Earlier, I was tutoring some speech kids working on reading. I just happened to have some comprehension flash cards targeting comprehension – oral or reading – of specific targets. These kids needed help with reading more than oral language, and so because I don’t have a lot of materials targeting reading, I decided to use the cards. One deck had about 12 cards with negative contractions (can’t, aren’t, isn’t, etc.), and the other deck had regular plurals.
Bottom line – this activity rocked. The kids missed the first couple. I told them to focus on “those tricky word endings,” (you know the kind that so many speech and language kids miss in oral language), and after struggling with the next few cards, by the end, they were getting it with no problems. They’d improved right then and there.
That got me thinking. These kids didn’t have deficits with plurals and contractions in oral language. But they did in reading. And I bet they did in writing too. They used to have these kind of errors in oral language, and we know from the research that young kids with speech and language deficits often turn into kids with reading deficits. I’ve never seen anybody targeting specific language structures like these in reading, but I’m pretty sure it would be a good idea.
I don’t think I’ve ever seen anyone specifically teach functions. Well, maybe, but definitely it seems rare. Which is a shame, because functions are huge in expressive language and semantics specifically. If you want someone to be better at describing, one of the best things you can do is teach functions. And if you want somebody to be better at expressive language, one of the best things you can do is to work on improving describing. Just a little contemplation can reveal just how common functions are in describing. Filling in the blank in “What’s a _______?” for so many things requires a function for the answer.
What’s a refrigerator? It’s an appliance (category) that keeps food cold (function).
What’s a ruler? It’s something that measures length (function).
What are quotation marks? They’re a type of punctuation (category) that shows that somebody is saying something (function).
Come to think of it, maybe I need to do a blog post about how we should teach categories more too. Anyway, assessing for deficits in using functions are common in tests and screens such as the DIAL, the CELF, and the PLS tests, so it’s easy to figure out if a kid has difficulties in this area. Someday good language therapy will include teaching functions to kids we’ve identified as having function using deficits. Hopefully that day won’t be too far away.
This question seems to perplex many, and the numbers do seem pretty staggering. Recent figures are something like 96% of SLPs being women in the U.S., with similar numbers abroad. As a male speech-language pathologist I thought I would chip in a few reasons why I believe these numbers are the way they are.
Some of these reasons have been offered before. They include
- There’s a perception of low opportunity and pay, especially considering the cost of the at least six years of college education required to become an SLP. This has been extensively discussed, such as here and here. Generally, there seems to be some justification for the perception, though it’s probably true that opportunity and pay is decreasing in many professions as the middle class continues its long decline.
- Gender roles and expectations definitely play a part. Fortunately, I had someone who knew about the field that suggested speech and language pathology as a possibility for me – a college professor trying to finally give me some direction as I was just about to graduate with a degree in communication. I had never even considered this profession, nor did I even know about it, before I was 22 years old. I’m guessing that more women than men have speech pathology suggested to them by others thanks at least in some part to gender expectations.
- Speech pathology is a helping, nurturing profession, which tends to attract women. Many men just tend to think that they can’t derive as much satisfaction from helping others. I obviously disagree, but I do understand how it took me so long of my own life to realize this.
I have a few additional reasons contributing to the huge disparity which I haven’t seen before.
- A big one is recognition. I think men crave recognition more than women, and teaching, nursing, SLPs, and similar professions are just not appreciated nearly enough. Individual greatness in these professions tends to go unacknowledged, as does the importance of the professions’ overall contributions to society. Men want to be heroes. This is genetic and evolutionarily driven. Meanwhile, our society tends to idolize men in some professions – sports, military, etc. – while ignoring the hard work, sacrifice, and importance of people in helping professions.
- Many men are timid about working with kids. Many SLPs work with kids. Every now and then the media decides to start focusing on (what I believe to be) the extremely small amount of male teachers who do something inappropriate with children, which causes suspicion of all male teachers that I believe is inaccurate relative to the actual risk.
- There is also some genetic, inherent component to women enjoying being around kids more, and especially younger kids. This really shouldn’t be ignored as a contributing factor, but it usually is. My experience has been that many male SLPs end up working with older children, I think in some part because of inexperience dealing with the behaviors of younger kids.
So one question then always arises in these discussions. What can be done to attract more males to speech pathology? Some contributing causes are more easily addressed, while others may take a long time. We can try to get the word out to more males. We can try to better prepare males, especially in dealing with behavior issues in the population SLPs often work with. I think though, unfortunately, that the most biggest hurdle to overcoming this issue may with the factor that contributes the most. Societal expectations need some shifting. We can start by taking cues from how many people react to those in certain other professions. When we start seeing things like special parking spaces for teachers and words like “That’s great!” when hearing that someone is a nurse or SLP, then maybe we’ll start seeing more males in these professions.
Goals for following directions are commonly seen in Individualized Education Plans (IEPs) of language disordered kids. Anecdotally speaking, they’re probably the most common language goal. Most of them tend to have some serious problems though, which perhaps we can illuminate from a quick analysis of one or two examples. And there’s one thing that’s really conspicuous by its absence. We’ll see if we can use these examples to figure it out.
Example 1: “Paul will follow two step directions in the classroom for three consecutive days.” What’s wrong with this? Plenty, actually, but one thing especially. Let’s say that for three straight days Paul is handed some trash, and after receiving the directions, “Paul, take this to the trash can and throw it away,” he does it. Goal achieved, right? There’s two steps and three days in the classroom, after all.
But what if Paul is twelve years old? What if Paul has been throwing away trash like this for years? Maybe he has done it so often, he knows what to do merely by giving him trash. He may not have even been listening to the directions. In this case, Paul has not been taught, nor has he accomplished anything that he wasn’t already able to do, despite having “achieved his goal.” The goal did not include something measurable that he wasn’t already able to do. And there still is that one thing that’s seriously missing.
Example 2: Mary will follow multi-step directions in the classroom or wherever at some percentage. Okay, this admittedly is a softball example, but it’s one I’ve seen plenty. What’s wrong? It’s not specific enough. I’m assuming it means more than two, but it doesn’t really say. Again too we run across the difficulty of the fact that no two directions tend to be equal in difficulty. “Get the ball and give it to me!” and “Please walk to the board and write the answer below the date,” are both notably two step directions. But they’re vastly different in difficulty. Which leads us to the one biggie that’s missing in these goals, and almost all following directions goals that I’ve ever seen. It’s the language itself.
Oral Motor Therapy and Facilitated Communication
…it is far easier to come up with an idea than it is to do the grunt work of scientifically verifying if that idea is a good one.
The stories of both non speech oral motor exercises and facilitated communication are both fascinating, and have sometimes had, at least in the case of facilitated communication, tragic results. So, then, what are the similarities? And what can we learn from them?
Facilitated communication (FC) is the technique of using a helper’s hand to guide a severely disabled person’s fingers or hands to type or point at a letter board. It is a practical requirement that the disabled person must not be able to communicate in any other way. The facilitator is trained in ways to help hold and support, but theoretically not guide, the patient’s hand to enable communication. FC was first enthusiastically embraced by many media outlets, and by the general special education community in the 1980’s and 1990’s, before being thoroughly refuted by research, and denounced by every major association that matters, including the American Psychological Association and the Association for Science in Autism Treatment. It seemed also that in many cases, these facilitators’ extreme desire to help their students led them to trump up stories of parental sexual abuse – stories that they didn’t seem to realize that they were concocting. FC seemed to generally fade from the public consciousness, but lately it has been revived. Unbelievably, Syracuse University helped its reemergence under the re-branding of “supported typing” by promoting its founder, Douglas Biklen to Dean of its School of Education, and by renaming its Facilitated Communication Institute as the School of Communication and Inclusion. (Maybe these people have been trying to jump on the autism explosion gravy train that earlier FC had just missed?)
While oral motor therapy has been less – let’s just say – notorious than FC, it has certainly garnered its fair share of criticism and controversy.
parallel talk - a great method for motivating children to talk without the frustration of high demand – the child is given opportunities to engage in activities that he finds interesting, while the caregiver talks about what the child is doing -the caregiver uses language that is at or just above the child’s level – often used in collaboration with self-talk
examples: for a child playing with a plane, say things such as, “You’re flying the plane. The plane is high. The plane is low. You gave the plane to me.”
play therapy – very useful for initiation, social language, turn-taking, sharing – can involve moving child from lower levels of play (such as banging or shaking toys) to higher (such as self directed play, play directed toward others, relational play, and symbolic play) – strategies are taught to caregivers, often involving allowing child to lead play, with adult redirection as necessary
priming – introducing topics beforehand – can involve stories, index cards, explanations, or anything that can quickly familiarize student with upcoming material – can occur immediately preceding the lesson, the prior morning, or the prior evening – especially effective when part of a routine
example: an autistic child’s anxiety increases in response to certain things, such as handwriting, so the morning activities are briefly explained to the child ahead of time each morning, including handwriting