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Welcome, speech–language pathologists!

What is this membership all about?

In order to implement evidence-based practice, we must know what the research shows. But knowing the research is a huge task, and unreasonable for individual SLPs to take on alone.

That’s where we come in. Our reviews inform you about the latest clinically-relevant research, and discuss how it can be applied directly to practice.

These Evidence You Can Use reviews are divided into three sections, per the age of clients you serve:

  • Birth to Three (birth–3)

  • Preschool & School-Age (ages 3–21)

  • Adults (21+)— brand new!

As a member you may belong to one, two, or all three sections.


What do the reviews look like?

You can read, print, or listen to our content each month:

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You can also browse by topic:

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…or search for a specific topic:

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Here are some sample reviews.

They’re all editorial reviews of the research, with lots of links out to additional information and sometimes even free therapy materials (that’s our favorite— when the scientists share treatment protocols!)


Cultural proficiency 101: Reconsidering the 30 million word gap

Birth to Three

Back in the 1980s, Hart & Risley conducted a hallmark study documenting that children from poor communities hear 30 million fewer words than middle class children. This finding has been often cited to document why so many low SES children perform poorly when they enter school and score lower on measures of language and vocabulary.

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Sperry et al. brought the results of this study into question, with the idea that the original methodology of the study may have been culturally biased and not applicable to real-life environments. In particular, the original study looked only at directed speech from the primary caregiver (usually the mother) to the child. They did not measure the number of words spoken by other members of the household, speech that the child may have overheard, and they encouraged the family members not to talk to each other so that they could focus on just the mother/child interaction.

While interaction between the primary caregiver is certainly important, Sperry et al. attempted to expand our knowledge of children’s verbal environments by measuring all speech directed to the child and all bystander or “overheard” speech. The findings were quite interesting. There was no significant gap between number of words heard among any social or economic class. Additionally, some working class and poor communities showed an advantage in the number of words the children heard. Additionally, there was significant variation within classes, rather than between classes. For instance, in this study, poor African American families in the south addressed far more words to their children compared to primary caregivers from other low SES communities (e.g. rural, working class).

These results are important to consider as EI therapists working with diverse families. Often times minority families are viewed in a “one size fits all” context, viewing the majority group (middle class white American families) as the model. In fact, in many cultures, children are not spoken to directly during the first few years of life, but still reach developmental language milestones similarly to American children. In sum, different cultures have different preferred ways of interacting with their children, which may all have different benefits. As culturally proficient therapists, we need to look at the whole family.

P.S. This article sparked a bit of a debate:

For a response to this article from another group of researchers, click here.

For Sperry et al.’s reply, click here.

And for another good plain-language overview, see here

Sperry, D. E., Sperry, L. L., Miller, P.J., (2018). Reexamining the verbal environments of children from different socioeconomic backgrounds. Child Development. doi: 10.1111/cdev.13072

Does the order of your therapy activities matter?

Preschool & School-Age

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You see a kindergartener with developmental language disorder (DLD) for language therapy. You pick some toys, a game, or a book that will elicit lots of examples of the grammar targets you’re working on. While you play, you give her plenty of models, and use recasts to help her correct her own productions. Sounds pretty typical, yes?

This article has a tip to make that intervention even better: if you’re doing auditory bombardment as part of language therapy, do it at the end of your sessions.

So often we read research studies and think, “That sounds great, but how would I EVER implement it in my real practice?” Here, we have a small study examining a specific, practical question on how to make the therapy we’re doing more effective. YAY. More of this, please!

In the study, a group of 4–6-year-olds with DLD got a half hour of enhanced* conversational recast treatment for targeted morphemes, of which the first or last 2–4 minutes were devoted to an auditory bombardment activity—something like having the child turn over picture cards while the clinician said phrases with the target structure. Overall, the therapy was effective, and the children improved in their use of the focus morpheme compared to controls. But—the researchers found that more children benefited from the therapy when auditory bombardment came last. Why? The authors suggest that it helped “consolidate the child’s internal representation” of the morpheme. Doing the bombardment first didn’t seem to offer any advantage over not doing it at all, based on a comparison with equivalent treatment groups from the authors’ previous work.

*Recasting, where the clinician repeats the child’s utterance, correcting any errors of grammar, is an evidence-based language intervention strategy. The “enhanced” part means that clinicians got the children’s attention before doing the recast, and also that they made sure to use different verbs each time. We know children learn better from a wider variety of examples. Check out the paper for more details on how the actual therapy worked!

Plante, E., Tucci, A., Nicholas, K., Arizmendi, G. D., & Vance, R. (2018). Effective Use of Auditory Bombardment as a Therapy Adjunct for Children With Developmental Language Disorders. Language, Speech, and Hearing Services in Schools. doi: 10.1044/2017_LSHSS-17-0077.

“Ouch!”—Selecting pain vocabulary for kids who use AAC

Preschool & School-Age

A couple years back, we reviewed this study that developed a list of pain vocabulary for kids who use AAC. Quick refresher on their rationale—all kids have and need to express pain, but for kids who use AAC, this can be challenging since we often don’t know what they want to say when in pain. So the authors asked children, parents, teachers, and adult AAC users how they would respond in painful situations, and compiled a response list. Makes sense, right?  This list should be widely used!  Well, not so fast. There were some caveats, including that the list was drawn only from participants in South Africa. But, we have NEW good news for you:

The same authors took that vocabulary list, and combined it with 16 other studies of children’s pain expressions. The studies included direct quotes from 2,683 children who spoke six different languages, and came from eight different countries. They took the pain words and phrases, divided them into descriptive themes and categories (e.g., indicates location of pain, or requests treatment), broke them down into single words, and separated these words into core (“you”), pain-related fringe (“medicine”), and other fringe (“movie”).

The end-result? A list of 60 pain-related words that children use most often to talk about their pain (see paper Appendix), as well as some useful categories of words that we might not initially consider when selecting vocabulary (e.g., “employing fake bravery”).

So, now can we feel confident using this list with kids on our caseload?  We’d say so, but of course with some awareness of its limitations. It is a great starting point, but as the authors point out—when selecting vocabulary for each individual child, we must consider his/her individual context/needs. Also, the review only included typically-developing children, so we can’t ignore that we may be missing out on some vocabulary unique to kids with disabilities, and specifically those who use AAC.

Johnson, E., Boshoff, K., & Bornman, J. (2018). Scoping review of children's pain vocabulary: Implications for augmentative and alternative communication. Canadian Journal of Speech–Language Pathology and Audiology. www.cjslpa.ca/detail.php?ID=1226&lang=en.

Want grammar skills to generalize? Load your therapy with “hard” verbs

Preschool & School-Age

In this paper from ASHA’s special issue on Statistical Learning, Owen Van Horne et al. added additional data to an older study that helps us learn how to superpower our grammar interventions (specifically regular past-tense marking) by taking advantage of the statistical properties of language.

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Kids tend to be most accurate with past tense -ed on verbs that they hear in the past tense a lot, that are easy to say, and that make a lot of sense in the past tense—words like played and jumped. Seems pretty obvious, yeah? We are good at stuff that is easy. And when your goal is early success for your clients, you follow a developmental model and pick the easiest targets to start with. But there’s another, less intuitive, school of thought that says: Hey, life is full of the easy verbs. To really learn how to mark tense, kids need to get the hard verbs too. Let therapy be the place where they hear the hard ones. (Think of the complexity approach for phonology; see here for a recent tutorial).

So here’s the gist of it—you want to concentrate on verbs that are more complicated in their past-tense-edness, in terms of:

  • Frequency: Kids hear them in the past tense less often;

  • Phonology: They take the more complex form of the past tense morpheme (–ɪd vs. –t/–d, as in “glided” vs. “hopped”); and/or

  • Semantics: They describe an action that’s ongoing or incomplete*

The authors tested this approach with 20 children (4–10 years old) with DLD and poor performance on regular past-tense probes. The children whose therapy targeted “hard” verbs first (all verbs came from the set analyzed in this paper) were more accurate with regular past tense in both structured probes (right after intervention) and in language samples (post-intervention and 6–8 weeks later).

How could this look in real life? You could take your go-to therapy tools (play sets, favorite books, etc.) and brainstorm some target words ahead of time to help you get started. Jot them down on a post-it and keep it right in the box. Always pulling out that farm set? Maybe the cow rested in the barn while the pigs wiggled in the mud.

*This part is the trickiest to wrap your brain around. It’s helpful to make a contrast with the kind of verbs we don’t want, the ones that have a clear endpoint implied. For example, “build.” Once you’ve built something, it’s done, you can’t keep doing it. Same with “eat” or “drop.” The linguistic term for this is telic (so verbs that are “endless,” like “breathe” and “feel” are atelic). That’s Greek, y’all. Again, you can refer to the source for this study’s word lists here for more examples.

Owen Van Horne, A. J., Curran, M., Larson, C., & Fey, M. E. (2018). Effects of a Complexity-Based Approach on Generalization of Past Tense –ed and Related Morphemes. Language, Speech, and Hearing Services in Schools. doi: 10.1044/2018_LSHSS-STLT1-17-0142.

Throwback (2018): Silent aspiration in healthy adults?!?

Adults

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True or False: Healthy people do not silently aspirate.

FALSE! Huh?  According to this study by Butler et al. (2018), while most healthy participants, of course, did not have penetration or aspiration, 18% of participants aspirated at some point during the study and 75% of those aspirators did not cough or clear their throats. Let’s dig a little deeper into the details:

The participants, aged 30–90, in this study were all HEALTHY. No history of swallowing, speech, or voice problems and no known neurologic or otolaryngologic disorders. They could walk, talk, and they all considered themselves to be healthy. No remote stroke. No reported pneumonias. Anyone with a reason for an SLP referral was not included in this study.

This study used Fiberoptic Endoscopic Evaluation of Swallowing (FEES) to look at the Penetration-Aspiration Scale (PAS) ratings of swallows of different volumes of water and milk. The breakdown of these results by age, sex, volume, and more is in Tables 3 and 4 and they are definitely worth looking at yourself if you ever read or write FEES reports.

Let’s get back to healthy people silently aspirating. First, over 80% of penetration episodes and 64% of aspiration episodes did not cause a throat clear or cough. This means we need to seriously reevaluate the assumption that silent aspiration is necessarily disordered and consider if, in general, we are over-interpreting penetration or aspiration that does not cause a response.

How much aspiration are we talking about here? The author describes “the majority (but not all) of the aspiration events in this study to be trace in nature ranging from a pea-sized amount of aspirate just below the level of the vocal folds to a small thin line of aspirate coursing down the anterior trachea.” So, it’s there, but typically not a ton of liquid entering the lungs. Also, most of the participants who aspirated did so intermittently. A third of the participants in their 80s silently aspirated at least once, but this only occurred in less than 3% of the trials.

Most of the people who were aspirating, silently or not, were over 60 with an increasing chance of aspiration as the participants got older. And, overall, PAS scores were slightly higher for milk (2% or whole) when compared with water, though this effect was only significant in participants over 70 (Figure 1). While the impact wasn’t huge, if you typically use milk in your FEES studies and your patient aspirated, you could consider also testing water. Or vice versa, depending on your concerns for that particular patient.

These results also raise the question: how do we know these “healthy” people aren’t actually getting sick from what they’re aspirating? While we don’t know for sure, there were no significant differences between aspirators and non-aspirators when looking at chest CTs. These healthy aspirators appear to be, well, healthy.

There are too many interesting findings in this article to discuss all of them here. Read the article to find out more about differences in aspiration risk between men and women and if aspirators and nonaspirators stayed in those same groups over time.

Anything else? Yes. We have to keep in mind that these results only apply to FEES. These results are inconsistent with findings from normative studies done with videofluoroscopy of older people. The authors discuss some possible reasons, but for now, stick with using these results to help interpret FEES.

The main takeaway from this study is that the normal range of aspiration is likely bigger than we had previously thought, especially in people over 60. These findings are a good reminder for us to always consider the whole picture of a patient’s health, history, and risk factors for aspiration pneumonia before automatically interpreting (silent) aspiration as disordered and something to be avoided at all costs. 

Butler, S.G., Stuart, A., Markley, L., Feng, X., Kritchevsky, S. (2018) Aspiration as a Function of Age, Sex, Liquid Type, Bolus Volume, and Bolus Delivery Across the Healthy Adult Life Span. Annals of Otology, Rhinology & Laryngology. doi: 10.1177/000348.

Like what you see so far?

That was just five reviews, sampled across sections. As a member, you’ll get content specific to your client population.

We search hundreds of journals every month trying to find clinically-relevant research to cover, and review everything usable that we find.

Want more info? Here’s our team, our FAQs page, and read current members’ reviews of us. Or email us at communications@theinformedslp.com with any questions you have. But, ultimately:

We’re here to make your clinical practice better.

With easy-to-read, efficient, and usable information for EBP.