Tuesday, June 24, 2014

The value of research...(pardon me for ranting)

Every action has a consequence. It's something that we learn as children and continue to witness throughout our lives. Yet, so many people seem to forget that our words have an extremely powerful way of coming back to haunt us. 
I think we all remember this little fiasco....
Journalism. I had the pleasure of graduating with an incredible journalist who has written for several small newspapers before graduating to a larger city newspaper. She is someone who truly puts effort into every article before its published. She goes out to city meetings, researches, and talks with members of the community. She also attends sporting events and writes about them too. I'm sure she is just one of many young journalists who spend hours dutifully researching and writing high-quality articles. It's true that even the best of these articles still has touches of her bias no matter how many facts are provided. That is just part of the reality of any form of writing. 

Marketing. I also had the pleasure of taking several history courses with an older gentleman trying to switch fields. He worked on developing advertisements. While he didn't talk about his profession often, it was clear that the advertising business is very much like a fast-paced competition to outsell a competitor's idea. We all know that the field is built upon the idea of convincing the consumer to buy a particular product because it's the best at X, Y, or Z. 

Problems, however, arise when a journalist or advertiser decides to morph into a "sensationalist" who blatantly goes on a wild rampage to attack someone or something that they really don't understand. 

I think it is pretty safe to say that an article in the June 8, 2014 of the Wall Street Journal is a wonderful example of poorly researched journalism. 

Speech therapy for children is becoming a do-it-yourself project for parents, thanks to a host of new technology tools and medical devices.
A "Do-it-yourself project?" Last time I checked, you need a Masters degree to be a Speech-Language Pathologist and simple gaining admission to an accredited program has become an increasingly difficult challenge across the country. Graduate school for Speech-Language Pathology is a combination of coursework (studying the lifespan of normal communication development, anatomy, and the causes/effects of communication impairments) and rigorous clinical placements. Students typically have placements in several different settings, including: clinics, schools, hospitals, skilled nursing facilities (SNFs/nursing homes), home health, and even prisons. There is also the matter of completing an additional period of supervision after graduating from an accredited program (Clinical Fellowship Year) before one can become nationally certified. Technology is great, but it cannot replace the countless hours of preparation and specialized training of a professional. 
According to one study, as many as one in four children struggles with a speech or sound disorder at some point during childhood. Not only do these issues cause anxiety among parents, they also weigh heavily on budget-strapped school systems.
The budget issues of school systems in the United States have an effect on every professional in the district. Teachers have to pay for classroom supplies for their students out of their own pockets. They are faced with increasing class sizes every year and assistant positions continue to be eliminated. Yet, they do the best they can with what they have been given. Many teachers and administrators write countless grant proposals seeking out the funding to bring in more advanced learning materials and technology to enhance the learning of ALL students. 

Speech-Language Pathologists are no exception to the pains of budget cuts. Many Speech-Language Pathologists serve two or three schools. I feel very fortunate that North Carolina has a caseload cap of 50 as many of my fellow clinicians serve far more students than that. This field is not for the faint of heart. It takes dedication and compassion. We do it because we care about our students. We do it because we love our jobs. We do it because we love our field. 

Until recently, the standard treatment involved having a child sit in a therapist's office, sometimes with a few other children, drilling sounds on flashcards for 30 minutes a week. Progress was sometimes slow and not always certain.
The "standard treatment" that is described in this article is far from the realities of my position. Yes, we see students with articulation (speech sound errors). However, that is just the tip of the iceberg when it comes to our field. Speech-Language Pathologists in the school system assess and treat a wide variety of communication disorders, including: articulation; phonological disorders (sound pattern errors); fluency disorders (stuttering); receptive language (understanding language); expressive language (using language); pragmatic language (social skills); voice disorders (how the voice sounds). Some school districts even allow their Speech-Language Pathologist to work with students who have difficult with swallowing (this role is generally more prevalent in hospitals and skilled nursing facilities).
Every student and subsequent treatment method is different. I serve students in their regular classroom, the Exceptional Children's classroom, or pull them into my therapy room depending on what is most appropriate for that individual. The same goes for their service time. Not every student needs to see me for 30 minutes twice a week. (Sometimes, I even take students to one of our outside courtyards for our sessions when the weather is nice.) 
As far as materials go, I like to think that school districts do the best that they can given their limited funding overall. Some districts may only be able to purchase tests and protocols. Some might be able to purchase a limited amount of therapy materials as well each year. We often have to either buy their own therapy supplies (which include I-pads, Apps, card decks, books, and other learning materials) or use homemade tools. We write grant proposals and try to get funding for new tools through Donors Choose too. Honestly, the best Speech-Language Pathologists can do therapy with just a few everyday items like paper, pencils, and a paperclip. 
Now, some companies have brought innovations to this notoriously sleepy and low-tech field in hopes of accelerating success for children and relieving school systems of some of the burden.
Considering all of the research, professional workshops, and range of settings for Speech-Language Pathologists, I would hardly call this field "notoriously sleepy." 
In some areas, "there have been huge caseloads and fewer clinicians available, says Joseph Donaher, the academic and research program director for the Center for Childhood Communication at the Children's Hospital of Philadelphia. "Technology may allow clinicians to reach more children who need services."
Technology has been a great help to the field. Therapists can work with patients who may not otherwise be able to access services via the computer, for example. It also helps to present skills in a new way to keep students engaged. Technology is great, but it is not a magic pill either. Claiming that it is a miracle cure that replaces Speech-Language Pathologists would be like me telling the pharmacist that I used WebM.D. to diagnose myself. He would refuse to give me any medicine until I saw an actual doctor. What happens when something goes wrong (and it inevitably will) and the program doesn't know how to respond?
........."Flashcards are boring at home," says Dr. Donaher in Philadelphia. "These tools help engage a child by making practice more fun and flashier with more bells and whistles."
Flashcards are boring. Well, I have to say that after a few hours I can get pretty bored of using my computer too. Students can practice many of their target skills at home by simply playing "games" with their parents. Mom and dad can challenge their child to an "I-spy" match or trying to name as many animals as they can that start with the /r/ sound. You can sing songs and read books aloud together. Social interaction is so much more valuable than sitting a child in front of a screen. (Hmm....bet our journalist didn't want parents to think of that so she just stuck to flashcard this and flashcard that. Oh, Apps and an I-Pad! How shiny!)

By the way, my students love a good game of memory match with my flashcards. We don't use them every day, but you really shouldn't discredit the value of simple objects for the power of a few flashy lights and noises. A little creativity can breathe new life into just about anything. 

Still, some speech therapists warn that these and other tools won't work for everyone. Colleen Worthington, director of clinical education in speech language pathology at the University of Maryland, stresses the importance of an accurate diagnosis and input from a speech language pathologist.
Oh, I have my doubts that it is just SOME. I think a poll would show that ALL Speech-Language Pathologists would say that NO TOOL IS PERFECT. We all learn and respond differently. 
"Technology is a wonderful tool for facilitating work on speech goals outside the school setting," she says. "However, you could frustrate a child if you aren't hitting the right solution."
Honestly, this quote is the one glimmer of hope for this entire article. Practicing at home is a great thing. I love it when parents are involved and want to help their child at home. However, I only start sending things home after we have had lots of practice so my students understand what they are supposed to do and how to do it. This helps them be and feel more successful. 

Indeed, knowing what is normal development and where a child might need more help can be difficult for parents.
To that end, PresenceLearning of San Francisco recently launched a free online screening tool called KIDinsight that parents can use to determine if a child's speech is progressing normally. It takes some of the "stigma and doubt" out of having a child assessed, says company co-founder and co-chief executive Clay Whitehead.
If a child is off track, PresenceLearning offers parents a free consultation to determine what to do next. The company also employs remote therapists and gives parents the option of scheduling online treatment sessions for their children.
Oh, honestly! Here we go again with the Apps and I-Pads solve everything! attitude. An online screening tool and free consultation IS NOT the same as a full evaluation conducted by a trained professional. 

I have to say that this entire articles sounds eerily similar to a marketing pitch that a certain company featured in this article tried not several months ago. Although that company was co-founded by a Speech-Language Pathologist, they certainly were not above attempts to demonize the field to push their product. They also seem to think that speech therapy is something parents can provide without the guidance of a trained professional for the low price of $124.

---- can be used with or without a professional speech therapist. Many parents fix their child’s speech problems using ----- at home. Each kit includes a customized lesson plan for your child, making ----- even easier to use. 

Just look at our parent comments!

So happy I didn't get speech therapy. I saved a fortune.

My son who was not able to get any of these sounds and was able to do it the first time we used them. After one week he was able to make all the sounds without the ---- and is still doing it.

After all, it's all about making a profit with a miracle tool that works "2x as fast" rather than properly informing the public. I'm not much of a conspiracy theorist, but part of me does wonder if they somehow sponsored this article. (And, by the way, I absolutely refuse to ever use or even recommend these products. I guess I need to go cry now since I'll never achieve their definition of a "Leader in Speech Therapy.")

Yo, speech therapists, I'm happy for you and Imma let you finish that therapy session....
but I need to sell my merchandise by discrediting your field.
For someone who attended both Yale and Columbia, I find that this article exceeds the normal boundaries of poor research and is a downright pathetic attempt at attacking a profession that is entirely driven on helping people. The author should take a step back from her personal vendetta and sincerely apologize to the readers for the travesty that her misinformation already has and will cause.

P.S. I have to give kudos to Complete Speech, the company behind the SmartPalate program, for stating in the comments that they designed their tool as a way to empower SLPs and their students rather than pitting the two against each other. Thank you. 


  1. Well said! I'm proud to be an SLP when people like you are willing to stand up for what is right!

    1. Aww, thank you so much! I just couldn't take such a huge insult being dealt to our field without saying something. I love being an SLP too much. :)

  2. Awesome post! I left a comment on the article touching on several points that you have made in your post......If the author had simply went out to see what we SLP's do for a day in multiple settings, he/she would discover the multitude of things that we do! I couldn't believe that article!!

    1. I thought about that same thing. The author could have easily found places that would have been willing to let her observe. I just do not understand why individuals in public positions try to demean the helping professions.