likely that our clients are showing us at least one strength, (if not more), while we are tallying all of their correct and incorrect productions of targets. We can note one unique client strength area and/or one positive communicative behavior and share it:
• “Student has a wonderful smile and everyone is always so happy to say ‘hello’ to him in the hallway.”
• “Student is really fun to talk with. She always asks the most interesting questions. She is really thinking a lot about the world and greater issues.”
• “Student is such a great communicator. She really works hard to make sure that people know what she wants to say and she never gets upset when she has to repeat herself.”
• “Student is such a polite and respectful young man. He always waits his turn and offers to help his classmates.”
• “Student is a creative-thinker with strong visual-spatial skills. He is able to re-assemble game pieces into different forms and objects.”
• “Student is highly observant and is able to report on his own accuracy of speech sound productions.”
• “Student is a self-advocate.She readily requests assistance from staff when a task is challenging for her.”
• “Student is supportive of his peers. He will encourage his partner in speech class and offer friendly suggestions.”
We can even add fostering strengths in subtle ways to our therapy, though the use of the common classroom compliment, “I like the way you…” For communication, we can explain the cause/effect relationship between words/actions, e.g., “I like the way you encouraged your partner. I saw her smile.” When we find client strengths as quickly as we currently identify client challenges, we can increase strength-based reporting in our paperwork and documentation, and with meetings with families and staff. With strength-based commenting, we may positively influence how our clients view themselves and how our clients are viewed by others.
An excited student (working on generalizing /r/) recently told me all about an upcoming summer blockbuster dinosaur movie. He wanted us to watch the movie trailer (and he was highly motivated to talk about the movie). We made a list of /r/ words from the film clips and our own articulation cards using index cards and markers. We highlighted where the /r/ sound appeared in the words and sorted the words by their underlying vowels. We practiced the words in isolation, in short phrases, and combined into silly sentences.
Rhotic vowels vary by the stress and syllable breaks within a word, and by their underlying vowel. Intervocalic /r/ sounds are often easier to produce because a stress break within a word makes it like a prevocalic /r/. For example, “Jurassic”, is often produced as “ju-RASS-ic” with the main stress on “RASS” and a syllable break (millisecond pause) before /r/. We don’t have to add /r/ coloring to the first syllable, e.g., either “jur-RASS-ic” or “ju-RASS-ic” is acceptable. Intervocalic /r/ sounds, like “Jurassic”, or “T-Rex” (“t-REX”), encourage /r/ within a word without requiring r-coloring.
Postvocalic /r/ words may be challenging because rhoticism is fundamental. In “dinosaur”, the postvocalic /r/ alters the vowel. We can add a prevocalic /r/ word after a postvocalic /r/ word, such as “dinosaur run”. We can blend the words together, “dinosaurrun” to encourage a close juncture with less separation (no pause) between words, and sounds crossing word boundaries, to encourage /r/ production in both words. As the student progresses, we can slowly fade the second word, e.g., “Say ‘dinosaurrun’, but just whisper the ‘run’ part.”
SEE ALSO Identifying Learning Styles
Syllable breaks can change intervocalic /r/. An intervocalic /r/ can be like a postvocalic /r/, such as “scary”, “SCAR-y”, which has the underlying stressed vowel “ay”, like in “hay”. We can practice it as “SCAR-ry” and add a helping prevocalic /r/ onto the second syllable. Intervocalic /r/ can either start or end a syllable.
Underlying vowels may be deceptive because rhoticism changes how they are realized. Practicing identifying underlying vowels and then adding r-coloring may help production. Dinosaurs and dinosaur actions combine to make interesting phrases and sentences:
vowel “ah”, like in “hot”
vowel, “ah”, like in “hot”
vowel “uh”, like “cut”
vowel “aw” (like in East Coast dialect “coffee” with lip rounding)
stressed vowel “ah”, like in “hot”
vowel “aw”, like “coffee” (see above)
vowel “uh”, like “cut”
Many dinosaur names have multiple/r/ sounds, such as “velociraptor”, e.g., “ve-LOC-i-rap-tor”, with an intervocalic /r/ and a postvocalic /r/ in “raptor”. We can even try challenging words with /w/, /r/, /l/ together, such as “world”, which requires multiple steps:
• Quick initial lip rounding for /w/
• Neutral (no strong lip rounding) for the rhotic vowel and consonant cluster
• Tongue retraction for the underlying vowel “uh” with added rhoticism
• Tongue tip alveolar placement for the /ld/ blend.
Dinosaur vocabulary provides a naturalistic method to form lists of /r/ words. Using promotional materials from a movie release, we can prepare students to talk about the actions and characters in advance. This student’s favorite phrase was about the “army of trained velociraptors”. Practicing words that children will likely use in conversation, with peers and family, may have the potential to foster carryover from structured settings to everyday life.
Once upon a time, not so long ago, I was testing a second-grade boy who is African-American. The student was bright and engaging, and I was beginning to wonder about the validity of the initial referral for evaluation. I was administering a comprehensive standardized language assessment.
One of the subtests required the student to provide a definition, such as responding to the question “What’s a dog?” with a set of descriptors: “It’s an animal. It barks. It wears a collar.”
The student was performing well and we were quickly advancing through the subtest. I asked him, “What’s a king?” He launched into details about castles, princesses, knights horses, and so on. I marked his response as correct and was about to present the next item. Suddenly, he froze for a moment, and then said, “Wait, I forgot something!” I nodded and waited.
“They’re White,” he added, appearing proud of his depth of understanding and the details that he’d shared. We finished the test and I praised him for his hard work. His response has haunted me for years. Kings are White in so many children’s picture books, stories, movies, and fairy tales that for a smart child, this trait would seem to be an obvious and important characteristic to include in a standard definition.
SEE ALSO: Language Barriers and Dysphagia
Providing a definition of an object, item, or concept, is generally accomplished through listing a variety of relationships including category, part/whole, location, and function, along with physical descriptors. When we define something we label its key characteristics. Our definitions themselves show us what elements within our society we value to differentiate between related items. They are a reflection of the values of our culture. The student’s definition that kings are White was directly related to the cumulative cultural exposure of the presentation of the concept of a king that he had received.
What definitions are we providing our students today? We may need to continually evaluate our therapeutic environments to determine what messages we are giving children. Do our materials visibly show various groups in positions of power? The societal construct of race, the sorting of people into particular groups and assigning meaning to these groups, based on a predetermined set of physical characteristics, changes generationally. All of us have the ability to redefine the concepts we present to include minoritized groups by race/ethnicity, and all of the other traits that society uses to separate, instead of unify people.
Invisibility is a form of microaggression, an unintended insult with far-reaching, systemic, negative effects. When kings are only presented as White, all other racial and ethnic groups are invisible in the definition of kings. We can evaluate all of the images within our clinical spaces – every poster, sticker, card, book, toy, etc. Every clinical material we use, from a storybook to deck of cards, reflects cultural values and teaches children cultural knowledge. We can take the perspective of different minoritized groups and consider what definitions these images are teaching. We can avoid unintentional micro-aggressions by fostering an inclusive environment. Through conscientious and deliberate actions, we have the ability to open up the concept of “king”, and much more.
Early in my career, I was completing what I expected to be a routine oral mechanism examination for a shy girl in the 4th grade. She opened her mouth wide and I shined my flashlight into her mouth. She had two complete sets of teeth, side-by-side – like a shark’s mouth. I was shocked. I had never seen anything like that, nor imagined that children could have two sets of teeth. I attempted to suppress the physical manifestations of my surprise.
In actuality, hyperdontia, having supernumerary and extra teeth, is not uncommon. Sometimes deciduous (baby) teeth do not fall out as expected, and the permanent, (adult) teeth erupt alongside them. When I told the classroom teacher, she was rightfully unconcerned, and apparently had a greater knowledge of childhood oral health and structure than I did at that time. The family was aware and saving/planning for oral surgery and orthodontia.
This girl taught me an important lesson and I am continually thankful for the experience. Ever since that day, before I look in anyone’s mouth, I ask a few questions. We often focus on our own perceptive abilities as the most important source of information, which may inadvertently cause us to ignore or devalue knowledge that clients offer.
SEE ALSO: Summer Camps Address Speech & Hearing
In a typical school setting, there may be children with hypodontia (almost no teeth), open bite (top and bottom teeth don’t meet), baby bottle caries (bottle rot), cavities, orthodontia, craniofacial disorders, velopharyngeal insufficiency, and a variety of malocclusions. Some children may have severely swollen adenoids, or infections. There are children who can curl, roll, and make their tongues into a clover shape.
Over the years, I expanded my initial interview questions to encourage clients to share more information:
• “Is there anything special about your mouth?”
• “Do you have any loose teeth?”
• “Did you ever have braces? or “Do you think that you will have braces?”
• “Does your mouth ever hurt?”
• “Do you know if you snore?”
• “Do you know if you are allergic to anything?”
• “Can you breath through your nose? Do you get colds a lot?”
• “Can you do any tricks with your mouth? Curl your tongue? Make funny sounds?”
• “Sometimes when kids are little, they might suck on their thumb or their fingers. Did you ever do anything like that when you were little?” (If yes, then, “Sometimes people will suck their thumb when they are relaxing, like going to sleep or watching TV. Do you do that sometimes?”)
• “We use our mouths to talk. We are going to look into your mouth to see what your mouth is doing. Do you want to see?” (Offer the client a mirror to watch the entire oral mechanism examination while you provide a friendly narration.)
There is something special about each person’s mouth and we are experts of our own mouths. Our clients know their oral structural and functional history from a personal perspective. Young children are often able to report on the state of their mouths when we give them the opportunity. Conducting an interview prior to an oral examination allows us to tap into our client’s knowledge and insight.
May is Better Speech and Hearing Month and a wonderful opportunity to increase awareness of every individual’s fundamental right to communication. Communication allows us to make social connections, develop emotional bonds with others, and have a sense of agency - to be active in the daily decisions of our lives.
Visible markers, from a poster, a button, a flyer, a coffee mug, or child-created art about talking, all serve as reminders to others about the value of communication. Often we take for granted skills that appear to come naturally (innately). Communication impairments have far-reaching effects for clients. If you have typical communication abilities and have not been exposed to communication disorders, then you have the privilege of not needing to understand the difficulties that others face. As clinicians we are ambassadors. We help others recognize that communication truly is a gift, and we can increase understanding for individuals with communication disorders.
SEE ALSO: Better Hearing in the Classroom
We can offer to lead classroom lessons on:
• Hearing conservation and ear protection
• Strategies to increase active listening
• Social skills and pro-social language
• Disability awareness and the idea that fairness is ensuring that people have the tools that they need to succeed
• Categorization and sorting as a method to learn new vocabulary
• Organization and time management
• Turn-taking, speaking and listening, and conversational skills
• And much more
Better Speech and Hearing Month is also a unique opportunity to teach other people about our work and the positive effects we have in the lives of our clients. Many clinicians may initially feel reluctant about self-promotion, or consider talking about achievements as bragging or boastful. There are many ways to inform, enlighten, enrich, and inspire others by sharing stories in humble and meaningful ways.
Do you think that the building staff and your colleagues understand what you do and all of the facets of your daily job? Are they able to see the progress that your clients are making?
Preparing and sharing short and simple vignettes may help others recognize how small changes are meaningful. A clinical vignette that focuses on the success of the client enables another person to recognize that positive gains have been made. Start noticing little differences. Watch what makes your clients smile. Watch what makes them proud. Sharing client achievements, which were accomplished in the therapeutic setting through your guidance, reinforces the importance of our work.
Reflect on your last few weeks of work and how your clients’ lives are changing. We do amazing work every day. Share an inspiring story or two with staff and colleagues, and they will see the power of communication, too!
Meetings with families may occur annually, monthly or even weekly. People respond to their physical environment and to the communication styles of those around them. We can show our care and our understanding for parents/caregivers by how we arrange the materials and our interactions. The items that are on the table and within reach reflect our values and our desire to collaborate. Our speaking style can show respect and collegiality.
• A box of tissue: for emotional responses and for colds/allergies
• Extra pens: lots of extra pens so that anyone can use them
• Post-It notes: to encourage others to use for quick reminders
• Extra blank notepads: to allow others to take their own notes
• Large mailiing envelope: to be offered to the famiy at the end of the meeting to carry all of the paperwork that they have been given
• Paperclips/binder clips: if multiple providers will be sharing documents, a binder clip can be used to hold papers together
Most of these materials may be stored in a prepared basket or small tote bin, that you restock regularly, and then have available and unpack at every meeting.
• Blank goal pages: show that the team is always ready to add/change/modify any of the goals
• Release of Information Form: to encourage communication with outside providers and agencies
• Multiple copies of the IEP: have multiple copes available and give each parent/caregiver a copy (especially when parents/caregivers are separated/divorced), provide teachers and other services providers with copies as needed
You can have a folder where you keep blank goal pages, forms, and any other agency specific paperwork stored in your tote bin.
• Introductions: begin with team member introductions and repeat these same introductions with descriptions, when each team member presents information, e.g., “The Occupational Therapist, (insert name), who works on self-regulation and sensory needs, will share her recommendations.”
• Positive Attribute: share a positive attribute about the client and possibly a recent event that highlights this unique trait
• Pause Regularly: after you share information, pause (count silently in your head for 10 seconds) to encourage family members and other staff members to comment
• Solicit Feedback: specifically ask others, “Does that feel right to you?”, “Have you seen anything similar at home or in the classroom?”, “What other areas are important?”
• Translate Jargon: explain every bit of jargon (even the terms that seem basic to you)
• Reframe: reframe difficulties as “areas for growth”, “current challenges”, “areas for improvement” to promote the idea of positive change
• Listen: when family members and staff share information, stop and listen to them
• Honor: honor and recognize the contribution of each team member, e.g., “Our special education teacher, (insert name), has created a variety of high interest activities to engage him in writing activities”, or “As a family, you have encouraged his creativity and his love of listening to stories.”
Sometimes meetings can be stressful and we have tools which may help encourage everyone to participate and to feel welcome.