SLPs roles often overlap with other professions. While collaboration is highly desirable, sometimes roles overlap so much as to be almost indistinguishable. It can be a disconcerting feeling – as though the earth has moved beneath your feet!  In this podcast we explore the following:

• The root causes of speech and language disorders. Understanding root causes helps us understand why multiple diagnoses and professions often converge at the same point.
• The relationship between auditory processing, memory and language.
• Simple but powerful interventions to help SLPs navigate our professional lanes more effectively.

It’s time to begin targeting root causes rather than treating symptoms! By honing in on these root causes and understanding the progression of interventions, we can achieve significantly better outcomes for our clients. Don’t forget to explore the wealth of materials available on The Speech Umbrella website and the value of sharing knowledge within our professional community.

 You may want to check out these free items available on my Resource Library: 

Baa Baa Black Sheep , One, Two, Buckle My Shoe , Rosner Words (Phonemic Awareness Word Lists)

 Helpful Links

Academy of Orofacial Myofunctional Therapy
PROMPT
Digging into Stability and Mobility with Char Boshart
Impossible R Made Possible
Three Therapy Takeaways from”The Brain That Changes Itself” by Norman Doidge
What Got Lost in Translation
Real Changes in Spoken Language with Sketch and Speak
Phonological Awareness Tracking Tool
Phonemic Awareness in Young Children
Prime to Rhyme
Nursery Rhyme Coloring Book
Cue the Move
Orange is a Carrot
Free Resource Library
Narrative Language Intervention with Douglas Petersen pt 1
Narrative Language Intervention with Douglas Petersen pt 2

 Transcript

Denise: 0:06 

Welcome to the Speech Umbrella, the show that explores simple but powerful therapy techniques for optimal outcomes. I’m Denise Stratton, a pediatric speech-language pathologist of 30-plus years. I’m closer to the end of my career than the beginning and along the way, I’ve worked long and hard to become a better therapist. Join me as we explore the many topics that fall under our umbrellas as SLPs. I want to make your journey smoother. I found the best therapy comes from employing simple techniques with a generous helping of mindfulness. Hello, welcome to the Speech Umbrella Podcast.

Denise: 0:39 

This is episode 102, and I’m calling it Where’s my Lane? If you’ve experienced driving on a dark and rainy night with faded lane striping, you know how unnerving that can be. That’s when I mentally berate the powers that be in charge of striping and I cry out to the universe where’s my lane? Okay, that’s a little dramatic, I know, but the situations I’m going to describe now are honest to goodness, lived experiences in our profession and could be equally unsettling. I was on a speech therapy Facebook site recently and happened upon a discussion among young SLPs who were discouraged because reading tutors were making more than them. It’s likely these reading tutors also had less education and less student debt to boot. To add to the confusion. The SLPs weren’t sure whether they had the knowledge to compete with the reading tutors. They were receiving all sorts of suggestions to take a variety of courses to up their game, some of them which were quite expensive. So to what end was their already expensive education if they had to pay more to make as much as a tutor? And to further the confusion? Should they be teaching reading? Should that have been part of their training? I know we’re not in this profession for the money, but we do want to be equitably rewarded.

Denise: 1:52 

Here’s another situation to consider. I recently took a course in myofunctional therapy which was very eye-opening. In fact, I need to do a podcast about that in the future, as we discussed various case studies. Not once, but several times, it was mentioned that a client’s long-standing speech disorder was corrected through myofunctional therapy. Not that the myofunctional therapist addressed the speech order directly In most cases the therapist wasn’t even an SLP, they were something like a PT or an OT but that the speech disorder was corrected as a side benefit of the myofunctional therapy. That begs the question if myofunctional therapy can correct a speech disorder, why wasn’t that part of my training? And where’s my lane as an SLP if someone else can do my job and correct speech disorders. Finally, here’s another situation to consider. I’m part of a group of audiologists and SLPs who meet to discuss auditory processing. At our last meeting, the audiologist who was presenting an intervention model said her employers had initially directed her to do the therapy. Later they changed their minds and assigned the therapy to the SLPs.

Denise: 2:51 

It seems as though the powers that be whoever that is don’t even know where the lanes are. So the question is can other professions do what we do and, if so, where does that leave us? In today’s podcast, I’m sharing how to thrive in our profession, even with these lean confusions. In order to do that, I’ll be presenting a simple view of speech and language disorders, along with powerful interventions. Before I jump into that, I want to take a moment and talk about why we have this confusion.

Denise: 3:17 

Our profession has grown a lot since the early days of speech therapy and we’ve discovered a lot about learning. All the other professions concerned with learning are doing the same thing. We’re making the same discoveries. The more we discover about the root of learning problems, the more professions will be addressing that area. There are fewer root causes than professions, and there are fewer professions than names of disorders. Don’t even get me started on all the names we have for speech and language disorders. We can have five to ten names for symptoms that stem from a single root cause. That’s sometimes needed for insurance purposes, but oh the confusion it causes.

Denise: 3:52 

This lame confusion was bound to happen as multiple professions who work with children with learning disabilities have been uncovering the root of their problems. We know speech and language disorders often go hand in hand with a learning disability. When the root causes are the same, it stands to reason there will be overlap of remediation techniques. Then we are not sure where our lane actually is. I think of this like an inverted pyramid, narrower at the bottom than the top. The root cause or causes are on the pointy end, at the bottom. Then come our interventions and next the various professions who administer the interventions and finally we have the multiple diagnoses to describe what emerges from the root causes. These diagnoses tend to multiply like gremlins fed after midnight, and it gets very busy, very crowded down there at the pointy end, right when we’re all treating the root causes. Now, well, not everybody is, but I should say more of us are discovering the root causes, which is fantastic, but we get a little bit crowded down there, then we get scenarios like this. Just take dyslexia, for an example Mass confusion over what dyslexia is, who can diagnose it, who can treat it and how. Oh my, there are a lot of theories on how to treat dyslexia. If we would just look at the root causes and treat those, it would simplify things so much.

Denise: 5:08 

Just because the view of speech and language disorders I’m going to present to you is simple, that doesn’t mean the interventions aren’t powerful. They are. I suggest that the most powerful interventions stem from the simple view. Here’s my simple view of speech and language disorders. Bear in mind that this view applies to a large portion of a pediatric caseload, but not everyone. Clients with autism don’t necessarily follow this model, but they can. Fluency clients don’t necessarily follow this model either, but there can be overlap.

Denise: 5:37 

I’ve made this analogy on previous podcasts, but it bears repeating. Every child I see is on a therapy journey, which I picture as a road. The road begins with motor skills and transitions into auditory skills. On this journey, there will be weather that affects their journey. The weather represents cognition, memory, temperament and social skills. It’s my job to figure out where on the road my clients are and apply the appropriate interventions.

Denise: 6:03 

You might be thinking, wait a minute, you didn’t say a single word about articulation or expressive language just now. That’s because I’m talking about root causes. Speech is movement made audible, that it’s first and foremost a motor skill. As for language, how do we learn to speak? Because, all other things being equal, such as motor and hearing, we hear, process, remember and reproduce the language around us, and that’s auditory processing. How do we apply interventions to root causes? Then let’s unpack this, beginning with motor skills.

Denise: 6:34 

We’re not OTs or PTs, but we are concerned with motor skills that impact speech. Also, it behooves us to recognize children who need OT and PT besides what we can offer. So many children, who are often dysregulated, have a great need for OT or PT, and one of the saddest things I saw during COVID was children who missed out on OT and PT services in favor of speech therapy because communication was deemed to be more necessary when in fact, ot and PT would have helped them to be more successful in speech and language therapy. But getting back to what interventions we can do, we can treat the muscles needed for speech. Here’s some suggestions for how to treat the root of motor speech problems.

Denise: 7:13 

You could take a course in myofunctional therapy how to treat the root of motor speech problems. You could take a course in myofunctional therapy. I recently did that and I am so grateful. I learned a boatload about how muscles that’s soft tissue affect bone that’s hard tissue and how critical a correct oral resting posture is. I learned additional ways to help clients achieve correct oral resting postures, which absolutely affects speech. By the way, my course was through the Academy of Oral Facial Myofunctional Therapy, which is really really in-depth. If you decide to take this route and take a myofunctional therapy course, I recommend finding a course that really does go in-depth and includes people from other professions. In your course you can learn a whole lot from the other people around you that are outside of our profession. Now you could also take a course in prompt therapy.

Denise: 8:01 

If you’ve been listening to me for any amount of time, you know I love prompt, but there are some pros and cons to prompt it helps to be aware of. Their assessment includes questions on the integrity of the oral structure, the palate, their dentition etc. But the course doesn’t provide guidelines on what constitutes an ideal oral structure. Also, one of their mantras is speech through speech, meaning the prompt technique rejects any kind of tools to improve speech aside from their tactile cues and speech itself. I don’t hold that position myself, since I’ve seen great results from using tools such as the myofunctional kits I use and the horns and straws for talk tools. That being said, there are so many pros to prompt. If you get prompt trained, you will understand how speech is three-dimensional and in what order. To teach sounds, you gain an understanding that you are remediating speech through using sounds to train the jaw, the lip and tongue movements. The sounds are the tools to balance muscle movements.

Denise: 8:52 

Children who are too young to do myofunctional therapy can really benefit from prompt. Also, clients who don’t have the cognitive ability to participate in myofunctional therapy can benefit from PROMPT. Prompt helped me understand how very, very important phonation control or diaphragm control is to speech. I think that often gets overlooked in speech therapist training. And finally, prompt directs your attention to a client’s cognitive and social abilities in addition to their motor ability, which helps you intervene at appropriate levels for that child.

Denise: 9:22 

And if you’re not up for a mile functional or prompt courses, take a look at Char Beauchart’s material. She has a fantastic knowledge of all things oral, motor and tons of material for SLPs. I interviewed her on episode 79 and we took a deep dive into oral motor issues, and you can learn a lot from Char. Last but not least, my course for R Impossible R Made Possible goes into how to assess and remediate the oral motor system. I also have several podcasts on R that I’ll link in the show notes. All of the above myofunctional therapy prompt. Char’s material and Impossible R teach how to remediate the root cause of motor speech disorders, and they range from a substantial financial investment to very affordable to free. So there’s something for everyone.

Denise: 10:04 

Now let’s return to the therapy road analogy and the second half of the road, which consists of auditory skills. There is a growing recognition that deficits in auditory skills lead to learning disabilities, which of course include language disorders. Here’s one way to think of it. I ask myself how typical developing children learn language. I conclude it’s through hearing processing and remembering what they hear. By the way, this is a research-based way to look at language disorders. Check out episode 88 to learn why. For the sake of simplicity here I’m not including the earlier part of the journey, motor skills. The assumption is you’ve done as much as possible in that area by now.

Denise: 10:41 

When looking at auditory processing. We must include memory, as that is critical. And here’s a word about memory. You can absolutely help clients improve their memories. I have seen it time and again. However, with cognitive impairments there will be constraints and in time you will eventually discover the point in therapy where your interventions are no longer effective, where you get diminishing returns. But even those clients with cognitive impairment can improve their memory sometimes.

Denise: 11:07 

It’s ironic that in motor speech disorders often the only recognized diagnostic label is apraxia, which is too severe of a description for most clients. We don’t even know how to talk about motor speech disorders because people just jump to apraxia. Then we can hardly talk coherently about language disorders because we have so many diagnostic terms. Even as I was preparing this podcast, I wondered if I should use the term auditory processing or auditory skills, or phonological processing or phonemic awareness. Yikes, I don’t care a lot about diagnostic terms, I just want to treat the symptoms.

Denise: 11:39 

Here are some powerful interventions that treat the root causes. They treat the ability to process, recall and then produce language, and in the process, reading disorders, also known as dyslexia, almost always get treated. There’s a clip for reading success by Dr David Kilpatrick, a method for teaching phonological processing, and I have several podcasts on this that I’ll link. There’s a book called Phonemic Awareness in Young Children by Adams, foreman, lindbergh and Beeler and I hope I pronounced all those names right and that is a great book that I used to actually develop some of my own auditory processing tools. There’s the phonological awareness tracking tool. This is a form I created which I use for both assessment and progress monitoring. I developed this as I started to delve into treating the root causes, and I use it with most of my language clients. Actually, I have another tool called Prime to Rhyme. I developed this tool to improve auditory memory of consonant vowel rhymes such as shoo boo too. I found it to be a great stepping stone to help children gain a greater ability to analyze and process longer words. And when they can analyze and process longer words, guess what they can analyze and process language and sentences. Guess what they can analyze and process language and sentences.

Denise: 12:53 

I’m in the middle of putting together all of the materials I’ve developed for processing, recalling and producing language, and while it’s not finished, I do have several products published, and they are the Nursery Rhyme Coloring Book Cue the Move, which is a following directions activity Orange is a Carrot, which is a poem activity, not to mention Prime to Rhymeological awareness tracking tool I just talked about. In my free resource library there is one to buckle my shoe, there’s a baa baa black sheep activity and there are lists of words that are called the Rosner phonemic awareness words, and they are lists that are the free version, if you will, of Equipped for Reading Success. Now there’s a couple of other interventions that are powerful for processing, remembering and producing oral language, and they are the Story Champs program for narrative language and Sketch and Speak for expository language. I have podcast interviews with the creators of these materials for both of these techniques, and those are awesome. All you need to do is go listen to them.

Denise: 13:52 

I use either of these interventions the storytelling or sketch and speak either concurrently with the auditory processing I’m doing or after a client has completed the auditory processing skills I’m working on. It’s just very client specific and also coming up soon. I have 50 stories that I have created that you can use for a narrative intervention. They are very simple and they’re meant to work with that group of children who are just beginning to be able to do narratives, because I found there was a gap there, and so those have all been drawn beautifully by an artist and they’re all written. I’m just preparing the marketing material, so watch for those, because those will be coming out soon. Finally, if you’re dying to get your hands on all of my materials for phonological awareness or auditory processing whatever we’re calling this reach out to me at denise, at the speech umbrella dot com, and I’ll send you my beta package. The only cost to you is to give me feedback.

Denise: 14:53 

You can see from all this, we don’t lack in materials to intervene in language disorders. In fact, we have too much. That is fluff. All of the things I just talked about are way better than the fluff. The trick is to know where to begin and the order of progression, which is where my phonological awareness tracking tool comes in very handy. To wrap things up, let’s talk about thriving in our profession.

Denise: 15:14 

In our new world of professions crossing lanes, all you really need is two things First, become well educated in treating the root causes of speech and language disorders and second, know the order in which to apply the interventions. Then you can navigate in your lane with confidence. You can speak knowledgeably about the symptoms you’re treating, no matter what diagnostic label has been applied. With this knowledge, you see your clients progress faster and farther. Check out my materials for language processing at thespeechtrimbellacom. You’ll find some in my store and others in my free resource library, and you’ll also find these materials on TPT.

Denise: 15:51 

If you haven’t signed up for the free resource library yet, take a look at thespeechjabellacom slash free. My mantra is when you master the simple, the complex takes care of itself. But another way of saying that is when you treat the root causes, the symptoms take care of themselves. I know I’ve just given you a whole boatload of things to explore and I’m going to link them all on this podcast. So just be aware it’s going to be as long as your arm. Go to the speech umbrella dot com. Slash blog slash 102, to see all of these links. åThanks for joining me under the speech umbrella today. I hope you learned something to help you in your therapy. If you did, please share this podcast with a fellow speech therapist and leave a five-star review on Apple, itunes, spotify or wherever you get your subscriptions. While there, come on over to thespeechumbrellacom where you will find transcripts, links and my free resource library. I also have some other valuable courses and therapy aids in my store. That’s all at thespeechumbrellacom. Let’s connect on social media. I’m dstrattenslp on Instagram and the Speech Umbrella on Facebook and YouTube. You can also find me on TPT. I hope to talk to you soon. Bye.

Dan: 17:01 

Thanks for listening to the Speech Umbrella. We invite you to sign up for the free resource library at thespeechumbrellacom. You’ll get access to some of Denise’s best tracking tools, mindfulness activities and other great resources to take your therapy to the next level. All this is for free at thespeechumbrellacom. If you’ve enjoyed this podcast, subscribe and please leave us a review on Apple Podcasts and other podcast directories. Thank you.