Podcast Transcript - Episode 35
SLP Toolkit Podcast, Episode 35, Transcript
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Well, Hey Lisa.
What's up, Sarah?
Not that much. Just a, you know, hanging out.
I have nothing to say to you.
I have nothing to say to you. I feel like I've seen you almost every day. So I'm out every day.
Literally every day.
Um, I'm out of ideas.
I know we have nothing. There's not a thing left to talk about.
We're like an old married couple.
It's really true. It's like when you go to dinner and you've got nothing left to say, and so you like pray for an interruption from someone? Like a text message.
Yeah. It's like my every day at work. I just keep looking at my phone, waiting for an email to come in something.
It's terrible. We have spent way too much time together. We might need a break. A little separations good for us. All right. So fortunately, we don't have to like stretch this out and make this a painful conversation and try to think of things to say, because we've got a guest.
Yes. Thank God.
Even better than looking for an email.
Right. Okay. So please introduce who's in the confessional with us today.
We are super excited to have Rebecca from Adventures in Speech, in the confessional today to talk about her amazing SLP summit course.
Good day. How are you guys?
Good. It's so good to talk to you. I know we just hung out a couple of weeks ago in front of a really small audience.
I know, I know that was so much
I will say I had the honor of doing the transcription for your course and it looks, it seems like our auto generator kind of software that gives us a base for what the transcription is. They don't speak Australian. I could go over a lot of different words and fix it. And I'm like, yo, it's still English.
Do you know when I, when my mom has listened to previous podcast, she says to me, Rebecca, you sound so yobbo, which has like, you know, like various Australian slang. So she's, she's told me, I have to try to be very articulate. So I don't sound too Australian because yeah, people can't understand some of my, um, my, I think I use long vowels, those, long Australian vowels. I drag it out a bit.
Well, I will say we're professionals at deciphering Australian English because we watch below deck and there were a couple of Australians. So I know that the pattern that I picked up was the, Oh, is an earth. So like Heller.
No that wasn't right.
This girl must be from a different every O as an ER.
I promise you.
Are you talking about the little blonde?
Yes, the real cute one. That's the Stu.
Interesting. Well, Rebecca and I have talked about this too, because I think you were kind of surprised how many shows we get from Australia that are on our Netflix. And so we were talking about a one day. I watched a lot of Australian shows. In fact, the latest that I just finished, probably not the best, but I I'm curious your take on this one. Um, Yummy Mummies. Did I say that right?
Never heard of it. Never heard of it.
No! How did we get that one? I don't know. And then the best one though, is it Instant Hotel?
Oh yeah. Yup. Yup. That's a good one.
I'm coming. I'm coming to Australia and I'm going to, is it Ben Dive Beach?
Bondi Beach. I'm going there and I'm staying in that little cute condo that the mom and daughter run.
Do you know that's just that's just like two hours from me. I'll be your tour guide.
Oh yes. I cannot wait. We keep wondering when we are going to a conference.
In real life.
In real life in Australia, like we need to make this happen.
Or anywhere at this point, but it used to be Australia. We used to think, when are there conventions and you know, clearly we have to go over there and check it out. Even though it's not our market, because you said that in Australia, you don't even have, I E like not IEP is, I know it's a very American thing, but that you aren't responsible for tracking the data on the goals and the progress reports like we are here. Right?
Yeah it's so different. It's so different. So in Australia, we don't in my state new South Wales, which is like the biggest state. We don't have like, school-based SLPs. So most of us work in a private practice, or we might work in like community health or something. It's so different. And when I went to the U S to work, I felt like I was like a fresh, a fresh little new grad all over again, because I had such a big learning process.
Yeah, it is. It's very different. And so how do, how do children receive services in Australia then? Because, you know, that's the reason there's to being seen in the schools in the U S is because of the free and appropriate education ruling, which allows them to get those services for free. So is, does healthcare cover if a child in Australia needs private? Therapy?
Yeah. Yeah. It's so interesting. We've got this new,it's called like the national disability insurance scheme. So most of the kids that come see me privately, they actually have a funding package if they have a diagnosis. And so they get like a government funding package. So I see mostly preschoolers because we get them in early and there's lots of early intervention. So I don't usually see school aged kids because I guess the goal is we support these kids, you know, before they go to school.
So I don't know. I don't know much about goal writing for minimal pairs at all. I'm going to put that out there right now, before you ask me that question, it's just not something I do much.
Well, just don't tell our partners that because we're still trying to get to a convention in Australia and do it as a work expense. So we'll have to get real creative in how we pitch that.
That is absolutely true. I hope he's not listening to this right now.
But let's get down to business because I think your course was, do we want the statistics from her course that were shared with us?
Oh gosh. First of all, I, you could, we can always kind of tell there's always these standout kind of courses, you know, and we can tell typically just by social media and which ones are getting a lot of attention and your course had a lot of attention, lots of posts about it. Lots of love, lots of comments we saw. And so I thought, well, one, it was clearly because it was brilliantly presented and you gave such great ideas. But you just also have quite a following. Everybody loves Rebecca.
Oh, it's the accent. If I didn't have the accent, I don't, I don't know. I think it lures people in. I lure them in yeah I lure them in but you know what I think for me, speech it's, when you think about all the kids that you treat and all the different communication areas, speech is , that one area that you can make really quick progress with, and it, it gives you that feel good, feeling that you're doing something right. Versus, you know, like if, if you've got those long-term kiddies that are always going to be on your caseload, sometimes the gains might not be as obvious. So I think speech, it, it reinforces that like, yeah, I'm doing this, I got it. I know at each week, you know, we're making big gains. So
Yes. And I'm glad I wanted to talk to you about that there, that we will get to the questions because you had a ton of questions.
Well, and that was what was so unique. I think we're what I had started to say before I geeked out on the stats was that idea of the questions that you got, you warned us in advance, that you would get a ton. And I thought, we thought, okay, yeah, they're going to come in. But literally even we printed some out for this podcast because, you know, the point of this was to answer some of these during the podcast. And it's like a stack tthis pile of just question after question, but to go into those stats, you had the highest attended summit course with over 17,000 participants, which is bananas.
And on top of that, you get scored on things like, you know, the amount of information learned and did the presenter hold our attention. And those sort of things, a perfect score is a five and you were 4.9 across the board. So I feel like we're at the Olympics right now where like the judges hold up the scores and you know, the whole audience. Nice job. Thanks.
Well, I better deliver now, then let's go.
No, pressure. No pressure.
No, it was, it was just, I love this topic and I have to tell you phonological processes have always been one of my favorites to treat because one, I love the diagnostic part of it. I find it fascinating, the error patterns that a child makes, you know, when they're learning and simplifying those speech patterns. And so I like to be the detective and try to figure out exactly what those patterns are versus like the, like our students who just have difficulty saying, like, their /r/ Sound, you know, and so one, you know, I know you talked about that, like this use this approach, get them in and out, but that is, this is different than, then what we would do with an articulation approach. So that student who can not say the sound right. It's this is specifically related to a child with phonological patterns of error.
Yeah. I just, yeah, I do. I just think of it as patterns. Like, it's just so easy just to think patterns. And I know that we're moving away from saying processes as well.
Oh good to know.
Like we're kind of using that term. Yeah that term patterns. And I think if you just kind of keep that in your head, like we're talking about patterns, it just simplifies everything. Versus my tongue, isn't doing the right thing in my mouth. That's to me is a bit more articulation. Like, you know, I'm not moving my tongue or, you know, something in my mouth. I'm not moving my articulators correctly to achieve the correct sound.
Yes. So I wanted to be clear because there was several questions I noticed where people were asking, do you have any tips for vocalic /r/? And I'm like, Oh, that's a different presentation, friends and good luck to you on that sound. Obviously we are doing /r/ when we're doing gliding /r/ and /l/, if they're doing that pattern of the error with the substitution, but vocalic /r/, you know, again, the, the, because the placement, the tongue, isn't quite in the right position. That's a whole other conversation, right?
Yes. And you know, when I lived in America, I had to try to, to put that on. So my kids could understand me doing the /r/ therapy. I sounded ter. I sounded like I was trying to teach them and teach myself at the same time, especially, I remember what I was doing, like the CELF or something. And I just, I remember I had to really emphasize it. Like, if you, like, can you give me /r/ phrase and I'll try my best.
Um, I'm what do you got, Lisa? You started to say something.
Roger rabbit really likes raspberries from the garden.
No, I can do that. I mean, the,
Oh the vocalic /r/.
Something about like a star, a spider a E I don't know, like I can't, I can't do them. I can't do them properly.
Yeah. Star. I was thinking star flower, airplane,
Yeah I would say it like, um, my, okay. My car has a star and a flower in it. I can't do it. I'm very, yeah. Over /r/. So that for me, I can't, I just can't say it. Like I overdo it and it's slightly off.
It's kind of awesome though, because you have to think about it so much. You have to think about the placement of the tongue in your mouth and, and practice it, you know? So it's almost, it could be an advantage in a way where.
Well that is articulation therapy. When I finally figured out that I'm just trying to replicate what they're doing, then trying to tell them those steps to move their articulators to where they need them to be. It was always that, well, nope, this is what I heard it was this, and we need it back here and, and really task analyzing that for them. So that is that's perfect.
If that's what you were doing for yourself as well.
Yeah. But I find /r/, is that tricky one because it's like, well, is that gliding, you know, is that, is everything just that pattern of going to w and then usually, you know, gliding is also /l/ to /w/, so I guess, is that pattern consistent or is it, you know, can they not move the tongue? And sometimes I kind of find it's like, it feels like a mixture of both, which is hard. Yeah. So I just do a little bit of each and I see, I don't look, I'm not one of those SLPs that follows that strict hierarchy. I know at the beginning of your career, it might help you get that structure. But I think my key message in the summit was that every child is so different and they respond to different cues. And I think you just have to play around and try what works within a framework and then go with what helps them.
I love that. It's, it's so true. One before, if you were not one of this, if one of our listeners was not one of the 17,000 people who just heard your SLP Summit presentation, you give us just a brief introduction to the minimal pairs approach.
Yeah. So basically a minimal pairs. It's an approach that we use for our children with those phonological impairment. So it's probably most of the kids that you see, you can use this approach for children with mild or the way to like severe phonological impairments. And they usually have those pattern based areas. And I know that we love those names like fronting and gliding and final constant deletion. So that's like the main like the main caseload or the main child in your head that you're thinking about. But, yeah, we can also use it for kids with those really funky patterns. Like, you know, I had a little one substituting /s/ for /f/ and I was like, that's, you know, that's unusual. I don't have a name for that, but it's a substitution and it's consistent. So those are the kids that you're kind of thinking about. And then basically, because the child says the words the same way, like they might look at you know, a key and they'll say tea but in their head, they're actually thinking key. Like they know what they want to say, but they're saying the word wrong. And for a listener like us, it has a different meaning because thinking they're talking about tea, like a cup of tea. So I guess the minimal pairs approach, what it does is where having these pairs of words, and we're asking the child to say them differently because they mean something different. And that meaning is I guess, the most important part of minimal pairs. And it's where it differs from cycles where you just have five words and you're just using those five words and you're not linking anything to the meaning. And I guess confronting the child that there's a communication breakdown. It doesn't make sense. And if you want me to understand you, you have to say the correct sound that matches the picture so that I know what you're saying.
Yes. I love when you talked about how feedback matters, this is like you can use the cues still in your feedback, but what you're really trying to get them to understand is that pragmatic difference that we're not on the same page here.
And the facial expressions is what I love. Like I always joke that I could never get Botox because I just use so much facial expressions in minimal pairs therapy. Like I pull like the, like the, what are you talking about face? You know, like if they, if they look at the tea picture, sorry, if they look at the key picture and they say tea and just like tea like do you use this to open up a door? And it's amazing. In the last few weeks, the, the word that everyone has been using when they've been implementing minimal pairs from the Summit is wow. It's clicked. Like, and I love that. And that's the point of minimal pairs is once the child understands that what they're saying, doesn't make sense. It can literally be a light bulb moment, moment, and things just click. And these patterns can just rapidly change because it's like, they understand the rule and they just swap and they get it.
It's like dominoes falling down, but it's just like, once you push it over, it completely goes, you were even saying you have that one kid that it didn't click for a minute, but then like by the third session just came in. Everything was great.
Yeah. And I just got a DM on Instagram yesterday with one lady who said two sessions for gliding of /l/. She's like, oh my God, I can't believe this happened. And I'm like, wow, I've never done two sessions before. Like, I think people are seeing the power of this approach. And at the end of the day, the reason why I pushed this approach is because there is so much research behind it and your kids, they can just make that progress and get off your caseload. Like, I don't want kids in speech for two years when they can only be on for 12 weeks.
And I think what's super cool here in the States, we have response to intervention, or sometimes they call it like multi-tiered supports where before they even get a treatment plan and are formally in special education to receive their services, you can do of these little, you know, like supports and see how they respond to it. So if you're trying these and you have the success, you can completely avoid getting them in special education. If, you know, it's that carry over piece. If you're working on it, you can get the teacher on board. You can get the parent on board and see how the child responds to these.
How many weeks can they be on RTI or MTSS?
I don't think it's defined by, I think it's probably defined by district how they, how they interpret it.
I feel like it's still at least nine weeks minimum, right?
Six to nine weeks I know for when a student is an English language learner was even twice that, because you've got to rule out the impact of any of the second language.
I'm only asking, because you're right. I, I feel like, you know, if this can make that kind of a, you know, if it clicks so much quicker with them and we can make that kind of an impact in a shorter time,
It's less paperwork.
Yeah So even if you're not even looking about how awesome that is for the kid, it's awesome also for the therapist that doesn't have to have all of those meetings and paperwork for something that they can correct fairly quickly. Yeah.
Yeah like I find like fronting groups before, um, in kindergarten. And I had like the teacher aide with me and, you know, we got together like the five kids that all had fronting and then together as a group, you know, we taught the role and we, you know, got to check to see if everyone was stimulable and everyone got to hear the difference. And even if, you know, the kids are at slightly different levels, they're still listening too. And like learning from their peers and they're still soaking that all up. And it just makes such a big difference. I even am, once the kid kind of understands minimal pairs therapy as well, even if there's another pattern that you want to target, because they, they actually get, like, they get the concept of there's going to be a communication breakdown. And if, you know, I want you to understand me. I have to click. I did a block of therapy with this little girl last term. And on my last session, before our six week, summer holidays in Australia, I just gave the mum some gliding work. And I'm like, Oh, I'll just see how she goes. You know, like she can get the /l/ and she came back to me last week for a session and it was in conversation. And so that was just because mum knew how to do minimal pairs. The child understood, you know, the idea of minimal pairs therapy. And six weeks later, she came back and I didn't actually have to do anything because it just carried on. It's just so powerful.
Yes, it's so cool. I have to say, preschools is my favorite age. I've done, you know, all the way through middle school, but preschool is my favorite. And I think it's because I get to be obnoxious and silly and fun. And so minimum minimal peers to me was always fun because like you said, it's that joke in that like pulling the faces of like, what the heck are you talking about? And they make it really fun. Most love it. So that was going to be my next question for you. And I know a lot of people ask this, not all kids love it. Not all kids love getting kind of called out. I don't mean that, but they, they get they're shy.
Or they're very serious, and they don't like that. They don't understand the joking or don't.
So you did talk about this in your presentation, but I did notice some questions about it. So what do you do? Do you stop this approach? If the child isn't responding favorably to it because of their personality?
Sometimes I do. I hate to start and stop an approach, but I'm very mindful of the child's reaction, but I think this is where there are those two minimal pair approaches. And a lot of people didn't know this. They kind of think of minimal pairs as you know, kind of in that first session, you're confronting the child straight away. But you know, with that other approach, it's called that perception, production one, you can just focus on, you know, those target sounds. So if they're fronting, you might pick, you know, let's say five K words. You can just focus on that and help them out. And, you know, I guess foster that success before you say, just wait a minute, like this, that doesn't make sense. So that is an option. But look, I have sometimes you have to work on that rapport. And for me, rapport is number one. So if you have to take a session or two to work on rapport and to build up that idea of you copy me, sometimes I get it wrong, or I get the parents to get it wrong. And I model like, Oh, I forgot that sound. That's okay. I'll just fix it up. I model it's okay. We all forget. We all make these little mistakes. I'm going to show you how we get past it. So that's another option.
I like that.
What about, um, what approach can you use when you have children that have really, uh, maybe severe to profound impairments? And I would think not necessarily from the number of patterns that they're using, but even if you have students with intellectual disability.
Yeah. So there's a couple of options, and I think it's good to know your options and to figure out, you know, how the child will respond. So a lot of people might use cycles for this because you can cycle through the patterns. And that's kind of nice, but I find that you still might have to do minimal pairs or something later. Like when you kind of look at cycles the, one of the biggest goals is to increase overall intelligibility. So it can get you, I find that for me, cycles can get you to a certain place and then I might do some minimal pairs. So that's one of the options. There's also the stimulus ability approach, and this is something I don't think people know much about. And it's when your child isn't stimulable for a lot of sounds. Um, and they're missing a lot of sounds. You actually just like, if you kind of do this fun play where you really stimulate and they don't have to, they don't have that pressure that they have to say, that sounds, they're just kind of soaking it all in. So I really like that. And there's free materials on Carolyn Bowen's website I'm on there.
Are you talking about auditory bombardment. Is that what you mean by letting them soak it in that you're just exposing them to words with those things
In a way, but with this, um, like you use gestures and you have like, like a baby bear, b.. b.. and you have a gesture attached to it and you might put them in like nonsense vows and, and like like be boo and then like ee bee and oo boo and things like that. And you kind of go through all the sounds and that goal is just to increase the child's stimuliability of sound so that when you do an approach like minimal pairs, maybe they've got more sounds to work with and that success can, you know, facilitates that success. So that's another one. And then I guess your third option would be multiple oppositions. And that's for your child who like I've had these before you have your child and they just say /d/ for everything, or they say /g/ for everything, or they say /h/for everything. So usually when they have that favorite sound, um, I would usually use the multiple oppositions approach, but do you know what you never know, because it's all about the child. Like you can go in with your plan and it goes out the window based on the child. So
That's all therapy right.
Yes. And that's it, it's having the tools in the toolbox. And so, you know, I love that we have these, this the resources that I love Carolyn Bowman's I used to use her, she had a screening tool that I used, like crazy before. I think I had my hands on Little Bees, but anyways, great website. I will link to each of those other approaches that you mentioned too in our, in our resources. So you guys, if you want more information on cycles or stimulability or multiple opposition, I will have some links for you there as well, I know we did get some questions about oral motor difficulty. So our kiddos with Apraxia or some kind of motor difficulty is minimal pairs and approach, we would use to target those speech sound disorders?
So this is interesting because kids can have both those phonological difficulties and they can have their motor planning, like those kids with childhood Apraxia of speech. Usually it's not just pure childhood Apraxia of speech. There's a lot of those patterns and stuff. And I think the role of the SLP is to figure out, well, what is impacting their speech the most? Is it the patterns or is it that motor planning? And so I've I'm seeing a couple of kids at the moment. And for a year we were really doing a lot of that DTTC and I started the Nuffield program, which is a very, you know, there's great research behind them, but then I noticed that once they got that motor plan and they can use a lot more syllable shapes, they were voicing and fronting. And those were the things that were really, really, really impacting their intelligibility. And I try to really target voicing from that, I guess that like motor planning point of view, but it was only until I did minimal pairs. They actually got it. And they, they love those cues of the quiet sound and the soft sound and independently, they were able to use, for example, their quiet pur and use their noisy burst sounds. So I think you, you just have to figure it out what is impacting that child the most. Does that make sense? I hope that makes sense.
Yes. And when we worked with Jenny Bjorem, gosh, couple of years ago, now on a screener for Apraxia. The point of it was, is that differential diagnosis, you know, and, and I think I really struggled with that concept too, of you've really got to get to kind of dive deep down in there and see what's going on. So that you can use the right approach, you know, obviously an articulate articulation approach isn't going to work with a child with a childhood of Apraxia maybe only treating the phonological patterns also, isn't the only approach that we would try. And so again, like you said, the cues, the gestures, even when you're talking about that stimulability approach sounds very much like what I would do with getting some of those sounds you know, stimulable for child with those more motor planning. So I do, I think, again, it goes back to like, just having all of these tools and the more you use them, you know, our job is to pivot, right. We've got to be flexible and just ready to try kind of that next thing. So.
Totally and I had a little one even last week and you know, they had difficulty with their clusters, which is very common cause it's, you know, it's a hard syllable shape, it's a hard sequence of movement. And, you know, I was kind of approaching it from that motor planning point of view. And I just thought, do you know what I'll, I'll try minimal pairs and see, and that's what helped the child understand. And mum, you know, when she reported back with the homework, she's like, Oh, he finally gets it. Like, so that was the missing piece for him. So it's just, yeah, it's very interesting. I think you just have to kind of spread, spread your mind a little bit more. Does that make sense, like yeah. Spread your mind and really try different things and see what's going to help the child learn best.
I love that. What, so, so I know, um, when we were talking about students, who've got maybe like some real severe patterns of errors that, you know, or they're not stimulus, but the other part of Lisa's question too, and I saw it come up a few times is, is does this approach work with our children who have cognitive impairments or more complex kind of communication needs?
I think it I think it's, it can be a bit more challenging. And I think if the research, I don't think, let me just grab my book. This is where I grabbed my book. It's a interventions for speech sound disorders book. There's a table in here and it kind of goes through the populations that the researchers, I guess they they use the approach with the most. Does that make sense? So do you know, what, can you ask me another question while I flip through and I will find
I was just thinking too with our students with intellectual disability, it's that component that when you're referring to the pragmatic component of minimal pairs, that if you have a student that is not understanding the vocabulary, then there's no meaning. So I would think that you would either need to be very conscientious of the words that you're selecting and make sure that they're words that the child knows or can learn, but also maybe even partnering that with, you're probably working on other skills beyond just speech. So maybe that is part of vocabulary development. And then connecting that in with your, your minimal pairs approach.
I was thinking that same thing that you would have to do, probably some additional testing to determine, like you said, the, the awareness, you know, it's not going to do a lot of good to be practicing the difference between key and tea if those are concepts that they're readily familiar with.
Yeah and maybe trying to see what you could select, like from core words, things like that, where it was, it would be things that would come up and not just be maybe tangental kind of words at first. So lots of considerations.
Yeah. I'm just looking at the table now. And, you know, it talks about the primary populations with our children with that mild to moderate and to severe phonological impairments, and the secondary, you know, populations. So they have done it with children with expressive language impairment, sensory neural hearing loss and then just with the additional considerations they say yeah, the children should either be stimulus or they should be able to engage, in that, ability to like follow instructions on how to copy sounds. But it doesn't specifically address that.
No, I would love that we were throwing these questions out at you, you know, and you're not, you're not quite sure what we're going to be asking. And your first solution is to go pull a book and research.
Yep. I don't know I don't know everything.
That wouldn't have been my go to my, go to is usually bull shit my my way through an answer. So that was quite impressive. The other question we got about populations is age. I know you said you work mostly with preschoolers, but a lot of people did ask, does this approach work with children who are older? Like you've been third grade, middle school.
And have had those patterns for quite a while.
Yeah. So I think in like, I guess the review on the typical age that we treat, it usually is those three to six year olds, because this is when those patterns are present. And when you, I guess, look at, I guess that idea of when these patterns should be suppressed or when a child have a more adult-like speech, it really is around that like five, you know, like five-year-old should be around a hundred percent intelligible. So I guess your hope is, is that they don't have these patterns beyond five or six, but if a child doesn't get early intervention, you know, of course they're going to have these patterns at six or seven or eight, if no one is addressing this with them
Or if they're not addressing it, you know using either the research-based techniques or if they're not digging in deep enough to really see what is the root of the issue, because it may not be phonological .
I really feel I know I tried to group these questions you know, by some I, I feel like somebody asked about even older children. And I went, as I asked the question, I went, Oh, please tell me you don't have children in middle school with phonological errors.
I know, I know I think I've worked for the eldest I've worked with is like a child like third grade. So a nine year old, that's like the oldest that I've personally, um, worked with. But yeah, I guess for me, I'm in Australia, we've got a big push on early intervention. So most of my kids are preschoolers, but when I was in the U S I had a lot of kindies and first graders who had these patterns. And I was surprised that like I had a first grader who was fronting like that surprised me because I wasn't used to that in Australia.
Well, and that's really interesting. We had we did a podcast episode last year or the year before I think on the articulation and norms and how we have been misinterpreting the norms all of this time, because that's what I tend to use for qualifying students for articulation sounds. So we had Kelly for our course and on here, and she went over Crowe and and
McLeod thank you on their articulation chart, which kind of blew up the internet because everybody lost their minds when they saw like /r/ was at age five or something. But so somebody did ask that here, there are so many norm charts out there. You know, what norm charts should we be using?
This was, this was, this is hard. So basically I I think you guys mentioned in the Summit, Oh, what's that poster behind you? So I made like this, this patterns poster, but every article I read, like one thing contradicted the other, and it was so confusing because, you know, like half a, like six months off, you know, it can be a big difference for fronting like three and a half, or is it four? And so I found it very, very confusing because there were studies from different countries, there was different numbers of students. And so I feel like there is not one article that summarizes it all neatly. Like I know a couple of authors really focused on clusters, for example. So I guess I don't use someone's norms. I just collated from a lot of different people. And then, because I love chatting to researchers, I know I sent this to Kelly Farquharson and then also to Dr. Alison Home, and I asked their opinion, like, what do you think is this what you're teaching? And they had some great feedback. So that collaboration was awesome because I was confused. And as a non researcher, just in everyday practice in SLP, you want to make sure that you're getting it right, and that you're interpreting this correctly. And that's where our amazing researchers are really Oh, they're stepping up so much. I love them all on Instagram. I think they're amazing
Having a resource like informed SLP or Meredith is trying to get that research into all of our clinician hands, you know in a way that that's practical and break down these things. I know I love that we're building those bridges.
Between science and practice.
And I guess, yeah, my hope is that, Crowe and McLeod, they do the same thing for, for these phonological patterns. Like, I'm kind of hoping that this will happen in a year or two, because it's done so much for our field or just, you know, to think about speech development. I would love, you know, a review, I guess.
Yes that's what they did a review.
Cause that's what I love a review on everything. And then yeah, having a nice little chart for those patterns, cause it could be a little bit confusing, I think.
Well, and I think what's super cool right now too, is not just that, you know, bridging the gap between practice and science, but that it's even just knowing who's out there and who's doing what. So even though like I saw Meredith on the informed SLP today on Instagram, did a post trying to collect different sites of different researchers. So she can compile that and share that with people. So like I follow of course, Kelly Farquharson is at class lab at FSU. But I, you know, just to know like what are people doing out there? And that's, that's the way we get even the research that we want to, if we're having that, those dialogues and say, this is what we need that can drive the research that's being done.
Totally. It's an exciting time guys. I really think like our field, like in the last year or two is really making big changes.
I think so too. I was just looking at a couple of the other questions. I think you talked about this during the presentation, but it's here. So I'm going to ask are you using the same set of targets with each of the sessions or do you pick new targets?
So the same, so I I picked my set of words. So I think I mentioned that, you can, and this is a can, you can pick three to five minimal pair target words, and it can generalize, but some kids are going to need more. So you might pick your 10, you know, 10 pairs, which would 20 words. So I do, I pick my set and I pick the set that I think is going to make the biggest difference for the child. And those are the words that I stick with, but problem solving if a child isn't generalizing I might add more words into the set, but basically they get really good at kind of saying, that's the set of words and our hope. This is where we fingers crossed with minimal pairs is that this rule clicks and that light bulb moment happens. And then it just filters across and it impacts all the other words. So it's not kind of like articulation where you just keep pulling out different words and things like that. You had your set of words and you generally stick to that.
And another thing I saw come up quite a few times in the questions was can you target initial medial and final position at the same time, are you, or should you, or should you, or are you focusing on one?
I don't think I've ever focused on medial position that kind of reminds me of that whole articulation approach where you have to do, you know sounds in isolation and syllables words and phrases. You know what I mean? It's like, no, the point, or I guess the theory behind minimal pairs is that, you know, you you're changing a rule, you know, like you're teaching a rule and it just like they learn the rule and then it applies I usually pick initial position because usually there are more targets, like there are more words for it to, to choose from because I really try to pick those meaningful words. But I have found with kids who are stopping, for example, sometimes it's easier to pick words in final position because I don't know if you've ever had kids who stopped, but they'll say if the word is fun, they might go fu bun. And it's like, no, like you started with your F and then you went back to bun. So sometimes for those kids, I might use words in final position because they're getting that long airflow and you can't kind of stop the airflow at the end. Same as with fronting as well. Sometimes it's way easier for kids to use those sounds in final position. So I could start with final and I have, I have done a little bit of a mixture before just to make sure that it is working, or if you start in final position with your treatment set, it doesn't mean that, you know, in a month or after six weeks, if it's not generalizing to initial position, cause this is what we predict is going to happen. If our predictions aren't happening, it doesn't mean that you can't add in an extra three pairs in a different position to facilitate the change.
That makes sense. And I always found it now. I mean, again, this is back in, when I first started practicing, it was always a challenge to find those meaningful words in pairs, you know, with, with their sounds that they're targeting or their pattern they're targeting. And now I know you have a fantastic resource that we can just purchase and we don't even have to stress it. So one talk about your handbook, but then two, how do we find the the target works?
Okay. Which one do you want me to talk about first?
Ok handbook. So, but I'll tell you the basis of this handbook. So I actually was just going to make like three, like a three page freebie on something to do with minimal pairs on how to get like a hundred trials like this little table. And then I started polling everyone on Instagram and I asked like, what questions do you have on minimal pairs? And I had 300 over 300 responses. And I was like, Whoa, like people are not understanding this and they have lots of questions. So basically I made a handbook that I hope answers every question that minimal pairs. So it goes from how to understand minimal pairs, like who's suitable, what's the overview. And then into how to like, I guess, choose the approach. What targets can you choose? What can you choose first? What are your options? So I was kind of hoping on all these different little tweaks that you've asked me. So like all these questions you've asked me, I've kind of I've got like one page on each of these questions and then, you know, really going through with charts and checklists and, activities and things like that. And even all the generalization stuff. So I guess I made this handbook to be like the, I don't know how to do this approach. Can you just give me something so I can pick it up, read it and implement it. Like, that was the goal of, of that. And there are word lists in the back, but I'll let you know, there are three free sites that you can get word lists too, that you can add in your show notes. Do you want me to name, drop them?
Yes. Please yes.
Free is helpful. Not everyone. I know I've created this, but this, you know, you can't buy everything all the time. And I think free is very, very useful as well. So I know that Caroline Bowen, she has a minimal pair word list on her website. And then if you go to Lesson Pix, they've got like a minimal pairs finder. So you can type in Tea and Key. And even if you don't use Lesson Pix, I don't have a subscription. It still comes up with words. And then I think if you just type in minimal pairs generator, like there is another website and it just pops up with stuff. So it might take more time. You might have to kind of, you know, go through it quite a bit, but there are those options there. Or you can just sit there like I do sometimes and just make rhymes up in my head, you know, like I literally go through and be like, okay, I've got this word, does that round with that? So you can do that in your lunch break as well. Just make up, make up rhymes, really options.
We've had a lot of questions about screening and assessment too. Does your handbook include like a checklist or a screening or something for diagnosing minimal pairs or phonological process kind of pattern errors? Or is there, or go-to resource that you love to use for that?
No, I think no one, no, sorry.
Yes, no, that's fine. Somebody did ask about the assessment and I think my big aha with the patterns was back well, and I imagine just the Goldman Fristoe story do this Lisa. So the two had the kind of complimentary tests called the
Was it the KLPA like the Khan Lewis Phonological.
Yes Khan Lewis thank you. And so you would, you would do the articulation assessment and then you would determine you would take those sounds and plug them into a different assessment and it would show you those patterns. And it was such a big aha for me, because again, I love the detective work of trying to see, like, what's going on here. There's more to this than just, you know, they can't say the sound. But I wondered if you did have any kind of assessment. I think Little Bees also does it.
I do. I do. I do. I can tell you the one that I use. But it's something I've used for a very long time. So I know, I guess, because in Australia I don't have to use, I don't have to get those standard scores, I guess, to meet eligibility criteria. I use a lot of different informal assessments because I just, I, I give the child the assessments that I need to get the information that I'm looking for. So an assessment for me is different for every single child because, you know, I'm trying to problem solve what's going on. So I know and I haven't checked out Little Bee, but I know Smarty Ears their app. They've got you know, their assessment toolkit and you can, as you go, you can type through you can like say if it's a distortion, like if it's /s/ or if they say key if there's key on there, you can tap it. And you can say that it was fronting and, and tap the /t/. And then at the end, what it does just like a magic click of the button, it brings up a chart and it it's like a pie graph and it shows you the percentage scores of the different patterns. So it might be like 46% of their speech was fronting 20% was cluster reduction. And then you can actually see what pattern is impacting their speech the most. So I'm a visual person, and I love that. Like that for me, it's less work than transferring something to another piece of paper and going through, it's like a click of the button and I can, I can get, I guess, an overview of what's happening with the child's speech.
I totally agree. And don't tell my lead SLP, but when I worked in the district.
You told your lead SLP this daily.
I just want you to cover your ears for a minute, but I did not love the Goldman Fristoe and I did not love a standardized assessment for articulation. I just needed something to help me determine, you know, what those errors were. And again, I wanted to be able to figure out the patterns. So I used the Little Bee app. I never used the Goldman Fristoe and the Little Bee app. What does articulation test center? It does the same thing you can Mark that this isn't like, they can't say a sound they're actually making that pattern, here. And so it was so helpful and gave me way more information than one of the standardized tests.
Well, I think we're restricted in the U S by it's by state. So in Arizona, our guidelines for eligibility, or just that you have to determine that there is an impairment, but there are some States that say that the impairment is determined by two different tests that both show two and a half standard deviations. I mean, this is written into their state law. So, you know, you're tied by where you live. But I think for us, even though we didn't have that written in, in our district, it was more about trying to come up with some, not standardization of tests, but of testing, as far as I don't want somebody to qualify a student just by giving the SPELT grammar test when we need to do something more comprehensive and and really dig in deeper. So it's about, you know, when you have a bunch of people and you're trying to get everyone to do something, but you told me every day, you didn't use that Goldman Fristoe. And then you would say
What I meant to say is I probably shouldn't say this on a podcast.
Because they care now?
Well, I don't know.
No, it wasn't. It was, it was not in our state law. So I think eligibility, that is one of the beauty of living in Arizona is just, you had to determine is it there? And then I think for artic, when it was more about the patterns, the stimulability, the impact, you know, there were other factors that, that to make it more comprehensive to get the data that you needed.
Yeah. And, and when you think about it, like a three, four, five, and maybe even six year old, they're probably going to have those phono difficulties. They've got the patterns, you know, like if they're coming to see you, it's because there's usually patterns present that we have to figure out. I kind of feel like maybe the Goldman Fristoe, you know, it could be a bit more useful for those older kids, you know, your /r/ and your /s/ or I don't know, but I think, I feel like we should be allowed to use the tools that we think are going to give us the information that we actually need. That's my opinion. That's my confession to do what we want.
I love it. That's a perfect confession. And I agree with you.
Yeah. Whatever supports that student.
There's this one component of our job called clinical judgment. And it's my favorite components research second as well. I'm kidding. I love research. Okay. The couple of questions about, so we talked about your handbook, first of all, I have to say pretty much any time somebody literally spells things out for me and compiles everything and hand it to me.
Yeah. I'm in, because one, I don't wanna reinvent the wheel two. I don't want to strain, you know, strain my brain, especially if it's a new approach for me, you know, I don't have the luxury of like doing this deep dive into what this looks like. So, so grateful for our brilliant SLPs who come up with these resources that are clearly thoughtfully put together and you did a lot of work in research on it. And so I cannot recommend that. And now I'm going to link to the handbook in the show notes. And then other resources, I know a couple of questions came up about some of the apps that you've talked about. One of them was farm animals, front and back or something like that.
Yeah. Oh, do you know what I love So I love metaphors for speech. You know, how there's lots of different cues you can use. Like you can say, you know, put your tongue back for /k/. I, um, I love the ideas of metaphors for kids because most of the kids I work with they're preschoolers. And so yeah, I made these little kind of like, not social stories in a way, but I kind of made these stories that introduce a metaphor for the rule that we're teaching. So yeah, I teach there's front and back sounds. And for final, constant deletion, we talk about just how animals have tails. So do some words. And so, you know, an animal was going to look really funny, like a cat without a tail looks really funny,or a fish without a tail looks funny. And our words might sound a little funny or strange if we don't put the tail sound on. And then so yeah, I've got these stories as part of my minimal pairs toolkit, which is like, the toolkit is like, do you know what I get minimal pairs? I'm ready. Just give me the cards, give me the visuals, give me the cues. I want to do this. So yeah, I just made up these really cute stories. And then that's the cue that you use throughout therapy. So I might be like, oops, did you forget your tail sound? Or, Oh, I think I heard a front sound then can you put on your back sound? So you kind of use these little metal metaphors, these, you know, to help kids make sense of these rules and patterns. Because as you know, some of those kids, they, you know, they just get a bit upset when you point out you know, that they're getting something wrong. So these cues and these little visuals, I just I love them. I love them with my little kids.
Yes. Again, that's why, it's my favorite. It's so fun.
Yeah. And I even get my kids to make some up sometimes. So that's really cute too. Like they make up their own little cues and you know what cues aren't for everyone. I'm going to put that out there. Every child is different. You know, some kids work well with these metaphors, some kids don't. So it's not like I don't promote there's one resource for every child. It's just not the case. You just need a couple of things in your toolkit and you figure out the child and their personality and what works best with them.
Yes. I love that. I know this question I was going to say, I know there was one more and I love that you talked about that you get a hundred trials in. And because that's, I had an actual I used this old school. What
Abacus thank you. That had a hundred things on it. And that's where we did, you know, and, or any kind of token to help incentivize them because somebody had talked a professor or somebody had told me that, that rule of just trying to get in as many attempts as possible. And so people did ask what do you do if, if you're doing work in groups, are you doing one?
No. I'm one-on-one and I usually have a parent or carer present. So I think that really makes it's optimal. I get great progress because I've got the one-on-one and a parent or carer I'm training them and they do the homework at home. So I've kind of got an optimal setting. Yeah,
That is so awesome. Because there were a few questions about what do you do if you've got four kids in a group and only one of them is, is doing, you know, phonological patterns or somebody, you know, they don't all have the same error patterns. How do you get the a hundred trials in? And so I, I did wonder, you know, how that looks in a group.
I think I've done this. I mean, I think at the last assignment that I had, where I had four kids that all had different speech sounds, and we had 30 minutes once a week to work on it, I inherited a caseload in IEP and it was a kind of a very short assignment, but I would get one up and going. And then they had, whether it be that I had iPads available or materials, they would, I would get them going. So they were aware of their sound and then they would keep practicing. I'd move on to the next kid. They're still practicing. They've got mirrors. They know what they're supposed to do. And so we just kind of move around the group and they were all practicing the entire time,
But do they have to be a little older.
They were older. That's what I was going to say. I think it depends on what their error sounds are, what their awareness is, how old they are. I think they were in second grade.
I was going to say I've used students in the group to like if one is a child, maybe who's got language, but no Arctic. Then I might use the language kid to work on the Arctic sounds, you know, so that we're all all practicing together. But yeah, you've gotta be a little older for that. And this is going to be, this is an approach for much younger students.
Yeah. The other thing as well is I've just cut down on games. Like I don't play games. I do, I do activities to keep a child engaged. Like yesterday. I literally, I had an ice tray, like an ice cube tray, and I had these little magnet balls. And for every single one that they said, I put the ball in the magnet tray so they could see something was happening. And then they had to say them all again. And I gave him a little magnetic stick and they got to pick up each ball. It wasn't, it was just quick, you know, like it was no nonsense. It was like, you say it, you get it. You say it, you get it. You say it, you get it. And you're picking things up. And I think I did over 200 practices with this little one, cause I did simple, simple activities like that. And I feel like that kind of that five minutes speech could work really well. If you could just have five minutes with the child and if you try to even get 50 or like 30 or 40 practices, and it's no nonsense, you know, kids don't need like an exciting game, you know, that takes three minutes to set up. I think if you just keep it incredibly simple, and even if you set the goal or you have a clicker, like we're going to get 50 practices or with the abacus, we're going to go through these three lines and you show me, I think using materials like I talk about getting I collect things in that have lots of little pieces, so I might have a bag and it's got 50 Lego pieces or I have a bag of pompoms. And if it's literally just putting a pompom in a jar, the child can see that there's an end. And you try to say, do you think you can finish, you know, say all your words and finish that in five minutes. I think those little tweaks can kind of help get the high practice trials in and there's that little element of competition and time and things like that. So those are my suggestions, but you can only do your best really. You know, if you've got restrictions, you can only do your best. Really.
Yes. I was fortunate in the preschool classroom that I worked in. You know, we, we were in, I was there for the whole day, you know, our whole day was three hour class. But so I had small groups and I had a whole group and then I had the one-on-one time. And so, you know, if there was a situations where it didn't make sense to do, I would approach like that in a small group, you know, that's when I would pull the one over. And like you said, the five minutes of just wait it out. But I do think we all, you know, have this tendency to think that we need all of this activity and filler and games and light shows.
Like dog and pony show to keep it interesting. I think the benefit here too, of working in a preschool is that if you can get the buy-in from the teacher and, or the instructional assistants and try to get them engaged so they can do carry over when you're not in there.
And show them how to do that targeted practice.
Right. Like Rebecca says she goes with parents. It's huge.
Yeah. Do you know what, I guess the biggest thing I've done and this could be something SLPs can do is if you train a teacher or a parent or carer that pragmatic cue. So I will tell my parents, you know, full run one routine in the day, or like, you know, when you're driving to school or, you know, if you're going for a walk, listen to your child for 10 minutes. And in that 10 minutes, that's when you use that cue of just wait, did you mean Tea or Key, teach them how to use that pragmatic cue. So that every day, at least in conversation, there is a communication breakdown and the child has a chance to repair it and learn that if I want someone to understand me, I have to make sure that I use the correct sound so that it makes sense. So that would be, I guess my biggest takeaway is train, train the people around the child to give this type of feedback.
I love it. I love it. I love it. I feel like we're going to need to do a follow-up course. Because again, it was so popular and I felt so terrible. We, somebody DM's us and said, you know, something came up and I didn't get to, to this course. And I have kids who really need this approach. And everybody told me I have to watch it. Is there any way I can get access to the course? And I was like, I am so sorry. Once the videos are down, they're down. I always want to be like, sure, here it is. You know? And so I said, you know, just make sure you follow her on Instagram where she gives lots of tips and tricks and, and check out her resources. But I have a feeling we're going to see Rebecca presenting a lot more and so, you know, make sure you watch for other opportunities to hear her speak. And so I hope that that's, that's what she'll do since I said, no, you can't have it. So anyway.
Do you know, I would love to do something. I'm going to put this out there. I would love to do something with some of the amazing speakers you've had in the past, who focused on speech sound disorders. I'd love to get a little yeah.
I know a couple of them.
Yeah that's like my dream.
I know who you are talking about. Okay, good. Because after we hang up hear I've got something that I want to talk to you about. Oh, that's perfect. So that worked out well. Anyway, you are a dream. Thank you. Thank you. Thank you again for your Summit presentation. It was amazing. And in this podcast, episode is loaded with so much information too. So I think this will be really helpful for people and we appreciate you.
You've got to send this podcast episodes to the person who wrote in.
Thank you, Lisa.
You're so welcome.
Thank you, Rebecca.
Thanks guys. Cheers.