Perspective Pieces

Recall that TISLP doesn’t review Perspective Pieces. However, we do love them (sometimes our FAVORITE publications each month are Perspective Pieces), and think you should be reading these gems, too. There were a TON published this month. Browse the titles for topics you’re interested in, and enjoy!

·      Understanding Word Reading Difficulties in Children With SLI

·      Practitioner Reflection That Enhances Interprofessional Collaborative Practices for Serving Children Who Are Deaf/ Hard-of-Hearing

·      Using Multilinguistic Strategies to Improve Decoding in Older School-Age Students in a Contextualized and Motivational Approach

·      A Review of Psychosocial Risks and Management for Children with Cleft Lip and/or Palate

·      The Role of Semantic Knowledge in Learning to Read Exception Words

·      Technology Training in Speech-Language Pathology: A Focus on Tablets and Apps

·      Reading Longer Words: Insights Into Multisyllabic Word Reading

·      Small Group Reading Instruction: Activities for Teaching Phonemic Awareness, the Alphabetic Principle, and Phonics in a Tier 2 Setting

·      Speech Assessment in Children With Childhood Apraxia of Speech

·      Does Access to Visual Input Inhibit Auditory Development for Children With Cochlear Implants? A Review ofthe Evidence

·      Efficacious Treatment of Children With Childhood Apraxia of Speech According to the International Classification of Functioning, Disability and Health

·      Beyond Eyes and Ears: The Need for Movement Analysis of Speech and Nonspeech Behaviors in ChildrenWith Cerebral Palsy

·      Leading the Way With Supervision Training: Embracing Change and Transforming Clinical Practice

·      Perceptions of Mentoring SLPs and Clinical Fellows During the Clinical Fellowship

·      How Stuttering Develops: The Multifactorial Dynamic Pathways Theory

·      Examination of Coaching Behaviors Used by Providers When Delivering Early Intervention via Telehealth to Families of Children Who Are Deaf or Hard of Hearing

·      We’ve Got Some Growing Up to Do: An Evidence-Based Service Delivery Model for the Transition of Care for the Young Adult with Cleft Lip and Palate

·      Are We Slipping Them Through the Cracks? The Insufficiency of Norm-Referenced Assessments for Identifying Language Weaknesses in Children With Hearing Loss

Communicating with families from a strengths-based perspective

"In writing from a strengths and abilities perspective, we write in a manner that is neutral and positive, limiting the extent to which we emphasize deficits in our interpretation of observed behaviors."

Many of us have been taught to write our evaluation and progress reports from a strengths-based perspective.The purpose of using strengths-based report writing is not only to be respectful and kind to the child and family (though that’s certainly enough!), but also because research has shown it improves the therapy process (e.g. clinician­–parent relationship) and outcomes (e.g. behavioral, academic); see article background for literature review. The authors state, “… documentation may be the anchor for how families have and share information…” and “…it’s important that … services occur in a way that leaves families with hope rather than despair.”

The purpose of this study was to evaluate current clinical practices. To do this, the researchers pulled 20 patient reports from an autism diagnostic clinic, collaboratively written by SLPs, OTs, and psychologists. They then analyzed 299 phrases from these reports, coding each as:

  • descriptive (e.g. “The child’s mother and stepfather accompanied him to the appointment.”
  • interpretive, positive (e.g. “Julie was easily redirected to tasks.”)
  • interpretive, negative (e.g. “Emily was generally unable to follow simple directions.”)
  • interpretive, neutral (e.g. “He exhibited a partial smile during the balloon activity.”)

Findings from the study demonstrated that, “…interdisciplinary providers… used phrases that were interpretive and negative significantly more often than other types of statements in their written diagnostic reports.” The authors state, “… clinicians may identify strengths and resources during a diagnostic evaluation, yet make intervention and programming recommendations around a specified diagnosis with little consideration for the identified strengths or family priorities.”

So, we may not be using strengths-based writing nearly enough. Now, an initial reaction from a clinician reflecting on his/her own writing may be, “Yeah, I use negative interpretive language. But it’s because I’m trying to get this kid the services he/she needs, and school districts and insurance companies don’t exactly pony up easily.” And the authors acknowledge this barrier—that reimbursement and service provision is deeply rooted in a deficits model. But does it have to be? Is there any data to indicate that negative interpretive language is more likely to result in service provision and reimbursement? Regardless, when the client, family, and intervention outcomes are the focus, writing from a strengths-based perspective has strong supportive evidence.

So, how can clinicians improve their skills? First, the authors suggest that some version of “active learning strategies”, with practice, coaching, feedback are likely to work better than passively listening to a brief CE course, for example. They also suggest clinicians may audit their own work by using Figure 1 from the article (which is basically a flow chart to figure out what type of language you’re using). Also, Table 5 in the article gives example of what strengths-based writing does and doesn’t look like, such as:

  • YES: “He hit his sister twice…” (descriptive)
  • YES: “He used happy and sad facial expressions on several occasions.” (neutral interpretive)
  • YES: “He maintained good eye contact…” (positive interpretive)
  • NO: “Social interactions were difficult.” (negative interpretive)
  • NO: “He was very impulsive in the waiting area.” (negative interpretive)

As can be seen, the use of descriptive, positive interpretive, and neutral interpretive is encouraged, and the use of negative interpretive is discouraged.

The authors state, “Providers are considered a guide or agent to the family, and their role is to assist them in identifying their own strengths and resources and help them realize their potential.” Also, “By focusing on strengths, we shift the starting point of care from problems (or deficits) to strengths and abilities.”

Braun, M.J., Dunn, W., Tomcheck, S.D. (2017). A pilot study on professional documentation: do we write from a strengths perspective? American Journal of Speech­–Language Pathology. Advance online publication. doi:10.1044/2017_AJSLP-16-0117

Self-advocacy during communication breakdowns

This article shows that some children and teens with neurodevelopmental disorders are at a particularly high risk for not speaking up (or gesturing, signing, using AAC) to indicate when they don’t understand what others trying to say. Self-advocacy during communication breakdowns is particularly challenging for boys with comorbid Fragile X and Autism, and also challenging for those with Down Syndrome. In addition to clinicians simply being aware of populations at particular risk for challenges, this article is also useful because their tasks for measuring non-comprehension are well-described. Thus, clinicians could reasonably use some of the tasks as inspiration for probing non-comprehension and resultant communicative behaviors in clinical settings.

Martin, G.E., Bartstein, J., Hornickel, J., Matherly, S., Durante, G., & Losh, M. (2017). Signaling of noncomprehension in communication breakdowns in fragile X syndrome, Down syndrome, and autism spectrum disorder. Journal of Communication Disorders, 65, 22–34.

*NEW*: Check out these perspective pieces!

Recall that The Informed SLP provides you with monthly reviews of empirical research (obviously... you're reading it right now!) This includes both quantitative and qualitative studies, levels 1a–3 (per ASHA). 

What hasn’t been covered to-date, however, are “Opinion” or “Perspective Pieces”Why doesn’t TISLP review perspective pieces? A few reasons: 1) they’re considered a lower level of evidence, 2) they tend to cover many points, referencing many different studies, rather than providing *a* new piece of evidence, which makes them tough to review in the TISLP style of brevity, and 3) these articles tend to be more readable by clinicians, so there's simply less need for a TISLP review. 

However! We're about to switch things up and, at least start TELLING you about these.
The thing is, if you're not reading these perspective pieces, you're really missing out. Many of them provide fantastic information for clinicians. So, as of January 2017, we've been collecting perspective pieces so that once every three months (or more often, if a bunch were published), we can provide you with links to the relevant ones. So—here ya go! January–March:

And more...

  • Gick et al. show us that the tongue is often bracing against the upper molars during speech, that this is normal, and cite a few previous studies with similar results. This finding isn't generalizable yet (particularly to kids; needs performed with more people, and extended to younger participants). Nonetheless, it’s an important point for pediatric SLPs to consider as we proceed with treatment of articulatory placement (as in, if you ask your student where his tongue is in his mouth, and he reports that the sides are touching his upper molars, don't freak out or ask him to change it).

  • Komesidou et al. discuss how “…expressive syntax is a vulnerable domain for children with Fragile X…”. In a longitudinal study of 39 kids (ages 2–10) with Fragile X, they found that children with Fragile X were able to make gains in expressive syntax over time (slowed in later years), but expressive language scores were significantly lower for those with Fragile X and autism symptoms.

  • Stadskliev et al. describe a parent support group for families of young AAC users. This small study provides insight into parents’ perspectives on learning to support their child with AAC, and provides clinicians with some ideas for how to better support children and their families.

Gick, B., Allen, B., Roewer-Després, Stavness, I. (2017). Speaking tongues are actively braced. Journal of Speech, Language, and Hearing Research. Advance online publication. doi: 10.1044/2016_JSLHR-S-15-0141.

Komesidou, R., Brady, N.C., Fleming, K., Esplund, A., Warren, S.F. (2017). Growth of expressive syntax in children with Fragile X Syndrome. Journal of Speech, Language, and Hearing Research. Advance online publication. doi:10.1044/2016_JSLHR-L-15-0360.

Stadskleiv, K. (2017). Experiences from a support group for families of preschool children in the expressive AAC user group. Augmentative and Alternative Communication. Advance online publication. doi: 10.1080/07434618.2016.1276960.

Factors in language development, birth to age seven

This longitudinal study of nearly 2000 children found that the effect of early life and home factors are clear in the early years, but that these “…have played out by age 4.” They also found that “…language abilities are more stable between 4 and 7 than between 2 and 4 years.” Meaning, it’s easier to know if a child will persist with a language disorder by measuring skills at age four than by measuring skills at age two (which many of us have figured out, clinically).
Also, the quality of life was found to be particularly low for the seven-year-olds with low language. These children “…experience significant limitations in school and psychosocial functioning at twice the rate reported in peers with typical language,” including low literacy skills and social–emotional and behavioral skills. Further, the authors state, “Health-related quality of life (HRQL) was measured on the parent-reported Pediatric Quality of Life Scale and “limitations” in HRQL were defined as scores falling ≥1 SD below the sample mean, a level found to be similar to that of children with severe or chronic health conditions such as rheumatic conditions and newly diagnosed cancer in a large population sample.” They state, “…it is a significant concern that children with low language were experiencing (HRQL) limitations at more than twice the frequency reported by their peers with typical language.”
McKean, C., Reilly, S., Bavin, E.L., Bretherton, L., Cini, E., Conway, L. Mensah, F. (2017). Language Outcomes at 7 years: early predictors and co-occurring difficulties. Pediatrics, 139(3).