It’s 10 AM: Do you know where your gym teacher is?

When you hear “cotreatment,” what other professionals spring to mind? OTs? PTs? How about your friendly neighborhood adapted phys ed teacher? In this study, an SLP and an adapted PE teacher (I’m guessing they don’t like to be called APEs?) teamed up to teach concept vocabulary to 10 pre-kindergarteners with Down Syndrome.

Why target vocabulary in gym class? A couple of reasons. One, having physical experiences related to a new word increases the semantic richness of the learning—something that we know helps kids. Two, a branch of developmental theory (dynamic systems theory, if you’re interested!) holds that language and motor skills develop in a coordinated, interconnected way. Plus? Getting up and moving during your vocab lesson is fun!

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Each week, five different concept words were targeted by the SLP only, the adapted PE teacher only, or both in a co-treatment condition. Teaching occurred in 30-minute large group lessons, four days per week for nine weeks total. Check out the article for specifics about what the lessons looked like in each condition—the key thing is that with co-treatment, the kids got to demonstrate receptive understanding of the concepts through a variety of gross motor actions.

Overall, the intervention had a weak effect with only the PE teacher (makes sense, since teaching words isn’t the point of gym), and a medium effect if the SLP was involved. Out of the ten children, four learned more concepts in co-treatment weeks as compared to weeks when the SLP or PE teacher worked alone. The other six did about the same either way. The authors noticed that the kids who learned better in co-treatment were the children with the highest non-verbal intelligence scores and better ability to use effortful control (so, for example, stopping when a grownup says to stop), but more research is needed to draw strong conclusions from those results. Big picture, here? This type of co-treatment, when done thoughtfully and collaboratively, doesn’t hurt and may help some kids. Also, when many of us are trying to get out of the therapy room and treat kids where they are, bringing intervention to gym class makes a lot of sense from a “least restrictive” point of view. And once again… it’s fun!

 

Lund, E., Young, A., & Yarbrough, R. (2019). The Effects of Co-Treatment on Concept Development in Children With Down Syndrome. Communication Disorders Quarterly, 1525740119827264. doi:10.1177/1525740119827264

And more...

  • Accardo and colleagues provide an overview of effective writing interventions for school-age children with ASD. Most interventions took place in the classroom and used mixed approaches, combining “ingredients” like graphic organizers, video modeling, and constant time delay—a prompting strategy borrowed from ABA. Within the review, Tables 1 and 2 give an idea of what each one looked like, so check that out.

  • Baker & Blacher assessed behavior and social skills in 187 13-year-olds with ASD, intellectual disabilities (ID), or both. They found that having ID along with ASD was not associated with more behavior problems or less developed social skills as compared with ASD only.

  • Cerdán et al. found that eighth graders who had poor comprehension skills correctly answered reading comprehension questions more often when the question was followed by a rephrased, simplified statement telling them exactly what they needed to do.

  • Curran et al. found that preschool-aged children who are DHH and receive remote microphones systems in their homes have significantly better discourse skills (but no better vocabulary or syntax skills) than otherwise-matched children who don’t get those systems.

  • Facon & Magis found that language development, particularly vocabulary and syntax comprehension, does not plateau prematurely in people with Down Syndrome relative to people with other forms of intellectual disability. Language skills continue to show growth in both populations into early adulthood. (We’ve previously reviewed specific interventions that have resulted in language gains among older children and teens with Down Syndrome. )

  • Hu et al. suggest that computer-assisted instruction (CAI) can improve matching skills in school-age children with autism and other developmental disabilities. Although techy and exciting, CAI on its own isn’t enough—evidence-based instructional strategies like prompting and reinforcement have to be programmed in, too. This CAI used discrete trial training, and was more efficient (fewer prompts and less therapy time were needed for mastery!) than a traditional, teacher-implemented approach with flashcards.

  • Lim et al. found that the literacy instruction program MULTILIT was effective with school-age children with Down syndrome. MULTILIT combines phonics and sight word recognition instruction, geared toward children with students who are “Making Up Lost Time in Literacy” (MULTILIT; get it?). The program was implemented 1:1 for 12 weeks, and the students made gains in phonological awareness, word reading and spelling. MULTILIT has been investigated by the developers, but this is the first time it’s been studied by other researchers—and with kids with Down syndrome in particular.  Note: This article wasn’t fully reviewed because the training (provided only in Australia) is not available to the majority of our readers.

  • Muncy et al. surveyed SLPs and school psychologists and found that, in general, these professionals are underprepared to assess and treat children with hearing loss and other, co-occurring disabilities, and that they lack confidence in this area. Participants reported many barriers to valuable collaboration with other professionals, like audiologists (hint: there aren’t enough of them!), and that they want more training in this area.

  • Schlosser et al. found that 3–7 year old children with ASD accurately identified more animated symbols than static symbols. The animated symbols represented verbs; for example, depicting a person turning around versus a still line drawing of “turn around.” It makes sense to see action verbs—well—in action; however, researchers acknowledge we can’t make grid displays full of animated symbols since that could be overstimulating. The next step is to test the effects of animation on symbol identification with other more well-known symbols sets like PCS.

  • Scott et al. used science books and a signed dialogic reading program with an 11-year-old Deaf student, and found increases in the student’s ability to answer comprehension questions.

  • St John et al. found that 92% of their sample of children and adolescents with Klinefelter syndrome also had a communication impairment. Pragmatic, language, and literacy impairments were common, and the researchers described some speech impairments as well. Establishing a comprehensive communication profile for this group is important because we’re still learning about Klinefelter syndrome, which is caused by one or more extra X chromosomes.

  • Updates on PEERS, a structured social skills program for adolescents and young adults we’ve discussed before! Wyman & Claro used the school-based version of PEERS both with adolescents with ASD (the target audience) and those with intellectual disabilities (ID; an overlooked group in social skills research who may benefit nonetheless). Both groups of students improved their social knowledge, and the ID group (but not the ASD group) increased social interactions with friends outside of school. Meanwhile, Matthews et al. found that speeding up the traditional, clinic-based PEERS program, by offering it in 7 weeks (twice weekly sessions) instead of 14, didn’t reduce its effectiveness.

Accardo, A. L., Finnegan, E. G., Kuder, S. J., & Bomgardner, E. M. (2019). Writing Interventions for Individuals with Autism Spectrum Disorder: A Research Synthesis. Journal of autism and developmental disorders, 1-19. doi:10.1007/s10803-019-03955-9

Baker, B. L., & Blacher, J. (2019). Brief Report: Behavior Disorders and Social Skills in Adolescents with Autism Spectrum Disorder: Does IQ Matter? Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03954-w

Cerdán, R., Pérez, A., Vidal-Abarca, E., & Rouet, J. F. (2019). To answer questions from text, one has to understand what the question is asking: Differential effects of question aids as a function of comprehension skill. Reading and Writing. doi:10.1007/s11145-019-09943-w

Curran, M., Walker, E. A., Roush, P., & Spratford, M. (2019). Using Propensity Score Matching to Address Clinical Questions: The Impact of Remote Microphone Systems on Language Outcomes in Children Who Are Hard of Hearing. Journal of Speech, Language, and Hearing Research. doi:10.1044/2018_JSLHR-L-ASTM-18-0238

Facon, B., & Magis, D. (2019). Does the development of syntax comprehension show a premature asymptote among persons with Down Syndrome? A cross-sectional analysis. American Journal on Intellectual and Developmental Disabilities. doi: 10.1352/1944-7558-124.2.131

Hu, X., Lee, G. T., Tsai, Y, Yang, Y., & Cai, S. (2019). Comparing computer-assisted and teacher-implemented visual matching instruction for children with ASD and/or other DD. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03978-2

Lim, L., Arciuli, J., Munro, N., & Cupples, L. (2019). Using the MULTILIT literacy instruction program with children who have Down syndrome. Reading and Writing. doi:10.1007/s11145-019-09945-8

Matthews, N. L., Laflin, J., Orr, B. C., Warriner, K., DeCarlo, M., & Smith, C. J. (2019). Brief Report: Effectiveness of an Accelerated Version of the PEERS® Social Skills Intervention for Adolescents. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03939-9

Muncy, M. P., Yoho, S. E., & McClain, M. B. (2019). Confidence of School-Based Speech-Language Pathologists and School Psychologists in Assessing Students With Hearing Loss and Other Co-Occurring Disabilities. Language, Speech, and Hearing Services in Schools. doi:10.1044/2018_LSHSS-18-0091

Schlosser, R. W., Brock, K. L., Koul, R., Shane, H., & Flynn, S. (2019). Does animation facilitate understanding of graphic symbols representing verbs in children with autism spectrum disorder? Journal of Speech, Language, and Hearing Research. doi:10.1044/2018_JSLHR-L-18-0243

Scott, J. A., & Hansen, S. G. (2019). Comprehending science writing: The promise of dialogic reading for supporting upper elementary deaf students. Communication Disorders Quarterly. doi:10.1177/1525740119838253

St John, M., Ponchard, C., van Reyk, O., Mei, C., Pigdon, L., Amor, D. J., & Morgan, A. T. (2019). Speech and language in children with Klinefelter syndrome. Journal of Communication Disorders. doi:10.1016/j.jcomdis.2019.02.003 

Wyman, J., & Claro, A. (2019). The UCLA PEERS School-Based Program: Treatment Outcomes for Improving Social Functioning in Adolescents and Young Adults with Autism Spectrum Disorder and Those with Cognitive Deficits. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03943-z

Traveling SLP Magic: How to be in two places at once

Where are my itinerant clinician friends—those SLPs who pack up their therapy room in a weird rolling suitcase thing, make nice with administrative assistants all over town, eat in their cars, and find themselves constantly thwarted by conflicting building schedules? Yes, hello there! Let’s talk about how things could be different.

In a word… telepractice. As much as we value being physically present for our students and colleagues, we’re living in the age of Facetime, video conferencing, and working remotely. The whole realm of using technology to be a place that you’re not is now mainstream, and easier for people to accept and accommodate than even a few years ago. And after all, a 15-minute drive can easily mean 30 or 40 minutes of lost productivity, once you factor in packing/unpacking, parking, check-in, and everything else involved with a transition between buildings. This article takes the perspective that it’s not whether SLPs should be using telepractice, but how. There’s been plenty of research showing that telepractice can work (see our reviews on the topic), we just need to be smart about:

What job tasks we target for telepractice, and

How we go about it

The article lays out two case studies of SLP using telepractice for (1) direct service to high school students, (2) remote supervision of an SLPA, and (3) remote observations and consultations by a district AAC specialist. They include a lot of really helpful details about how they set these systems up, so definitely check out the article if you’re thinking about trying something similar. The authors studied the effectiveness of telepractice in these cases through a survey. The participants reported that:

  • Telepractice was effective and generally easy to implement for both direct and indirect services/supervision

  • The dreaded technical issues could be dealt with

  • It could be motivating to students, and

  • The SLPs had increased flexibility and decreased travel time

The downsides? Tech troubles did happen, and there were also some issues communicating and coordinating with sites. Choosing the right partners and laying down the groundwork is critical to making it work!

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The last part of the article lays out some very practical pro tips for other SLPs. For example, they recommend holding a team meeting upfront to demonstrate the systems you’ll use, answer questions, and secure buy-in from everyone involved. Also consider small but impactful steps like scheduling email reminders (with backup contact information and links to video sessions), or using two separate computers on the clinician end of thingsone for the audio/video, and one for all your other therapy “stuff.”  And if your admin needs any convincing? Remind them that you’ll be saving them time (from travel) and potentially money (from mileage reimbursements)!

Note: Not all states allow Medicaid billing of telesessions quite yet. So if you’re in the schools, that is an important thing to check first.

 

Boisvert, M. K., & Hall, N. (2019). Telepractice for School-Based Speech and Language Services: A Workload Management Strategy. Perspectives of the ASHA Special Interest Groups. doi:10.1044/2018_PERS-SIG18-2018-0004

How am I supposed to know if an app is evidence-based?

Aha! This is a fun one. The simple answer is that the iPad has been around for less than a decade (shocking, huh?), and there is very little research on apps in our field (the little we do have is on AAC and aphasia). Nooooo! So you see where this is going: it’s not easy. The best you can do is perhaps, 1) know the research on the effective ingredients of speech–language treatment in the first place, and see if you can identify those within the apps, and 2) know the research on multimedia learning (not from our field; see article for overview) and use that to also guide your thinking. Then, of course, EBP also requires considering clinical practice and client data as well…

Challenging as this is, Heyman (2018) has started to pick at the question with a survey and interview study of hundreds of SLPs, asking how SLPs are selecting apps for therapy. The results:

How do SLPs know which apps to consider?

They’re mostly relying on word of mouth and social networks.

Then how do SLPs make purchase decisions?

“The main finding reported was that participants used apps because they were engaging and motivating to children…”

The top two features SLPs reported as important were:

  1. different developmental/difficulty levels and

  2. child-friendly theme

(See article for a ranking of 25 other features SLPs prioritize!)

Finally, “Participants emphasized that apps were a tool and used them in the same was as any other tool or toy...”

What do we think of this?

Well, it seems that SLPs’ biggest concern is just getting kids excited about the therapy process. And that makes sense. But, ideally, we need to find a way to start to identify which apps will actually give us the features and flexibility to make good progress on speech–language goals. Heyman provides a checklist of features that could be considered, including things like: Can targets be repeated? Can items be skipped? How much control do you have over the screen (e.g. ability to remove elements)? … But we need a lot more research in this area to know which of these features matter, and when.

In the meantime, a little more digging by SLPs could certainly help! Heyman states, “Interestingly, only 22% of respondents looked at the developer sites in order to obtain information about apps; yet, information regarding the background and research evidence are often provided on the developer site.”

 

Heyman, N. (2018) Identifying features of apps to support using evidence-based language intervention with children. Assistive Technology. Advance online publication. doi: 10.1080/10400435.2018.1553078.

And more...

Brinton et al. found that five elementary-age children with DLD rarely described characters’ mental states (responses, plans, emotions) when generating stories and struggled to answer direct questions about characters’ mental states. The authors suggest that children with DLD may have difficulty with social and emotional concepts. 

Chenausky et al. found that baseline phonetic inventory and ADOS scores were most predictive of speech target approximations post-speech therapy in minimally verbal children with autism (more than IQ, language, age). And that’s not terribly surprising (except the age part—cool that they made good speech gains in older elementary children!). Perhaps the more interesting thing about this study, though, is what they did in speech therapy. It’s called “auditory motor map training”, and is basically the addition of rhythm (tapping drums) and intonation (singing the speech targets) to speech therapy. The researchers are finding that adding these tactile and auditory cues is better than not having them; so worth trying! 

Cooke and Millard asked school-aged children who stutter what they considered to be the most important therapy outcomes. The children reported increased fluency, independence, and confidence, as well as others knowing how to support them and how to make communication situations feel easier. This study serves as a good reminder that stuttering is more than dysfluent speech. The cognitive (thoughts and attitudes) and affective (feelings) components should also play a role in how we evaluate therapy outcomes.  

Dyson et al. taught 20 vocabulary words to elementary-age children with low vocabulary scores using examples, games, and worksheets. After 10 weeks of 20-minute small-group sessions, children learned five new words on average; significantly more than children in a control group. (Email the authors for free materials!)

Giusto and Ehri found that third-graders with poor decoding and average listening comprehension benefitted from a partial-read aloud test accommodation with pacing (PRAP). When examiners read aloud only directions, proper nouns, and multiple choice questions, the students improved their reading comprehension of the test passages. Although you may not be directly assessing these students, these findings may be helpful if you’re ever in the position to recommend accommodations for this subset of children.

Gough Kenyon et al. found that, compared to typical peers, 10- to 11-year-olds with developmental language disorder (DLD) struggled with making elaborative inferences (drawing on background knowledge not stated) but not cohesive inferences (linking information given) after reading a passage. They suggest targeting elaborative inferencing to boost reading comprehension for children with DLD.

Millard et al. add to the evidence base for Palin Parent–Child Interaction Therapy for young children who stutter, finding a reduction in stuttering severity and improvements in both parent and child attitudes and confidence following a year of participation in the program.

Sabri & Fabiano-Smith analyzed a case study and found that, given early implantation and support in both languages, a bilingual child with cochlear implants can acquire two phonological systems, although likely at a slower rate than other bilingual children.

Using (and maybe struggling with) the Lidcombe Program with your young clients who stutter? Van Eerdenbrugh et al. studied the challenges clinicians have with implementing the program and surveyed experts to come up with solutions.

 

Brinton, B., Fujiki, M., & Asai, N. (2018). The ability of five children with developmental language disorder to describe mental states in stories. Communication Disorders Quarterly. Advance online publication. doi: 10.1177/1525740118779767.

Chenausky, K., Norton, A., Tager-Flusberg, H., & Schlaug, G. (2018). Behavioral predictors of improved speech output in minimally verbal children with autism. Autism Research. Advance Online Publication. doi: 10.1002/aur.2006.

Cooke, K., & Millard, S. K. (2018). The most important therapy outcomes for school-aged children who stutter: An exploratory study. American Journal of Speech-Language Pathology, 27(3S), 1152.

Dyson, H. , Solity, J. , Best, W. and Hulme, C. (2018), Effectiveness of a small‐group vocabulary intervention programme: evidence from a regression discontinuity design. International Journal of Language & Communication Disorders, 53: 947-958. doi:10.1111/1460-6984.12404

Giusto, M., & Ehri, L. C. (2018). Effectiveness of a partial read-aloud test accommodation to assess reading comprehension in students with a reading disability. Journal of Learning Disabilities. Advance online publication. doi:10.1177/0022219418789377

Gough Kenyon, S. M., Palikara, O., & Lucas, R. M. (2018). Explaining reading comprehension in children with developmental language disorder: The importance of elaborative inferencing. Journal of Speech, Language, and Hearing Research, 61(10), 2517–2531. 

Millard, S. K., Zebrowski, P., & Kelman, E. (2018). Palin Parent–Child Interaction Therapy: The Bigger Picture. American Journal of Speech–Language Pathology, 27(3S), 1211–1223.

Sabri, M. & Fabiano-Smith, L. (2018). Phonological Development in a Bilingual Arabic–English-Speaking Child With Bilateral Cochlear Implants: A Longitudinal Case Study. American Journal of Speech–Language Pathology. Advance online publication. doi: 10.1044/2018_AJSLP-17-0162.

Van Eerdenbrugh, S., Packman, A., O'Brian, S., & Onslow, M. (2018). Challenges and Strategies for Speech-Language Pathologists Using the Lidcombe Program for Early Stuttering. American Journal of Speech–Language Pathology, 27(3S), 1259–1272.

How do you interpret “educational performance”?

We don’t have to remind you of all the challenges facing children with speech sound disorders (SSD), especially since roughly 90% of school-based SLPs serve students with SSDs. Although we have that in common, we’re pretty different in how we (and our districts/states) interpret “educational performance,” a key phrase from IDEA. These differences have a huge impact on which students ultimately get services—and which students don’t.

By surveying SLPs nationwide, the authors of this article found a lot of variability. The guidelines we use come from different agencies (states, districts, state speech–language–hearing associations, etc.), but at least some of the differences are due to our individual decision making, because the survey found that “SLPs are familiar with their state guidelines but do not consistently use them as evidenced by considerable variability within and between states.”

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Essentially, we are taking different factors into account when looking for the impact (or lack thereof) of SSDs on kids’ school success. Are you looking at only at grades? Do you weigh access to the curriculum, oral participation in class, or spelling? Do you take social-emotional adjustment into the mix? Consider how you determine educational impact now, and how either a narrower or broader view of the concept would change your practice. Would you have more artic/phono students? Fewer? Would they get services earlier, or keep them longer? Would you do your evals differently? Having the most possible students in therapy isn’t really the goal (must think least restrictive environment), but under-serving these students is definitely a problem.

Big takeaway here: other SLPs out there are likely making decisions very differently from how you are—and it’s time we talked more about it. As you reflect on the questions above, talk with your SLP coworkers and friends—even consider the conversations you might have with administrators, policy makers, and your local and state agencies. Small changes in policy (or how you and your coworkers apply the policy) could help ensure kids with SSDs get the services they need in the schools.

Farquharson, K., & Boldini, L. (2018). Variability in interpreting “educational performance” for children with speech sound disorders. Language, Speech, and Hearing Services in the Schools. Advance online publication. doi: 10.1044/2018_LSHSS-17-0159.

School-based assessments: Why do we do what we do?

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Fulcher-Rood et al. interviewed school-based SLPs across the United States about how we choose assessment tools and diagnose/qualify our students. They wanted to understand not just which tools we use, but why we choose them, what “rules” we follow when we make diagnostic decisions, and what external factors affect those decisions. We’ve reviewed some other surveys of SLPs’ current assessment practices in the past—on the use of LSA, and on methods we’re using to assess bilingual clients—and these findings are kinda similar. There’s a lot of detail in the survey, but we’ll just focus on a couple things here.

  • We give a LOT of standardized tests, and qualify most of our students for service on the basis of those scores, with reference to some established cut-off (e.g. 1.5 SD below the mean)
  • We don’t do a ton of language sample analysis (at least the good ol’ record-transcribe-analyze variety)
  • We use informal measures to fill in the gaps and show academic impacts, but those results are less important when deciding who qualifies for service

None of this is likely to surprise you, but given what we know about the weaknesses of standardized tests (especially given diversity in home languages, dialects, and SES), the arbitrary nature of most cut-off scores, and the many advantages of LSA and other non-standard measures… it’s a problem.

So, what barriers are we up against when it comes to implementation of evidence-based assessment practices? First—let’s say it all together—TIME. Always time. Standardized tests are easy to pull, fairly quick to administer and score, and you often have a handy dandy report template to follow. Besides that, we’re often subject to institutional guidelines or policies that require (or *seem* to require) standard scores to qualify students for services.

None of the SLPs in the survey mentioned that research was informing their selection of assessment tools or diagnostic decisions. That doesn’t necessarily mean none of them consider the research—they just didn’t bring it up. But guys! We need to be bringing it up! And by “we,” I mean YOU! The person taking your all-too-limited time to read these reviews. The authors of the study pointed out (emphasis mine) that “there are differences between policies (what must be done) and guidelines (how can it be done)... potentially, school-based SLPs interpret some of the guidelines as mandatory, instead of as suggested.” Maybe there’s some wiggle room that that we aren’t taking advantage of. We can speak up, evaluation by evaluation, sharing our knowledge of research and best practices.

It all boils down to this: “While it is important for SLPs to adhere to the policies set forth by their employment agency, it is equally important for SLPs to conduct evaluations guided by best practice in the field. SLPs may need to advocate for policy changes to ensure that evidence-based practice is followed.”

Fulcher-Rood, K., Castilla-Earls, A. P., & Higginbotham, J. (2018). School-Based Speech-Language Pathologists’ Perspectives on Diagnostic Decision Making. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2018_AJSLP-16-0121.