Rethinking Language Therapy

Dear Speech Friends,

If you haven't noticed I've been Missing In Action lately. The past few months I have been questioning my techniques for language therapy and instruction. You probably could have guessed since I'm doing this whole language disorders review. I'm just not convinced of the validity of some of the techniques I've seen. It feels like language therapy is similar to trying to solve an entire puzzle with only one or two pieces. This whole questioning phase has been crazy. It has seriously rocked my "beliefs" in what I do as a speech language pathologist. I feel lost in purpose.

It surprises me how much this feels like a time in my life when I questioned my belief in God. I am a person of faith. Religion was part of my upbringing. But my faith in what I believe came from my own questioning, deep reflection and personal experiences. This is in no way meant to be a religious post. It's just truly a perfect analogy for what I'm going through right now and I'm trying to describe the reason behind my MIA status.

Have any other SLPs out there gone through this same questioning of our validity as Language Therapists? Don't get me wrong, I seriously think we do a world of good out there. SLPs are the smartest, most creative, fun and caring group of people out there. And our ability to think through and adapt lessons to individual children's needs is like our superpower. But are we doing it the best way? Are our techniques proven? Are our models of service delivery adequate?

Let me tell you this, I have no doubt that we are helping kids! I'm just not posting awesome ideas of therapy techniques right now because, well, I'm going through a shift of therapy emphasis and it's taking some time to "convert" if you will.

I hope I haven't offended anyone with this post. I'm a lover of all people, religious or atheist or don't-care-ist. But be it said that we are all speech language pathologists and we should probably believe in the validity of what we do. :)

Hope all is well with you speech friends of the world. If you are a school based SLP my thoughts are with you and the dreaded end of year paperwork and filing that ensues. WE CAN DO IT!!! Think of how great you will feel in a week or two!

Best,

Annie

Oh dear!

Oh dear, I'm a little behind! Never fear, our review of chapter 3 is coming soon. If you are on the ball, you will have already read it and are well on your way through chapter 4. If, by chance, you went on a vacation and have been working on your professional portfolio in order to upgrade your educators license, then you are probably behind. Okay, I know that it's just me. Please forgive me for being behind on our review. Chapter 3's quiz will be up by the end of the week. It is a meaty chapter. All about the principles of language intervention. It's basically the whole reason I wanted to do the review. Not the best week for a meaty chapter. Oh Well! Why do big things always happen at the same time? If you haven't read chapter 3 you still have time :) See you in a few days!

Annie

p.s. my little weekend vacation was THE BEST!!!! If you haven't been to Moab, Utah I would HIGHLY RECOMMEND IT! I know I'm biased, as a home-grown Utah girl, but seriously Utah is one of the most gorgeous places on earth!

Chapter 2 Review Quiz Now Available

Dear Friends,
It's time to discuss what we learned when we read over Chapter 2: Evaluation and Assessment. Here are my notes that I jotted down while reading this chapter. Please click the link to take the short quiz and share what you learned or re-learned. Even if you didn't read the chapter, you can take the quiz and help us get a feel for how SLPs out there are doing their evaluations and assessments.

Chapter 2 Quiz

Brief Notes on Important Questions and Interesting Things from Chapter 2

• Evaluation and Assessment are not synonymous. Woah, that seems important. According to my text.... 
• Evaluation: determining eligibility
• Assessment: describing communicative functioning, determining the child’s communication needs, and creating a program to address those needs 
• Team work! We work with other professionals who know a lot in their respective fields of study. I need to make more of an effort to learn from the other professionals I work with. Such a good reminder!
• Case History: What should we include in it? How to make a more relevant, efficient and appropriate case history for each student?
• Parent Interview, Teacher interview, team member input...IMPORTANT! I should make an effort to discuss the child with their teacher and parent more thoroughly as part of my assessment.
• What tests to evaluate which areas? This is something we really need to discuss and should be a whole separate post!
• Language sample analysis. Maybe I should make a more official rubric for what to look for in my language samples. What do you do with your language samples?
• While administering standardized tests. Keep the child in mind. Is he bored? Tired? Overworked? Don't give the hardest sections first.
• Make an assessment plan with: 
• areas to assess, 
• questions to be answered
• what to use to assess (standardized texts, criterion referenced measures, language sample, etc)
• I've never actually made an assessment plan but I can see how smart it is to have one! Maybe I'll make a form and try it out.
• What do you use to screen for language disorders? Maybe I should make a list of what things a classroom teacher can look for that might indicate a language disorder. Where would I find some good screening measures for language disorders for all ages?
• Classroom observations? Do we need to do them? I think we should! But I never have time. Guess I should make time. Are there any good language observation forms out there?
• Consider context! Observations in multiple contexts is important. It is important to see how child functions in ideal situations as well as difficult ones.
• Intralinguistic profiling: An idea of how a child functions in each area of language. This is something I haven't formally done in the past. It seems very IMPORTANT and useful! Note to self: make a simple form to help me make sure that I have at least considered each area of language for each child. It will help me assess strengths and weaknesses for each child and determine what goals to address. Reassess needs yearly, make a new informal profile every year!
• I need to really think through and research what criteria needs to be met for dismissal? 
• How often to assess each child? Frequently, but not all the time. Treatment time should be dedicated to treatment, but reassessing needs is important too. Maybe gather assessment data 4 times/year? Possibly, right before progress reports? What do you think is the right balance between frequent enough or too frequent assessment?
• Comprehension and production should be assessed separately.
  
  

  Domains of Language			Comprehension	Production
  Form	Syntax & Morphology	Inflectional marking of words
  		Sentence components (noun phrase, verb phrase)
  		Sentence Types (negative, interrogative, embedded, conjoined)
  	Phonology	Ability to produce sounds
  		Consistency of sound production
  		Phonological simplifications?
  Content	Semantics	Knowledge of vocabulary?
  		Concepts about objects and events
  		Semantic relationships among objects and events
  Use	Pragmatics	Range of reasons for communication?
  		Communication skills? (turn taking, topic maintenance and change)
  		Appropriately modifies speech for different listeners and social situations?

  
  

Chapter 1 Review Results: Models of Child Language Disorders

Wow, thank you to everyone who participated! I am very inspired by all of your support and participation in this review of language disorders. Let's keep up the great work. Without further ado, here is our brief review of Chapter 1.

Chapter 1: Models of Child Language Disorders

After sifting through the surveys there were 3 important questions that arose after reading this chapter.

1. How would you explain what a language disorder is to a parent, a co-worker, or a colleague?
2. What criteria is most important when identifying a language disorder?
3. There are many different models of child language disorders that encompass theories about why, how and what we should do in approaching language disorders. Is it important for the practicing clinician to know these models? How do they help us in our treatment of language disorders?

Here is my attempt to summarize a couple answers to these very important questions.

1. So, what IS a language disorder?

As a practicing clinician I find this one of the most frequently asked questions, as well as one of the hardest to answer. Language disorders are hard to define because language itself is such a broad term. Language is what we use to communicate. It involves words, combining those words to make meaningful messages, interpreting messages, and ultimately using words and word combinations to communicate with others in a meaningful way. A language disorder can look different for each child. One child may have difficulty learning vocabulary, or using the right grammatical forms or even just coming up with a sentence to adequately describe what they are thinking. Another child might talk well but has a hard time understanding the point of a story. Some children appear "socially awkward" because they don't naturally pick up on social language cues about what is appropriate or not. We often further define a language disorder based on the individual child's strengths and weaknesses but when you hear the term language disorder just know that it usually involves some level of difficulty with understanding or using language.

I know this explanation could use a lot of work. How do you describe a language disorder to parents, teachers or colleagues?

2. What criteria should be used to identify a language disorder?

In the school-based SLP world, criteria is often reached by scoring below an arbitrary cut-off on at least 2 standardized measures and the professional interpretation of informal measures such as language samples or criterion referenced assessments. Often the cut-off on standardized tests is low enough to be a severe language disorder. This is a necessary evil to keep our caseloads manageable and provide services to those who need it the very most. It makes me sad that we do not have the resources to provide services to all children with language deficits. I recently tested a child who would truly benefit from language services. His scores were well below average, but not low enough to meet the criteria for services. I am in this constant battle with myself when I think about these cut-offs. On the one hand, it makes my heart sink to think about those children who could understand and communicate so much more with our services. On the other hand, I am so overwhelmed with my large caseload, I am ashamed to admit sometimes I am grateful for the low cut-off.

It is so important to keep in mind that every standardized test is not created equal. Some are better than others at identifying children with language disorders. It is overwhelming and time consuming to determine which tests are best. But it is so important for us as professionals to be aware of the the validity of tests. It would be great if we could have a discussion about which tests are the best in the future. Keep an eye out for a post on this topic in the future.
 

3. Does it really matter if I know all the models of language disorders?

This chapter discussed some different models of language disorders. A "model" is a basic theory about how a language disorder works. As practicing clinicians we don't have a lot of time to agonize over which theory is most correct. We are mostly concerned about how to help the child.While reviewing this chapter I was surprised to realize that I had developed some of my own beliefs and views about language disorders that fit into certain models better than others. It all seems so much more applicable now that I have lived and breathed language therapy. Your interpretation of how a language disorder works really does effect the way you approach treatment of that disorder. I would encourage everyone to review these models and think about which ones you believe to fit your experience with language disorders the most. I think it is an important exercise for all of us to contemplate our beliefs and reasoning and keep an open eye to other theories.

Language Disorders Challenge Schedule

Thanks to everyone who participated in our chapter one review. We'd like to invite everyone to join us in our review challenge.

Most people who filled out the survey said that realistically we need to take 2 weeks for each chapter. So let's plan on doing a chapter every 2 weeks or so. At the end of the two weeks I will post a survey for each person to fill out with what they found was most applicable to us in the clinical setting. I'll compile the input and post it on the blog.

I am using a fabulous textbook called Language Disorders from Infancy Through Adolescence: Assessment and Intervention 3rd edition by Rhea Paul. It's a really great text. I will list the title of each chapter so you can find the chapter from your text that relates most with the chapters in our schedule.

I made a hard copy schedule that you can print out. If you'd like me to email it to you so you can print it out email me at annie_merrill@yahoo.com. I'm excited to get this review running.

March 18-31 Ch. 2: Evaluation and Assessment

April 1-14 Ch. 3: Principles of Intervention

April 15-28 Ch. 4 Special Populations

April 29-May 12 Ch. 5: Cultural and Linguistic Diversity

May 13-26 Ch. 6: Prelinguistic Assessment & Intervention

May 27-June 2 Ch. 7: Emerging Language Assessment and Intervention

June 3-16 Ch. 8: Developing Language Assessment

June 17-30 Ch 9: Developing Language Intervention

July 1-14 Ch. 10: Language, Reading & Learning in School

July 15-28 Ch 11: Assessing Language for Learning

July 29-August 11 Ch. 12: Language for Learning Intervention

August 12-25 Ch 13 Advanced Language Assessment

August 26-September 8 Advanced Language Intervention

How Did Your Reviewing Go?

Dear Amazing SLPs,
Did you get a chance to review chapter one of your language disorders textbook? If you did, you are SO AWESOME! I know it's going to help us all be better speech-LANGUAGE patholgosits! :) If you didn't have time, no worries. You can still join us any time. Just pull out your old text books and notes. Once you've done that, please share your experience with us by taking this very short survey. It's anonymous and anyone can take it. No need to sign up for anything. I'm also trying to figure out how we're going to motivate eachother to stick with this review and what is the best way to share experiences. Please, please, please, take a minute to fill out this survey. I will write a post summarizing what everyone found most useful as soon as I get a good amount of participation. Remember we're not studying for a test, we're studying for the real deal. I'm so excited to hear from you. Okey dokey (or, in the words of my nephew, "donkey donkey"), click this link to take the survey...
http://www.surveymonkey.com/s/Z9Z8GYM
Happy Reviewing!
Annie