5 Reasons why I do what I do

happy-sun

I’ve got my happy sun face on today because this morning I saw a little girl who, despite numerous challenges, just succeeded in saying her first words. As I got in the car after our session I confess there were a few tears of gratitude and joy. It’s not the first time I’ve been able to reflect on what a blessing it is to be able to work with families and help give their children a brighter future. Lately I’ve been thinking a lot about motivation and why people do what they do. Reading Viktor Frankl’s “Man’s Search For Meaning” has probably heightened this reflection process. Well today was a reminder for me of why I do what I do as a paediatric Speech Pathologist and given that I also love lists here’s my list of why I love being a speech pathologist.

  1. First Words. Seriously this is the magic happy stuff! Nothing compares to seeing a little one say their first word and at the same moment seeing a parent light up as they realise their child just said it!
  2. From I’m Not to I Am. So often I see kids who have had years of being told and telling themselves what they are not e.g. “I’m not a good reader”, “I’m not the sort of kid that has friends” and my pet peeve of all time, “I’m not smart like (other child)”. One of my favourite things is seeing the transformation in a child who has defined themselves by what they are not into a child who starts to see what they are. For example, “I am learning to be a good reader”, “I’m learning how to make and keep friends” and “I’m a different sort of smart to (other child)”.
  3. Opening Doors. Often when a family is first accessing speech pathology services they feel like their child’s future is bleak and there are so many doors that are closed to them. It’s a wonderful feeling to be able to help them develop skills they need to open more and more of those doors to their future. Then, once that child grows up they can choose what they want to do rather than being trapped by what they can’t do.
  4. Strengthening Families. I firmly believe that families are vital to our individual and collective success and happiness. By helping parents to better understand and relate to their child and by helping children to communicate or eat more successfully I have the privilege of helping to strengthen that family so they can develop deeper and more lasting relationships with each other.
  5. Laughter and Tears. Watching children giggle and smile as they learn and succeed and then ultimately crying when they find out they don’t need to see “Miss Rachel” anymore.

 

 

 

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Don’t try this at home – the hidden dangers of oral stimulation techniques

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A parent forwarded me a blogpost recently which set my Evidence Based Practice danger detector alarms ringing. The article seemed like a lovely case study with cute photos of a smiling boy and “discusses how the electric toothbrush and other methods can help with speech and language development.”

This is the sort of post that parents find, trust and act on. It seems to have social proof and was apparently written by a speech therapist. If you look past the pretty colours and photos (surrounded by advertising and sprinkled with affiliate links) the informed sceptic can see a hidden danger lurking beneath the surface. This danger is like a crocodile waiting quietly in a seemingly peaceful river. An unsuspecting parent doesn’t even know it’s there until it’s too late. So I’m here to call out a warning to parents and carers before more children are potentially harmed.

I’m loathe to do it but in the interests of accurate referencing here is the original post:

Warning: do NOT try this at home

By way of background I’m not a therapist who is risk-averse or against exploring new ways of doing things. I’m open-minded and if there is minimal evidence for or against a given approach and it makes sense in light of the evidence that is available and the needs of a specific child then I’m willing to give it a try but I monitor how each child responds and adjust the course of action constantly. In fact, I often push the limits and feel like a bit of a rebel in what can sometimes be a very cautious profession. The profession is like this because we tend to be lovely people who want to help everyone and so we tend to worry if we might accidentally hurt someone.  Which brings me back to the article in point. The claims are quite frankly a load of bull and potentially harmful. The article started out quite sensibly but then I started to feel a little like Alice trying to converse with the Cheshire Cat and getting more and more confused in the process. Here’s a sample of the twisted logic in the absence of any supporting evidence other than a one off case study with limited information about what other interventions were used:

Claim: If your baby hit all of their developmental milestones except speech and if they tend to be quiet and don’t say much, you might think he or she is just a “good baby.” However, this could be a sign that their speech and language isn’t developing properly.

Response: I totally agree – this is generic claim is consistent with a wide array of speech pathology literature and common clinical presentation of otherwise normally developing children with speech and language delays.

Claim: “What may even be a greater sign of speech and language delays is when the sensory receptors in your child’s mouth aren’t working. What are sensory receptors? They are the senses in your mouth that tell you when food is hot or cold, salty or sweet, crunchy or slimy. If your child’s brain isn’t “computing” those sensory receptors, much like our computer virus, it will shut down and stop working.”

Response: The authors are suggesting that impairments in sensation such as temperature and taste “causes” speech and language delay. As far as I am aware there in NO literature to suggest an even tenuous link between these oral skills. In fact there is literature to suggest speech and non speech behaviours may even use different types of receptors and motor pathways. See here:  Speech_Motor_Development.pdf

Additionally, this claim assumes that the majority of speech and language delays are due to motor/sensory deficits. Given the high prevalence of phonological vs motor speech disorders and that language delays potentially have NO motor components at all I feel quite confident stating that it is highly improbable this is the case. If there is any evidence to the contrary I would love to see it.

Claim: the author then lists a variety of potential indicators of low oral tone but specifically describes them as, “signs of weak muscle tone used for speech and language. Children with these types of challenges may also have what is called Apraxia, which is a neurological speech impairment and breakdown of messages being sent from the brain to the muscles in your child’s mouth.”

Response: Again, it is highly improbable that the majority of speech and language difficulties have a motor based aetiology. Apraxia, or Childhood Apraxia of Speech (CAS), also known as Developmental Verbal Dyspraxia (DVD) is very rare. ASHA reports an incidence rate of approximately 1-2 per 1000 children which accounts for only 3-4% of the children referred for speech disorders (see: ASHA report on incidence of CAS). Having parents “looking” for this disorder is like raising public awareness to prevent coconut related head injuries for residents of New York city; a possible but highly improbable risk. Yes, CAS is a serious speech disorder, and some children have it, but if your child has speech and language delays odds are it’s NOT due to CAS. A good speech therapist will carefully consider numerous factors and engage in a comprehensive differential diagnosis process before diagnosing CAS. To make it even more ludicrous CAS itself isn’t even directly associated with low tone and although it may be also be present, low tone is not one of the key criteria for the differential diagnosis of CAS.

Claim: “I noticed he had not yet discovered his tongue and couldn’t use some of the muscles in his mouth. That meant we needed to first “awaken” the sensory receptors in his mouth with muscle exercises and greater exposure to hot, cold, sweet, sour and other food textures.”

Response: Eating and speaking are DIFFERENT skills!!!!! Eating different foods does not result in better speech outcomes. Non Speech Oral Motor Exercises (NSOMEs) do not result in better speech outcomes. To quote Wilson et al (2009), “Although the efficacy of NSOMEs remains empirically untested at this time, studies of typical developmental speech physiology fail to support a theoretical framework promoting the use of NSOMEs.” Thus not only is there no supporting evidence for this claim there isn’t even a sound theoretical framework underpinning a likelihood of benefit. See here and here for more details.

Claim: The therapist goes on to say that they recommended the use of an electric toothbrush as, “the vibrations force children to manipulate the toothbrush with their tongue, lips and jaw, which is the first step to strengthening those muscles and awakening those sensory receptors.”

Response: According to any peer reviewed literature I have come across, vibration has not been shown to strengthen oral muscles or “wake up” sensory receptors. The only evidence provided is the narrative description of Tuck’s case. I doubt the electric toothbrush is all that was used to treat this child and the observed gains may well have been due to other interventions. So in line with this low level evidence and to counterbalance Tuck’s case, I have personally treated more than one child whose parents had been told to use a vibrating toy or implement such as a Z-Vibe to increase oral tone or sensation and as a result they had in fact LOST oral sensation and their feeding had DETERIORATED as a result. This would suggest that not only are there children for whom this approach doesn’t work but furthermore it is a potentially harmful approach.

Claim: This one is the real doozy of a claim that is completely incomprehensible to me, “You may think this idea is just for children with speech and language delays, but you’d be wrong. These types of activities are good for all children as they are developing their speech and language milestones as babies and toddlers.”

Response: Good for ALL CHILDREN!? What on earth!? What study suggests this? Why? How? When? In light of the cases I have seen where children have suffered real and lasting damage as a result of excessive use of oral vibration stimulation this claim is astoundingly risky. To be suggesting routine use of oral vibration using an electric toothbrush for all babies and toddlers is a wild leap from the already unfounded assumptions previously refuted and would be putting otherwise normally developing children’s oral development at risk.

I’m assuming the author is not a snake oil merchant but simply a well-meaning and poorly informed therapist.  I hope that my little professional rant here can help parents to be more aware of the hidden dangers of these sorts of therapy approaches and to seek well-informed professional advice.

In closing, if you want to brush your toddler’s teeth with an electric toothbrush to take care of their dental hygiene needs by all means go ahead, but keep the toothbrush for cleaning teeth not treating speech

“If I can do it, you can too” – it’s a lie

I came across yet another rags to riches, motivate everyone to become a millionaire, type of story today and in the same day have also processed numerous job applications from a variety of people seeking employment and was struck by the contrast. In many of those self made millionaire stories the claim is that anyone can do it, you just need to do X (usually buy their book or program LOL) and you’ll be living the dream too. I just want to say that the whole “If I can do it, you can do it” tagline for career and financial success isn’t true. It’s a lie and it’s denying us all true success.

Now before I offend everyone I firmly believe that each of us has unique potential and gifts to share with the world. And with that in mind I’m going to share why I think this fallacy is taking away rather than adding to people’s lives and feelings of fulfilment.

Firstly, what is the “it” the person is referring to? Everyone making millions, being entrepreneurs or leading society in some way is not actually how I think we make our greatest contribution. Yes we need people to do those things and are contributing in that way BUT we also need people who enjoy growing things other than a bank account.

How do we define success? For me my definition of business, personal and financial success is very different to my best friend, sister, husband and parents – and these are all people who I share very similar value systems with. Why is that? I think it’s because success is  a uniquely personal thing. For example buying and wearing footwear is a burden to me – for many women buying and wearing shoes is a wonderful thing and something they aspire to do more of. But that’s not me. I think success is when we can spend much of our time in what Gay Hendricks (author of The Big Leap) terms our “zone of genius”. It’s when we are doing the things that bring us fulfilment and are in a state of flow. You know those times when you were doing something and realised that hours have passed and you’ve been thoroughly immersed in what you were doing. The beauty of this is that your zone of genius is entirely unique to you. Yours might be creating art, gardening, teaching children or writing code for apps but whatever it is it lights you up and when you do the world lights up because you are doing it.

So, if being successfully means that we are living in this zone as much as possible it means that we each need to be finding our own unique path to success. Therefore the old “if I can do it, you can too” line is distracting us from finding our own path and treading it confidently. So be authentically unique – learn from but don’t imitate others. The fact is the world needs you to be your own unique and quirky self and contribute what only you can. I think we’ve got enough self-made millionaires, what I want to see more of in the world is self-made fulfillmentaires!

Every now and then I fall apart…it’s a taco eclipse of the heart.

Sometimes no matter how hard you work you still feel like you’re battling uphill against an ever escalating mountain of tasks. Events beyond your control hijack your well laid plans and good intentions and you end up feeling overwhelmed. Those moments where you feel like a taco that’s snapped in half whilst someone is piling more on and you’re desperately trying to hold it all together.This might sound all doom and gloom but the wonderful part is that somehow you get through those times.

After having had “one of those weeks” last week I’ve found it amazing how much better I’ve been able to bounce back and recalibrate compared to normal. That is not something I’ve previously been remotely good at. So how did I do it? Well, the first thing I did was to self-reflect on where I was actually at. I listed off all the things I was worried about and then intentionally set them aside or metaphorically passed them back to the person they belonged to. Then I accepted that every one of those tasks, worries and emotions are things that I have chosen and that I continue to choose every day. I chose to have children who need me, I chose to marry my husband, I chose to buy a house (and associated mortgage), I chose to work for myself and forsake the “security” of a government job, I chose to employ staff who need my support, I chose to expand my business. And each of those choices led me to be where I am right now (although I never predicted this is where I would be!). We can’t have the choice without the consequence, you can’t pick up one end of the stick without the other, but you can choose which sticks you pick up, what you do with them, and when you put them down.

So if you’re feeling like you’re falling apart take a moment to reflect on what you have chosen and see if there is anything you can “unchoose”. For me it was the vicarious stress of one of my staff – she didn’t try to put it on me but I picked it up but after reflection I’ve been able to put it back down.

What have you “unchosen” lately? Did it make a difference for you?

The hidden dangers of silent reading

I have noticed an increasing trend towards encouraging “silent reading” even in the very early stages of literacy development. Today I was in a meeting regarding a student in grade 1 and the teacher reported he was having behaviour problems during their daily silent reading session. It highlighted to me that many teachers, speech pathologists and parents aren’t aware of the danger associated with silent reading particularly for young children. The other dedicated and experienced health and education professionals within that meeting weren’t aware that reading aloud enhances comprehension and is vital in laying solid foundations for future literacy success.

“Reading is good for you!” I hear you say, “How could it possibly be dangerous!?” Well there are 2 main dangers I see:

  1. Reading silently results in poorer comprehension even for mature readers (see reference below).
  2. Practicing a skill incorrectly means you will get better at doing the task incorrectly therefore systemic decoding errors are reinforced while reading silently and that is certainly not the foundation we want to lay for our early readers!

A study by Hale et. al. (2007) identified that reading comprehension for readers of a variety of ages was enhanced when they read aloud. Here’s a link to the article if you are interested in reading more:

http://files.eric.ed.gov/fulltext/EJ800965.pdf

So, the take away message is that encouraging our children to read aloud more often and even as they become more independent readers may help to enhance their comprehension. Go forth and read out loud everyone!

You’re writing your progress notes wrong!

“You’re writing your progress notes wrong!” Yes I said it straight up with no apologies to another health professional after a brief discussion around record keeping. She was feeling overwhelmed and was writing comprehensive and detailed notes that were not useful when she was referring back to them but she was worried about reducing the level of detail because she might not record everything.

I started using this format as an early career Speech Language Pathologist and I continue to love it and use it to this day. It’s perfectly suited to outpatient paediatric work, especially when you see children for numerous consecutive sessions. So here are the juicy how to details…

BOP your notes on the head!

B = Background

O = Observations

P = Plan

That’s the simple structure and here is a more detailed explanation of how I actually use this to ensure my notes are accurate, complete, succinct and efficient.

B = at the start of my entry I specify what type of consult it was, who attended, circumstances which may impact on therapy performance (e.g. hasn’t had a sleep today) and anything the parent has reported regarding home practice or changes they have observed.

O = Here’s the critical section. I break this into each goal/target I had for the session and then just write the goal and what my observations were in relation to this goal/target. That way I make sure that my session and record keeping are all focused on the session goals and I don’t get caught up just describing activities.

P = I record a specific plan of what the next step is for this client so then when I come to prep for next session there’s  the essence of my plan ready to go. I fondly term it a “post-it note plan” because before I started using electronic record systems I used to write the plan out on a post-it note (as well as in my notes) and then stick the post-it note in the front of the child’s file so that it was there ready when I came to plan. Even though I don’t use post-it notes any more the “post-it note plan” term has “stuck” (very punny) and it helps me to ensure that my plan is simple the goals for the next session and any to-do list items in relation to that child.

So there you have it. Progress notes for speech pathologists made super-simple and super-efficient and effective. Oh, in case you were wondering once my colleague who was “doing it wrong” took on board my suggestions and trialled it for a week she found she cut her note writing time in half and found that her planning was more effective and that she was better able to stay focused on client goals within a session even.

Happy notes writing everyone!

How I use Trello to achieve annual planning Nirvana

I’ve just recently discovered Trello in my quest for organisational nirvana (remember my “be organised” mantra for 2015?). I’ve played with it but wasn’t overly excited until I started doing some long term planning and suddenly found myself so far into planning Nirvana I nearly started singing “Smells Like Teen Spirit”. The only thing that stopped me was the fact that no-one knows for sure what Kurt Cobain was actually saying in that song. So I opted for “Come As You Are” instead …anyway enough Nirvana and on to being organised!

So here’s how I did it and why it has worked for me.

I created a separate organisation called “Planning” I then created three boards. I’ll break it out here and explain how each of the 3 boards are set up first:

  1. Annual Plan – here I made a bundle of lists with one for each month eg “April 2015” as far into the future as I wanted to plan.
  2. Monthly Plan – here I made 5 lists for each week of the month with an assigned a number eg “Week 1”
  3. Weekly Plan – you thought you guessed it and I made 7 lists for each day of the week but I didn’t, tricked you! I actually just made 4 lists “To Do”, “Doing”, “Waiting” and “Done”

So here’s how the magic happens.

Firstly when I brainstorm and do my big picture planning I create a card for all of the milestones I need to hit to be able to achieve my long term plans. I plonk those cards anywhere and then I can consider things like school holidays etc and factor those into how much I try to allocate to each month and I schedule accordingly. The nice thing with Trello is that you just drag and drop cards to a different list if you want to change when you are meeting a specific milestone. Then at the end of each month I move the next month’s list from my Annual Plan board across to my Monthly Plan Board and then allocate each task to a specific week. Once they are all allocated I just archive the empty list. You could also recycle the empty list and move it back into your Annual Plan as the same month for the following year if you wanted. Then each week I move the cards from the relevant Monthly Plan list onto my “To Do” List on my Weekly Plan board. As I start doing a specific one I move it to my “Doing” list and then eventually to my “Done” list. This may not be important for you but as someone who gets easily distracted by anything bright and shiny it helps me stay on the priority milestone I’ve chosen until it’s done. At the end of each week I just archive all the cards from the “Done” list and so I’m ready to tackle the next week! The “Waiting” list on my Weekly board is for any milestones that are dependent on someone else (e.g. I’ve delegated it to one of my staff). This helps me remember to follow up if I need to and check on the finished product.

So I promised I’d tell you why it works for me:

  • It’s free! YAY! Pretty backgrounds and extra features will cost you but the free account is suiting me just fine…lucky I don’t mind blue.
  • I like how this system just rolls along without needing me to change dates etc if things need to be changed.
  • It is a great way for me to tie together my personal, business and research goals all in the one system (I have them colour coded).
  • I can add extra things that are more short term (eg clinical reports) to my weekly plan as needed.
  • I’ve been using it to plan out some projects as well and I like the simplicity of the visual layout.

What I don’t like:

  • You can’t delete stuff – sometimes I mess up and I don’t actually want to save/archive it, I just want to scrap it. You can only edit or archive it Trello.

The irony is that the lyrics of “Come As You Are” provide insight into my favourite part of using Trello which is the flexibility to move and adjust the time-scaling on my project milestones as needed.  So in the words of Kurt:

“Take your time, hurry up
Choice is yours, don’t be late”

I’ve tried  a dizzying array of project and task management apps recently and  Trello is a tool that is working for me at the moment. What organisation tools or systems do you like and why? Post a comment, I’m really keen to hear what works for you.