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Speech in the Schools

Belonging in Competition
August 27, 2015 1:58 PM by Teresa Roberts

Competition may be inherently divisive and alienating, as people are sorted into predetermined roles based on “winning” and “losing”. People handle competition in different ways, and some types of responses are more successful than others. Ideally, we gradually learn to manage our frustration when we don’t win a game. Recently, I was touched by one student’s empathy, and his attempts to resolve a situation when two of the other students in the group began quibbling about the game.

This student’s initiative prompted us to put together a short book about “How To Be an Awesome Game Partner”. We examined competition from three different angles, (1) mindset or cognitive framework of the concept of game, (2) resilience and positive self-talk, and (3) self-regulation and problem solving. How you view a specific situation may shape how you interpret the outcome of events. The ability to self-soothe and provide oneself with affirmations may be a key part of resilience and the ability to attempt new and challenging activities. Self-awareness of one’s own state of being and generating solutions to manage emotional states is part of self-regulation.

Students offered suggestions based on guided prompts.

Cognitive Framework: “What are different ways to think about what happened in a game?” and “What are different ways to think about winning and losing?”
•    Remember it’s just a game. It’s not real life. It’s not like the “Hunger Games”.
•    You gotta believe you’ll have a chance. If not today, then maybe another day, or maybe in a little bit.
•    Sometimes people get lucky in a game so it’s not always fair.
•    Think about the times that you’ve won before and know that you will win again.
•    Think about things you’re good at.

SEE ALSO:  Building Sounds One Block at a Time

Resilience: “What could you say to yourself to feel better?”
•    You’re doing good.
•    At least you did your best.
•    Second place is good.
•    You gave it effort.
•    You’re still a winner inside.

Problem Solving: “What could you do if you get upset while you are playing a game?”
•    Take a short break
•    Take a walk
•    Write it down
•    Talk to the teacher about it
•    Stop the game

As a group, and as a team, we created guidelines about how to view competition. The collaboration involved in the project established a sense of unity toward a common goal and a shared understanding. This new sense of community may have helped students feel that the entire game experience is a part of group belonging, instead of a solo act. As clinicians, we infuse multiple objectives within single lessons, with long-term goals around developing successful life strategies. Sometimes the lesson we had planned becomes less important than the lesson that emerges.

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Beginning With Goodbye
August 21, 2015 9:50 AM by Teresa Roberts

There’s always a small thread of sadness mixed in with the happiness when a client completes therapy.

Our relationships with students are temporary. Sometimes they last a few years, and sometimes they last a few months or less. Yesterday, a student who has been making excellent progress on her articulation asked me, “What happens when I’m finished with my R’s?”

“You don’t need to work on any other sounds. Your R’s will sound awesome all the time. You’ll be a rock star!” I replied.

I think that she was really asking me if we would ever spend time with each other again after she finished with her R’s. Perhaps she already knew the answer.

Students may move, our job positions may change, and hopefully, in many cases, students graduate from speech. As clinicians, we understand and accept that these relationships are transient and that is reflected in our very title of “Itinerant”. We work quickly to establish rapport, which means that we make a meaningful positive connection with another person (each client). We are skilled at developing the clinician/client relationship because we care and our feelings are genuine.

 SEE ALSO: Summer Camps Address Speech and Hearing

There are many different ways to conclude these relationships and to say goodbye. Most of us celebrate the accomplishments of our clients, and the ending is marked as a new beginning. We make assumptions that many of our clients understand the nature of the short-term therapeutic relationship.

We often do not know what our time with clients has meant to us until much later, as we incorporate everything we learn from each session and each new client into our practice, steadily increasing our clinical skills. We may never have the opportunity to know what our time with our clients has meant to them and how it has affected their lives.

Should we begin clinical interactions with the awareness of the limited duration of the relationship?
•    “I’m glad that we’ll be able to spend a little bit of time together to work on your sounds.”
•    “It will be fun to play together for a few months to work on your speech.”
•    “We can do a lot of cool stuff together during this school year (or while you are in X grade) to help you learn new words.”

Should we add closure rituals to the concluding sessions that honor the reciprocal nature of our work?
•    “I’m going to tell you some wonderful things I learned from spending time with you. You can tell me what you learned, too.”
•    “I loved spending time with you. I really thought that it was fun when we (add activity). What did you think was fun?”
•    “It’s been great to see you every week. I’m going to miss your (add positive traits), and I’m glad that we got to hang out together.”

Saying goodbye in any relationship carries an emotional element, whether it is one of many goodbyes or part of a formative time period.

Even after all these years, there’s always a small thread of sadness mixed in with the happiness. How do you say goodbye?

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Winning the Job Lottery
August 14, 2015 8:04 AM by Teresa Roberts

“What would you do if you won a million dollars?”

A few years ago I was working with an entertaining group of fifth grade students who were practicing producing their speech sounds at the sentence and conversational level. We were taking turns answering social questions from a deck of cards. We turned over the card with the question, “What would you do if you won a million dollars?”

Each of the students shared their fantastical ideas about what they would do if they won the money, then one of the students turned to me and asked me what I would do. I suddenly realized that I wasn’t sure what I would do. Another one of the students smiled and announced to the group, “Well, she certainly wouldn’t be here with us!” and we all laughed.

I’ve often wondered about the student’s comment that I wouldn’t be working as a clinician if I received sudden riches. It’s common for people to daydream about a life without worry that appears to be promised with independent wealth. Waking up everyday and spending long hours balancing client contact, documentation and compliance paperwork, staff interactions, and organization/institutional practices, isn’t easy. Sometimes we see work as mainly burdensome and taxing, instead of seeing the beneficial reciprocal relationships that exist, as we are enriched through clinical interactions.

There are two ways to consider the idea of imaginary, newly found wealth that may provide insight into one’s own clinical values and career identity. Therapeutic services are often within the guidelines of a predetermined system, which is rarely as fully funded as it could be. In times of perceived scarcity, it may become easier to focus on limitations than on possibilities.

SEE ALSO: Metacognition & Success Mindset


Thinking about your work without any limitations may open up freedom of thought.

•    What would you want to change about your job if you had the resources to make many more things possible?
•    In what ways might you change your professional life?
•    How could you improve your daily practice if you had unlimited resources?

Releasing ourselves from superimposed boundaries may help stimulate creativity and identify what we value. Our work includes aspects of altruism (public service), self-improvement (professional development), creativity (materials generation and intervention), interpersonal skills (client rapport), and much more. When we brainstorm about what we would do and what we would change if we had access to financial resources, we might learn where we want to put more of our clinical energies.

Another way of examining the question of what you would do if you won a million dollars is “How would you feel if you could never work as a clinician again?” Having the identity of a practitioner carries meaning. It may even be a source of pride. Our work is often difficult, but it is meaningful and important work. We believe in what we do. Even if we don’t win the million dollars, perhaps we have all already won the “Job Lottery” because speech language pathology is a fulfilling and stimulating career.

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When Being Quiet Isn’t Listening
August 7, 2015 8:24 AM by Teresa Roberts

Some years ago, a student showed me how ‘sitting quietly’ doesn’t necessarily equate to ‘listening’. His teacher was concerned about his behavior during reading and his auditory comprehension skills. He was a friendly and gregarious student who was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and mild language/learning challenges.

We decided to role-play reading to find ways to help him. We rearranged a section of the clinic room, placing a group of stuffed animals in a semi-circle, replicating how the students sit on the carpet around the teacher while she reads. The student sat with the stuffed animals while I sat in front with a book.

We reenacted reading in two different ways:

“First I want you to show me what happens when you get in trouble during reading. Just pretend to do whatever you do before you get in trouble. It’s all pretend so we can figure out how to make reading better.”

I read a few pages from the book while the student squirmed around and whispered to the stuffed animals. He scooted closer to some of them, knocking them over and giggling. We stopped and I asked him if he had been able to hear the story. He said that he hadn’t been able to hear any of it.

“Now I want you to show me what happens when you don’t get in trouble during reading. Show me what happens when you are doing what the teacher wants you to do. It’s all pretend play right now so we can help make it better.”

I read a few pages from the book. The student sat with his legs crisscrossed and his back straight. He stared directly at the book, looking intently focused. After a few pages, I asked him if he had been able to hear the story. He said, “No.”

I asked, “Why didn’t you hear the story?” He said that he was working too hard to sit still to be able to hear anything. He reported that it took all of his energy and attention just to be quiet. He wasn’t able to attend to the story whether he was talking or sitting silently.

SEE ALSO: Dually Assessing Hearing Loss and Autism 

I met with the teacher and the student’s mother. We had a new understanding of his effort and his insight. We decided to use an inexpensive portable personal sound amplifier (designed for adults with hearing loss) with him, which I purchased. The student wore headphones during reading and the teacher talked into the microphone. This stopgap measure helped him to focus on the teacher’s voice, as class-wide amplification systems are still not widely available.

We make assumptions that certain behaviors represent internal actions, as if we can judge another person’s cognitive processes by external physical manifestations. Classroom expectations include the continual processing of auditory information, which is often measured by how successfully a student is able to sit quietly. Sometimes our own framework of associations between behavior and thinking will not match the framework of our students. We can design ways to let students tell us about how their own outward appearance may or may not be associated with specific cognitive functions.

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Metacognition and Success Mindset
July 30, 2015 5:03 PM by Teresa Roberts

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.

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Categorical Negation
July 24, 2015 8:21 AM by Teresa Roberts

Which of the following is not an easy way to ask a question?
a)    Inclusivity
b)    Exclusivity
c)    Negation
d)    Both (b) and (c)

My colleague and I worked with a friendly, middle school student, who had language-learning challenges. In the classroom, the students read classic and modern novels with regular quizzes (characters, setting, events, etc.). The teacher met with us to share her concerns. Although the student was generally able to understand the novels, he often failed the quizzes because he didn't understand the format of the questions.

Assessment measures frequently include varied question types. Even when the content and the knowledge measured remains constant; the question format affects the difficulty level:
•    Inclusivity: Identify all items that fit within a specified group based on a shared characteristic.
o    “Circle all of the animals.”
o    “Which of the following are animals.”
•    Exclusivity: Identify items, which would be excluded from a group. Determine the key trait of one group (inclusive group), and contrast the characteristics of the inclusive group with the characteristics of other items.
o    “Circle everything except the animals.”
o    “All of the following are animals except:”
•    Negation: Negation, a form of exclusivity, is about recognizing shared category members and non-members.
o    “Circle everything that is not an animal.”
o    “Which of the following are not animals.”

SEE ALSO: Question Parents Carefully 

With exclusivity and negation questions, there is only one added word that signifies non-belonging (except, not, never, etc.).

We wanted to increase the student’s understanding of negation questions. At the next session, I used picture cards of familiar entities/objects with high contrast, starting with “deer” and “boat”. We brainstormed characteristics for each item using a T-chart. For “deer”, we listed: “animal, tail, antlers, prey”, and for “boat”: “sails, lake, water, ride on it”. We made a field of two possible choices with specific traits for each choice.

Keeping the T-chart in front of us, we took turns asking questions in negative forms, following initial modeling: “I want one of the two cards. I’m going to ask you for the card I want in a tricky way. I’m going to tell you what I DON’T want, and then you will know which card I really DO want. Give me the one that does NOT have sails.”

We then moved to general knowledge questions, which used negation, presenting a hierarchy of question types with instructions about how to interpret each question:
•    “Is a ball round?” – yes/no question
•    “What shape is a ball?” – Wh-question with single word answer for a known fact
•    “What shape is NOT the shape of a ball?” – Identify the known fact (round shape) and then generate an answer within the same category (shapes), which does not meet the criteria (shape of a ball).

Categorization, category members/titles, descriptors, and key traits, are common areas for language intervention. We frequently focus on inclusivity. We can expand categorization by teaching exclusivity, negation, and non-belonging. All of our early lessons about grouping shared items become the basis for answering higher-level complex questions. Answering questions correctly includes knowing what is wanted, as well as what is not wanted.

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Demographic Meanings
July 16, 2015 7:26 PM by Teresa Roberts

“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.

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Interrupting the Monologue
July 9, 2015 10:34 PM by Teresa Roberts

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.

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First Class Clinicians
July 3, 2015 6:04 AM by Teresa Roberts

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.

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Window into Stuttering
June 25, 2015 3:07 PM by Teresa Roberts

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.

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Speaking and Being Heard
June 18, 2015 5:14 PM by Teresa Roberts

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.

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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.

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Becoming Our Own Client
June 11, 2015 9:05 PM by Teresa Roberts

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.

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Safety in Silliness
June 5, 2015 8:04 AM by Teresa Roberts

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.

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The Study of Strengths
May 29, 2015 9:46 AM by Teresa Roberts

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.

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Dinosaur Rhotics
May 21, 2015 10:42 PM by Teresa Roberts

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:

Postvocalic

Word

Stress/Syllable

Underlying vowel

Park

Single syllable

Stressed vowel “ah”, like in “hot”

Army

Single syllable

Stressed vowel, “ah”, like in “hot”

herbivore

HER-bi-vore

·       “herb” stressed vowel “uh”, like “cut”

·       “ore” unstressed vowel “aw” (like in East Coast dialect “coffee” with lip rounding)

carnivore

CAR-ni-vore

·       “car” stressed vowel “ah”, like in “hot”

·       “vore” unstressed vowel “aw”, like “coffee” (see above)

Trainer

TRAIN-er

·       Prevocalic r-blend

·       Unstressed 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.

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