Making the Case for Educational Impact in Articulation Therapy

Over the past nearly 40 years I've heard a lot of conversation around articulation therapy and "educational impact."  To this day the discussion continues to center around whether students who exhibit what may be considered mild speech sound disorders (SSD) like a lisp, are eligible for services because their difficulties don't impact academics. For instance, these children are not writing "thun" instead of "sun." Historically then, articulation therapy in the school setting may not be provided. The notion of not providing services because there is no "impact" on academics narrowly restricts the definition of educational impact. Personally, I consider any speech sound disorder as just that, a speech sound disorder, and have come to consider educational impact as a euphemism for “keeping caseloads low” and ignoring basic communication even as it relates to CCSS.  This distresses me. I am passionate about what we do and I don't like when we allow bureaucracy or misinterpretation to interfere with our responsibility. I'm taking a grave risk of overwhelming you, dear reader, and I understand the concerns around massive caseloads and staggering special education numbers, I'm sharing, nonetheless.

1. When I graduated in 1983, I had to have certification to work in the schools in NJ. My certification was as a Speech Correctionist! Working on SSD was a huge part of our job, whether mild or severe.
2. From 1985-87, when working as an itinerant SLP for Essex County Educational Services Commission, servicing the nonpublic schools, we ONLY worked on articulation.
3. The criteria and interpretation for educational impact varies from state to state.
4. Educational impact is subjective and too narrowly defined.
5. Educational impact should include things like: calls attention to the student, socially isolates them, causes peers to comment or tease, interferes with establishing peer relationships, and causes embarrassment or frustration to the child. 
6. Untreated speech sound disorders have the potential to impact individuals across the life span in terms of social stigma and economics as it relates to employment. 
7. The following was included in a letter to Stan Dublinske, the ASHA Director of School Services in 1980, from the Department of Health, Education, and Welfare and explores the problem with the term educational impact: "The broad issue raised in your inquiry is whether the definition of "speech impaired" in the regulations implementing the Education of the Handicapped Act, Part B (as amended by P.L. 94-142) is interpreted to mean that children with communicative disorders who have no other handicapping condition are ineligible for services as "handicapped children" unless educational assessments indicate concomitant problems in academic achievement. An interpretation is needed because "educational performance" is not specifically defined in the Part B regulations. However, the standard for determining whether a child fits into any of the categories of handicaps listed in the Act and regulations is that the impairment "adversely affects a child's educational performance." Under Section 602(1) of the Act, a child with one of the listed impairments must need special education to be a "handicapped child". For children who need a "related service" but no other. special education services, the Part B regulations in section 121a.14(a)(2) allow a State to consider that service as "special. education", bringing those children within the scope of the Act. . I agree that an interpretation which denies needed services to speech impaired children who have no problem in academic performance is unreasonably restrictive in effect and inconsistent with the intent of the Act and regulations." 
8. In an article written in 2002 for ASHA's Perspectives for School Based Issues, Stan Dublinske wrote, "It was ASHA's position that local education agencies requiring such educational assessments and denying services to children with obvious speech or language impairments because they did not have a concomitant problem in academic achievement were using a very narrow definition of "educational performance." In various discussions with staff in the now Office of Special Education Programs (OSEP), ASHA explained that "educational performance" included performance in communication. At that time there was a big push to ensure that all school children acquire "basic skills." ASHA made the point that mastery of "effective oral communication" was a basic skill. As a result, a speech or language impairment necessarily adversely affects educational performance. Therefore, children needing speech-language pathology services should not be denied services just because they do not show discrepancies in age/grade performance in academic subject-matter areas."
9. Students can receive articulation therapy if a school does due diligence via a multi-tiered system of support.

Enter Response to Intervention, (now merged with Positive Behavior Intervention and Supports; PBIS) and called a Multi-Tiered System of Support (MTSS).  MTSS is a three-tiered framework offering support for ALL learners, advanced and struggling alike. Tier 1 supports the entire child and is appropriate for all students and aligns with core standards. Tier 2 offers support for students who need supplemental services beyond what can be provided within the context of core instruction. It is specifically focused on an area of need and is more short-term. Tier 3 addresses unique needs and individualized support and typically is done via special education.

I provide therapy for mild SSD through tier 2. Students are offered articulation therapy with an emphasis on home and school collaboration for approximately 12 weeks. Speech sessions are only 15 minutes long two times per week and involve quick, motivating drills with 100 repetitions (phew). Parents are asked to come in for a brief meeting so I can explain their role and how they can help their child while supporting what I do at school. I do give students homework and ask that it is practiced four times per week for only 5-10 minutes.  If students are making progress and practicing with an adult partner at home, but haven't begun carryover, I will continue to a point I feel generalization can occur organically. 

This is my bottom line; any judgment of educational impact must factor in the whole child including social-emotional and the core standards of speaking and listening. In addition, the implications on future employment and social stigma cannot be ignored. As highly trained professionals it is on us to provide articulation therapy while fostering collaboration with parents to support our therapy. Speech therapy for mild SSD can be so rewarding as the outcomes are often favorable. I once received a note from a middle school student depicting me soaring through the air with my cape flowing behind me as I said, "Ssssssssss!" It was a thank you note. I knew what correcting that lisp meant to that child and I was pleased to do it.

An Inspiring Example of the Communication Connection

Image by Quinn Kampschroer from Pixabay

Today was my first day back to work after a wonderful summer. I love summer vacation, make no mistake, but I also like getting back into my routine. I enjoy fall, yet late summer is amazing! Tourists go home. My kayak isn't tossed about by the wake of the motor boats. I can hear the birds instead of blaring radios. It becomes cooler to hike and the bugs start to disappear. It's truly a great time of year.

As I returned to work, the importance of what we do as SLPs (and educators) wasn't lost on me. We know communication is connection. We know the cost of when the intimacy of conversation is lost. I was reminded of how valuable communication is, beyond how we form sounds or sentences, beyond assessments and Facebook controversies, this past winter.

Our son, Mack was traveling from New York City home to NH for the holidays. It was his first year of college and we couldn't wait to see him, to hold him, to talk to him. As he was heading to the bus stop, he saw a homeless man who had no socks. Mack stopped, removed his socks, and gave them to the man.  "Thank you," the man said, "but do you have a minute? I really appreciate the socks, but I could use someone to talk to. People give me food and money, but nobody ever talks to me." Mack sat down next to the man and spent the next fifteen minutes talking, just talking. The man asked which Mack preferred, Dunkin Donuts or Starbucks, random small talk. And they just talked. It cost Mack nothing and it offered another human being connection and dignity and worth. When Mack recounted the incident, he said, "Ma, he only wanted someone to talk to. I could do that."

As I go into this school year I hope I don't forget how valuable what we do is. In this fast paced, social media driven world there are lots of hashtags about communication and plenty of slogans, but the real impact is sometimes simply seeing another person and taking the time to talk.

Enough IS Enough

Next week I start my 36th year as an SLP. THIRTY-SIXTH YEAR! Somehow I thought it was 37, but I guess it just feels that way. :) I am fairly happy with where my journey has taken me. I've grown both professionally and personally, but haven't quite reached that point of complete satisfaction. I still compare myself to young SLPs with their cute Teachers Pay Teachers stores. I still compare myself to the seasoned ASHA SLPs with their positions and professional clout. I compare, I compare, I compare. ENOUGH!

I am reading Brené Brown's Daring Greatly and she purports that much of society's problems are rooted in the "fear of being ordinary." Our social media feeds are clogged with posts of people living seemingly extraordinary lives. I know when I see posts I think, "What am I doing wrong? Why doesn't my life look so spectacular?" Brown digs deeper and describes a "culture of scarcity." In our culture of scarcity we never have enough and sadly when comparing ourselves to the perfectionism social media and media in general underscores, we never will.


As I read, I thought about how I could combat this as I approach a new school year. It occurred to me a series of daily affirmations about what I have that is enough might be a great place to start. Now, this doesn't mean I stop here, I can always do more, but where I am today is good enough for today. Tomorrow will bring something else, another change, a growth moment. So without further ado...
As an SLP:

• I am good enough
• I am successful enough
• I am competent enough
• I am talented enough
• I am creative enough
• I am compassionate enough
• I am smart enough
• I am professional enough
• I am thorough enough
• I am empathetic enough
• I am clever enough
• I am valued enough
• I am well read enough
• I write well enough
• I am organized enough
• I have enough
• I do enough
• I am enough

As a human:

• I am thin enough
• I am funny enough
• I am pretty enough
• My house is good enough
• My husband is good enough
• My children are good enough
• My car is good enough
• My bank account is full enough
• My clothes are good enough
• I am fit enough
• I run fast enough
• I have enough
• I am extraordinary enough
• I am enough

I am enough for me and the handful of people who know, accept, and love me for me. You are enough. So let's stop comparing and start this year doing what we do best. Let's live and be content. WE ARE ENOUGH.

Back to School 2019

Well, here I am, a blast from the past!! It has been a while since my last post, hasn't it? That's okay! I'm being gentle with myself regarding my hiatus and am just going to jump right back into the blogosphere.

In eleven days I will be back at work and although my years in the school system are winding down, I still get butterflies. My head is in a better space than in the past and I am even feeling excited to get back into my routine. I am looking at my future year and my future future. I have the beginnings of a plan and am itching to see how things pan out.

To begin, I have been immersing myself in learning (outside of the required continuing education required for licensure, etc), so back to school has had a literal meaning. I thought I would share what I've been doing and what is coming up, because I think it has in large part kept me jazzed about going back as well as going forward.

1. I have a student who was challenging what I had been taught as an SLP. What I learned and was using didn't seem to be the most effective therapy for his complex articulation disorder. I was picking my friend Sparklle SLP's brain and she mentioned trying the multiple oppositions approach. As much as she tried to explain it to me, I was confused and I wanted to employ it correctly. I bought Phonological Treatment of Speech Sound Disorders in Children: A Practical Guide 1st Edition by Jacqueline Bauman-Waengler and Diane Garcia. This book was a game changer for me. It very clearly described and explained the contrastive approaches for treating phonological disorders. The little guy who was so vexing to me, became my most improved student!
2. At the end of June when most of my students were on field trips, I took a course offered by Karen Dudek-Brannan on vocabulary assessment, vocabulary selection, and vocabulary instruction. She often referred to Contextualized Language Intervention: Scaffolding PreK–12 Literacy Achievement written by Teresa Ukrainetz. This is my next purchase and read!
3. ASHA Connect in Chicago, need I say more? Well, okay. Many folks aren't always satisfied with the ASHA conferences/conventions. They walk away wanting more. To that I say, "go get more!" It's impossible to provide deep information in 90 minutes. I view these conferences as an opportunity to travel, connect with friends, meet new people, explore the exhibit hall, and if a particular topic whets my appetite, I seek out more information on my own. That's my responsibility as a lifelong learner.
4. While doing ESY this summer, another student left me with questions. This was not a student I had evaluated, so I didn't have a history. Again, I wasn't quite sure what was happening and asked some questions of my friend Pam, of Small Talk.  She questioned the possibility of tongue tie. Many years earlier I had purchased a book called, Tongue Tie: from confusion to clarity-a guide to the diagnosis and treatment of Ankyloglossia. Apparently Carmen Fernando's monograph is a definitive work. At the time I had been curious about the subject, (I did not pay the $250.00 it now costs), but had no pressing need to read the book.  Now I did, and it was GREAT.  I wonder what took me so long? :)
5. Late July brought the SLP Summit, which was quite good. I took 5 of the 8 webinars offered and again was inspired to learn more.
6. As an SLP working in the schools my salary is dependent on "steps" and credits beyond my degree. I got my masters degree in 1986! I really had had enough of school. I did get 12 credits beyond my masters but I need 15 to increase my salary. So, I'm finally taking an online course; The Practice and Power of Vulnerability in the Classroom. While I don't have a classroom, I think the course has real potential for my work with all students, but particularly those with social pragmatic difficulties. As an added bonus the required reading is Brené Brown's Daring Greatly!
7. The training I am MOST excited for happens in October. I will be embarking on a four day training in orofacial myology. It helps that I was the winner of a $500.00 discount while at ASHA Connect! I am so excited for this and cannot wait to see the doors it opens for me as I begin planning the next chapter in my career.

As SLPs we have ethical responsibilities to ourselves, our profession, and the public as well as a responsibility to maintain professional competence. Personally, I feel these responsibilities have the added bonus of keeping me relevant, focused, competent, and excited to to what I do. Bring on the the 2019-20 school year. It's going to be great!

FunGames Speech Therapy Card Game : A Review

Finding high quality and engaging materials can be a challenge for the pediatric SLP, or any SLP for that matter. These days we have access to so many products and materials, it's hard to flesh out what will be useful across targets and age ranges.  We also want to make sure there is a long term usefulness. I often ask myself, "If I pull this out again next month, will my students be as excited as the first time I introduced it?" I also realistically have to consider if the product/material engages me! I want to be just as excited about what happens at my speech table as my students. Since so many of us spend our own money, the decision on where to invest becomes even more challenging and there is nothing more exasperating to me than having purchased and downloaded materials from TpT that have never been printed or used. I shudder to even think about how many products I have on my computer that have never been used. Consequently, hard goods have an appeal over digital products because they are front and center; manufactured, purchased, and ready to go, no printing, laminating, or cutting.

I was recently contacted by Maya, from FunGames, about a product she and her aunt, an SLP with 28 years experience, had developed. Their motivation was to design therapy materials that created solutions for some of the typical SLP challenges. The Express Game was born out of a desire for materials that offered enjoyable therapy, convenient card size, durable quality, crisp, clean, and real photos, common categories, relevant pictures, card flexibility, and box sturdiness.

Maya offered me a copy of The Express Game to review, no other compensation was provided. The following review contains my humble opinions only.

What I really loved about this product:

• The Express Game comes in an extremely sturdy "shoebox" style box. It is visually appealing and for a tactile person like me, has a smooth finish.
• Included in the starter set are 130-2.75 x 4.75 cards in 10 categories (clothing, fruit, vegetables, tableware, school supplies, musical instruments, cookware, furniture, and electronics).
• The cards are brightly colored and feature clear, crisp photos without text. Again, as someone who notices texture, these cards have a really nice feel.  The cards themselves are waterproof and rip-proof. While I haven't done rigorous assessment of that claim, I can say, they are most definitely of sturdy quality. 

• The textless nature of the cards allow them to be globally relevant and functional across any language. Some of the cards can be used for single word vocabulary activities while others can be used for developing words of classification as they feature several pictures belonging to the category.
• Since the cards are real photos they can be used for any age and population.
• This product is well suited across therapeutic and educational domains. Early educators, special educators, and  ELL teachers as well as an SLPs working with pediatrics and adults can find ample uses for these cards.
• The cards are a practical size and are held easily by little hands.
• The cards are easily used for individual therapy and group therapy.
• The Express Game is very versatile and I have used it already with favorable results. It comes with a manual that includes many suggestions for therapy and games. 

• An extension game is available here and includes 52 more cards in the categories of sports, camping, beach, and media.
• The cards themselves are easily carried in a bag for use at multiple sites. SLPs will need to use their own bag for this and a small bag might be a nice addition to the product, so the entire box doesn't need to be carted site to site.
• The interior of the box is slotted for convenient organization of the individual category decks with extra slots available for your own additions or the commercially available extension sets.

Other considerations:

• Interestingly, there are no animals included in either product. I would like to have seen those in the starter set.
• There are no blank cards included.
• While the cards themselves are a great size for little hands, they are a little slippery.
• Cards with text options might be useful, however, I do understand that would impact the global appeal.
• When I originally ordered The Express Game, it was $59.93.  I consider that price somewhat high. I see the price is now $49.93 which I believe is more reasonable.
• Transporting the entire box for the itinerant SLP, might be cumbersome. Including a cloth bag for carrying the cards between sites would be handy.
• What makes the cards virtually indestructible is the fact that they are 100% plastic. From an environmental perspective I would like to see them made from a more sustainable material or even from recycled plastic. 

Overall, I am quite pleased with these cards and am excited to devise new ways to use them. I appreciate the opportunity to have given these cards a spin! Maya has generously offered a 20% discount for my readers (Thank you, Maya). You can find The Express Game here. Use the coupon code AnnieDoyle20 to receive 20% off the FunGame Original 130 Flashcards. This code will be available until June 25, 2019.

I would love to know if you purchase this product and I hope my review was helpful.

A Little Help with /r/

I have most definitely dropped the ball on my poor blog. I feel a little guilty, but I've been told guilt is only productive for about ten minutes. I should be over it by the time I'm finished writing. :)

I was working with a student today whose profile is fairly complex. We were working on /r/ using the "ka-la" technique. While we had the "ka" piece down the "la" was proving more of a challenge. I think this is because we previously worked on /l/ and curling the tongue way back is counter intuitive, given all our work on tongue placement for /l/. We have tried play-dough, used a mirror, flashlights, flossers, and the jumbo mighty mouth by Super Duper Publications. It was tough.  This student needed some feedback that just wasn't happening.  I pulled out the mini mouth finger puppet also from Super Duper Publications. I asked the student to simultaneously move the mini puppet tongue while producing the "ka-la."  Wonder of wonders it worked. My student could see and feel what the tongue should be doing for this method!

Now, how to maintain the connection for home practice? I whipped out some red felt, a red pipe cleaner, and my trusty glue gun. Voilà! After trimming off the annoying glue threads and trimming around the felt a bit, we made sure it worked well with a few trials (it did!).  My student was super excited and now has a puppet to practice with at home.  Phew! Whatever it takes, right?

A Message for Full-Time SLP-Moms

While it may seem like I've abandoned this blog, I haven't! I have a multitude of paper scraps with notes, thoughts and ideas stowed and tucked in a multitude of places. I just took a break. The past twenty years have been spent as a working Mom.  I'm still trying to settle into my empty nest life and I haven't yet found my rhythm nor my place, so today I wanted to share a memory I had as I scrubbed floors.

Many years ago we had friends over for dinner, friends I truly love. It had been a long week and I spent my Saturday cleaning and cooking a turkey dinner. A veritable Thanksgiving feast. As we were tucking into pumpkin pie and coffee, the conversation shifted to parenting. It was then my friend looked at me and said, "Well, you're not a full-time mom."  Six words uttered that have been etched in my memory and heart. My response was simple and to the point, "Make no mistake, I am a full-time Mom."

Often when I worked late on an evaluation, those words echoed. When I had to rush my children out of the house for an early morning meeting, those words echoed. When my husband would bring a pizza to school and we would eat in my speech room, those words echoed.  I have long since forgiven the cavalier attitude that I presume accompanied those words, yet even today those words echoed, forgiven, not forgotten.

Yes, I was and am a full-time SLP, working for both the salary and the benefits that provide dental and health care coverage to my family and now college educations (as well as the love of the job).  I also fondly remember helping with bake sales, waiting for my little ballerina to finish dance class, being the den leader for cub scouts, teaching religious education, kindling a spirit of volunteerism at walks for cancer and life, driving to track meets, cross country meets, lacrosse games, editing college applications, baking bread and washing floors and dirty clothes. I was a full-time Mom, after all, and that was what I did.

I know mom-guilt is real but, I share this to remind all working moms who feel even the slightest tinge of guilt to release it.  I've heard it said that guilt is productive for all of ten minutes, after that it becomes destructive. We work, in large part, to provide for our families, nevertheless we are also models of success, perseverance, love and dedication. Working moms shine in ways that can't be quantified. Be gentle with your professional self and be gentle with your personal self. It was good for me to remember not to take either of my selves too seriously, nor to separate them!

Years have passed since that eventful dinner party. Our kids are both seeking adventures on their own and I have quite a bit more time on my hands. Despite this one thing remains, I am to this day a full-time Mom and I am pleased to say, "In my heart, I always will be."