Mistakes in Data Collection

Today Shaneh Raymer shares some information from a PD she attended this summer:

This summer I attended a course during the SLP summit.  For those of you who are not familiar with SLP summit, it is a virtual convention of sorts.  They offer a variety of classes that you can attend live online or watch afterward.  You can use these for CEUs for your license!  Best of all it is *FREE*.   I believe they will be offering another one this Winter so if you need CEU hours check it out!   I attended a course entitled “ Mistakes in Data Collection”  Melissa asked me to share what I learned so, here we go…..

To be honest, most of the information was “ common sense”  but is always a good reminder.  Also as a part of the disclosure the presenters were hoping to sell their product “ SLP toolkit”.   I believe this is an online program to organize goals / data.  Luckily, we already have that with our Edplan

Here are the “mistakes”  that were discussed:

Not taking data.

The first thing they address was that we need to take data!   When doing good therapy this can be difficult.  But, without it we cannot assess effectiveness of  our treatment.   They suggest 50 responses per session.  I think for artic it is certainly possible but probably not for most language tasks!    It was suggested  that when you take data to take it quickly at the beginning of the session.  It is hard to take data during the actual  therapy time when you are teaching , and managing the group.

Not Reflecting  on Data

So, now that you have taken data, actually look at it and see what it means.   They remind us to not only pay attention to percentages towards progress with goals but also the type and amount of cueing we use to achieve that percentage.   I usually try to include the activity that we did in therapy.  When I look back I can see if they did better with a book, computer activity etc.

Not creating measureable objectives

These presenters stressed to “ avoid the mega goal”.   We all want to keep our number of benchmarks manageable but when we put too many concepts into one goal, it is impossible to take data!  If we are taking data on several sounds or concepts our data can be skewed.

Make sure it works for you

Make sure that however you take data that it works for you.  If you come up with a system that is compatible with your style you are actually more likely to take the needed data.

One other point that was mentioned is using criterion referenced test as part of data collection.  Just as a refresher, “Criterion-referenced tests and assessments are designed to measure student performance against a fixed set of predetermined criteria or learning standards—i.e., concise, written descriptions of what students are expected to know and be able to do at a specific stage of their education.”   You would get a baseline score and then have them take it again at a later point to measure their progress.

I am not familiar with any personally.   But, I think they could be a great tool for older students  ( my caseload is preschool)   and a good way to show progress to  parents and teachers.

SLP summit is a great way to earn some extra hours for CEU credit , check it out if you need hours!

Thanks Shaneh!

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Article 4

Krista Rice writes:

Speech Disfluency in School-Age Children’s Conversational and Narrative Discourse

This was an insightful article. I know I will consider what the authors found in this study in future assessments and even during current therapy sessions.

To begin, the authors note that previous research illustrates that children who stutter typically do so more during conversational tasks than other communicative tasks (i.e. narration). However, this research has analyzed the fluency of preschool aged children.  The article I read, Speech Disfluency in School-Age Children’s Conversational and Narrative Discourse, makes comparisons among school-aged children. The authors compared speech samples of children who stutter (CWS) and children who do not stutter (CWNS) by comparing structured conversation and narration.  The participants were divided into groups based on age (younger 6:0-7:7 and older 8:0-10:5) and diagnosis of a fluency disorder (CWS and CWNS). All of the participants demonstrated typical development of articulation, language and voice skills. The authors used an experimental version of the TOCS to elicit structured conversational speech samples and narrative speech samples. The structured conversational task was completed first, and participants were given open-ended commands and open-ended questions.  The participants then completed the narrative task, formulating a story using the same picture scenes from the conversational task. The examiners provided explicit directions to tell a story and did not engage in any communicative exchange during the narration.  The authors analyzed the types disfluencies produced by all groups of participants into 2 broad categories: stuttering-like disfluencies (monosyllabic word repetitions, audible sound prolongations, blocks, sound or syllable repetitions) and non-stuttering like disfluencies (typical- phrase repetitions, revisions and interjections). Each word of the samples was analyzed for the disfluency type and frequency. The authors further determined the percentage of disfluencies in the each sample, percentage of stuttering-like disfluencies per word and percentage of non-stuttering like disfluencies per word.

 

The authors determined that significantly more types of stuttering-like disfluencies occurred in the narrative task than the conversational tasks in the CWS groups (age did not matter). As predicted, the CWS groups produced more stuttering-like disfluencies than the CWNS groups in both types of discourse.  There were no significant differences found between the ages of the groups or the frequency of disfluencies between conversation and narration. When comparing non-stuttering like disfluencies, there were no significant differences found in types of disfluencies between conversation and narration or the frequency of non-stuttering like disfluencies. The authors noted that CWS groups and CWNS groups produced similar amounts of non-stuttering like disfluencies in both types of discourse. However, the younger group in this study produced significantly more typical disfluencies during the conversational tasks than the narrative task and there was not a significant difference found in the older group.

 

The authors suggest that the CWS narrative samples contained more types of stuttering-like disfluencies because of the linguistic commands of narration in itself. Also, the speech sample length did not appear to be a determinant factor in the frequency of stuttering-like disfluencies as the conversation samples were approximately three times longer than the narration, but the frequency of disfluencies was higher in the narrative samples. The authors suggest that narration appears to elicit more stuttering-like behaviors vs. conversation in school-aged children. Previous research supports this conclusion, noting that narrative tasks put more communicative responsibility on the narrator as they are responsible for the communicative expectations alone.  The authors noted differences in previous research; preschool aged children are more likely to demonstrate stuttering-like disfluencies during conversational task. This current research illustrates that school-aged children are more likely to demonstrate stuttering-like disfluencies during narrative tasks.  The authors suggest this is the case because children’s narrative skills increase over the elementary years, as children develop higher linguistic skills, higher vocabulary and the use of more complex sentences; plus children continue to develop higher awareness of the listeners expectations during narration task

 

What I take from this article is that: 1) our assessment procedures should include both types of discourse- conversation and narration; 2)  consider the age of the child (preschool or school-aged) when selecting tasks to obtain speech samples, ensuring that we are utilizing types of discourse that will provide an opportunity to observe true stuttering behaviors. I plan on applying this in treatment sessions as well, creating speaking situations that utilize a type of discourse where students are more likely to produce stuttering like disfluencies. This will allow for more opportunities for the students to practice their strategies and modification techniques, while also informally targeting language skills. This can also help in planning and creating activities to address multiple goals in mixed therapy groups; 3) carefully consider the types of disfluencies. While reading the article, I kept thinking about the Fluency professional development taught by Dr. Lonnie Harris. I remember him discussing the types of disfluencies and how certain ones (what the authors call stuttering-like disfluencies- monosyllabic word repetitions, audible sound prolongations, blocks, sound or syllable repetitions) are a red-flag when evaluating the fluency of a younger child to determine if the child actually has a fluency disorder or if the child is demonstrating developmental stuttering. This research article illustrated that types of non-stuttering like disfluencies and frequency of non-stuttering like disfluencies were about the same among the CWS and CWNS groups. This is important to remember as we are evaluating the fluency of a student.

Article 3 for Scholarly Article Review

Sorry these are a day late! Hope everyone had a good “snow break” 🙂

Jamie Priddy shares:

Secondary School Teachers’ Beliefs, Attitudes, and Reactions to Stuttering

The purpose of this article was to study secondary school teachers’ beliefs, attitudes and reactions to stuttering within their classroom setting due to the fact that teachers, as well as speech-language pathologists, indicated the need for more knowledge and training in the area of fluency. The authors achieved this by completing semi-structured interviews with 10 teachers of adolescents who stutter in Belgium. Each head teacher or teaching assistant had a student who stutters in his or her classroom. Results were broken down into two sections: the teachers’ beliefs and attitudes toward stuttering and their reactions to stuttering in the classroom.

Teachers’ Beliefs and Attitudes

During the interviews, a majority of the participants stated that they do not know much about stuttering in general. They defined stuttering in terms of the associated behaviors (repetitions, stumbling over words, etc), rather than as a neurological disorder. They also noted that most of their knowledge about stuttering came from internet searches, movies, and TV shows. In regards to their teaching, the participants mentioned that students who stutter could potentially disrupt their lessons by slowing down the lesson or making it harder for peers to understand a presentation made by the student who stuttered.  One belief that the majority of participants agreed upon was the fact that focusing on the stuttering could create a problem. According to the teachers, focusing on the stuttering could lead to labeling or extra emphasis added to the disorder, which could cause more distress for the student. In my opinion, this is a belief shared by most people that encounter someone who stutters, regardless of their relationship to the person. I even see this reaction toward stuttering in my school building. For example, teachers and parents would rather pay less attention to the stuttering than have an open discussion about it, particularly if the student or child is young or does not react negatively to the stuttering.   One positive fact that surfaced during the interview was regarding reactions of peers. Multiple participants were surprised to see how patient peers were toward their classmates who stuttered. The teachers expected for peers to laugh or make negative comments, but learned that adolescents were very accepting of fluency disorders within the school setting. This part made me smile because I experience this with my middle school students! From my experience, it is so easy to make assumptions and generalizations about middle and high school students being disrespectful and hurtful toward other students. But when you take the time to build relationships with the students and really get to know them, they will surprise you and be more accepting of others than you would ever believe!

Reactions to Stuttering

One main theme emerged in regard to the teachers’ reactions to their stuttering students: all teachers want to show understanding and support to their students. Of course each teacher will accomplish this in different ways, such as trying to react as little as possible to the stutter, easing the students’ stress, building relationships with the student, or offering specific measures to make the student feel more comfortable in the classroom (ex: only calling on the student to answer a question when he or she raises hand). Each of the participants agreed that having a trusting and open relationship with their students is extremely important in helping them succeed and feel more confident in the classroom; however, openness about stuttering rarely occurs. I believe this is an area that we, as SLPs, can share our expertise. We can share our knowledge about stuttering with teachers in our buildings, so that they might feel more confident discussing it with their students. We can explain that there are advantages to talking with students who stutter, and that it likely won’t draw negative attention just by being open

about the subject. When teachers feel comfortable discussing stuttering with their students and other peers in the classroom, each student learns and may become more open and accepting of the disorder.  Lastly, the participants disagreed on how to react to the stuttering of a student during a lesson. Some teachers believed in giving the student extended time to respond, while others believed in finishing the words or thought for the stuttering student. Again, SLPs can play a large role in educating teachers and other school staff on this subject.

Conclusion

Overall, this study gathered qualitative data to gain understanding into teachers’ beliefs and attitudes about working with students who stutter. The results concluded that teachers working in secondary education feel confident in dealing with stuttering students; however, their beliefs and reactions may be based on previously learned assumptions about stuttering. More knowledge is needed in this area for teachers to become more comfortable not only dealing with stuttering in their classrooms, but also in supporting their students educational and emotional needs in regards to their fluency disorder. We are given a wonderful platform to share our knowledge and be the bridge between teachers and their students who stutter.

Dixie Cups Activity

 

Today, Carrie Kaelin shares a quick, fun, and versatile idea:

This is such a fun activity. My students LOVE it. I saw a blurb about it in the ASHA Leader at some point last year. It is easy to adapt to almost any lesson, for both articulation and language. Just write a target word on the bottom of each cup. The students ‘earn’ a cup….one at a time; at the end of the lesson they can build with them. I keep their ‘earned’ stack near me and then give them the stack all at once when it is time to build. This way, they don’t fiddle with the cups during the lesson.
Thanks!
Carrie

Maintenance of Social Anxiety in Stuttering: A Cognitive-Behavioral Model

Our second article today is brought to you by Allison Forrester:

Iverach, L., Rapee, R. M., Wong, Q. J., Lowe, R. (2017) Maintenance of Social Anxiety in Stuttering: A  Cognitive-Behavioral Model. American Journal of Speech Language Pathology. 26: 540-556. American Speech-Language-Hearing Association.

This article addresses the application of leading models, which describe cognitive-behavioral factors that contribute to the maintenance of social anxiety in nonstuttering people, to the experience of social anxiety for people who stutter. Social anxiety is a chronic anxiety disorder, which tends to be disabling as well, negatively impacting people’s lives. These models were applied to stuttering to determine cognitive-behavioral processes that may increase the persistence of social fears related to stuttering. They found that social anxiety in people who stutter may persist due to multiple factors, such as, negative social-evaluative cognitions, attentional biases, safety behaviors, fear of negative evaluation, anticipatory and post-event thinking. In conclusion, the identification of these factors may help inform and develop psychological treatment programs for the people who stutter. These treatments may address social anxiety and psychological needs of these individuals. The article discusses the processes that were found to be common in the models and they were used to identify five main ideas that may play a role in the maintenance of social anxiety in stuttering. These ideas are as follow: Socially anxious individuals assume that they will be negatively evaluated by others and overestimate the consequences of negative evaluation; socially anxious individuals form a negative mental representation of the self as seen by the audience, socially anxious individuals engage in negative self-focused attention and demonstrate attentional biases towards social threat; socially anxious individuals engage in cognitive and behavioral strategies to temporarily reduce anxiety; and socially anxious individuals engage in anticipatory and post-event processing.

Social interaction and communication are essential parts of an individual’s life and are required in almost every facet of daily life. Stuttering is a complex communication disorder which occurs in ~4-5% of the population. Social anxiety is a chronic, disabling anxiety disorder that occurs in ~8-13% of the population. Research shows that ~22-60% of people who stutter (adults) also have social anxiety and ~24% of adolescents who stutter have social anxiety. In summary, people who stutter may experience negative social reactions over and over, which leads them to have greater social anxiety based on the belief that negative evaluations will occur in social situations. The findings in this article were what I expected to discover.

Thanks, Allison!

Scholarly Article Reviews-Week 1

We have 2 reviews for you this week!

The first article review is brought to you by Katie Cohen, SLP at Maupin and Roosevelt-Perry Elementary schools:

Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). Stuttering in School-Age Children: A Comprehensive Approach to Treatment. Lang Speech Hear Serv Sch, 43(4), 536-548.

This article is a response to an article written and published by the editor of LSHSS, Dr. Marilyn Nippold that included the following scenario:

A young SLP contacts a former professor to request help with a student, Ben, for whom she is assessing and developing a treatment plan.  The former professor responds to the SLP stating there is a need for more research on treatments that specifically decrease the frequency count of stuttering events for the pediatric population.

· I have an issue with this: The former professor should have suggested another resource, maybe a colleague or practicing SLP from whom this SLP could have gotten some help on creating a treatment plan for Ben rather than broadly stating that we need more research.

In her article, Dr. Nippold formally calls for more research on treatments that decrease the frequency of stuttering.

This article responds to Dr. Nippold directly using three themes.

Theme 1. Agreement with Dr. Nippold’s call for more research.

Very straightforward.  I agree we do need more research on techniques to improve speech fluency.

Theme 2. Overview of recent literature including strategies to improve speech fluency, as well as, increase acceptance and decrease negative consequences.

Suppose an SLP solely focuses on decreasing the frequency count. If students avoid certain words and respond in very short utterances, they will likely exhibit a decreased frequency count. However, this can occur with increased anxiety, fear, and lack of acceptance.  On the other hand, acceptance can “lead to reduced stuttering severity, increased fluency, and improved communication.” Acceptance is an integral part of the therapy process and includes concepts that are also central to mindfulness, acceptance and commitment therapy, as well as, cognitive behavioral therapy.

Stuttering is a multi-dimensional disorder; therefore, there is not one specific treatment type to help our students with fluency impairments.

Theme 3. Several strategies to minimize the adverse academic impact of stuttering on the school age population.

The authors’ strive to make suggestions that are “consistent with common clinical practice” and “reflective of real life experiences”.  Here are two long-term objectives (LTO) with short-term objectives (STO) the author’s provide.

LTO1: Ben will experience a decrease in bullying.

STO1.1: Ben will talk with the SLP about what is going on in the classroom.

STO2.1: Ben will participate in a fluency group with other students who have a fluency impairment. –Ben will gain acceptance, identify a role model, and practice self-expression in a safe environment.

STO3.1: Ben will invite a close friend/ classmate to attend a speech therapy session with him at which Ben (with the SLP) will educate the peer about stuttering.

STO4.1: Ben will create and give a presentation to his class in order to teach about stuttering.

 

LTO2: Ben will be able to answer questions when called upon.

STO1.2: Ben will raise his hand to participate in class at least once each day. – Ben has a sense of control over when he speaks, which decreases the anxiety, however, he is still answering a question.

STO2.2: Ben will answer questions out-loud on prearranges topics of his choice that he is most comfortable with. – This will improve his participation in the classroom, as well as, build confidence.

Comprehensive assessment:  When evaluating (or in some cases re-evaluating) a student with fluency of speech needs, it is imperative to look closer at the whole picture in order to develop a treatment plan more tailored to the individual student’s needs.  Factors that should not be overlooked include:

· classroom participation via observation and teacher (or instructional assistant) interview

· emotions via observation and interview (parent, teacher, self, etc.)

· fluency count via direct measure of speech sample

· avoidance behaviors via observations and interviews (parent, teacher, self, etc.)

 

In summary, this article claims that SLPs, when working with school-aged students with fluency impairments, should focus on decreasing the frequency count in addition to -rather than instead of- acceptance.

Thanks, Katie!

MLK Day and Literature Unit

Welcome back!! I just wanted to remind you of the literature unit for January. If you did not see it the first time, you can find it here.

If you are looking for some materials to incorporate MLK day into your sessions, the TPT store has some great resources! I clicked the “free” box and still came up with some great options for therapy!! This was the very first item that popped up for me. It struck me that this would be good to use with the EET prompts (although you would have to add a space for “what else”).

How are you getting back into the swing of things?

**If you have a recommendation for the January “SPOTLIGHT” Please send me who and why (very briefly) ASAP!!**