The Big Picture: Top Three Things I Learned at ASHA 2016

I had the wonderful opportunity to attend the ASHA 2016 convention in Philadelphia, PA this year.  I had a great time meeting up with old friends from graduate school, making some new SLP friends and attending some really great sessions.  The thing I find the most interesting is seeing "the big picture".  I enjoy listening to speakers explain information from their area of expertise and research, of course, but what I find the most fascinating is the fact then when I take a step back, I can see how each session's information fits into the very big puzzle of that thing we all label as "communication".  Standing on the outside looking in, is so advantageous as we can see where links exist between each individual area and how these links support, aid, and assist other areas of communication.  With that concept of "big picture" in mind I'd like to share with you a list of some of my take-aways from this conference.

The top THREE things I learned at ASHA 2016:

1.  It's all about LANGUAGE:
     It doesn't matter WHAT the diagnosis is, the research is supporting our crucial role in language intervention as the KEY to unlocking so many other areas of language.  We all knew this right?  Well now we have the research to support it!  For example:

• Bashir, Gillam, Montgomery and Singer shared the NEED for more treatment targeting language comprehension for children with SLI who also exhibit WM (working memory) capacity limitations.  They explained how research is showing there is NO VIABLE way we can actually INCREASE one's working memory capacity, therefore our shift in treatment should be to make other skills automatic, which are currently using up a lot of working memory resources.  If we cannot increase a child's WM capacity, we can at least help the child master linguistic skills to the point of automaticity so as to free up WM to learn novel information.
• Katz and Fallon discussed how to we can effectively assess written language skills, and guess where they began?  Comprehension of both spoken and written language (a.k.a. reading).  To fully assess written language abilities we need to first know how the child understands spoken language and comprehends reading in order to determine how those skills relate to their verbal expression, both in oral expression and in writing.
• Mirasala, Jagla, and Knapp shared the invisible obstacles (impacts on behavioral, academic, social, executive function skills) adolescents with SLI experience and how they manifest as children get older.
• Camarata and Lancaster are asking us to reconceptualize SLI as a continuum rather than a specific entity due to the nature of the symptomology and numerous subtypes we currently see exist under this diagnosis.  Moving toward a continuum approach could completely change the way additional services in the school setting can be provided.  If we determine a spectrum of severity, would that not lend us to provide treatment and support according to severity level rather than simply diagnosis? 
• Diane German shared her research regarding the three types of word finding issues, their characteristics, and assessment and treatment.  Once we take note of which word finding subtype(s) the child demonstrates we can build our treatment around the effect techniques her research currently supports.
• Kahmi, Vermiglio and Wallach, shared their support for the need to understand the linguistic underpinnings that lie unearthed in many children diagnosed with (C)APD.  Their research suggests if we can adequately identify the underlying language issue, this population could be treated far more effectively and efficiently than current practices.
• Bashir and Singer (again?! I KNOW but they are great!) explained how improvement in language skills can effectively enhance the 5 core EFs (executive functions) students require for daily living and academic success.

      I'd love to go on and on but just looking at this list ALONE supports my new motto "It's all about the Language, 'bout the Language, no trouble"! (influenced of course by the lovely Meghan Trainor)

2.  Be META:

     I wonder if we, as SLPs, are so focused on trying to reach our goals (data=proof=progress...but does it? Hmmm.) and teach specific skills that we forget probably the most important part of language intervention, teaching our children strategies that will generalize to novel experiences, unfamiliar classroom assignments and new daily life situations.  There is empirical support for teaching our students to use language (internal-self talk, or external-self talk) to THINK about THINKING, to THINK about LANGUAGE for numerous populations (EF deficits, WM difficulties, SLI, ASD, anxiety, depression, etc.).  We call these skills metacognition and metalinguistics.  We not only see the use of metacognition and metaglinguistics skills improving executive function skills BUT there is also some evidence supporting the use of these skills to teach ToM (Theory of Mind), or now the newest "fancy schmancy" term I heard at the conference, ISL (Internal State Language...um...ok. Whatev's you know what I'm talking about either way) for children with ASD (Autism Spectrum Disorders).  In fact, I did attend an interesting discussion on ToM which reviewed a very small scale study (2 subject single case design comparison) which compared the use of repeated book reading as a method to facilitate ToM in a child with SLI and a child with ASD.  The findings suggested repeated book reading was a very good technique for the child with SLI, as the child improved in answering various types of ToM questions over time with repeated exposure.  The child with ASD, demonstrated more resistance and for some question types, even negative trends rather than improvements, based on this one study.  Of course we cannot throw out the baby with the bathwater here based on one study but it may help us to begin thinking about how important teaching and modeling metalinguistic and metacognitive skills can be for our ASD population with regards to ToM/ISL facilitation.   Interesting stuff, nonetheless.  So, don't forget to be meta and teach these very necessary skills to our students. 

3.  Success takes TIME and HARD WORK: 

     If you are an SLP with a huge caseload or a parent with a child struggling reading this, please understand that NONE of the improvements happen over night.  Many of the presenters expressed that these types of deficits and delays take a lot of time and hard work for the child to achieve success.  Note that I did not say "achieve remediation" or "achieve typical functioning", or "achieve all A's on their report card".  The idea of success for ANY of our students/clients should be synonymous with the terms "functional" and "independent" (to the degree they can be).  There is no magic cure, no pill, no computer program, no app, no one-size-fits-all technique that can ever substitute for hard work and individualized instruction.  So be patient with yourselves and with your students/clients.  See the real functional progress you are making, and be sure to get the most bang for your buck.  Use the strategies what will facilitate this "success" by giving the child the skills to use and generalize to other settings.  You know the old adage "Catch a fish, a man eats for a day.  Teach him to fish he eats for a lifetime."  So, let's teach our kids to fish!

Happy talking and fishing!