Do you believe that your actions affect your life outcome? Do you believe that you can influence other people by what you say and do? Do you believe that you can be part of a group of people who bring about positive change in the world?
The ability to have power over our own actions and the actions of others is agency. You are an agent — the one doing the action — instead of a recipient, or a person who has things done to them. When we have a sense of agency, we believe that what we do matters — there is an outcome. Agency is empowerment. When individuals do not have a sense of agency, they may become passive (not initiate) and prompt-dependent (wait for another to prompt them), or even demonstrate learned helplessness (feel powerless and ineffective).
Renowned psychologist Arthur Bandura’s work in social cognitive theory described three types of agency that people use in their daily lives:
· Personal agency: the ability to do things to meet your goals.
· Proxy agency: the ability to influence other people to meet your goals.
· Collective agency: the ability of a group of people to work together to meet a goal.
Our work with students affects how they view themselves. We can show students how they are agents in the therapeutic process and within a group.
Personal agency: you can make things better
· Recognize hard work: “You’ve been working really hard on telling your tongue where to go for your /r/ sound! All your work is making a difference!”
· Celebrate progress: “Remember last year when you used to say ‘wed’ for ‘red’? You don’t do that anymore. You changed your speech.”
· Specify goals: “You told me that ‘squirrel’ is a hard word for you to say. You can set a goal for this word.”
Proxy agency: you can influence other people
· Request: “Ask your partner if you can … ”
· Bargain: “Maybe you could tell your partner that he could choose the activity first next time?”
· Convince: “Give you partner two reasons why you think that you should pick the activity.”
· Thank: “Did you see how your partner smiled when you thanked him for letting you go first? You made him feel appreciated.”
· Praise: “Did you see how your partner sat up straight when you said she did a good job saying her /r/ sound? You made her feel proud.”
Collective agency: we can create good things together
· Co-created materials: each student takes a turn decorating a book, or game that will be used by the whole group.
· Co-created stories: each student takes a turn adding an element to a narrative to create a cohesive story.
· Sharing created materials and resources: sharing materials that one group has created with another group or with staff, e.g., “We made a great book of vocabulary words! Let’s share it with the teacher so that other students can use it, too.”
We develop an understanding of our place within our community by how we interact with each other. We can highlight students’ roles in their own success, and provide opportunities for contributions and collaborations that help others.
I had to leave a training activity because I was starting to cry. I don't believe that anyone noticed except the person who was sitting next to me. I told him, "This isn't safe." He offered to speak to the instructors for me, but I declined. I left the room, shed a few tears in the bathroom and then got myself together and returned.
We were reading about critical race theory and culturally responsive teaching.1 The articles described how educators could shift their thinking about minorities and underrepresented groups from a deficit approach to an asset approach. Instead of looking for bad things within a community, we could look for all of the good things that supported, nurtured and uplifted a group of people. Every community has its own unique strengths. Educators were encouraged to conduct a form of ethnographic study to learn about the strengths of the different communities of their students. The articles contained noble ideas.
Then suddenly, we were told that we needed to complete a community asset assessment for our own childhood. This may sound like a fine activity to you, and if it does, I'm glad that you had a childhood that you feel comfortable sharing. Not everyone had safe experiences as a child and not everyone trusts others enough to know that they will not be judged for circumstances that were beyond their control. Being asked to complete this activity was not an appropriate task for me. I didn't participate and faced mild disapproval from one of the instructors. Although the disapproval was disheartening, it was insignificant in comparison to the distress I would have felt had I completed the activity.
We often assume that everyone has happy lives that they want to share. We assume that people feel safe with others and willing to disclose personal information. As clinicians, it is common to establish rapport through questions about preferred activities, favorite things, family members, etc. Not all of our questions are safe for children. Not all children feel comfortable answering questions that come from a place of privilege that assumes everyone has only positive experiences.
There are many resources about working with children experiencing hardships. Here are a few minor changes in asking questions that I have adopted:
- Allow students to opt out: "It's okay to pass."
- Give a choice: "Would you like to share about X, or share something else? You can choose."
- Use the word "family" instead of the word "parents."
- Ask if a child celebrates a holiday, instead of assuming that they do. (Even a birthday.)
- Introduce activities around objects before people, e.g., describe a location before the participants.
- Use known shared topics, such as school.
We can think about how we expect a child to respond whenever we ask a personal question. If our expectations for responses are always positive, we may be seeing the question from our own place of safety and assumed values. Imagine a negative response to the question and a description of unpleasant or traumatic events. We can reframe personal questions and recognize that these types of questions are not innocent.
I saw something upsetting this week. I wasn’t sure whether or not I should tell you about it, but I decided that we learn a lot not just from good things, but bad things too. It was a brief incident that highlighted greater concerns at the individual, local and national level.
From the clinic room, you could hear young voices swearing in the hallway. The third and fourth grade students had finished lunch and were waiting for recess. A group of boys were standing together near the first grade and kindergarten classrooms. They were talking loudly and using profanity.
A teacher walked up to the boys without them noticing. When the boys finally saw her, the group became divided. Half of the boys stopped talking, and then made “ooooh” noises, which likely represented “you’re in trouble.” The other half of the boys began to swear louder and dance around. Suddenly, they stopped swearing and switched to racially-based imitations of a foreign language, used in mocking attribution to the racial background of teacher.
The teacher attempted to learn their names, but they all ran off down the hallway and out the door to recess. She followed them from a distance. When she finally reached a few of them, she said, “There are little children in the classrooms. They can hear you. You need to be quiet when you are by the classroom doors.”
The teacher seemed visibly shaken by the incident and I was at a loss of how to help. I could see the confusion and distress on her face. She was not a regular teacher in the building and did not have strong connections to the students and staff. She worked as a special education itinerant and traveled to multiple school sites. I expected that she was simply trying to do her best to provide a positive learning environment for the children she served at that building.
I spent a long time thinking about what happened, and found that I had more questions than answers:
· What are the current national norms for the ages at which children begin to use profanity and derogatory racial and ethnic terms and expressions?
· What are the primary means that children learn racially-based insults?
· Are racially-based insults the new “taboo” words now that profanity has become more commonplace in society and the media?
· Are racially-based insults more or less common between different minority groups, or between dominant majority and minority groups?
· Could behaviors that appear to be defiance actually be rejection of a positive relationship due to one’s own fear of rejection?
· Could positive adult relationships be so rare for some students, that initial rejection is viewed as more beneficial than continued failed attempts?
· Are there recommended ways for staff to respond to racially-based insults from students?
· Are rewards and punishment appropriate methods to address these issues?
· How can we help staff remember that child behaviors are not personal?
If something upsetting has happened to you at school, I am profoundly sorry that you had to experience it. This story was about me. I was the itinerant specialist in the school building. The only way that I have been able to process what happened thus far is from a distance.
Every day is a chance to make a positive difference in the lives of clients, families, and colleagues. Our daily activities are important and have immediate effects. When days are hectic, it becomes easy to feel rushed and overwhelmed. Reflecting on the primary motivation of our work can guide us. We can see how our time matters.
Speech-language pathologists support communicative growth and foster social engagement for clients. When we take a moment to list just a few of our plans for one week, we can highlight the incredible work of our field.
We use data from previous therapy sessions, client input, partnerships with staff and families, and research to guide our intervention. Here are a few highlights from my upcoming week:
• Articulation: Respond to the teacher’s comments about the child’s oral reading skills in the classroom and analyze why the “ire” sound, as in “fire” is the most challenging /r/ sound for the child to produce.
• Fluency/Stuttering: Continue a heartfelt discussion with a student who shared that he is afraid that he won’t be able to warn somebody in time if there is an emergency because of his stuttering.
• Voice: Begin a lesson on the basic anatomy and physiology of the vocal mechanism by watching the YouTube video “Inside the Voice” featuring a narrated endoscopic view of the larynx for a child who has a diagnosis of vocal nodules.
• Language: Practice retelling events with two and three-part picture sequences to show the relationship between the concepts “first/then” and “before/after” for a child who has attention and executive functioning challenges.
• Language and Literacy: Use the Reading Rockets Word Study lesson on word families, phonological awareness, and orthography for the multiple spellings of the “o” sound (no, know, bow, dough, etc.) for a child with a language learning disability.
• Pragmatics/Social Language: Begin a lesson on how positive and negative comments in conversation affect the feelings of peers for a child who has a diagnosis of Autism Spectrum Disorder.
• Collegial support: Share resources to conduct a small group activity on asking questions and stating preferences for adolescents with significant developmental delays.
• Family partnerships: Prepare and send home practice materials for a child who has mastered “or” and “ar” r-controlled vowels, as in “four” and “far”.
• Medical partnerships: Prepare a letter to the primary care physician detailing concerns about oral anatomy, tongue range of motion, and likelihood of ankyloglossia (tongue tie), which may be affecting progress in speech sound production.
When we list just a few of the many different tasks we perform within a week, we can see direct connections between our time and positive outcomes. What are you going to do this week?
While assessing a middle school student for the presence/absence of a language disorder, I asked the student the following question, “Jan saw Pedro. Dwayne saw Frances. Who was seen?” The student did not respond correctly to this trial item and benefited from repetition and modeling. To answer the question correctly, you need to understand passive sentence construction.
Typically developing children begin to understand passive sentences between ages 5-6 years old and begin to produce passive sentences at between ages 7-8 years old. In English, the general declarative sentence structure for a statement is Subject + Verb + Object (SVO). Different languages use different word order. SVO is the second most common word order represented in languages of the world, with SOV having the greatest representation.
SVO word order, as in the sentence “The dog chased the cat”, has the agent (the dog) + the action (chased) and the object (the cat). The dog was performing the action and the cat was receiving the action. Objects can be animate, like the cat, or inanimate, as in “The boy ate the cookie.” Declarative sentences use an active voice where the initial focus is on the entity that brings about the change.
In a passive sentence, we rearrange the word order and may add elements, such as past tense (was/were) + past participle (chased) + the preposition “by”. The recipient is listed before the agent, e.g., “The cat was chased by the dog”. The instrument used to complete the action appears before the agent, e.g., “The cookie was eaten by the boy.” Passive sentences have Object + Verb + Subject (OVS) word order.
To answer the question, “Who was seen?” the student would need to convert both declarative sentences into passive sentences, e.g., “Pedro was seen by Jan. Francis was seen by Dwayne.” Passive voice is powerful because the emphasis is on the recipient and not the agent. We even use passives to highlight outcome and remove cause or blame, e.g., “The window was broken”, where no agent is included. Textbook authors often use passive voice to describe historical events in which the exact agents (individuals) may not be known, e.g., “A mighty fortress was built.”
We can help students understand passives by providing multiple opportunities to convert active to passive and vice versa by manipulating sentence elements. We can explicitly teach the movement of words using index cards, with each word on a card, in order to rearrange the sequence and insert additional words. We can use picture cards of entities and objects (Jan, Pedro, dog, cookie, etc.) to show the roles of “agent” and “recipient”. Understanding how to interpret and generate passive sentences allows an individual to change the focus of an action, its nuance, and its significance.
1. Owens, R. (2016). Language development : An introduction (9th ed.). Boston: Pearson.
2. Matthew S. Dryer. 2013. Order of Subject, Object and Verb. In: Dryer, Matthew S. & Haspelmath, Martin (eds.) The World Atlas of Language Structures Online. Leipzig: Max Planck Institute for Evolutionary Anthropology. (Available online at http://wals.info/chapter/81, Accessed on 2016-09-26.)
Tip elevation: Does your tongue tip lift to the top of your mouth, right behind your front teeth, to the little speed bumps of your alveolar ridge? The tip elevates and the right and left surface portions of the tongue push against the alveolar ridge causing a dip (narrow passageway) to form for airflow. The tip hoovers in space near the top of the mouth.
Blade elevation: Does your tongue tip point downward and lightly rest (stabilize) on the inside of your lower bottom teeth with the flat blade of your tongue contacting the alveolar ridge? The blade is the broad portion right behind the tongue tip. You can feel the blade resting on your alveolar ridge when your mouth is closed and your tongue is molded across the roof of your mouth. Blade productions may be considered mild distortions.
For typical speakers, fricative phoneme /s/, and its voiced cognate /z/, are produced at the alveolar ridge. The tongue is lifted forming a narrow constriction (tiny tunnel) for rapid airflow that causes friction. Air rushes quickly through a thin channel making a high frequency sibilant sound.
Sometimes it’s hard for children to control and balance the tongue to form and maintain a narrow opening. Speakers may develop any number of compensatory strategies for /s/ and /z/, such as changing tongue placement and airflow. Some individuals substitute a blade production, raising the broad section of the tongue with the tip contacting the lower teeth.
When treating /s/ and /z/, it’s beneficial to determine whether the client is producing all alveolar sounds with tongue tip elevation. In English /t/, /d/, /n/, /l/, and the tap sound, (middle consonant sound in “butter”, and “matter”, which is a fast sound that is something in between /t/ and /d/), are made with tip elevation.
We need to have the client’s mouth slightly open to see if their tongue tip elevates (rising movement) or lowers, or even if it tries to stick out, or move toward one side or the other. We need a window to view tongue movement. To make a window, you can use a flavored tongue depressor or the client’s pinky finger to keep the teeth slightly apart:
• Tongue depressor: Have the client lightly bite on the tongue depressor with one end at the molars and the other end sticking straight out of the client’s mouth.
• Pinky finger: Have the client place the very tip of their pinky finger on the back molars and lightly close their mouth (but don’t bite).
Shine a penlight flashlight into the client’s mouth. Have the client smile to increase the width of the window (so you can the sides of the mouth through the opening).
Check for tip elevation by having the client produce words for the alveolar consonants:
/t/: “ten”, “take, “talk”
/d/: “did”, “dig”, “dog”
/n/: “nine”, “net”, “neat”
/l/: “light”, “let”, “lock”
tap sound: “letter”, “kitty”
Remember that having your mouth open for a while can make you drool, so take quick breaks between words and have some tissues available. You can have the client watch their own productions in the mirror so that they can learn about their tongue patterns, e.g., “Let’s watch and see what your tongue likes to do for the /t/ sound. Look it lifted up high” (or “Look the tip went down”, or “Look it tried to stick out”).
Remember tongue placement is language-specific and it is important to review the phonetic inventory of every language to which a client has been exposed.
It helps to know whether or not all alveolar sounds are elevated before we ask for alveolar placement with tongue tip elevation for /s/ and /z/.
Children who have challenges with pragmatics and social language often struggle with recognizing that people have different perspectives on the same situation. People interpret actions, behaviors, and events from their own unique viewpoint. One of my colleagues recently shared an interesting technique to teach multiple interpretations through perceptual differences. Visual imagery can inspire a discussion of different ways to view the same stimuli. Optical illusions are designed to evoke variable interpretations. Using optical illusions provides students with specific examples of how we can see the same things differently.
The SLP began with a basic lesson on visual perception based on physical location. She sat across from the student and opened her laptop computer. She proceeded to exclaim loudly and theatrically, “Oh, that’s so awesome! That’s amazing!” She used Google images to search for pictures of the student’s preferred topic and began to comment on the details. The student, who could only see the back of the laptop, reacted to her statements about his favorite topic and said, “What? What is it?”
The SLP stood up and walked over to the opposite side of the table where the student was siting and said, “Oh, I guess from your perspective, all you can see is the back of the computer. From my perspective, I could see pictures of (student’s favorite things). Why don’t you come over to this side of the table and we’ll both have the same perspective of the screen?”
Next the SLP used a series of images of famous optical illusions with two interpretations, such as the duck or rabbit combination, and the old lady or young lady. The student would label what he saw in the picture and then the SLP would say, “Hmmm, well, from my perspective, I see (alternate image).” Soon, the SLP and the student were working collaboratively to find both possible images for the pictures.
The SLP then presented hidden animals artwork, which required flexible thinking to see how objects could represent other objects, e.g., how a cloud could be shaped like a horse in Jim Warren’s painting “Seven Horses”. The SLP repeatedly used the words and phrases, “perspective”, “my point of view”, and “from here, I can see X”. She periodically praised them both by saying, “Wow! I think we’re seeing this from the same perspective!”
We all have different sensory experiences. With food, music, art, etc., what is positive to one person, isn’t necessarily enjoyable to another person. Our sensory systems and our life experiences affect how we respond to stimuli. Optical illusions showed the student how two people could look at the same picture, one single shared stimuli, and construct different meanings.
When I talked with my colleague about this creative approach, she laughed and said, “How could I start telling him that people have different thoughts about something without physically showing him that people actually see different things?”
We know that we make positive changes in the lives of our clients, but our work can also make a meaningful difference to the next generation of speech-language pathologists.
Many years ago, when I was learning to be a clinician, I observed Dr. Bob, a speech-language pathologist in private practice. Dr. Bob specialized in working with children with Autism Spectrum Disorder (ASD). On the day that I observed, he spent 30 minutes with a precocious five-year-old boy who had ASD.
Dr. Bob and the child sat side-by-side at a table to complete a wooden alphabet puzzle. Each puzzle piece was a letter of the alphabet and had a colorful drawing of an animal that matched the letter. They took turns placing the alphabet pieces into the board. With each turn, they alternated between multiple tasks:
• They looked at the puzzle piece together, and looked at each other while Dr. Bob made expressions of interest and curiosity about its design
• They pretended to put the piece in the wrong way before fixing it, or pretended to give the animal the wrong name
• They traced the letter’s shape
• They made the sound of the letter
• They labeled the animal, e.g., “that’s a giraffe”
• They described the animal, alternating between physical characteristics, habitat, actions, etc.
• They pretended to be the animal or pretended to see the animal in the room, raising their hands up to their eyes as hand binoculars
This one simple puzzle was used to address social, language, and literacy goals:
• Social reciprocity and turn-taking
• Problem solving and absurdities
• Letter and sound correspondence
• Orthographic knowledge
• Phonological awareness
• Naming and describing
• Asking and answering questions
• Imaginative and dramatic play
Dr. Bob was laughing. The child was laughing. It looked like fun. They were both having fun throughout the session. The half-hour passed quickly. I saw how the therapy was engaging, interactive, and enjoyable. It took years before I understood how much had happened within that short time frame. It wasn’t until I learned more about intervention, disorders, and clinical management that I fully realized the complexity of the session.
My observation was just a moment of time within his busy day, as new clients arrived every half hour. I was one of countless students who observed, as teaching and clinical training were foundational values of the clinic. Allowing university students to observe is a form of generosity. When our therapy sessions are open and welcoming to university students, we are giving ourselves to our clients and to the future of the field.
I am grateful that Dr. Bob taught me essential skills:
• Incorporating multiple goals into a session
• Managing therapy time efficiently
• Using materials in creative ways
• Infusing social development into every activity
Even though no one is as skilled as Dr. Bob was, we still do have a lot to offer. We have clinical experience. We provide intervention that benefits clients and can enrich university students’ education. Open the therapy room doors and let everyone observe the fun! Our work changes lives and Dr. Bob’s work changed mine!
Are you new to a school building this year? There are, of course, the obvious tasks:
• Make friends with the secretaries and custodial staff
• Connect with administration and share how happy you are to be at the school
• Complete a monthly calendar for annual IEP and re-evaluation due dates
• Access or create a caseload spreadsheet with student names, grades, service minutes, communication domains (articulation, language, fluency, etc.), and additional special education services
• Begin the on-going process of scheduling students (magically triangulating student needs, school/class schedules, special activities, additional services, teacher feedback, etc.)
• Start a data collection and attendance system to document services
There are a few more activities that might be beneficial:
• Clean-out the space
• Look at the room from a child’s perspective
• Thank the prior clinician
Clean out the space: Colleagues have recently spent hours cleaning out neglected speech rooms. There were file cabinets with materials from the 1980’s, including moldy felt board storybooks, and mimeograph worksheets for an old paper-duplicating machine that was discontinued with the invention of the photocopier. There were two nonfunctioning Language Master Systems (early recording and audio systems that used magnetic tape) and prior editions of standardized tests that are no longer valid. As tempting as it is to just close the file cabinet drawers and leave the mess for another 10 years, don't do it. By leaving piles of already worthless materials untouched, you may be subjecting a newly hired clinician, who just graduated from college, to start the year completing an archeological exploration into the history of Speech Language Pathology. Recycle, donate, discard, or repurpose materials!
Child’s Perspective: Adults are not the same height as children. Sit on the floor. Sit on your knees. Change your height and look all around the room. Think about what you notice, what you can and can’t see, and what you can and can’t access. Design the room from the point of view of the child.
Thank the Prior Clinician: Every child can make a card for the prior clinician.
• Use blank cards or construction paper and art supplies to have students make cards
• Provide a model of the typical layout and format of a card with the correct spelling of the clinician’s name and common words
• Provide a choice of three different writing prompts:
o Thank you: “Let’s think about speech class last year. What kinds of things did you do? What kinds of things did you learn? This is a thank you note. What’s one thing that you want to say thank you for?”
o Advice: “Your speech teacher from last year has a new job. What is some great advice that you want to give your speech teacher for their new job?”
o Summer news: “You might have done some interesting things this summer. Let’s think about what fun/interesting/funny things happened this summer. What summer thing do you want to share with your old speech teacher?”
• When all the cards are completed, you can send them as a packet to the prior clinician
We can start the year with closure, with gratitude, and with an organized fresh start!
I hate making clinical mistakes. They make me feel bad about my skills and myself. Mistakes may often be based on lack of information, which affects the development of a relationship. Sometimes the desire to make a difference as quickly as possible negatively affects the collection of comprehensive background information and prolonged rapport-building activities. Often mistakes can come from not knowing our clients as well as we should.
Lack of information can be in any area:
• Client history
• Client temperament, personality, and interaction styles
• Child preferences and interests
• Client communication and learning strengths
• Family understanding of communication disorders
• Family grief stages and fears
• Family expectations
• Teacher concerns
• Classroom curriculum and objectives
• Peer interactions and behavioral concerns
A lack of information combined with the false pride of “expertness” is a dangerous combination. We may know about communication disorders and be highly trained in providing intervention, but that doesn’t mean that we automatically know about the needs of every single client.
Gathering information takes time. Mistakes are often based on rushing to act before learning as much as you can about a client.
When I make mistakes, I move through stages:
• Discomfort: Something about that session or interaction didn’t feel right.
• Confusion: What made it feel off?
• Shame: I can’t believe that I didn't do a good job.
• Anger: Why is this so hard!
• Self-righteousness: I’m a skilled professional. What I do is important.
• Reflection: There are lots of different ways to accomplish a goal.
• Awareness and understanding: I know how I could have made it better.
• Remorse: I wish that I could go back in time and do it over.
• Learning and planning: I will design systems and strategies to prevent this from happening again.
• Apologies and amends: I will let the client and the client’s family know that I am sorry and provide suggestions about what might work better in the future.
Whether we are new clinicians or have many years of experience, we may still need basic systems and procedures to make sure that we aren’t skipping steps and starting with only limited information. We can create our own checklists, reminders, routines, forms, etc., that require us to slow the process and proceed methodically.
Rapport comes from knowing and understanding our clients and their needs. Although we may be able to intuit a great deal of information based on our clinical experience, we can also incorrectly assume that we know more than we do. Taking time to learn about our clients lets us create a therapy plan that matches who they are. I still make mistakes sometimes, though fortunately, mistakes help us learn. There’s always something new to learn because every client is a unique individual!
Everyone enjoys something. It might take us a while to find out just what will make another person smile, but if we watch closely, we can find it.
Some years ago I was working with a student who had significant cognitive delays and behavioral challenges. He attended his neighborhood elementary school, however, the staff was not sufficiently equipped to manage his needs. Teachers alternated shifts throughout the day providing one-on-one supervision. He would dart away from staff, run throughout the building, and one a few occasions, even run outside of the building. There were safety concerns that led to a discussion about increasing supports and/or changing educational placements to a new school.
A meeting was convened with the family, teachers, staff, and administration. The mood was tense. It was expected that I would speak first. I sat silently for a moment during the introductions and thought about this child. I thought about what he had been doing that day and I thought about what made him happy. He frequently walked in the hallway with a staff member. He always waved and greeted the other children and staff. Whenever he saw another person, he would smile with a wide grin. He was socially motivated and his greetings were sincere.
At the start of the meeting, everyone at the table turned to me. I said, “He has the most beautiful smile. Everyone lights up when they see him. He loves to visit with people.” The sense of relief was immediate. The parents smiled. The father laughed. It was as if we had all been holding our breath and we suddenly began to breath again. The child’s parents had expected to hear only negative comments. We did eventually share the extent of his needs, but we didn’t share that information first. The meeting proceeded well and everyone was in agreement about the child’s needs.
The way that we describe our clients shapes how they are viewed. This child demonstrated behavioral concerns, but these were not his only defining characteristics. When we are able to describe people from multiple perspectives, we recognize strengths and individuality.
SEE ALSO: Opinion Poll
Sometimes it’s difficult to recognize positive traits when you are overwhelmed or frustrated. We can find strengths, skills, and preferences through focused observation by looking for a smile. At some point during the day, in some interaction or within some activity, a child will smile, even if it is fleeting.
• Note when the child smiles: describe the activity and communication partners
• Note when a staff member smiles at the child: describe the style of engagement and type of interaction
• Note when a peer smiles at the child: describe the events leading up to this shared exchange
A smile shows you happiness. Find the smile and it will guide you to the positive moments!
All of our treatment materials teach cultural values and morals. The words, photographs, drawings, games and activities represent what society perceives to be important. They imply ways to behave and belief systems.
My colleague and I were swapping stories about some of the outdated materials that we’ve found stored in the back of unused cabinets. Here were a few examples that we’ve seen:
· “An unmarried woman is called a “ ... ” as a sentence completion task
· “Go get a gun” to practice /g/ sounds at the short phrase level
· A picture of a woman’s hand, an engagement ring and the ring on her hand for three-part sequencing
· “Thong” (meaning flip-flop sandals) for “th” words
· A drawing of an ancient Egyptian bowing forward on the ground for “slave” to practice /s/ blends in CCVC combinations
· “What is this boy doing?” with a picture of a young boy sitting by the side of the road with his thumb out to represent hitchhiking to practice describing
It’s easy to see how these examples are inappropriate, dated and often amusing. Words change meanings, events change public understanding and habits shift generationally. The funny part is that no one thought that there was anything wrong with these materials when they were created, manufactured, sold and used in clinical settings. What if there is actually something inappropriate about the materials that you are using today? How would you even know?
ADVANCE Opinion Poll: How long do symptoms of speech or hearing deficits go undetected?
According to the 2015 American Speech-Language-Hearing Association (ASHA) Member and Affiliation Counts, 96.3% of ASHA certified Speech Language Pathologists are female, and 92.2% of ASHA members self-identified as non-minority (Caucasian/White).1 The National Center for Educational Statistics provides 2014 data on national public school enrollment for children: 62.1% White, 17.4% Hispanic, 12.4% African-American, 5.3% Asian, 0.2% Pacific Islander, 0.7% American Indian/Alaska Native and 2% two or more races.2 Children are rarely in leadership positions with adults. The power differential between children and adults likely prevents children from advocating for their cultural values or explaining why something is offensive.
Our professional organization does not mirror the populations who we serve. This may affect our ability to identify cultural appropriateness of materials and activities. Look at your materials in different ways:
· Are the drawings physically accurate or are they caricatures?
· Do the people featured in images reflect the diversity of your caseload?
· How do the activities and objects reflect the culture of the children and families you serve?
· Are the activities representative of what children would be doing today?
· Are the objects common to children’s experiences today?
· What are the underlying messages that are communicated by the images, activities, and objects?
· How do your materials reflect what you think is important in society?
· Do you agree with the values that your materials represent?
· Would families that you serve want their children to adopt the values that you are demonstrating? Have you asked them?
We don’t have to wait until our materials are laughably out-of-date and obviously offensive. We have the ability to partner with children and families so that what we teach honors a modern, diverse world.
1: ASHA Membership Profile: Highlights and Trends. (n.d.). Retrieved July 22, 2016, from http://www.asha.org/research/memberdata/
2: Digest of Education Statistics-Most Current Digest Tables. (n.d.). Retrieved July 22, 2016, from http://nces.ed.gov/programs/digest/current_tables.asp
Humans may be able to remember thousands of words, but we definitely can’t always find the word we want when we want it! We may have unlimited storage for words and concepts, but we definitely have limited retrieval.
We can make word recall easier through organization and categorization. When we think of with a word, we search through a large lexicon, like an internal database of words and concepts that reflect our understanding of the world. We typically store words through hierarchical relationships with increasingly broad superordinate categories, e.g., a poodle is a dog, which is an animal. We also store concepts together by similarities across key features, such as animals with paws, like cat, dog, lion, tiger, bear, etc.
When we recall a word, we search through specific categories stored in our brains. Scientists at the University of California in Berkeley have even charted the semantic maps that cover the cerebral cortex use fMRI data. Children who have language disorders often have difficulties with retaining, storing, recalling, and organizing words. Categorization activities are designed to illustrate meaningful relationships. Clinicians help children sort items into groups, describe group members, and explain exclusionary (doesn’t belong) and inclusionary (does belong) criteria.
Sorting may use one or more criteria. Dual sorting is when you need an item that matches two different semantic criteria, e.g., “What is a food that is cold?” or semantic plus phonological/orthographic criteria, e.g., “What is a food that starts with the letter A?” Dual sorting requires cross-referencing. You may access your entire list of foods, and then find foods that start with A. You might think of things that start with A, and then reference that list with foods. We see both of these strategies when we practice these activities with children.
OPINION POLL: How long do symptoms of speech or hearing deficits in children typically go undetected?
Categorization games can be cooperative. Children work together as a team using the letters of each child’s names as one of criteria. We write the first child’s name vertically along the left hand side of the paper, leaving room to add words across the page. If the child’s name is Thomas, we start with the letter T and pick one of the category titles for the first letter, e.g., a food that starts with T is tomato.
Here are some sample categories:
• Things that smell
• Things that are cold
• Things in the water
• Things in the sky
• Things with wheels
We all contribute words that match the criteria for each letter of the child’s name, before moving to the next child’s name. We vary the game in different ways:
• Using one category for all the letters
• Using one letter for all of the categories
• Rolling dice to determine the number of matching words needed
• Making the words into silly sentences, e.g., Thomas’ pet turtle eats tomatoes
Children join together to complete each name. Cooperative and collaborative games help children create a personalized final product that reflect everyone’s contribution.
Fairies represent magic and wonder.
The word “fairy” is a magic because it helps students transition from consonantal /r/ to vocalic /r/. The intervocalic /r/ in medial position allows us to produce /r/ at the end of the first syllable and the beginning of the second syllable, “fairrrr-- -rry”.
We can teach the postvocalic /r/ through anticipatory placement of the upcoming consonantal /r/. After a child has mastered placement for initial /r/, such as “red”, “road”, etc., moving to vocalic /r/ may be difficult. Transitional words have a syllable ending and syllable initiating /r/.
Fairy words can become the basis for an articulation activity. Students and I created two rainbow fairy boards with nine pictures each: red fairy, blue fairy, orange fairy, green fairy, pink fairy, flying fairies, flower fairy, fairy crown, fairy wand, fairy forest, fairy castle, fairy wings, fairy garden, fairy dreams, butterfly, rainbow, mushroom house, and unicorn.
We compared the different types of /r/ sounds and practiced placement for each /r/.
Initial consonant /r/: “rainbow”, “red”
Middle consonant /r/: “mushroom”
- Practice pulling tongue to the back of the mouth and elevating the sides of the tongue toward the molars to make a cup shape
Initial /r/ blend: “green”, “dreams”
- Break the word into two syllables, “mush-- -- rrroom” to emphasize /r/
- “Green”: Tongue stays in the back of the mouth for “g + r”
- “Dreams”: Tongue likely starts in the middle of the roof of the mouth and quickly moves from “d + r”. We actually say the /d/ in the /dr/ combination with a sound that is more like “j” and “dg” in “judge”.
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Vowel /r/ “air”: “fairy”
Vowel /r/ “or”: “orange”, “forest”, “unicorn”
- Underlying vowel is “ay” (like “hay”) with the mouth open and the lips spread in a slight smile. Hold the “ay”, and slowly retract the tongue and move it into the /r/ spot, “faaaaay-- -- -rrrrr—rrry”.
Vowel /r/ “ar” (like “car”): “garden”
- Underlying vowel is “aw” (like the East Coast dialect for “coffee”) with the lips puckered and rounded. Break the words into syllables. Hold the “aw” and slowly retract the tongue and move it into the /r/ spot
- “Forest”: “fawwww-- -- rrrrr—rest”
- “Orange”: “awwww—rrr-- -range”
- “Unicorn”: “uni-cawwww- -- -rrrrrr- n”
Vowel /r/ “er” (like “fur”): “butterfly”, “flower”
- Underlying vowel is “ah” (like at the doctor’s office, say “ah”) with the mouth open and the lips in neutral position (not rounded and not smiling). Hold the “ah” and slowly retract the tongue and move it to the /r/ spot, “gaaaahhh-- -- -rrrrr- -den”
We can capture the whimsy of fairies with engaging pictures, while using the power of anticipatory articulatory placement to teach vocalic /r/.
- This is one of the more difficult vowel /r/ sounds. The underlying vowel is “uh” (like“duh”).
- Butterfly: Break the word into syllables. Practice “bu-ttuh- fly” with the “uh” sound and slowly retract the tongue to the /r/ spot, “bu-- tuhhh-- -- rrrrrr-- -- fly”
- Flower: Separate the word and transition from “fl-- ow” to “uh”, “fl-- ow-- -- uuhhh-- -rrrr”
Cell phones and tablets allow for immediate audio and video recording. Students typically begin by making silly recordings of greetings and funny sayings.
Since most of us are initially surprised at how our voice sounds on a recording, we watch British Radio 1 Scientist, Greg Foot’s YouTube video, “Why does your voice sound different on a recording?”, which explains the inner ear and how vocal fold vibration causes the bones of the skull to vibrate. Students quickly become accustomed to hearing themselves and master skills operating the recording and playback buttons.
Students participate in generating word lists and sentences with their target words. We practice the sentences before recording, using a highlighter pen to underline target sounds on a cue card. Students make three recordings and choose the best recording to save. The QuickVoice app lets you label, store, organize, and send audio recordings.
For families who have access to technology, we send the recordings by email or text message. Students are encouraged to provide a description and directions to their parents/caregivers, such as, “This is me saying my /s/ words. Remind me to pull my tongue back, and lift the sides of my tongue to touch the insides of my top teeth.”
We make audio recordings at regular intervals. We compare current speech and prior recordings to show progress, such as, “Remember when it was hard to say words with ‘s’ and ‘th’ sounds together? You can totally do this now!”
OPINION POLL: How long do symptoms of speech or hearing deficits go undetected?
Video recordings let us monitor articulatory movement. Using a cell phone or tablet camera, you can focus the entire video on the mouth. Students hold a flashlight to provide extra lightening to the mouth. Video recordings let us view the best productions and pinpoint placement differences that change the quality of the sounds.
Students can direct their own mini-movies using the Apple iMovie app. A video recording of target words can become a mini-movie with sound effects, a musical score, introductory titles, and fancy transitions between scenes. Students can be cinematographers, recording each other and splicing together scenes for a montage video.
Watching and listening to recordings hones our observational skills. We can attend to small details and change the rate of presentation (slow, speed up, or freeze the recording) to pinpoint specific examples. Observation is different from interaction. In an interaction, we are conscientious about the thoughts and feelings of the other person. We are simultaneously considering the needs of our communication partner and how we are presenting ourselves. We are busy organizing our thoughts and caring about how we are perceived.
Recordings free our attention from the burden of interaction. We can study recordings objectively in a relatively decontextualized manner without worrying about the requirement to respond directly to the speaker. Students are often able to recognize their most successful and most challenging productions when they focus on watching themselves. Recordings let us study our speech.