Stuttering Support Group

Allison Forrester shared this in the comments of the last post, but I wanted to make sure everyone could see it. One of her students attended the last meeting and really enjoyed it!

 

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Assessment considerations for students with hearing loss

Today, Kristin Kelly (SLP at Heuser Hearing and Language Academy) shares some insight into assessing children with hearing loss. She says:

One of the joys and challenges of our profession is that we never know who is going to walk through our door.  We are constantly charged with learning about new topics and we often encounter students who are the only one of their kind on our caseloads.  I’d like to share some information that may help when assessing students with hearing loss since you may only have one on your caseload.  Students with hearing loss present with a wide range of communication abilities from severely disabled to non-disabling.  Some (but not all) of this information may apply to the student on your caseload.

Standardized Assessment

My goal during standardized assessment is to determine (among many things) how a student can perform in the areas of communication being examined in ideal conditions.  The impacts of noise, distance, inconsistent amplification and “real world” communication situations can be considered during the functional examination or other supporting evidence.  If the testing plan lists “hearing aid(s)” or “cochlear implant(s)”, they must be worn during testing.  If a student comes in with a dead battery or no amplification, I reschedule the testing.

1. Modality

a. Spoken Language.  Many students with appropriate amplification use spoken language to communicate.  Continue with standardized testing as you deem appropriate.  Be aware of lip reading.  Many students need a clear visual of your face for best performance.  I note in my report if I think a student is lip reading but I don’t discourage it.  I might address listening only skills during the functional exam by using a speech hoop.  (A speech hoop is an embroidery hoop covered in audio speaker fabric so a student cannot read lips or facial expressions but has access to the auditory signal clearly.  If you cover your mouth with your hand it distorts the auditory signal and they can still “read your cheeks”).

b. Total Communication.  If a student uses true total communication with spoken English and Signed Exact English, standardized testing can be administered through the interpreter and scores should be considered valid.  It would be wise to have a conversation with the teacher and the interpreter to clarify the use of SEE and ASL and how the test items need to be interpreted.

c. American Sign Language.  If a student uses ASL as their mode of communication, standardized scores should not be reported.  Since ASL has its own vocabulary, syntax and pragmatic rules, it should be treated like any other spoken foreign language.

2. Seating arrangements.

a. Sit on the side of better hearing.

b. Keep the protocol out of sight.

c. If there is one, work with the interpreter to determine the best seating arrangement.

3. Testing Behavior (ours…not theirs)

a. Students with hearing loss are typically VERY perceptive to visual cues.  This includes looking at the correct response picture, facial expressions when they point to the right or wrong picture, small gestures used when giving the directions, etc.  Be careful!

b. Processing time…allow extra before assuming that they do not understand

Non-standardized Assessment

The gold standard of non-standardized assessment is the language sample.  A language sample provides information about vocabulary, grammar/syntax, pragmatics, answering “wh” questions, comprehension, communication breakdown repairs, and articulation/voice/fluency in context.  I always try to use a sample of 100 words or more but will use less if that is not possible for that particular student.  I can even get my percentages for new goals from the language sample I used on the assessment if the sample is good enough.  The reason I often shy away from more formal data probes is that kids with hearing loss are often therapized.  They figure out what you are asking them to do on the first trial and then get the remaining 9/10 correct.  They can often perform certain skills in isolation but do not show those skills “in real life”.

Another factor in assessing students with hearing loss is to consider their receptive language more in depth.  This may include going to levels of listening before single word comprehension.  The following is a quick list of questions that I ask myself or the parent during early childhood evaluations.

Listening Skills.

1.  Detect environmental noises?

2. Turn to name being called?

3. Understand when music is on and when it goes off?

4. Understands some single words?

5. Can follow simple routine directions? (with/without gestures)

6. Understands a wide variety of words?

7. Can follow 2 step routine directions? (with/without gestures)

8. Imitates words? (how accurately)

9. Imitates phrases/sentences? How long?

10. Makes any discrimination errors (e.g. bat vs bag, eyes vs ice, goat vs boat)?

11. Has difficulty understanding you from a distance?

12. Has difficulty understanding you in noisy situations?

13. Has difficulty understanding you if he/she can’t see your face?

14. Can answer questions about something he/she heard? With picture support? Without picture support?

 

Other assessment considerations

1. Information from audiology

a. Current hearing status

b. Hearing age vs chronological age

c. Recent changes in hearing or in hearing technology

2. Child developmental history/Medical history

a. Cause of hearing loss

b. Risk factors for other learning difficulties or additional diagnoses

3. Parental input for modalities and amplification/Home support of recommended communication strategies

 

When in doubt, ask for help!  We all have our areas that we are passionate about and this is mine.   Give me the opportunity to “geek out” with you over these students! I hope this helps!

Kristin

Book Study: Therapy Applications

Today is our final book study post, so if you haven’t gotten in all your comments, please do so before you leave for winter break! Today, Lexie Cunningham shares some therapy applications based on our book:

The conundrum of school-based speech therapy is presented in a raw and real fashion in this novel, as Katherine openly discusses her disdain and disappointment with speech therapy services as a child. From a speech therapists standpoint, we are constantly faced with the moral dilemma of adverse impact. In the case of Katherine, I have asked myself over and over again what it is I would have done had she been referred for speech therapy in our public school system. Clearly there is academic impact in that she avoids speaking during classroom activities/discussions. She is a loner in social situations with peers. She has few friends, and her teachers have no idea how to handle her stutter. Yet, Katherine despises having attention directed towards her disability. She would not want to have been pulled from class for therapy. From day one she was against formal speech therapy services. In her case, she states that she liked her first speech therapist and wanted to please her. However, when she wasn’t “cured” the first go around it made a lasting negative impression on her.

From a clinical standpoint, we have all been trained on stuttering modification therapy techniques vs. fluency shaping therapy techniques. I would venture to say that most of use of combination of both in our daily practice. We arm students with the fluency shaping techniques such as easy on-set, light articulatory touch and continuous phonation. At the same time, we also educate our students on stuttering modification techniques like pull-outs, cancellations, etc. We provide a safe and loving environment for our students to practice their techniques. Like with Katherine, many of us have students who are able to be completely fluent in our therapy rooms. They politely complete the tasks we give them, come religiously every week and even convey their appreciation for our time and patience. Yet, they continue to suffer once they leave our therapy rooms. So what do we do?

In my opinion, there are three big concepts from this book that have inspired me to modify how I conduct school-based speech therapy services for students who stutter:

  1. Honesty
  2. Education
  3. Collaboration

I can say with absolute certainty that in the last ten years, I don’t think I have ever sat down on day one with a student who stutters and had a real and honest conversation with them about my role. I was teary-eyed when Katherine stated in the book that she felt like a failure when two weeks following her first formal speech therapy treatment, her stutter returned and she felt like a failure. I wonder how her childhood years might have been different had her therapist stated from the beginning that she was not going to be able to “cure” her stutter. I want to make a conscientious effort with all my students to let them know up front that I’m here because I care, because I want to give them all the knowledge I have on the subject, because I want them to go out into the world armed with some tricks up their sleeves. I want them to know that nothing in life is a guaranteed success, but that they are not alone. I wish Katherine had been given that.

I hope that all of us who read this book feel the need to do a better job of educating teachers about how to handle students that stutter. Yes…we do give them handouts about stuttering. Some of us tell teachers not to spontaneously call on our kids, to give them plenty of time to prepare if they are required to speak in front of the class, etc. But do we educate them on our own non-verbal body language and how we are impacting the feelings and anxiety of the stutterer with our eyes? Or in Katherine’s case, even the lack of eye contact? Do we do a good enough job of educating adults in our buildings about the importance of not finishing sentences? And even more importantly, do we educate our students who stutter how to be self-advocates for themselves? Katherine mentions throughout the book that she was weary of certain people based on their initial reactions to her stutter. She was constantly making assumptions about how others perceived her. Again, I wonder how her childhood might have been different had she been told at a young age not to assume that people were judging her or feeling sorry for her. She speaks during her boarding school years how she amassed a small “army” of safe people. Yet, how neat would it have been for her to have had the confidence to go up to some of those girls or to a teacher and say, “That makes me uncomfortable. I stutter. Sometimes it takes a while for me to get out my message, but it doesn’t mean that I don’t have something to say.”

The most important impact this book has had on me is the need for collaboration with my students who stutter. I realize that they know more than I do, and should really be the ones driving the therapy process. It never occurred to me that my kids probably have an elaborate system in place for maneuvering through communicative exchanges until I read chapter four. Katherine lists her “tactics for communication warfare” which included speaking in an accent, timing when to enter a conversation, and word substitution to name a few. Perhaps before we begin teaching therapy techniques, we consult with our kids on what system they already have in place. If a student knows that they don’t stutter when they speak in an accent or when singing, start with continuous phonation or a modification of melodic intonation therapy.

In the end, with all of our students not just those who stutter, it’s really about showing them that someone cares. Yes…this is a job. We show up, we do our paperwork, we see the kids, and we get our Winter Break, Spring Break, and Summer Vacation with a pay check every two weeks. But with anything in life, in the end it’s about the relationships that we have made along the way. The people that we have impacted. The courage to do the right thing and the willingness to be kind even in tough situations. So love your students. All of them. The good and the bad. You will never know the impact that you have made on them…unless they decide to travel the world and write a book!

Thanks, Lexie!

Gingerbread Men vs. Snowmen (Part 2: The Cute Apocalypse)

I know you’ve been wondering, “Where all the cute at?”

Here’s some cute that Aubrey Apel and I put together last year.  It’s a fun, religion neutral, themed unit.   It addresses several goals and can last from Thanksgiving until winter break.

Craft:

You could of course make cookies, but at my sites, I can’t do food.  Aubrey Apel and I used the attached patterns.  We cut the snowmen from white paper, the gingerbreads from brown paper and laminated several of each.  The students decorated them (sometimes as a barrier game, sometimes just for fun) using Wikki Stix/Bendaroos (pictured below). We described the finished “men,” took photos to hang on the walls, then cleaned them up and started over.  Several students gave their gingerbread people super powers, bringing the conversation to a whole new level. Here is a template for the figures.

 


EET activities, AAC vocabulary:

For describing, comparing, contrasting and vocabulary, we started with these Boardmaker activities:

The board maker activity set contains

1. A printable Compare-Contrast book with EET color-codes and symbolated text.

2. An on-screen drag and drop sorting activity.

WH questions and comprehension:

“The Gingerbread Man”

Tell the story using a picture book or watch this  Video:  https://www.youtube.com/watch?v=U89dkGrsYZY WH question game:  https://jeopardylabs.com/play/the-gingerbread-man5

Watch the video or tell the story using a storybook.  Check that your version of the story has the same details as the jeopardy game before using it.  You can edit the game as needed.  I tell the story from memory using picture supports and compare comprehension of a story to comprehension of a video.

“Frosty the Snowman”  Video:  https://www.youtube.com/watch?v=Yvi9XYP9mao WH question game:  https://jeopardylabs.com/play/frosty-the-snowman2

The lesson just uses a 10-minute clip.  Play the video up to the point where the policeman hollers “stop!” (10:20 on the time counter).  The Jeopardy questions cover just that section of the film.

We did this as a “whole class” push in during the last days before break.  Teachers enjoyed the break and were sometimes surprised at how many students did not comprehend or recall parts of the film.

More: Some older groups flew through the material, so we expanded using The Gingerbread Man Loose in the School by Laura Murray

Out with It-Overall Takeaways

I have really enjoyed reading this book and experiencing Katherine’s journey through her life as a person who stutters. I was asked to discuss the major takeaways from this book, which seems difficult because there were so many great challenges, experiences, and successes throughout the book.  The two major takeaways that I feel were really important are: 1) ‘stuttering does not have any neat answers’ and 2) ‘happiness and fluency do not walk hand in hand.’ These ideas are so important and are woven throughout the book and really stand out as central themes.

The first theme, or idea, relates to the fact that there is no cookie cutter approach to stuttering therapy and no ‘magic pill’. Throughout her life, Katherine is searching for an answer or a ‘cure’ for her stutter, but never really finds it. She describes stuttering as a ‘messy condition full of gray areas’ that will be her ‘steady companion’ for the rest of her life. Through her experiences and growth, she has found some of the answers she was looking for and feels empowered and ‘better armed’ with knowledge and understanding. She becomes better at handling moments of dysfluency and has even learned to laugh at them, instead of allowing them to be defined and archived as the worst days or moments in her life.

The second theme is all about Katherine discovering who she is, embracing her stutter and respecting that it has played an important role in the person she has become. At the end of the book, Katherine really speaks about acceptance of her stutter and how it has defined who she is in so many ways. “I have seen all of my flaws and vulnerability lain across every room I have entered. I have witnessed the frailty and strength of my heart. It has made me humble; it has made me cry more violently and love more deeply; it has shown me the finest in people and the worst in them; it has made me sensitive to the world around me.” She says that her stutter is the best part of her in many ways and she isn’t sure who she would be without it. All of her experiences throughout her life have helped define who she is today. After two decades, she realizes that fluency does not equal happiness and that everyone has problems in this ‘messy, complicated’ world, but it is how we choose to address them that determines the power they have over us.

After reading this book, I feel it has empowered us as therapists to better understand where a person who stutters comes from and that stuttering is a complex communication disorder with no specific cure that impacts individuals’ lives in so many different ways.

-Allison Forrester, SLP at Noe Middle, Manual High, and PACT at U of L

Lauren Wempe, SLP at Atkinson Elem., put together a graphic organizer, much like we might use with our kiddos, to recap the story:

Thanks, ladies!