Well, this blog did not turn out the way I had planned. My time has been consumed lately with things at work that I cannot put off. As a result I have had very little time to tackle the subjects on here that I wanted to tackle. Please forgive me if you have been checking this blog and are disappointed at the lack of information or content you find.
Due to to this change in plans, I have decided to redo the way I approach this blog. Instead of addressing individual therapy ideas or approaches, I want to address struggles I am having with individual clients. As any speech therapist knows, the most difficult thing about therapy is learning how to change the therapy approach to fit the specific client. This is something I am struggling with a lot right now as I have several clients who are not responding to the therapy molds I have been given. I think that by using this blog as a way to discuss my stuggles and search for answers I can still discuss the different therapy methods I am using and the evidence for and theory behind those methods, but it will be in a much more pertinent way.
I hope this will be a better way to maintain and fill this blog and I look forward to sharing my experiences here. If you happen to read a post and feel inclined to post a commet, please do so. I always welcome input. Here's to future posts and learning!
Tuesday, February 19, 2013
Thursday, December 6, 2012
Oral Motor Exercises
So, the next big therapy technique I want to tackle is oral motor exercises. This particular therapy tool is a beast of a tool. The uses, strategies, goals, and outcomes vary depending on population and disorder. There is a huge variety of tools to use in oral motor therapies and there are even more opinions and strategies on how to perform OMEs effectively versus inappropriately. There is not a whole lot of scientific evidence out there for any of it, but there is some science to discuss. This is probably one of the most debated and argued about therapy technique used in the field of speech language pathology today. There are strong voices for and strong voices against OMEs. Now, if you are at all like me, then you were told over and over in graduate school that oral motor exercises are bad, downright evil even, and should never under any circumstances be used in therapy. Anyone caught using oral motor therapy would be considered a quack and not worthy of the title Speech Language Pathologist. Then you entered the real world and were faced with professionals from all over the place who not only use oral motor exercises, but swear by them as the only effective tool for treating a spcific problem.
Again, if you are like me, you are left wondering, "What the heck? What is going on here?" There is no way both extremes can be right. So, I did some investigating. As a part of this investigation, I have collected two books written by some of the most prominent proponents of oral motor exercises in speech and language therapy. I have been going through them to learn what it is these people are basing their therapy strategy on, why they think their strategy will work, and what the expected outcomes are. I invite you to join me as I delve deeper into the world of oral motor exercises. For those of you who have already made-up your mind about OMEs, I challenge you to keep an open mind and just explore. You never know what you will find. For those of you trying to decide, I invite you to explore and ask questions. Thinking critically is going to be very important. Don't be afraid to ask hard questions and demand evidence, or at the very least logical conclusions that can be backed up with serious scientific theories.
Over the next week, I will be creating different posts outlining a specific aspect of OMEs and attempting to weigh the pros and cons of this much debated therapy technique. I think you will find, as I have, that the issue is far more complex and variable than most people realize. There are things about it that may surprise you, and things about it that may not. Regardless of what you think about it in the end, I hope this journey will at least be one of learning. Let the exploration begin!
Again, if you are like me, you are left wondering, "What the heck? What is going on here?" There is no way both extremes can be right. So, I did some investigating. As a part of this investigation, I have collected two books written by some of the most prominent proponents of oral motor exercises in speech and language therapy. I have been going through them to learn what it is these people are basing their therapy strategy on, why they think their strategy will work, and what the expected outcomes are. I invite you to join me as I delve deeper into the world of oral motor exercises. For those of you who have already made-up your mind about OMEs, I challenge you to keep an open mind and just explore. You never know what you will find. For those of you trying to decide, I invite you to explore and ask questions. Thinking critically is going to be very important. Don't be afraid to ask hard questions and demand evidence, or at the very least logical conclusions that can be backed up with serious scientific theories.
Over the next week, I will be creating different posts outlining a specific aspect of OMEs and attempting to weigh the pros and cons of this much debated therapy technique. I think you will find, as I have, that the issue is far more complex and variable than most people realize. There are things about it that may surprise you, and things about it that may not. Regardless of what you think about it in the end, I hope this journey will at least be one of learning. Let the exploration begin!
Monday, October 22, 2012
Applied Behavioral Analysis Therapy
The first therapy technique or method I am going to discuss here is Applied Behavioral Analysis Therapy, or ABA therapy. Before I write too much I want to say this - this is a very brief overview of this therapy technique that has been around for a very long time and has both a lot of clout and a lot of support. I am not in any way trying to be dismissive of this therapy model with my brief summary or my opinions about it. I am trying to provide a quick overview that will be help someone decide if they want to spend more time researching this topic or not.
Applied Behavioral Analysis is a particularly popular therapy in working with both children and adults who have social pragmatic and/or behavioral difficulties. ABA was first introduced in the 1950's and '60's as a psychological therapy strategy. This therapy has its roots in psychology research, from which the terms are taken.
The term applied refers to the idea of focusing on behaviors or outcomes because they affect things that are concerning to society as a whole. For example, you may study a theory that explains certain behaviors in a research setting, but that study does not become applied research until you study how the theory relates to the outcomes those behaviors effect in the real world. You may study the definition and mechanisms a social pragmatic deficit, but it is not applied theory until you are understanding how those deficits affect a person with such a deficit.
The term behavioral refers to the actual behaviors a person exhibits. If you present an item to a person and they reach for it, their reaching is the behavior. If you want them to perform certain tasks in order to receive a reward of some type, their performance is the behavior.
The term analysis refers to the ability of the researcher or person applying the technique to control the target behaviors. So, if you are trying to control a person's pointing gesture, you need to be able to control when and where that person will use this gesture. Once you control the behavior, you are able to analyze it and better understand it.
These three terms combine to form the title of a therapy technique that seeks to control the behaviors of an individual who struggle to perform in certain areas so that they might "trained" to perform in an acceptable manner. The reality is this therapy techniques is a behavioral model for training people to do what you want. The model is widely applied in working with social pragmatic and behavioral disorders. In the realm of speech language pathology, you will see this therapy used with those who have neurological disorders such as an Autism Spectrum Disorder or seizure disorders.
The efficacy of ABA therapy in the speech and language area is generally accepted, but this acceptance is based largely on its efficacy in psychology based studies. There is a large body of evidence for this therapy technique as an effective method of behavioral control, but the evidence for it as an effective method for addressing social pragmatic challenges is not as strong. The anecdotal evidence for it suggests that, as with most speech and language therapies, it is successful for some clients and not useful for others. However, this may have more to do with the way in which therapy is administered than with the theory behind the therapy. The idea that behavior can be elicited and then controlled has been proven over and over and is considered to be reliable. What is not reliable is the idea that behavior can be elicited and controlled in the same way for every person.
Autism Speaks, a large Autism advocacy group based in the United States, endorses ABA therapy as an effective therapy method for children and adults with an ASD. They explain ABA therapy as a method for learning a wide range of skills including language skills. It should be noted, though, that much of the evidence for ABA therapy they are referring to comes from modified forms of ABA therapy that combine ABA with other therapy techniques. Their website is a great resource for more information as well as for ideas on how to use this therapy technique in your clinical practice or at home. Their website is listed below.
My own personal feeling about ABA therapy, based on my use of it and my observation of its use by others, is that it has a limited range of use. The idea that a person will continue to work for a reward time and time again seems to represent a type of thinking that suggests we as humans are not capable of higher level reasoning, that all we can see is what is directly in front of us. In particular, it suggests to me that those with difficulties in the area of social pragmatics or with behavioral challenges are only concerned with rewards and thus they can be controlled with a series of rewards. Another problem I have with this technique is that it is touted as THE therapy technique for children with an ASD, implying that Autism is a behavioral disorder. I feel this is exceptionally short sighted and not an accurate way of approaching therapy for Autism. While Autism has historically been treated by psychologists, it is not a psychological disorder. It is a neurological disorder with behavioral symptoms which stem more from physiological and linguistic difficulties than they do from psychological difficulties. Thus, approaching therapy for this population from a purely behavioral perspective seems to be irresponsible and, in my humble opinion, not within the boundaries of evidence based practice (EBP). That doesn't mean you can't use it, it just means that your approach to using it needs to consider all the factors involved for each person. ABA therapy can be effectively applied. For lower level skills such as learning to point or learning follow a certain structure, this therapy can work very well. When trying to learn social interaction skills or learning how to express your feelings appropriately, it becomes harder to be successful at using this therapy.
Here is an example of ABA therapy being administered.
Below are several links for more information on this therapy technique if you care to do more research for yourself or want more resources.
Dimensions of Applied Behavioral Analysis PDF
Revised Dimensions of ABA PDF
Treatment Integrity in ABA with Children PDF
Autism Speaks ABA resources
ABA Professionals website
Applied Behavioral Analysis is a particularly popular therapy in working with both children and adults who have social pragmatic and/or behavioral difficulties. ABA was first introduced in the 1950's and '60's as a psychological therapy strategy. This therapy has its roots in psychology research, from which the terms are taken.
The term applied refers to the idea of focusing on behaviors or outcomes because they affect things that are concerning to society as a whole. For example, you may study a theory that explains certain behaviors in a research setting, but that study does not become applied research until you study how the theory relates to the outcomes those behaviors effect in the real world. You may study the definition and mechanisms a social pragmatic deficit, but it is not applied theory until you are understanding how those deficits affect a person with such a deficit.
The term behavioral refers to the actual behaviors a person exhibits. If you present an item to a person and they reach for it, their reaching is the behavior. If you want them to perform certain tasks in order to receive a reward of some type, their performance is the behavior.
The term analysis refers to the ability of the researcher or person applying the technique to control the target behaviors. So, if you are trying to control a person's pointing gesture, you need to be able to control when and where that person will use this gesture. Once you control the behavior, you are able to analyze it and better understand it.
These three terms combine to form the title of a therapy technique that seeks to control the behaviors of an individual who struggle to perform in certain areas so that they might "trained" to perform in an acceptable manner. The reality is this therapy techniques is a behavioral model for training people to do what you want. The model is widely applied in working with social pragmatic and behavioral disorders. In the realm of speech language pathology, you will see this therapy used with those who have neurological disorders such as an Autism Spectrum Disorder or seizure disorders.
The efficacy of ABA therapy in the speech and language area is generally accepted, but this acceptance is based largely on its efficacy in psychology based studies. There is a large body of evidence for this therapy technique as an effective method of behavioral control, but the evidence for it as an effective method for addressing social pragmatic challenges is not as strong. The anecdotal evidence for it suggests that, as with most speech and language therapies, it is successful for some clients and not useful for others. However, this may have more to do with the way in which therapy is administered than with the theory behind the therapy. The idea that behavior can be elicited and then controlled has been proven over and over and is considered to be reliable. What is not reliable is the idea that behavior can be elicited and controlled in the same way for every person.
Autism Speaks, a large Autism advocacy group based in the United States, endorses ABA therapy as an effective therapy method for children and adults with an ASD. They explain ABA therapy as a method for learning a wide range of skills including language skills. It should be noted, though, that much of the evidence for ABA therapy they are referring to comes from modified forms of ABA therapy that combine ABA with other therapy techniques. Their website is a great resource for more information as well as for ideas on how to use this therapy technique in your clinical practice or at home. Their website is listed below.
My own personal feeling about ABA therapy, based on my use of it and my observation of its use by others, is that it has a limited range of use. The idea that a person will continue to work for a reward time and time again seems to represent a type of thinking that suggests we as humans are not capable of higher level reasoning, that all we can see is what is directly in front of us. In particular, it suggests to me that those with difficulties in the area of social pragmatics or with behavioral challenges are only concerned with rewards and thus they can be controlled with a series of rewards. Another problem I have with this technique is that it is touted as THE therapy technique for children with an ASD, implying that Autism is a behavioral disorder. I feel this is exceptionally short sighted and not an accurate way of approaching therapy for Autism. While Autism has historically been treated by psychologists, it is not a psychological disorder. It is a neurological disorder with behavioral symptoms which stem more from physiological and linguistic difficulties than they do from psychological difficulties. Thus, approaching therapy for this population from a purely behavioral perspective seems to be irresponsible and, in my humble opinion, not within the boundaries of evidence based practice (EBP). That doesn't mean you can't use it, it just means that your approach to using it needs to consider all the factors involved for each person. ABA therapy can be effectively applied. For lower level skills such as learning to point or learning follow a certain structure, this therapy can work very well. When trying to learn social interaction skills or learning how to express your feelings appropriately, it becomes harder to be successful at using this therapy.
Here is an example of ABA therapy being administered.
Below are several links for more information on this therapy technique if you care to do more research for yourself or want more resources.
Dimensions of Applied Behavioral Analysis PDF
Revised Dimensions of ABA PDF
Treatment Integrity in ABA with Children PDF
Autism Speaks ABA resources
ABA Professionals website
Tuesday, October 16, 2012
Introduction
I am in my first year of practice as an actual speech language pathologist and I am continually finding myself scratching my head and wondering how to approach treatment for my clients. If you are at all familiar with my field, then you know that the hype over the past few years has been all about using evidence based practices. Sadly, though, the evidence for most therapy practices is lacking, which leads to disagreements over efficacy and validity of various therapy methods. As you can imagine, this is quite frustrating for those of us who are new to the field and trying to learn good versus bad therapy techniques. There has been more than one occasion when I have felt the mission given to me as a speech language pathologist is an impossible one, particularly when it comes to knowing which strategy or method to use and how to best apply it.
In my frustration at the lack of evidence readily available and my eagerness to learn how to be a good clinician, I have decided that one way to help myself, and potentially others like me, is to explore the myriad of therapy techniques and models out there and then try them out. This blog will be a review, of sorts, of the theory behind each method, the scientific evidence available, the anecdotal evidence available, and my own experience - when possible - with each one. I am hoping to learn a lot through this process and maybe even provide a resource for other therapists.
Please feel free to post comments or suggestions on each post. The feedback will provide added perspective as well as useful information. I know what I am taking on here is a gigantic task, but it can't be anymore impossible than the one I have already been given. Here's to a great adventure, and perhaps some answers, in speech language pathology!
In my frustration at the lack of evidence readily available and my eagerness to learn how to be a good clinician, I have decided that one way to help myself, and potentially others like me, is to explore the myriad of therapy techniques and models out there and then try them out. This blog will be a review, of sorts, of the theory behind each method, the scientific evidence available, the anecdotal evidence available, and my own experience - when possible - with each one. I am hoping to learn a lot through this process and maybe even provide a resource for other therapists.
Please feel free to post comments or suggestions on each post. The feedback will provide added perspective as well as useful information. I know what I am taking on here is a gigantic task, but it can't be anymore impossible than the one I have already been given. Here's to a great adventure, and perhaps some answers, in speech language pathology!
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