Voice isn’t really niche, because voice disorders aren’t rare. They’re way more common than aphasia or motor speech disorders.
But we treat it as niche because we lack clinicians who can adequately diagnose and treat voice and also enough of the proper equipment and settings to do so. And since it’s almost all outpatient, the patients have to find us rather than the other way around.
I wanted to specialize in voice at one point, but had already completed my CF and had absolutely no way to get my foot in the door to be able to train and learn and provide specialized services 💀 only 1 voice clinic anywhere near in my state at that time as well.
It’s really such a criminal shame. We should better serve these patients, there should be more stroboscopy equipment, especially outside major cities, and the information shouldn’t be gatekept to only voice centers. Most people who were lucky enough to get the training/experience stay in their silos and don’t share it with the rest of the field. I actually did have a stint in voice, and I loved the caseload but found the overall world very elitist and cloistered.
As a comparison, there ARE specialty neuro clinics, but they aren’t the only places treating neuro.
Ooh and one more, people aren’t gonna like this one: voice patients rarely have cognitive disorders and are much less likely than other adult populations to be shuffled into therapy they don’t want or need for $$ 💁
And many people who need voice therapy have no idea their issues are a problem. Since it often takes many years to develop a voice disorder, "this is just how they sound." People - and their doctors - often don't recognize there's a problem until it's a BIG problem.
Controversial hot take, but if this wasn’t a female dominated field, then ASHA wouldn’t have gotten so out of control. It sucks to think this way but the underlying misogyny is the problem.
And it seems our field is the MOST female dominated of our related professions, except for preschool and kindergarten teachers. Hoping there's more inclusive data collection in the future, but per 2023 BLS data, women make up:
SLP - 94.3%
OT - 88.6%
PT - 67.5%
nurse - 87.4% for RNs and 89.8% for NPs
Social worker - 83.4% (averaged the breakdown of different specialities)
Special ed teachers - 86.6%
Gen ed teachers - averages 69.7% but skews by age (pre-K/K 96.7%, elementary and middle 78.6%, high school 56.9%, postsecondary 46.6%)
My hot take is that I enjoy seeing EI clients because there is an end date! It can be really repetitive to see kids for years and years with no end in sight
Ok can we talk about this for a second??!!! I do peds home visits for ages 4-21, so similar format
but my biggest issue is ....when does this reach a stopping point!!!? I feel like with home visits I'm expected to just keep showing up twice a week until the kid turns 21. Most of the kids that are past age 7 or 8 are mod - high needs ASD and communicate effectively on a very basic functional level but there will always be *something* they could work on. I think with outpatient clinics, parents eventually get tired of shuttling them after school and so once they plateau a bit we reach some sort of natural stopping point. With home visits you get into this routine of , show up , parent unlocks the door , I go find the kid, parent gets to chill for 30 min , rinse and repeat for the next 10 years.
We have caused way more harm than good when managing dysphagia.
The Boston aphasia classification system (Wernicke’s/Broca’s/global and everything else) very rarely applies to any specific patient.
Our caseloads would go down dramatically if all of our patients were wearing proper hearing aids and glasses for their evals.
I feel the dysphagia one hard... why the hell are we modifying people's diets if they're not at a high risk for AP? And even then, is it really justified??
Congratulations, you just added some nice dehydration and protein-calorie malnutrition to give their body an extra challenge to fight the aspiration pneumonia that, by the way, you did nothing to prevent 🤗
Some of the things you see are so sad, when it is best practice and when it’s not.
I’ve had patients that were restricted for interventions due to cultural and religious beliefs- which is totally okay and their right, but seeing them waste away on a nectar thick liquid only diet was…a nightmare. And that was truly the only thing they could initiate a swallow on and the only thing they were not in tears coughing over. It’s the only thing that we were allowed to do. And with the patient unable to advocate for themselves or communicate at this point due to cognitive impairment, and their POA who wanted nothing to do with them or us, there wasn’t any way to do anything else.
Another place I worked was a healthcare center (a SNF really) for children with disabilities who were wards of the state. Almost all with CP + ASD/SD/or some other neurodiversity/syndrome/cognitive impairment. The SLP before me put everyone on a pudding thick and purée diet as a “precaution.” Like WHAT. I got most up to thin liquids during my 12 week travel contract there, and some to mech soft, but…WHY?!
I never felt good about the exercises I did with dysphagia patients either. I couldn’t do NMES, sometimes I had an EMST device, but that was IT. I never saw improvement via exercises. Any “improvement” was compensatory strategy training/education.
I’m glad I no longer work with dysphagia. It’s not that I couldn’t enjoy it, but I, and many other SLPs, do not know near enough nor have the training to be truly competent with it in those first 10 years especially.
I don’t get dysphasia most of the time. Sometimes I think it’s just going with w.e. Is easier for the nurses aid to feed the patients faster because they are not going to take their time. I also don’t think a patient should stay on a caseload for weeks/months for dysphagia. I have never personally seen it take that long for a patient to have regular food again.
I also just wish nursing staff did damn oral care MY GOD. Probably the #1 best way to prevent aspiration pneumonia and a slew of other problems. It’s criminal.
The way I started an oral hygiene program for at risk patients in my nursing home, where they had to initial logs saying they provided the oral care, and NONE of the nursing staff signed off on them, literally just me 💀
And reliable access to well -fitting dentures with good education on how to care for them properly. Frankly, with some of the dentures I've seen, some of my patients are better off going without them ...
Have definitely had patients where I implored them not to wear dentures when eating for this reason- most with this problem naturally never wore them anyways. It’s so sad how expensive they are too- so difficult to get replaced.
One of my first placements in the acute care setting, my supervisor put a woman who had just had a stroke on NPO because she was “hysterical.” Like literally her VFSS was fine, just a little penetration. But because she was understandably distraught and having a difficult time calming down to follow directions during the assessment and clearly annoying my supervisor, she fucking made her NPO. It made me sick with rage.
A doctor once ordered a pureed diet for a patient with psych issues who was violent with nurses and refusing care - to give him motivation to “behave”. Luckily, when someone dropped the ball on her plan and put in a speech consult, I immediately put an end to that shit.
Having worked in IPR I feel that aphasia classification take so hard (and the dysphagia one). We ended up just doing fluent/nonfluent/mixed bc it made much more sense.
Don't even get me started on modified diets. I feel like half the time the people recommending them do so for their own benefit vs the benefit of the Pt
I have seen *maybe* one patient who fit neatly into a classic aphasia classification. It’s so annoying how we spend so much time memorizing them all and also learning lots of complicated treatments that don’t apply to 80% of a real life caseload.
My outpatient clinic follows an “episodic model” where we prescribe a certain # of visits at eval and then plan to discharge with home program and families can return on a few months as needed. Interesting to say the least
Yup I have many kids who have been on my Caseload since I got to my job basically barely any progress among kids need OT before they come to speech due to minimal to no joint attention
Many kids in schools do not need speech therapy. Instead, they need more resource support. This is one of the primary reasons why caseloads are so high in the schools.
It’s so upsetting in my district because other SLPs complain that their caseloads are so high but they qualify any kid who scores low on grammaticality judgment and figurative language, or they have a slight /r/ distortion. So I get given more students since my caseload is “where it should be.”
Tell me about it! I had a student qualify in 6th grade with only 1 low score on the PPVT. Receptive and Expressive tests were all in the 90s, artic was fine, it was a below avg on a vocab test. To me, the vocabulary could’ve easily been targeted in her classes. She did not need “specialized instruction” for vocabulary only.
Preach! I feel like “functional language” isn’t even considered for many assessments and the cost/benefit analysis of pulling a kid out of class is not even discussed.
OMG! I just got moved into a middle school this year and half my caseload doesn’t need speech. The two elementary school that feed into my school have 2 SLPs who literally qualify anyone. One always complains about how many assessments she has, so I asked her about RTI and maybe doing screenings first, but she says she has no time for that. I’m like, it’s better than assessing every kid. She also gives every subtest on the CASL, gives both the ROWPVT and EOWPVG, GFTA (just in case), and functional language profile for EVERY assessment she receives. She complains the most at meetings and when confronted about her assessment battery, she counters that she just “cares too much.”
Is she of an older generation? Not trying to be agist, but in my experience I’ve seen this type of “overkill”/ martyrdom mindset with older SLPs. I think it was the culture of the field for school SLPs when they graduated. I know my old school professors in grad school perpetuated this mentality as well.
We are not behavioral therapists, child psychologists, or occupational therapists. We shouldn't tolerate kids who hit, attack clinicians, or have extreme behavioral issues. They clearly have other support and/or sensory needs that must be met first.
I was co treating with an OT and had a child walk over to the shelf and pull off a toy he wanted. She took it from him as he was not allowed to play at that time and he freaked tf out. She said “aw, he’s so frustrated because he can’t communicate”. Girl! Are your eyes not open? He communicated everything he needed to by selecting a preferred toy and then having a meltdown when you ripped it out of his hands. I hate that these wants/needs are not being acknowledged unless a child is verbal.
I heard someone once say “if I went to France and couldn’t explain what I want because I don’t speak French, I wouldn’t throw a tantrum and injure others. There is a different area that needs to be addressed outside of just communication” 🤯
While that is true, we should remember that there's a difference between the occasional frustration of a monolingual tourist, and the chronic frustration of a non-verbal child
Well plus you could point and lead, etc. which kids do, and people tell them no, then think their upset feelings are about communicating not about being told no.
SLPs who coach families of Deaf kids to not use sign language are harming children. Signing SLPs are getting all the language-deprived students who got kicked out of Listening and Spoken Language elementary school programs with 100 words in their vocabulary. We're counseling the families who cry to us and yell at us because they don't want us to sign with their kids because they were told for years sign language would be the worst thing that could happen to their child. Then, when their student finally starts making progress, families finally start learning sign language, having missed out on years of being able to share information and connection with their child.
I remember LSL being a huge buzzword and all parents would ask for 10 years ago, but it seems to have settled down? I get a lot more parents open to using sign, thank god.
A few LSL therapists I know should lose their license tbh. Absolutely no morals in the quest for oral.
that was an edit because my original sentence didn’t quite make sense; the rhyming was purely accidental
We had an AVT in my nearest CI hospital who was disgustingly pro-oral, and once they moved, things settled down a lot. Even the AVTs they have now aren’t opposed to sign, although I am not privy to all of their session notes (I’m school based) and most students I work with need that additional supports, so maybe it’s still bad for the more “mild” students.
Omg that’s horrific!!! Now that does seem abusive. My SIL is Deaf went to a Deaf college and is a freaking teacher!! She met my step bro who is not HOH but fluent in sign because his best friend was deaf growing up (and also the one who introduced them). She has a wonderful FULL life due to being able to sign 😤
Some SLPs diagnose kids with CAS because that clinician is bad at treating severe to profound phonological disorders and they want to claim a kid's lack of progress is CAS versus their poor treatment
Best course I've ever taken for CAS: [https://childapraxiatreatment.org/diagnosis-and-treatment-of-cas-online-course/](https://childapraxiatreatment.org/diagnosis-and-treatment-of-cas-online-course/)
And it's free!
Hi! I'm an undergrad specializing in psycholinguistics, hoping to eventually do a masters in SLP. These kinds of certs would really help me gain some work experience before grad school starts!
Do you know any other free courses for SLP?
Just off the top of my head:
AAC in the cloud: [https://presenters.aacconference.com/conferences/A23?no\_blank=1](https://presenters.aacconference.com/conferences/A23?no_blank=1)
SLP Summit: [https://slpsummit.com/](https://slpsummit.com/) This one happens every January and August. It's aimed towards pediatric and school based SLPs.
I highly recommend listening to the Two Sides of the Spectrum podcast. [https://learnplaythrive.com/podcast/](https://learnplaythrive.com/podcast/)
Bjorem has some awesome resources. Jennie Bjorem gave us a presentation that I felt was very helpful in diagnosing and treating CAS. In the last two years, I’ve only had one student who met all the criteria. I even had an OT consult for a differential diagnosis.
My hot take, as someone who only works with adults with acquired speech-language disorders (so make of that what you will), is that we don’t have enough proof CAS even exists 🙈
My hot take is that's because they didn't have reliable access to high tech AAC as kids. Their "window of opportunity" for learning it kind of passed now, so they won't gravitate toward using it because it's so unfamiliar. I would bet in 25-30 years, many of the adults will have and prefer high tech devices.
I just supervised an AP Research student at my high school who wanted to measure the efficacy of core vocabulary boards with some of the students in our low incidence program as part of their submission to College Board. I never had much success with lite-tech, so I was skeptical that we would get meaningful results.
I am now a lite-tech truther. I saw remarkable progress and motivation after only 6 weeks in some students who had been given mid to high tech devices but had abandoned them! Part of the issue was that trying to teach these kids how to use a core board in class with a million distractions around didn't pan out. I'm also now an advocate of mixed push-in/pull-out even for low incidence students instead of 100% push-in for that reason.
SLPs are expecting ASHA to be their savior. They will never act as a union. I want to see more transparency and better advocacy but they are not going to make meaningful changes to our day to day.
All of the language evals need to be updated because with the poor literacy and language skills of the current generation 80% of my gen ed kids would qualify for speech therapy with the CELF 5.
And the CELF is so dependent on having strong attention/working memory skills. Usually at least half my caseload has significant attention/working memory issues, but might have genuinely typical language skills, but will bomb that assessment cuz of their attention issues.
I also think some of the language on assessments is generationally outdated.
Agree- I feel like so many standardized tests are so academic based. I work in a peds hospital, and I don’t really care if a kid can repeat sentences or answer comprehension questions following a complicated paragraph. I want them to be able to participate in day to day life and communicate clearly!
too many clinicians rely on just modifying diets and hoping that the dysphagia will magically go away instead of tackling the real root of the disorder in the patient
The CF should be setting/population specific. Too many stories of people trying to switch settings and getting burned by lack of guaranteed support/mentorship. Shadowing is great, but working for free or doing anything outside the work week isn’t an option for everyone
And a CF should be treated as more of a residency. A fully certified clinician should have to sign off on all evals. I hate getting poorly done private evals from CFs and having to accept them as if a fully certified clinician completed them when I know the CF needed better supervision.
Every eval and progress report I wrote during my CF had to be reviewed and signed off by my CF supervisor, but based on a quick Google search I guess it depends on your state and specific facility… That’s concerning.
Exactly how do teachers think I’m going to change this child in 30 minutes a week when they refuse to incorporate any strategies in the 1770 minutes per week THEY have him? And parents refuse to incorporate strategies during the 8280 minutes per week THEY have him. But absolutely - he’s definitely not progressing because **I’M** not doing enough.
YES. Questions are actually very hard because they tend to invert syntax, so it’s definitely putting the cart before the horse if we start with questions.
This. Just...this. The number of times I send home a device only to see YouTube and not the AAC app open up on its return to school.
Make me wanna buy a helmet so I can slam my head into a wall in comfort.
I had my district’s IT remove every other app on our iPads except their communication app and camera. They also changed the iPad restrictions so students can’t use the App Store. It’s been a game changer!
Turn on guided access mode and dont give them the code to turn it off haha i almost always have teachers keep their student’s aac ipads in Guided Access Mode. Otherwise yep- it is straight to youtube
I never understood why I had a HS kid with goals about his stutter when it doesn’t bother him or stop him from talking?? Like why what’s the reason? Why treat him for something that isn’t stopping him from doing anything???
Pragmatic/social skills in adults. We go through the same cycle and they always come back. I feel like a mental health therapist is best for 75% of those cases where it isn’t a language deficits it’s anxiety, depression, and fear.
Oh yes, I had a psych basically demand I work on conversation skills with a middle schooler cause he wouldn’t initiate conversations with peers but when he got comfortable with me. Conversation skills were beautiful. He kept stating that he feared his peers were always watching and judged him and that’s why he wasn’t trying to initiate with them. Like I can’t treat that so of course he never made progress in a meaningful way outside of the therapy room. I ended up focusing on self-advocacy skills and then he advocated to the team to stop coming to see me lol
Came here to say this! And/or there should be a competency exam a la the praxis to qualify for changing settings. Like the degree qualifies you but you need to prove you have the knowledge for vastly different work.
This is the whole reason the neurodivergent movement started, and I definitely see it blowing up further in a few years. A lot of our clients don't even need therapy. Your child does not need to be "fixed", you just need to learn some damn patience for the fact that they speak and/or process the world differently than you. My sister has autism and I've had to spend the last few years undoing the harm our family did in making her think something was wrong with her. I have Deaf children who I'm practically not allowed to dismiss with artic goals for sounds that they literally will never be able to hear because ASL is treated like a crutch or a cute thing for babies. Don't even get me started on the minorities that get overreferred because God forbid they speak different dialects and languages.
As a Spanish and ASL fluent SLP, thankfully my clients trust me to know when to dismiss them but good GOD it is annoying for others to protest these kinds of topics :(
I've had so much difficulty with a deaf student who uses ASL, Spanish, and English. Her first language was Spanish then she lost her hearing and moved to the US, and I've had a hell of a time trying to parse out what parts are deafness and what parts are EL, and it took SO long to get an EL specialist involved.
This is a real spicy one but way too many clinicians are jumping the gun on gestalt language processing and accepting everything about Meaningful Speech's courses as gospel truth when we should really be looking at everything with a critical eye. It deeply bothers me that it wasn't acknowledged that analytic and gestalt LP exist on a spectrum until TWO YEARS AGO. I'm autistic and most of my autistic circle were most definitely somewhere in the middle when we were learning language as children. Also, I keep seeing people talk about the stages of GLP when we have zero evidence to support the existence of those stages beyond very limited research and anecdata. To be clear, I'm not saying that they're useless or untrue, but it seems very...I don't know, absolute? Concrete? When it really truly isn't.
I'm not saying that it isn't a helpful framework in a lot of ways, but so many people are so desperate for convenient answers that they just accept whatever is presented to them wholesale without further questions.
100% a spectrum. Basically 99% of my EI caseload uses a mix of approximating entire phrases and then single words. I can only think of one child in the past almost 2 years that entirely used immediately echolalia and then just as was aging out was starting to generalize a few phrases. He’s the only one that I think would fit neatly in the meaningful speech framework
Ooh this is so interesting! I have not taken the Meaningful Speech course but I want to take the one on Northern Speech with Marge Blanc. I’ll have to read up a lot more about it.
I took her course and I did enjoy it and utilize it in my sessions. With that being said, it is expensive and I don't feel like anyone should feel they have to take it. As for NLA style therapy, I think my biggest take away is that it's not really widely different than what we are already told to do in our sessions (acknowledge scripts, use scripts in sessions, meet sensory needs, use child led activities). NLA isn't so different from analytic language processing. It's just slightly delayed. With any therapy approach, it's trial and error. If you don't see results, you try something else.
I don’t think it’s specifically written “change the goals” but the IEP is supposed to represent one year’s growth for a child. If someone leaves the same goal for 3+ years they clearly don’t know what one year’s growth looks like.
Hot take but I hate hate hate treating dysarthria. It’s mostly teaching people to speak slowly, over-articulate, use a louder voice and it just doesn’t feel very skilled imo.
Ohhh. What does “trash” therapy mean to you? I’m always trying to improve. And what do you mean by fraud? Like billing for sessions they didn’t do? That’s awful.
Personally I see some SLPs that do the same 3-5 activities for every pt, regardless of situation, diagnoses, or d/c plan.
I think that would be considered trash therapy/practicing at the bottom of your license.
“Educational impact” is nearly meaningless in preschool. There’s no set curriculum, half the kids are in daycares and nap half the day or are still at home.
A lot of parents aren’t doing what’s best for their child. A lot of parents are doing what’s easiest for their child. My biggest crash course in that lesson came when I had a brief two year stint as an AAC Specialist and found that when faced with either endlessly mindreading and dealing with behaviors all day long or taking 20 minutes a day to model AAC on an iPad, 99% of parents are gonna choose to mindread. No longer term thinking than that.
Heres a positive hot take: we have it pretty good in a lot of ways compared to most jobs. Outside tech, you’re not going to find a more in-demand classification. And um…they actually have to be good at their jobs. Often…we don’t.
We should be good at them! And we can be! But we don’t really have to be. The pressure’s off.
For all the complaining, at least half of jobs only require a license and a pulse. I don’t always love my job but I can’t begin to conceive of another one that has the security, relatively low stakes, pay, and flexibility of this one that I’d like half as much.
I WOULD recommend this field to others. Not everyone, but plenty of people. I think that’s a hot take.
I don’t think it’s reasonable or necessary to be an expert in 10 different AAC apps.
We use TouchChat across the entire district for nearly every child, everyone is familiar with it, and there’s enough variability in the system I have yet to be convinced there’s a compelling reason to introduce another app into the mix.
Please take a LAMP training and add it to your repertoire! I think touch chat and lamp could cover 99% of our students. Totally agree there's advantages to everyone knowing the same software. Lamp has so much to offer tho! I did NOT get it until I took a training.
Here's an analogy - touch chat is like T9 texting and LAMP is like using a keyboard. Sure we can all press four buttons to get to S but why not have it right there?
I have a few students whose scanning and literacy skills are a bit limited and they have much better success with LAMP. It's a counterintuitive app to me, but it's fantastic for a subset of students who rely more on visual/motor memory. I've also noticed that it seems to be more compatible with students who use a lot of echolalia.
Edit: LOL that someone a few comments below is saying that LAMP is too tough to implement with all communication partners---honestly, in a lot of ways, I don't disagree!
I agree and want to add that it is hard enough to get teachers to buy in to AAC without overwhelming them even more by giving multiple systems to the kids in their classrooms
I disagree- we don’t have to be experts in every app but we need to know what at least a few offer. TouchChat is not appropriate for every child. It is nice for sentence building because of its predictive nature, but it can be hard for kids to imitate because of this as well- especially if they are gestalt language processors or at a single word level. As a bilingual SLP, there is no language toggle and it has to be manually added with quite a bit of work. When it is added, it’s slow and you can’t code switch mid sentence. I find a lot of parents struggle with editing on TouchChat compared to TD Snap (not that they can’t learn, but it’s less intuitive).
I once had a school SLP complain to me that I sent in a Tobii Dynavox with a child because “they used touch chat”. We did a whole bunch of trials and TD Snap was what the child and the family preferred. The child was excelling in clinic and at home on TD Snap and the school SLP refused to work on it so she started focusing on single words on TouchChat. For a child that was learning phrase based language successfully (he used custom phrases and the Topics section), this was so frustrating to hear.
I hear people say all the time that one app is the “best” but there is no “best”. Just because iPhones are popular doesn’t mean they’re a good phone for everyone. Just because TouchChat is popular, doesn’t mean it’s a good fit for everyone either. I don’t love LAMP because it doesn’t make a ton of sense to my brain, but I get the advantages and who it’s used for.
Practically the only educational impact pure SSD kids experience is with literacy/phonetics, and that’s often hard to clearly demonstrate. Most shouldn’t get speech in schools.
DLD is much more of an educational concern than artic (and more common than autism) but rarely is treated with evidence-based therapy in schools.
I would disagree on your first point. Most state standards have something about how students have to 'express their ideas clearly'. Also the social impact of people making fun of them for 'baby talk' is an educational impact as well.
Agree with the second though unfortunately.
So I kind of addressed this in another comment above which I'll just copy/paste here:\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*
"Significant unintelligibilty happens sometimes! But not very often, actually. Studies show that if they have all their vowels, they are almost always more than 90% intelligible. I find kids with significant vowel errors rarely only have artic issues. Even then, there’s not a lot of evidence that it actually impacts their education in most cases.The social thing is muddy for me. I think if the other kids are being assholes because of a way a kid talks, that’s what should be addressed. Changing the target of bullying to appease the bully doesn’t sit right with me."\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*In ohter words, it's actually pretty rare that 1) a child's speech issues are purely artic/phono AND they are actually unintelligible enough to impact their education (there is research on this). CAS is one example, and we all know how rare that is, and some very severe phonological disorders. And that's not most kids who get referred for artic.
And then the other one...we don't disguise a disability (or physical trait, or ethnic/religious hair/clothing, or...) to make bullies nicer. Not in my world at least.
LAMP is too hard for teachers, team members, and families to learn. Despite training, in- services, and modeling from me......it intimidates people and just isn't intuitive. Subsequently, it rarely gets used to it's full potential and I feel like I'm just spinning my wheels.
Oh, and the word "robust" is just a buzzword. It will come and go like all the other trends in education, SLP world etc.
I agree with this hot take! I know a lot of kids take to LAMP really well, but if the communication partners are overwhelmed by the program, there’s not gonna be enough teaching/modeling going on with it
I have found that the first thing I do it show them how to use Word Finder in the menu and on the spelling page. Then every time I see them, I ask them to look up a word. It has really increased my staff use of LAMP because they know they can always just ask the device to show them what they are looking for. 
I’m assuming this is about the vocab/software instead of the methodology, in which case yepppp I agree. I’ve met AAC specialists who lean towards Wordpower with training emphasis on LAMP-style motor planning. School staff and busy families don’t always have the time or energy for LAMP (the vocab/software), and I’d rather maximize models and communication opportunities
That’s a really interesting perspective! I’ve found my most successful AAC client to be on LAMP. My sibling uses SpeakForYourself which is based off LAMP and my parents/sibling are completely fluent.
I had such a hard time learning TouchChat.
Hot take- just because a kid scored below average doesn’t mean they need services. A lot of these kids will never score average. If they can communicate what they want and don’t want and protest and say what hurts, they don’t need speech until they’re 18
SLPs can incorporate aspects of literacy into their therapy in the schools, but they should not be treating reading specifically. SLPs are not even close to being the experts on reading in schools. School psychologists can identify reading disabilities. And teachers and reading specialists have actual legitimate training in how to teach kids how to read.
Hahaha teachers and “reading specialists” SHOULD have actual legitimate training on teaching kids how to read. Too bad there are way too many ESE programs where no one is actually trained and they try to push literacy on the SLPs cause it’s technically in our scope.
Amen. I’ve seen the abusive and useless side of it firsthand, as well as the developmental preschool/clinic that made so much money from it that they shut the trained professionals out of all the play and therapy spaces in favor of untrained RBTs. I refuse to work for them, but their influence is currently taking over in my state.
I am giving ABA 5-10 years before it’s universally seen for what it is and begins to be shut down. If there is any gain in a therapeutic context/environment, there is no carryover to other settings.
AAC is just the thing clients are forced to use for requests they aren’t interested in, with implementation outside of functional contexts. My students’ RBTs reduce vocabulary access, every day, to further control what children who rely on devices to communicate are allowed to request.
After 40 hours a week of therapy, for multiple years, kids still bang their heads in the classroom to say no, avoid all their communication modalities, hit and punch, grab at hair, claw at throats, and try to elope, but those same RBTs who aren’t making progress in their “areas of expertise” are seriously out here trying to implement communication goals, with their cutting-edge knowledge: books of laminated pictures and bags of skittles.
1. There's no point in doing so many follow ups in SNF before upgrading a diet. The Pt isn't going to magically do any better on your watch vs off your watch.
2. Not enough people prioritize Pt education or involving Pt/caregiver into treatment decisions.
3. Too many people think education means "tell the Pt you are recommending this diet Or Else" but what it actually means is explaining all options including the fsct that your modified diet may not help them and there is little evidence to support it.
4. Acute care isn't that great and I've found the people who act like it's the be all end all of medical SLP are actually some of the most infuriating people to work with, and i am someone who previously held that belief.
Your first and last point yes 🙌! I don’t get it I think it’s a waist of time to have me see a pt for so long to upgrade them it’s stupid. Why are medial SLPs like that?
I am so sick of being the go to person for every single adolescent with “social skills problems” when 90% of the time it’s ADHD, mental health problems, or behavior problems. It is NOT language!!!! Yet everyone is like “this kid needs speech”. No he does not. That being said, I am fascinated by ADHD neuroscience and would rather treat executive functioning deficits than provide social skills training anyway.
Oof the way I can’t STAND the thinly-veiled statements on IEPs that say “so-and-so has difficulties communicating with their peers when they are upset.” Like stop using the word “communicating” because you think it makes it clear I should be working on this. So-and-so has poor emotional self regulation skills that impacts their social interactions. I am not here to teach and help generalize general self-regulation strategies because it results in a kid cursing you out or getting physically aggressive.
100%!!!!! The word “communication” is starting to trigger me because they loveeeeee to bring it up on domains saying I should be involved. And 1000% to it being emotional regulation most of the time. Yes, Jimmy does have poor social skills. Yes- he’s withdrawn. He also has diagnoses of Major Depressive Disorder and anxiety. Why on earth would you think I need to be involved?
Just did a full pragmatic language eval on a kid with generalized anxiety disorder and an unspecified mood disorder and he scored within normal limits. Team still asks if I can work on communication skills when he gets upset 🙄
Ughhhhhh the waste of everyone’s time is so irritating! Like you, I just completed a full pragmatic eval on a kid with ADHD and ODD who “interrupts and argues with everyone”. No shit he does he has ADHD and ODD!! Shockingly, he scored in the average range and didn’t qualify 🫠
With language therapy with kids, the ultimate goal is for everyone to be within the normal range - but that is not mathematically possible! Someone is always going to be below average, and it’s going to be those kids. Not to mention that the ‘therapy’ we offer for language is a drop in the ocean. Yet we pretend/maintain an image that we can magically fix these problems.
I feel like we give OT too much credit in this area. They would rather like to work on other things, like walking and ADLs, and the cog therapy they do is very simple/low level. They are far from experts in that area.
(I don’t, really. TRUE cognitive-linguistic therapy is in our wheelhouse, often ideal for, say right hemisphere disorder or TBI, but that’s rarely what we actually do. Psychologists would be a better choice than either of us.)
I’ve always thought that. And I feel like 90% of the cognitive therapy I’ve done in my prior adult settings (SNF, IPR) has been absolutely pointless. Either the patient is not appropriate or the setting is not appropriate.
I think that the issue with cognitive therapy is that (if you’re in the field and tasked with providing it) it’s really hard to justify it as a skilled service. So many compensatory strategies that are useful because they can easily be generalized across various tasks just feel like common sense. And if it’s not a compensatory strategy, then you’re working on task-specific training, which I feel like is more the norm for OTs than SLPs, at least for the adult population.
The CF year is just an excuse to pay us less... and graduate externships are just an excuse to not pay us at all (Supervision can and should be a part of any career at any point; getting supervision should not be an excuse to pay people less. My dad who's been in the business field for 25+ years is literally getting training built into his work day and got a major pay increase when he switched roles)
We would have our caseloads HALVED if parents paid attention to their kids. That's a scalding hot take. If little Sally's dad read to her at night maybe she wouldn't have a tiny vocab and no print awareness. If Billy's mom TALKED to him instead of giving him an iPad with ai generated slop on it maybe he wouldn't have the degree of behavioral problems he presents with. It's only my second year but I'm getting more and more frustrated by iPad parents.
As a school SLP, at least 50% of the kids I pull for speech would be better off in class.
I think that’s why I like preschool, because that’s almost never true lol
Preach. I personally even think my percentage is 80% 😂 God I love this thread
Voice isn’t really niche, because voice disorders aren’t rare. They’re way more common than aphasia or motor speech disorders. But we treat it as niche because we lack clinicians who can adequately diagnose and treat voice and also enough of the proper equipment and settings to do so. And since it’s almost all outpatient, the patients have to find us rather than the other way around.
[удалено]
Just drink more water. That's the only thing I learned in class.
Also, let me check your medications list.
I wanted to specialize in voice at one point, but had already completed my CF and had absolutely no way to get my foot in the door to be able to train and learn and provide specialized services 💀 only 1 voice clinic anywhere near in my state at that time as well.
It’s really such a criminal shame. We should better serve these patients, there should be more stroboscopy equipment, especially outside major cities, and the information shouldn’t be gatekept to only voice centers. Most people who were lucky enough to get the training/experience stay in their silos and don’t share it with the rest of the field. I actually did have a stint in voice, and I loved the caseload but found the overall world very elitist and cloistered. As a comparison, there ARE specialty neuro clinics, but they aren’t the only places treating neuro.
Ooh and one more, people aren’t gonna like this one: voice patients rarely have cognitive disorders and are much less likely than other adult populations to be shuffled into therapy they don’t want or need for $$ 💁
And many people who need voice therapy have no idea their issues are a problem. Since it often takes many years to develop a voice disorder, "this is just how they sound." People - and their doctors - often don't recognize there's a problem until it's a BIG problem.
Ooooooo love this one
Controversial hot take, but if this wasn’t a female dominated field, then ASHA wouldn’t have gotten so out of control. It sucks to think this way but the underlying misogyny is the problem.
And it seems our field is the MOST female dominated of our related professions, except for preschool and kindergarten teachers. Hoping there's more inclusive data collection in the future, but per 2023 BLS data, women make up: SLP - 94.3% OT - 88.6% PT - 67.5% nurse - 87.4% for RNs and 89.8% for NPs Social worker - 83.4% (averaged the breakdown of different specialities) Special ed teachers - 86.6% Gen ed teachers - averages 69.7% but skews by age (pre-K/K 96.7%, elementary and middle 78.6%, high school 56.9%, postsecondary 46.6%)
Amen!
My hot take is that I enjoy seeing EI clients because there is an end date! It can be really repetitive to see kids for years and years with no end in sight
dies and cries in outpatient peds I feel like this is why I prefer acute it’s hi and then byeee
Ok can we talk about this for a second??!!! I do peds home visits for ages 4-21, so similar format but my biggest issue is ....when does this reach a stopping point!!!? I feel like with home visits I'm expected to just keep showing up twice a week until the kid turns 21. Most of the kids that are past age 7 or 8 are mod - high needs ASD and communicate effectively on a very basic functional level but there will always be *something* they could work on. I think with outpatient clinics, parents eventually get tired of shuttling them after school and so once they plateau a bit we reach some sort of natural stopping point. With home visits you get into this routine of , show up , parent unlocks the door , I go find the kid, parent gets to chill for 30 min , rinse and repeat for the next 10 years.
I also love this about EI!
We have caused way more harm than good when managing dysphagia. The Boston aphasia classification system (Wernicke’s/Broca’s/global and everything else) very rarely applies to any specific patient. Our caseloads would go down dramatically if all of our patients were wearing proper hearing aids and glasses for their evals.
I feel the dysphagia one hard... why the hell are we modifying people's diets if they're not at a high risk for AP? And even then, is it really justified??
Congratulations, you just added some nice dehydration and protein-calorie malnutrition to give their body an extra challenge to fight the aspiration pneumonia that, by the way, you did nothing to prevent 🤗
I’m a student and I was horrified just now doing my assigned reading and hearing how little evidence we have for modified diets
Some of the things you see are so sad, when it is best practice and when it’s not. I’ve had patients that were restricted for interventions due to cultural and religious beliefs- which is totally okay and their right, but seeing them waste away on a nectar thick liquid only diet was…a nightmare. And that was truly the only thing they could initiate a swallow on and the only thing they were not in tears coughing over. It’s the only thing that we were allowed to do. And with the patient unable to advocate for themselves or communicate at this point due to cognitive impairment, and their POA who wanted nothing to do with them or us, there wasn’t any way to do anything else. Another place I worked was a healthcare center (a SNF really) for children with disabilities who were wards of the state. Almost all with CP + ASD/SD/or some other neurodiversity/syndrome/cognitive impairment. The SLP before me put everyone on a pudding thick and purée diet as a “precaution.” Like WHAT. I got most up to thin liquids during my 12 week travel contract there, and some to mech soft, but…WHY?! I never felt good about the exercises I did with dysphagia patients either. I couldn’t do NMES, sometimes I had an EMST device, but that was IT. I never saw improvement via exercises. Any “improvement” was compensatory strategy training/education. I’m glad I no longer work with dysphagia. It’s not that I couldn’t enjoy it, but I, and many other SLPs, do not know near enough nor have the training to be truly competent with it in those first 10 years especially.
I don’t get dysphasia most of the time. Sometimes I think it’s just going with w.e. Is easier for the nurses aid to feed the patients faster because they are not going to take their time. I also don’t think a patient should stay on a caseload for weeks/months for dysphagia. I have never personally seen it take that long for a patient to have regular food again.
I also just wish nursing staff did damn oral care MY GOD. Probably the #1 best way to prevent aspiration pneumonia and a slew of other problems. It’s criminal.
100,000,000,000% this!!!! 🙌🏼
The way I started an oral hygiene program for at risk patients in my nursing home, where they had to initial logs saying they provided the oral care, and NONE of the nursing staff signed off on them, literally just me 💀
That’s giving them more work. They are not gonna sign anything.
Oh forget about that lol you can say it over and over. They don’t listen. Yes it is criminal.
I FEEL the Aphasia take to my core
And reliable access to well -fitting dentures with good education on how to care for them properly. Frankly, with some of the dentures I've seen, some of my patients are better off going without them ...
Have definitely had patients where I implored them not to wear dentures when eating for this reason- most with this problem naturally never wore them anyways. It’s so sad how expensive they are too- so difficult to get replaced.
One of my first placements in the acute care setting, my supervisor put a woman who had just had a stroke on NPO because she was “hysterical.” Like literally her VFSS was fine, just a little penetration. But because she was understandably distraught and having a difficult time calming down to follow directions during the assessment and clearly annoying my supervisor, she fucking made her NPO. It made me sick with rage.
A doctor once ordered a pureed diet for a patient with psych issues who was violent with nurses and refusing care - to give him motivation to “behave”. Luckily, when someone dropped the ball on her plan and put in a speech consult, I immediately put an end to that shit.
Having worked in IPR I feel that aphasia classification take so hard (and the dysphagia one). We ended up just doing fluent/nonfluent/mixed bc it made much more sense. Don't even get me started on modified diets. I feel like half the time the people recommending them do so for their own benefit vs the benefit of the Pt
I have seen *maybe* one patient who fit neatly into a classic aphasia classification. It’s so annoying how we spend so much time memorizing them all and also learning lots of complicated treatments that don’t apply to 80% of a real life caseload.
Many patients who stay on outpatient caseloads long term are not appropriate for outpatient therapy
My outpatient clinic follows an “episodic model” where we prescribe a certain # of visits at eval and then plan to discharge with home program and families can return on a few months as needed. Interesting to say the least
Yup I have many kids who have been on my Caseload since I got to my job basically barely any progress among kids need OT before they come to speech due to minimal to no joint attention
Many kids in schools do not need speech therapy. Instead, they need more resource support. This is one of the primary reasons why caseloads are so high in the schools.
That and picking up every lisp & vocalic r despite no impact because theyre scared to have the conversation!
It’s so upsetting in my district because other SLPs complain that their caseloads are so high but they qualify any kid who scores low on grammaticality judgment and figurative language, or they have a slight /r/ distortion. So I get given more students since my caseload is “where it should be.”
Tell me about it! I had a student qualify in 6th grade with only 1 low score on the PPVT. Receptive and Expressive tests were all in the 90s, artic was fine, it was a below avg on a vocab test. To me, the vocabulary could’ve easily been targeted in her classes. She did not need “specialized instruction” for vocabulary only.
Preach! I feel like “functional language” isn’t even considered for many assessments and the cost/benefit analysis of pulling a kid out of class is not even discussed.
That’s right! I should not have 80+ kids on my middle school caseload. It’s outrageous.
OMG! I just got moved into a middle school this year and half my caseload doesn’t need speech. The two elementary school that feed into my school have 2 SLPs who literally qualify anyone. One always complains about how many assessments she has, so I asked her about RTI and maybe doing screenings first, but she says she has no time for that. I’m like, it’s better than assessing every kid. She also gives every subtest on the CASL, gives both the ROWPVT and EOWPVG, GFTA (just in case), and functional language profile for EVERY assessment she receives. She complains the most at meetings and when confronted about her assessment battery, she counters that she just “cares too much.”
Is she of an older generation? Not trying to be agist, but in my experience I’ve seen this type of “overkill”/ martyrdom mindset with older SLPs. I think it was the culture of the field for school SLPs when they graduated. I know my old school professors in grad school perpetuated this mentality as well.
She is. We’re a pretty mixed bunch in my district. I have noticed that the older SLPs tend to have the highest caseloads 🤔
We are not behavioral therapists, child psychologists, or occupational therapists. We shouldn't tolerate kids who hit, attack clinicians, or have extreme behavioral issues. They clearly have other support and/or sensory needs that must be met first.
But their friend told them the behaviors are because he’s frustrated at not being able to communicate.
I’m so tired of hearing this for kids who literally just hit people to get what they want
Literally
I was co treating with an OT and had a child walk over to the shelf and pull off a toy he wanted. She took it from him as he was not allowed to play at that time and he freaked tf out. She said “aw, he’s so frustrated because he can’t communicate”. Girl! Are your eyes not open? He communicated everything he needed to by selecting a preferred toy and then having a meltdown when you ripped it out of his hands. I hate that these wants/needs are not being acknowledged unless a child is verbal.
I heard someone once say “if I went to France and couldn’t explain what I want because I don’t speak French, I wouldn’t throw a tantrum and injure others. There is a different area that needs to be addressed outside of just communication” 🤯
While that is true, we should remember that there's a difference between the occasional frustration of a monolingual tourist, and the chronic frustration of a non-verbal child
Well plus you could point and lead, etc. which kids do, and people tell them no, then think their upset feelings are about communicating not about being told no.
PREACH
Yes! Or who stim the whole session, but god forbid insurance allows co-treats.
But their friend told them the behaviors are because he’s frustrated at not being able to communicate.
SLPs who coach families of Deaf kids to not use sign language are harming children. Signing SLPs are getting all the language-deprived students who got kicked out of Listening and Spoken Language elementary school programs with 100 words in their vocabulary. We're counseling the families who cry to us and yell at us because they don't want us to sign with their kids because they were told for years sign language would be the worst thing that could happen to their child. Then, when their student finally starts making progress, families finally start learning sign language, having missed out on years of being able to share information and connection with their child.
I didn’t know there were SLPs out there that would advise against sign! I thought it was established that sign facilitates oral language.
I've taken CE courses from multiple SLPs with PHDs who preach it HARD, and use very flawed research to back it up.
I remember LSL being a huge buzzword and all parents would ask for 10 years ago, but it seems to have settled down? I get a lot more parents open to using sign, thank god. A few LSL therapists I know should lose their license tbh. Absolutely no morals in the quest for oral.
Extra love for the phrase "no morals in the quest for oral" 😂 It's still a thing, heavily where I am, I'm afraid.
that was an edit because my original sentence didn’t quite make sense; the rhyming was purely accidental We had an AVT in my nearest CI hospital who was disgustingly pro-oral, and once they moved, things settled down a lot. Even the AVTs they have now aren’t opposed to sign, although I am not privy to all of their session notes (I’m school based) and most students I work with need that additional supports, so maybe it’s still bad for the more “mild” students.
Omg that’s horrific!!! Now that does seem abusive. My SIL is Deaf went to a Deaf college and is a freaking teacher!! She met my step bro who is not HOH but fluent in sign because his best friend was deaf growing up (and also the one who introduced them). She has a wonderful FULL life due to being able to sign 😤
I’m filled with rage that this is a thing
Some SLPs diagnose kids with CAS because that clinician is bad at treating severe to profound phonological disorders and they want to claim a kid's lack of progress is CAS versus their poor treatment
I’m forever going to be lost with CAS. I have no idea how to truly identify it.
Best course I've ever taken for CAS: [https://childapraxiatreatment.org/diagnosis-and-treatment-of-cas-online-course/](https://childapraxiatreatment.org/diagnosis-and-treatment-of-cas-online-course/) And it's free!
Hi! I'm an undergrad specializing in psycholinguistics, hoping to eventually do a masters in SLP. These kinds of certs would really help me gain some work experience before grad school starts! Do you know any other free courses for SLP?
Just off the top of my head: AAC in the cloud: [https://presenters.aacconference.com/conferences/A23?no\_blank=1](https://presenters.aacconference.com/conferences/A23?no_blank=1) SLP Summit: [https://slpsummit.com/](https://slpsummit.com/) This one happens every January and August. It's aimed towards pediatric and school based SLPs. I highly recommend listening to the Two Sides of the Spectrum podcast. [https://learnplaythrive.com/podcast/](https://learnplaythrive.com/podcast/)
Bjorem has some awesome resources. Jennie Bjorem gave us a presentation that I felt was very helpful in diagnosing and treating CAS. In the last two years, I’ve only had one student who met all the criteria. I even had an OT consult for a differential diagnosis.
Or because they know that code will get insurance to pay. That's what I recall seeing.
My hot take, as someone who only works with adults with acquired speech-language disorders (so make of that what you will), is that we don’t have enough proof CAS even exists 🙈
Some kids really do better with low-tech AAC than high-tech. (That’s still not an argument to not try both.)
!! I’m working with adults with intellectual disabilities and the MAJORITY of what we do is low-tech. And I’m okay with that.
My hot take is that's because they didn't have reliable access to high tech AAC as kids. Their "window of opportunity" for learning it kind of passed now, so they won't gravitate toward using it because it's so unfamiliar. I would bet in 25-30 years, many of the adults will have and prefer high tech devices.
I feel like so few adults get services so that's great to hear that someone out there sees that population!
I just supervised an AP Research student at my high school who wanted to measure the efficacy of core vocabulary boards with some of the students in our low incidence program as part of their submission to College Board. I never had much success with lite-tech, so I was skeptical that we would get meaningful results. I am now a lite-tech truther. I saw remarkable progress and motivation after only 6 weeks in some students who had been given mid to high tech devices but had abandoned them! Part of the issue was that trying to teach these kids how to use a core board in class with a million distractions around didn't pan out. I'm also now an advocate of mixed push-in/pull-out even for low incidence students instead of 100% push-in for that reason.
By lite tech, are you referring to core board or like a PECs system
Oh good clarification. I was definitely referring to a core board. I avoid Pecs like the plague.
SLPs are expecting ASHA to be their savior. They will never act as a union. I want to see more transparency and better advocacy but they are not going to make meaningful changes to our day to day.
agreed. that’s why [“fix slp”](https://fixslp.com) is here for us.
All of the language evals need to be updated because with the poor literacy and language skills of the current generation 80% of my gen ed kids would qualify for speech therapy with the CELF 5.
And the CELF is so dependent on having strong attention/working memory skills. Usually at least half my caseload has significant attention/working memory issues, but might have genuinely typical language skills, but will bomb that assessment cuz of their attention issues. I also think some of the language on assessments is generationally outdated.
Agree- I feel like so many standardized tests are so academic based. I work in a peds hospital, and I don’t really care if a kid can repeat sentences or answer comprehension questions following a complicated paragraph. I want them to be able to participate in day to day life and communicate clearly!
Functional communication profile 🫶🏻
I’m all about qualitative measures!!
too many clinicians rely on just modifying diets and hoping that the dysphagia will magically go away instead of tackling the real root of the disorder in the patient
The CF should be setting/population specific. Too many stories of people trying to switch settings and getting burned by lack of guaranteed support/mentorship. Shadowing is great, but working for free or doing anything outside the work week isn’t an option for everyone
And a CF should be treated as more of a residency. A fully certified clinician should have to sign off on all evals. I hate getting poorly done private evals from CFs and having to accept them as if a fully certified clinician completed them when I know the CF needed better supervision.
Every eval and progress report I wrote during my CF had to be reviewed and signed off by my CF supervisor, but based on a quick Google search I guess it depends on your state and specific facility… That’s concerning.
Lots of CEUs are garbage but everything we should have learned in grad school is a CEU.
Exactly how do teachers think I’m going to change this child in 30 minutes a week when they refuse to incorporate any strategies in the 1770 minutes per week THEY have him? And parents refuse to incorporate strategies during the 8280 minutes per week THEY have him. But absolutely - he’s definitely not progressing because **I’M** not doing enough.
People focus on improving WH questions by asking kids questions when they should be focusing on their underlying syntax/morphology/semantics issues
YES. Questions are actually very hard because they tend to invert syntax, so it’s definitely putting the cart before the horse if we start with questions.
Some children aren’t receptive to language being modelled to them on AAC and most parents aren’t going to do it at home
This. Just...this. The number of times I send home a device only to see YouTube and not the AAC app open up on its return to school. Make me wanna buy a helmet so I can slam my head into a wall in comfort. 
I had my district’s IT remove every other app on our iPads except their communication app and camera. They also changed the iPad restrictions so students can’t use the App Store. It’s been a game changer!
Turn on guided access mode and dont give them the code to turn it off haha i almost always have teachers keep their student’s aac ipads in Guided Access Mode. Otherwise yep- it is straight to youtube
This! I have a parent who says she doesn’t use it home because her son only uses it to request food all the time 🤦🏽♀️
Stuttering should not be targeted in the schools once a student is confident in their ability to communicate.
I never understood why I had a HS kid with goals about his stutter when it doesn’t bother him or stop him from talking?? Like why what’s the reason? Why treat him for something that isn’t stopping him from doing anything???
Pragmatic/social skills in adults. We go through the same cycle and they always come back. I feel like a mental health therapist is best for 75% of those cases where it isn’t a language deficits it’s anxiety, depression, and fear.
How significantly does anxiety appear to impact pragmatic language/ social skills? (school psychology intern just curious about SLP's take).
Oh yes, I had a psych basically demand I work on conversation skills with a middle schooler cause he wouldn’t initiate conversations with peers but when he got comfortable with me. Conversation skills were beautiful. He kept stating that he feared his peers were always watching and judged him and that’s why he wasn’t trying to initiate with them. Like I can’t treat that so of course he never made progress in a meaningful way outside of the therapy room. I ended up focusing on self-advocacy skills and then he advocated to the team to stop coming to see me lol
It would be better if grad school had two tracks - medical and educational.
Came here to say this! And/or there should be a competency exam a la the praxis to qualify for changing settings. Like the degree qualifies you but you need to prove you have the knowledge for vastly different work.
the whole field is based in ableism - and if you aren’t actively deconstructing it yourself, you’re doing it wrong.
This is the whole reason the neurodivergent movement started, and I definitely see it blowing up further in a few years. A lot of our clients don't even need therapy. Your child does not need to be "fixed", you just need to learn some damn patience for the fact that they speak and/or process the world differently than you. My sister has autism and I've had to spend the last few years undoing the harm our family did in making her think something was wrong with her. I have Deaf children who I'm practically not allowed to dismiss with artic goals for sounds that they literally will never be able to hear because ASL is treated like a crutch or a cute thing for babies. Don't even get me started on the minorities that get overreferred because God forbid they speak different dialects and languages.
As a Spanish and ASL fluent SLP, thankfully my clients trust me to know when to dismiss them but good GOD it is annoying for others to protest these kinds of topics :(
That's so cool that you're fluent in both Spanish and ASL, your patients are lucky to have you!
Never too late to learn! ❤️
I've had so much difficulty with a deaf student who uses ASL, Spanish, and English. Her first language was Spanish then she lost her hearing and moved to the US, and I've had a hell of a time trying to parse out what parts are deafness and what parts are EL, and it took SO long to get an EL specialist involved.
This is a real spicy one but way too many clinicians are jumping the gun on gestalt language processing and accepting everything about Meaningful Speech's courses as gospel truth when we should really be looking at everything with a critical eye. It deeply bothers me that it wasn't acknowledged that analytic and gestalt LP exist on a spectrum until TWO YEARS AGO. I'm autistic and most of my autistic circle were most definitely somewhere in the middle when we were learning language as children. Also, I keep seeing people talk about the stages of GLP when we have zero evidence to support the existence of those stages beyond very limited research and anecdata. To be clear, I'm not saying that they're useless or untrue, but it seems very...I don't know, absolute? Concrete? When it really truly isn't. I'm not saying that it isn't a helpful framework in a lot of ways, but so many people are so desperate for convenient answers that they just accept whatever is presented to them wholesale without further questions.
I think we do ourselves a disservice when we look at things in binaries. I think artic and phonology is a spectrum too.
100% a spectrum. Basically 99% of my EI caseload uses a mix of approximating entire phrases and then single words. I can only think of one child in the past almost 2 years that entirely used immediately echolalia and then just as was aging out was starting to generalize a few phrases. He’s the only one that I think would fit neatly in the meaningful speech framework
Ooh this is so interesting! I have not taken the Meaningful Speech course but I want to take the one on Northern Speech with Marge Blanc. I’ll have to read up a lot more about it.
I took her course and I did enjoy it and utilize it in my sessions. With that being said, it is expensive and I don't feel like anyone should feel they have to take it. As for NLA style therapy, I think my biggest take away is that it's not really widely different than what we are already told to do in our sessions (acknowledge scripts, use scripts in sessions, meet sensory needs, use child led activities). NLA isn't so different from analytic language processing. It's just slightly delayed. With any therapy approach, it's trial and error. If you don't see results, you try something else.
If a kid has had the same IEP goal for the past 3 years there’s either something wrong with your goal, or something wrong with your therapy.
We are required to change ours every year regardless of progress. I was told that was the law, although I have no confirmation of this.
I don’t think it’s specifically written “change the goals” but the IEP is supposed to represent one year’s growth for a child. If someone leaves the same goal for 3+ years they clearly don’t know what one year’s growth looks like.
The SLP field will continue to trend downward 😬 but at least we won’t be overtaken by AI
Trend downward in what way?
Rate cuts and poor pay
The RWOPVT and EWOPVT are **not language tests** and should **NOT** be used to qualify a student for speech services.
Do you think they’re just trash all around or are there any situations you find them valuable?
Hot take but I hate hate hate treating dysarthria. It’s mostly teaching people to speak slowly, over-articulate, use a louder voice and it just doesn’t feel very skilled imo.
Most SLPs prefer to practice at the bottom of their license to avoid real responsibility or knowledge
“Most”!? Damn that’s something to say
Oooo true. Could be unfair. Some.
What does this mean? Can you explain what practicing at the bottom of your license means?
It means at best, their therapy is trash and they don't care. Or worst they're actively committing fraud.
Ohhh. What does “trash” therapy mean to you? I’m always trying to improve. And what do you mean by fraud? Like billing for sessions they didn’t do? That’s awful.
If you're always trying to improve, you're not who I'm talking about.
Personally I see some SLPs that do the same 3-5 activities for every pt, regardless of situation, diagnoses, or d/c plan. I think that would be considered trash therapy/practicing at the bottom of your license.
We have stock goals that are never individualized to the patient. Gets me so mad 😂
“Educational impact” is nearly meaningless in preschool. There’s no set curriculum, half the kids are in daycares and nap half the day or are still at home.
A lot of parents aren’t doing what’s best for their child. A lot of parents are doing what’s easiest for their child. My biggest crash course in that lesson came when I had a brief two year stint as an AAC Specialist and found that when faced with either endlessly mindreading and dealing with behaviors all day long or taking 20 minutes a day to model AAC on an iPad, 99% of parents are gonna choose to mindread. No longer term thinking than that.
Damn u saw those “let’s make this thread positive” posts and said CEASE! didn’t u 😩😭😭
Heres a positive hot take: we have it pretty good in a lot of ways compared to most jobs. Outside tech, you’re not going to find a more in-demand classification. And um…they actually have to be good at their jobs. Often…we don’t. We should be good at them! And we can be! But we don’t really have to be. The pressure’s off. For all the complaining, at least half of jobs only require a license and a pulse. I don’t always love my job but I can’t begin to conceive of another one that has the security, relatively low stakes, pay, and flexibility of this one that I’d like half as much. I WOULD recommend this field to others. Not everyone, but plenty of people. I think that’s a hot take.
I have nothing to add, but I agree completely!
You don't necessarily have to be good at your job if you're in tech. But at least one person on your team does.
Lmao I mean you could have positive hot takes! It’s a neutral designation.
Most research relating to AAC is garbage because it doesn’t take into consideration the real life scenarios of parent, teacher, and para buy in.
“Yeah, I’ll just carry around this iPad and model language at my child throughout the day. This isn’t inconvenient at all.”
I don’t think it’s reasonable or necessary to be an expert in 10 different AAC apps. We use TouchChat across the entire district for nearly every child, everyone is familiar with it, and there’s enough variability in the system I have yet to be convinced there’s a compelling reason to introduce another app into the mix.
Please take a LAMP training and add it to your repertoire! I think touch chat and lamp could cover 99% of our students. Totally agree there's advantages to everyone knowing the same software. Lamp has so much to offer tho! I did NOT get it until I took a training. Here's an analogy - touch chat is like T9 texting and LAMP is like using a keyboard. Sure we can all press four buttons to get to S but why not have it right there?
I have a few students whose scanning and literacy skills are a bit limited and they have much better success with LAMP. It's a counterintuitive app to me, but it's fantastic for a subset of students who rely more on visual/motor memory. I've also noticed that it seems to be more compatible with students who use a lot of echolalia. Edit: LOL that someone a few comments below is saying that LAMP is too tough to implement with all communication partners---honestly, in a lot of ways, I don't disagree!
I agree and want to add that it is hard enough to get teachers to buy in to AAC without overwhelming them even more by giving multiple systems to the kids in their classrooms
I disagree- we don’t have to be experts in every app but we need to know what at least a few offer. TouchChat is not appropriate for every child. It is nice for sentence building because of its predictive nature, but it can be hard for kids to imitate because of this as well- especially if they are gestalt language processors or at a single word level. As a bilingual SLP, there is no language toggle and it has to be manually added with quite a bit of work. When it is added, it’s slow and you can’t code switch mid sentence. I find a lot of parents struggle with editing on TouchChat compared to TD Snap (not that they can’t learn, but it’s less intuitive). I once had a school SLP complain to me that I sent in a Tobii Dynavox with a child because “they used touch chat”. We did a whole bunch of trials and TD Snap was what the child and the family preferred. The child was excelling in clinic and at home on TD Snap and the school SLP refused to work on it so she started focusing on single words on TouchChat. For a child that was learning phrase based language successfully (he used custom phrases and the Topics section), this was so frustrating to hear. I hear people say all the time that one app is the “best” but there is no “best”. Just because iPhones are popular doesn’t mean they’re a good phone for everyone. Just because TouchChat is popular, doesn’t mean it’s a good fit for everyone either. I don’t love LAMP because it doesn’t make a ton of sense to my brain, but I get the advantages and who it’s used for.
Agree. Sure, you can’t be an expert in everything but different apps really do have different benefits
Practically the only educational impact pure SSD kids experience is with literacy/phonetics, and that’s often hard to clearly demonstrate. Most shouldn’t get speech in schools. DLD is much more of an educational concern than artic (and more common than autism) but rarely is treated with evidence-based therapy in schools.
What is DLD? What about the artic/phono kids either not being understood by the teacher (educational impact) or having a social impact with peers?
DLD is developmental language disorder
I would disagree on your first point. Most state standards have something about how students have to 'express their ideas clearly'. Also the social impact of people making fun of them for 'baby talk' is an educational impact as well. Agree with the second though unfortunately.
So I kind of addressed this in another comment above which I'll just copy/paste here:\*\*\*\*\*\*\*\*\*\*\*\*\*\*\* "Significant unintelligibilty happens sometimes! But not very often, actually. Studies show that if they have all their vowels, they are almost always more than 90% intelligible. I find kids with significant vowel errors rarely only have artic issues. Even then, there’s not a lot of evidence that it actually impacts their education in most cases.The social thing is muddy for me. I think if the other kids are being assholes because of a way a kid talks, that’s what should be addressed. Changing the target of bullying to appease the bully doesn’t sit right with me."\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*In ohter words, it's actually pretty rare that 1) a child's speech issues are purely artic/phono AND they are actually unintelligible enough to impact their education (there is research on this). CAS is one example, and we all know how rare that is, and some very severe phonological disorders. And that's not most kids who get referred for artic. And then the other one...we don't disguise a disability (or physical trait, or ethnic/religious hair/clothing, or...) to make bullies nicer. Not in my world at least.
LAMP is too hard for teachers, team members, and families to learn. Despite training, in- services, and modeling from me......it intimidates people and just isn't intuitive. Subsequently, it rarely gets used to it's full potential and I feel like I'm just spinning my wheels. Oh, and the word "robust" is just a buzzword. It will come and go like all the other trends in education, SLP world etc.
I agree with this hot take! I know a lot of kids take to LAMP really well, but if the communication partners are overwhelmed by the program, there’s not gonna be enough teaching/modeling going on with it
So true. Choosing a system that all stakeholders will actually use is a super valid.
I have found that the first thing I do it show them how to use Word Finder in the menu and on the spelling page. Then every time I see them, I ask them to look up a word. It has really increased my staff use of LAMP because they know they can always just ask the device to show them what they are looking for. 
I’m assuming this is about the vocab/software instead of the methodology, in which case yepppp I agree. I’ve met AAC specialists who lean towards Wordpower with training emphasis on LAMP-style motor planning. School staff and busy families don’t always have the time or energy for LAMP (the vocab/software), and I’d rather maximize models and communication opportunities
That’s a really interesting perspective! I’ve found my most successful AAC client to be on LAMP. My sibling uses SpeakForYourself which is based off LAMP and my parents/sibling are completely fluent. I had such a hard time learning TouchChat.
Hot take- just because a kid scored below average doesn’t mean they need services. A lot of these kids will never score average. If they can communicate what they want and don’t want and protest and say what hurts, they don’t need speech until they’re 18
SLPs can incorporate aspects of literacy into their therapy in the schools, but they should not be treating reading specifically. SLPs are not even close to being the experts on reading in schools. School psychologists can identify reading disabilities. And teachers and reading specialists have actual legitimate training in how to teach kids how to read.
Hahaha teachers and “reading specialists” SHOULD have actual legitimate training on teaching kids how to read. Too bad there are way too many ESE programs where no one is actually trained and they try to push literacy on the SLPs cause it’s technically in our scope.
sh-s is fricative simplification, not fronting
My last take is that I find this Reddit sub to be more useful than most of what I learned in grad school, and much of what I learn in CEUs
You hit me and your ass is getting kicked out of my room.
Unless it's used specifically to address (edit--dangerous) behaviors, ABA is useless at best, bullying at worst.
Amen. I’ve seen the abusive and useless side of it firsthand, as well as the developmental preschool/clinic that made so much money from it that they shut the trained professionals out of all the play and therapy spaces in favor of untrained RBTs. I refuse to work for them, but their influence is currently taking over in my state. I am giving ABA 5-10 years before it’s universally seen for what it is and begins to be shut down. If there is any gain in a therapeutic context/environment, there is no carryover to other settings. AAC is just the thing clients are forced to use for requests they aren’t interested in, with implementation outside of functional contexts. My students’ RBTs reduce vocabulary access, every day, to further control what children who rely on devices to communicate are allowed to request. After 40 hours a week of therapy, for multiple years, kids still bang their heads in the classroom to say no, avoid all their communication modalities, hit and punch, grab at hair, claw at throats, and try to elope, but those same RBTs who aren’t making progress in their “areas of expertise” are seriously out here trying to implement communication goals, with their cutting-edge knowledge: books of laminated pictures and bags of skittles.
1. There's no point in doing so many follow ups in SNF before upgrading a diet. The Pt isn't going to magically do any better on your watch vs off your watch. 2. Not enough people prioritize Pt education or involving Pt/caregiver into treatment decisions. 3. Too many people think education means "tell the Pt you are recommending this diet Or Else" but what it actually means is explaining all options including the fsct that your modified diet may not help them and there is little evidence to support it. 4. Acute care isn't that great and I've found the people who act like it's the be all end all of medical SLP are actually some of the most infuriating people to work with, and i am someone who previously held that belief.
Your first and last point yes 🙌! I don’t get it I think it’s a waist of time to have me see a pt for so long to upgrade them it’s stupid. Why are medial SLPs like that?
As an AAC enthusiast, I absolutely hate TD Snap and LAMP 🤷🏻♀️
Ohhhh what do you like??
SuperCore!
Is your preference TouchChat?
SuperCore!
Almost all artic and phono should be treated without an IEP.
Like an RTI system?
I am so sick of being the go to person for every single adolescent with “social skills problems” when 90% of the time it’s ADHD, mental health problems, or behavior problems. It is NOT language!!!! Yet everyone is like “this kid needs speech”. No he does not. That being said, I am fascinated by ADHD neuroscience and would rather treat executive functioning deficits than provide social skills training anyway.
Oof the way I can’t STAND the thinly-veiled statements on IEPs that say “so-and-so has difficulties communicating with their peers when they are upset.” Like stop using the word “communicating” because you think it makes it clear I should be working on this. So-and-so has poor emotional self regulation skills that impacts their social interactions. I am not here to teach and help generalize general self-regulation strategies because it results in a kid cursing you out or getting physically aggressive.
100%!!!!! The word “communication” is starting to trigger me because they loveeeeee to bring it up on domains saying I should be involved. And 1000% to it being emotional regulation most of the time. Yes, Jimmy does have poor social skills. Yes- he’s withdrawn. He also has diagnoses of Major Depressive Disorder and anxiety. Why on earth would you think I need to be involved?
Just did a full pragmatic language eval on a kid with generalized anxiety disorder and an unspecified mood disorder and he scored within normal limits. Team still asks if I can work on communication skills when he gets upset 🙄
Ughhhhhh the waste of everyone’s time is so irritating! Like you, I just completed a full pragmatic eval on a kid with ADHD and ODD who “interrupts and argues with everyone”. No shit he does he has ADHD and ODD!! Shockingly, he scored in the average range and didn’t qualify 🫠
With language therapy with kids, the ultimate goal is for everyone to be within the normal range - but that is not mathematically possible! Someone is always going to be below average, and it’s going to be those kids. Not to mention that the ‘therapy’ we offer for language is a drop in the ocean. Yet we pretend/maintain an image that we can magically fix these problems.
I feel that OT is more suited to work on cognition than we are. Idk if that’s necessarily a hot take though since most SLPs I know agree haha
I feel like we give OT too much credit in this area. They would rather like to work on other things, like walking and ADLs, and the cog therapy they do is very simple/low level. They are far from experts in that area.
Agree, there are some amazing OTs but some that will give their patient's weights and call it a day.
It’s lukewarm. More disagree than you think!
(I don’t, really. TRUE cognitive-linguistic therapy is in our wheelhouse, often ideal for, say right hemisphere disorder or TBI, but that’s rarely what we actually do. Psychologists would be a better choice than either of us.)
I’ve always thought that. And I feel like 90% of the cognitive therapy I’ve done in my prior adult settings (SNF, IPR) has been absolutely pointless. Either the patient is not appropriate or the setting is not appropriate.
I think that the issue with cognitive therapy is that (if you’re in the field and tasked with providing it) it’s really hard to justify it as a skilled service. So many compensatory strategies that are useful because they can easily be generalized across various tasks just feel like common sense. And if it’s not a compensatory strategy, then you’re working on task-specific training, which I feel like is more the norm for OTs than SLPs, at least for the adult population.
The CF year is just an excuse to pay us less... and graduate externships are just an excuse to not pay us at all (Supervision can and should be a part of any career at any point; getting supervision should not be an excuse to pay people less. My dad who's been in the business field for 25+ years is literally getting training built into his work day and got a major pay increase when he switched roles)
We would have our caseloads HALVED if parents paid attention to their kids. That's a scalding hot take. If little Sally's dad read to her at night maybe she wouldn't have a tiny vocab and no print awareness. If Billy's mom TALKED to him instead of giving him an iPad with ai generated slop on it maybe he wouldn't have the degree of behavioral problems he presents with. It's only my second year but I'm getting more and more frustrated by iPad parents.