This is a transcript from our podcast episode published January 24th, 2022. The podcast episode is offered for .1 ASHA CEU (introductory level, professional area). This transcript is made available as a course accommodation for and is supplementary to this episode / course. This transcript is not intended to be used in place of the podcast episode with the exception of course accommodation. Please note: This transcript was created by robots. We do our best to proof read but there is always a chance we miss something. Find a typo? Email us anytime.
A special thanks to our Contributing Editor, Caitlin Akier, for reviewing and editing drafts of our transcripts. Her work helps keep our material accessible.
[00:01:39] Kate Grandbois: So today's episode, we're very excited for it's a little bit different than a lot of the episodes that we have published so far because we had a chance to interview an SLP household name. Nancy Kaufman came into the, the zoom room, the SLP nerd cast studio, if you will, and had such a lovely conversation with us today, and we're so excited to share it with everybody.
[00:02:38] Amy Wonkka: Yeah, we really are. And on top of that, we were able to pick the brain of one of our board members who knows more about all things, motor speech than we do.
[00:02:47] Kate Grandbois: Yeah. So if anybody listening is a regular listener, they know that I, Kate knows zero about motor speech disorders. Amy knows more than zero, you know,
[00:03:02] Kate Grandbois: You know, a lot more than zero. Um, but this is not really our area of specialty. So as we were preparing for this interview, um, we were lucky enough to recruit the help of one of our advisory board members, Mike Bright. Um, for those of you who are regular listeners, Mike has joined us on the podcast a handful of times before, and he's so knowledgeable and this is his area of specialty and he really helped us to craft good questions and think about our, you know, how we think about how we think about some of the larger picture, big picture things that we wanted to get into with Nancy.
So Mike, if you’re listening, thank you so much for helping us.
[00:03:41] Amy Wonkka: Thank you.
[00:03:46] Kate Grandbois: Another really interesting perspective about this episode was related to some bigger picture questions that we weren't really expecting to add.
[00:03:58] Amy Wonkka: Yeah. I mean, I feel like this [00:04:00] season in particular, we've done a lot of listening, learning, and kind of just thinking more deeply about what informs evidence-based practice.
And at least my perception historically has always been like evidence equals published research. Right? You read the article and that makes it real. Um, but when you zoom out and you think about the evidence-based practice guidance from Ash, and we think about that diagram, we really need to remember that.
I need to remember that the research, the published research is really just one part of what we should all be considering as clinicians when we're making evidence-based decisions .
[00:04:45] Kate Grandbois: and not to go too deep on a tangent before, cause I know this is really about motor speech, but when we were talking to Nancy and the, the treatment model that she's developed, um, it really made us think about, we had this great conversation after we wrapped up about [00:05:00] what constitutes evidence-based practice and how this model fits into our evidence-based practice.
And remembering that evidence-based practice in speech pathology is comprised of four components. So we have the research articles that we all know are evidence-based practice. And I think a lot of us, that's what we focus on when we think about. But there's also internal data collection. There's internal progress monitoring.
What are you seeing in your treatment room? What data collect? What data are you collecting in your treatment room that provides evidence that your treatment is working? It's also clinical judgment. So based on your knowledge and the data and best available information in front of you, what is your judgment about whether or not your treatment is rooted in evidence and client and family values is what you're doing in your treatment room aligned with not only your client's family values, but your client's values.
And yes, children [00:06:00] can have values too. That's another really important soapbox for another time, but the reason that this relates to motor speech and this interview is that a lot of the things we do in our treatment room aren't necessarily clearly laid out in literature. Um, and Nancy Kaufman has developed this treatment approach this treatment package, um, that is, is really effective and rooted in a lot of principles of science. And we think it's really important for our listeners to have that as a backdrop, as we go into the interview.
[00:06:37] Amy Wonkka: Well, I think just like everything else in every other guest we've had on.
It's it's a reminder for all of us as clinicians to take on that responsibility of, you know, collecting the data and having our own internal evidence help be an equivalently important piece of our evidence-based practice. [00:07:00] Um, so just because you read it in a peer reviewed study, doesn't mean it's going to be the best approach for your clients.
Um, And likewise, there may be things that either haven't been researched yet, um, or are part of a broader treatment package that makes it more challenging to isolate independent and dependent variables and all of those components. Um, so when you're thinking about things like that, the burden on the clinician burden is a strong word, but the responsibility for the clinician to be sure that they're really doing their best effort in terms of doing your best effort, um, in terms of collecting that internal data and making sure that you're picking something that's effective, uh, for your client is really important.
[00:07:42] Kate Grandbois: Agreed. So let's, before we get into the interview, we do have to read our learning objectives and our financial and nonfinancial disclosures, because it is all part of what ASHA makes us do to offer this episode for ASHA CEUs. So sometimes people will write in and ask me to skip it. We [00:08:00] can't ASHA makes us read it.
So hold on to your hats. We'll get through this as quickly as possible. Learning objective number one, describe components involved in the Kaufman speech to language protocol. Learning objective number two, define compensatory placement and when this approach might be appropriate and learning objective number three, describe how the K SLP approach might be used as part of evidence-based practice.
Disclosures Nancy Kaufman financial disclosures. Nancy is the author of materials and e-courses relative to the K SLP methods and are sold through Northern speech services. She receives royalties on the sales of these products. Nancy Kuafman, nonfinancial disclosures. Nancy is the author of two webinars produced for apraxia kids that are carried in their online library.
Kate's financial disclosures. That's me. I'm the owner and founder of Grandbois therapy and consulting LLC. and co-founder of SLP Nerdcast. My non-financial disclosures. I'm a member of ASHA, SIG 12, and serve on the AAC advisory group from Massachusetts advocates for children. I'm [00:09:00] also a member of the Berkshire association for behavior analysis and therapy, mass ABA, the association for behavior analysis international and the corresponding speech pathology and applied behavior analysis special interest group.
[00:09:11] Amy Wonkka: Amy that's me. I'm an employee of a public school system and co-founder of SLP nerd cast. And my non-financial disclosures are that I am a member of ASHA's SIG 12, and I also serve in the AAC advisory group for Massachusetts advocates for children.
[00:09:26] Kate Grandbois: So without further ado, if you've made it this far into the episode, through our ramblings and our intros and all the things we bring you an interview with Nancy Kaufman
[00:09:40] Kate Grandbois: we're so excited today, we have sort of a speech celebrity joining us an SLP household name, uh, today on the show we get to welcome Nancy Kaufman. Welcome Nancy.
[00:09:50] Nancy Kaufman: Thank you. I'm so happy that you called upon me to do this podcast. I love the name SLP nerd cast, and I would fit right in [00:10:00] there.
[00:10:01] Kate Grandbois: Well,welcome fellow nerd.
That's very exciting. Um, do you want to start us off by telling us a little bit about yourself?
[00:10:05] Nancy Kaufman: Sure. So, um, I'm Nancy Kaufman, I'm born and raised in Michigan and, um, I'm the owner and director of my own, um, facility Kaufman children's center. And it's located in West Bloomfield, Michigan. Um, I have been practicing for over 40 years.
I don't know if I should say that or not.
[00:10:30] Kate Grandbois: That's something to be proud of. You should say that with pride.
[00:10:32] Nancy Kaufman: Yeah. I look forward to going into work every day. I love it. I love all the people that I work with. We have grown, I started out all by myself with a answering machine, if you know what that is. And um, and now we've grown to 75, um, staff and we just have hundreds of families and it's just been just an amazing opportunity [00:11:00] for an occupation.
I just have been loving it.
[00:11:03] Kate Grandbois: well as a fellow business owner, I, that is incredibly impressive. So hats off to you. That's a lot of hard work and dedication over the years. Um, you know, I started out by saying you're a household name you've done, or an SLP household name, rather you've been speaking for years.
You've, you know, produced so many materials that so many of us are familiar with and you've been really involved with the Northern speech services with Northern speech services and apraxia kids. And I wonder if you could tell us a little bit about those resources so that our listeners know where they can go as they listen to do a little bit more learning and dive a little deeper.
[00:11:43] Nancy Kaufman: Sure. You know, Northern speech services and I have been working together for at least 30 years and they are, um, located in Michigan as well. Um, and Tom Slominsky is the owner and director of, of, um, that program. And they put on conferences all over the [00:12:00] country.
Um, and so they have been the host for many of my conferences and, you know, over the last almost a couple of years, we haven't been traveling and I don't know if I miss it. I mean, I, I miss the live audiences and the feedback and the interactions and the questions. It's, it's been such a wonderful time, but, um, now we're going to be having to do more zoom conferences and all day conferences on zoom.
I mean, I feel sorry for the audience to tell you the truth. Um, I love to have fun while speaking and, and it's really just been a blast. Um, and then Apraxia kids, my goodness. Yeah. Clearinghouse. Like, if you, anything that you want to know about childhood apraxia of speech, definitely, uh, go through, uh, uh, apraxia-kids.org and everything should be there for you.
[00:12:48] Kate Grandbois: Well, that's good to know. We will put all of those links in the show. For anyone, um, who is interested in learning more, um, and to sort of start diving into some of [00:13:00] this clinical staff, as our listeners know, I don't know very much about motor speech. Amy knows a lot more than I do, and that's okay. I'm comfortable with my place on the learning continuum.
Um, but I wonder if you could maybe start us off by laying the, giving us some background information about, uh, for those who are not as familiar in your work. So what is the K SLP approach? Could you give us a little bit of an overview or some guiding principles of what that is?
[00:13:28] Nancy Kaufman: Absolutely. So it's the Kauffman speech to language protocol, KSL P um, and I actually was influenced by many different people putting, uh, this method together when I was a student and this was in the late seventies.
Um, I had a brilliant, uh, supervisor Carol Goff. And she came up with this concept called word shells. And so for children who struggled to speak, instead of trying to teach them full adult forms of [00:14:00] words, which they would not have success with, she would teach them the shell of the word, really this just the gestalt, and then fill in the details of those words, both motorically and acoustically as the child progressed in therapy.
And I just loved that and she taught me all about it. And then as a graduate student, um, we had a guest speaker on phonology. I know I'm dating myself, but it was the first time I ever learned about phonology. And what, and this was Dr. Frederick Weiner. What he was talking about was a phonological processes.
And what he said was that this is the way that children's simplify their speech motor output when they cannot handle the adult forms of words. And the way that they simplify them is they employ actual rules, like final consonant deletion, and deaffrication, and cluster reduction and stopping and fronting and gliding.
And all of those words that most SLPs have learned about. And when I was listening to [00:15:00] him, I was thinking, wow, that's the way to give ourselves rules to implement for children who struggled to speak, who aren't simplifying their speech motor output in a very specific way. They're really struggling. And so if we're going to shape the success of approximations toward target words, we can rely on our, um, understanding of phonological processes to do that.
So for a child to be successful producing certain words, we may need to, um, leave off a final consonant. We may need to glide a liquid. We may need to, um, implement stopping or fronting because these are natural phonological processes that even children who are neuro-typical and just beginning to speak, all of them implement those rules as well.
So it gave me an idea and I said, Hey, in this word shells techniques, now we can technique. Now we can put in phonological processes as the way to [00:16:00] help children to simplify their output until they can manage the full target adult words. So that was another piece of the KSLP. Another huge influence was applied verbal behavior or applied behavioral analysis.
And back in my day, ABA was completely rejected by speech and language pathologists. And that's a shame because so much of what we learn about behavior is going to be very important to us. We're teachers, we're teachers of a behavior, and this case for childhood apraxia speech, we're teachers of behavior of speech, motor skills, and moving that into functional expressive language.
Well, how do you teach? We have so much research about behaviors, how to, um, establish a behavior that doesn't exist. So kids that are minimally vocal, uh, [00:17:00] improving upon a behavior that is there, but it's not really age appropriate, or it's not in this case, uh, intelligible speech or eliminating behaviors that interfere with that process.
And we know about those types of things where children can really interfere with their own best progress by some of the behaviors that are interfering with that. Um, and, and those kinds of, um, behavioral principles have also been a huge aspect of the KSLP and I actually didn't know that the KSLP followed best principles of behavior learning until I started, I got introduced to applied verbal behavior.
Um, and that was only recently, maybe 10, 15 years ago. And the KSLP has always followed best principles of behavior learning. Um, and it was just exciting to know that and to, to find that out and I can go on and on, but if you don't mind, I'll tell you a little bit more. So I met Tamara love ,[00:18:00] Tamara Casper I'm thinking of someone else, Tamara Casper is an SLP BCBA, and she's the first SLP BCBA I've ever met.
And she had come to several of my conferences, um, and then came up to speak with me. And she said, you know, I work with a lot of kids with autism. And at the time I did not work with a lot of kids with autism. And she said, you know, there hasn't really been a very good approach for teaching kids with autism who are minimally vocal, how to speak.
And the KSLP follows all of the principles that we would be implementing anyway for receptive language, for expressive language, for behavior management, um, that the KSLP fits right in. And so she brought that information to a mentor of hers, Dr. Vincent Carbone, who's a behavior analyst and an excellent, uh, teacher and, um, he did a research, a little research on the KSLP methods as they [00:19:00] related to what they were doing with kids with autism and what they were doing to teach kids with autism was basically bombarding them with full words and just hoping that because of that bombardment, they would then try to speak them.
So he looked at that as opposed to teaching successive approximations toward target words. And he learned that there were fewer trials to criterion when taught the approximations instead of the full echoic or the full production of words that are just bombarded. So that was really an exciting piece of research.
And then from there, and just really continue to put all of this together. And when new research comes out about childhood apraxia of speech, which, you know, we're such a young field and especially in CAS, there isn't a lot of research out there, but the research that has come out, the KSLP has already been meeting those criteria.
And that's always made me feel even better about all of the successes that have been accomplished with the KSLP [00:20:00]
[00:20:00] Kate Grandbois: well, as a, as a, I'm also an SLP BCBA. And I am I, this is I'm shocked. I mean, it makes perfect sense, but this is the last thing I was expecting you to tell me or to tell us. Um, and I, as you're saying it, I think it makes a lot of sense.
And I just, I had no idea there was an overlap there.
[00:20:20] Amy Wonkka: Well, I, oh, sorry. I have to say I had a similar experience to yours in that, as I learned more about ABA, I did the coursework for the BCPA. Um, I've had a lot of those same feelings where, oh, geez. I didn't realize that this shaping of successive approximations was actually a thing from another field.
Um, but I, I definitely have had that same experience where you kind of find out that what you're doing has, has all of this research behind it. I would like to jump in with a question about successive approximations.
[00:20:56] Nancy Kaufman: Okay.
[00:20:57] Amy Wonkka: All right. So many people [00:21:00] myself included know about your Kaufman card sets for successive approximations.
And I know that you've said, you know, you don't have to buy your materials. You can use the approach with a lot of different things. I have to say, as someone who has used your materials, I find them very helpful. Um, and it's nice to at least see those successive approximations on there and get a feeling for how you apply those rules of simplification to come up with those successive approximations.
Um, can you talk to us a little bit about kind of how that approach works and who are the clients that it's most likely to work the best for? Are there characteristics in somebody that would make you not want to use successive approximations?
[00:21:43] Nancy Kaufman: Yeah. Good questions. I mean, first of all, I started to put together the KSLP in the early eighties.
And I did not have any materials until the mid nineties. So there was a lot of time where I didn't have a produced [00:22:00] materials and like everyone else, I was grabbing pictures and trying to put them together in terms of simple to complex speech, motor skills and, um, trying to have just the right, um, you know, pictures to show so that we can then fade our cues off of that and move children from, you know, uh, imitation to the ability to label, but eventually to functional use the words, um, in the natural environment.
Um, so. Anyone can do this approach without materials, but I was getting frustrated. And so I put, um, first of all, I had a test. Um, I was frustrated with the tests that were out there. They didn't give me the information that I wanted. I wanted to know what vowels, what consonants and what syllable shapes was, were within a child's repertoire.
And then where were they breaking down as you moved through those in a test so that we can decide where to start in our therapy methods. Um, so air go, the [00:23:00] Kaufman Speech Praxis tests for children and Wayne state university press, um, was the ones that publish it and pup were the ones that published it and it is still being published by them today.
And then I had no materials. And so I started with kit one. Kit one was really trying to look at the very simple consonant vowel combinations. And you know, when you look at speech, it's a motor skill. And so you can divide it into fine and gross motor really, or I should say gross and fine motor. And the grosser motor consonants are the, are also of course the easiest consonants to produce.
So I wanted pictures that contain the gross motor consonants like Mo and ha and maybe what, and then combinations of those from simple to complex syllable shapes. And, um, and then we would have a visual referent [00:24:00] for the syllable shapes that we want to work on. I tried to make them all real words. There isn't any reason to work on nonsense syllables in my opinion, at this level, uh, because you can easily say, um, just to get bilabial to an alveolar but why not bunny bunny bunny?
Because it's a real word. Well, that was my thinking anyway. Um, and so kit one was established and then we needed more on, uh, the more complex consonants. And I feel like once you get through kit one, you really have broken through speech motor coordination. And then kit two is kinda more like articulation really, or it's trying to get complex consonants, not only produced accurately, but in apraxia of speech.
A lot of the times all, all the consonants and vowels can be produced accurately in isolation, but then they collapse or they're changed in connected speech. So that kit two is more about what I would say, the [00:25:00] word synthesizing those complex consonants in, in really initial medial final positions. Um, so that was why that was produced.
And then the fun stuff came along. Um, so, uh, uh, producing the workout book and the workout book was, was prepared to help with getting children to combine those simple words, shapes that they've learned to, um, produce functional, expressive language beyond single word utterances, but just staying with the simple and more gross motor MOBA and why I'm adding a hwab, but we really shouldn't, but it's easier to say those consonants that way when I'm just talking about them.
Um, and then the Mudd family got produced. So the reason for the mud family was in my clinical experience, simple by syllabics, like happy Bonnie, [00:26:00] Tommy tuba. Were a very important. To be able to put two different, simple syllables together. And so the Mudd family of dogs, I had their names kind of follow simple bisyllabic names with the exception of a few.
So Paddy and Mona and Toby, um, Heidi, and then some of them have just the vowel change, like nanny, poppy, Bobby, but then they could use those as subjects and then move into the three word combinations and move into progressive's and, and, and so forth and to sequence story narratives.
[00:26:32] Amy Wonkka: Well, and I feel like one thing that's been helpful to me as a clinician with a successive approximation approach is that you move pretty, pretty quickly, especially in that kit one to the target word shape.
So you might not have the target sounds in there, all the target sounds, but the target word she is a pretty quick jump. If we're thinking about, you know, uh, CBC V word, [00:27:00] right? You're you have your students or clients marketing those two syllables pretty early on. Um, and I feel like that in itself can make such a big difference in intelligibility for the listener.
[00:27:14] Nancy Kaufman: Well, what we want is for what we've practiced in something like kit one, there are other things that we use besides kit one, by the way, there's a lot of other things we use besides the KSLP materials in a session. But what we want is for those words, to transfer to the ability, to name the item without any cues, and then eventually to use those words for requesting and commenting in the natural environment, especially if you're just at that single word level, but we want a group of nouns that also have lots of different, simple syllable shapes for the children to move from imitation with all sorts of queuing, to fitting those cues out to spontaneous naming, and then to requesting and [00:28:00] commenting. And also we want a list of favorites. Even on those early learners, we want to know what are their favorite foods, drinks, toys, activities, people and pets, names, places they love.
And we're going to look at those words and find out what is their best approximation of those, and then help them to produce their best approximation while in therapy. We're continuing to push in all of the details of those words toward that target adult form. So
[00:28:27] Amy Wonkka: So the people who are listening, can't see like my enthusiastic head nodding and thumbs ups.
But I think that that is such an important point. I don't know if you could talk to our listeners a little bit more about that because some times. As clinicians, we might get a little stock in the like drill work and forget about the fun and the application to real life and real world situations.
[00:28:55] Nancy Kaufman: Yes.
So many people think that the KSL [00:29:00P are flashcards and they should just be drilling with them and it's just not true. And I wish that people would at least take my course if they're going to be using the materials so that they really understand how to implement them. But they're just one simple way of having a visual reference for the simple syllable shapes, because we can't always contrive opportunities to produce those specific syllable shapes in the natural environment. Um, but yes, of course the whole idea is for them to then use words and use them functionally and naturally. Um, but also my, I do see children at a table. I do, I cannot in no matter if they're two years old or 10 years old, some people think that if they're two, you should just follow their lead and play and you're on the floor.
And I feel like that's not going to get me or them where I want them to go. And so, yes, I'll seat them, but [00:30:00] lots of toys and lots of interesting materials, a to keep their motivation and attention and interest and cooperation, but B to then use the toys so that we can maybe contrive some words that have to do with the toy to then be producing what we've practiced.
[00:30:20] Kate Grandbois: I have a question from the perspective of someone who knows very little about this, you've talked a lot about the use of successive approximations. Are there characteristics of a speech profile that would lend itself better to that approach? Or are there presentations, um, client or student presentations where you would say that, that the successive approximation approach is not appropriate?
[00:30:42] Nancy Kaufman: Um, if the, so we're gonna, if there, if the child has an issue with articulation, that would mean that they have trouble producing isolated vowels and consonants. [00:31:00] And so we have to work on perfection of those isolated sounds. And sometimes if this is actually something that you had asked me in the past, but, um, if a child has articulation challenges, as well as has difficulty combining consonants, vowels, and syllables to form words, and to maintain their motor plans.
Um, we might have to provide a compensatory placement for a vowel or consonant that they don't have, or they are not stimulable to produce accurately. We can't wait till a child has, uh, let's say the word cookie. We can't wait till they have a “k”, in their repertoire to teach them the word cookie. They may not be stimulable for it.
And no matter what wonderful techniques we have implemented, they still are not able to produce that. But what we know is. Children who are just developing their speech may front, [00:32:00] those sounds to k and g to t and da and we can teach. We're not going to just wait and see what the child enters we could, but, and, and we probably should see what they try to say, but I would take them to or duty for cookie, but I would model correctly.
So I would say, oh, did you want a cookie? Tell me T oh, here's your cookie. Always modeling correctly, always working on the cup. And if we gain the cut and the child is now stimulus for it, we can't just then change it up and go, okay, now you can say cookie because that's co articulation. But what we know about co-articulation is that we could reconfigure that word cookie into something that's already assimilated and then push on the latently.
And then we're going to extinguish their, their, uh, production of and teach it as cook E because moving from a cup to a calm [00:33:00] movement is much easier than co articulating key, which is very difficult to do. And that's another influence on the KSLP method way back when, I don't know if you remember McDonald deep, it was a test, the McDonald Deep Test, but it was a test to look at coarticulation.
We always need to think about co articulation when we're choosing target words, when we're implementing therapy, what, you know, once we get a new continent, what would be the easiest way to co articulate it without too much challenge? And then, you know, they would then have, um, re it would result in failure.
[00:33:41] Kate Grandbois: I've never heard of that test, which doesn't mean anything, but I wasn't, I wasn't aware that that's a thing. I wonder, um, as, again, as someone who doesn't know much about this, when you say compensatory placement, what exactly do you mean by that?
[00:33:57] Nancy Kaufman: [00:34:00] Um, let's say that the child is unable to produce L right with their tongue at the ridge behind the teeth, which is called the alveolar ridge. Um, and they're not stimulable for it. Yeah. Um, they like to say the word look all the time and that as they should, young children want our adult attention. And so we'd want to teach the word look.
Now they might be replacing that L with an N nook. They may be replacing that L with a Y like yike you or I, or you yook at me or what get me a w um, but now they're at the, at the level where we need to teach L and it would be appropriate for their age or their ability. And they're still not stimulable. I would let them protrude their tongue, just slightly, not all the way out, but a slight dentalizing and do a luh.
And I would do [00:35:00] that with all initial L. So the question is, well, if I'm teaching it that way, are they going to maintain it that way? And the answer is no, in my experience. And we have just established that it's vast and it's lengthy. The children pull their tongue in because it's actually harder to protrude it a tiny little bit.
Um, anytime I've ever used compensatory placements, that children then are gain it appropriately. It's same thing like with a T sometimes I'll let them bite their tongue a tiny little bit and spit, and then we're going to put that sound in the final position of a word, because then it's kind of still isolated and it doesn't have to be coarticulated.
And this is all about, you know, just, um, technique, but we would do both and I'd still let them dentalize and spit. I know the word spits, not very attractive, but that's what we told the children. Um, and they like it. Then they try it and then they don't keep talking like that. They don't [00:36:00] spit their t’s as they mature and as they gain more appropriate skills.
[00:36:07] Kate Grandbois: So you think about whatever the new realizes on its own and you don't need to follow up with specific. Shaping procedures or teaching procedures to get them to move from the compensatory placement to the more accurate placement
[00:36:20] Nancy Kaufman: I have to say. I've never had to do that. However, let's say they don't have an /r/ in their repertoire, which many children don't.
And even though the norm say that they're not even supposed to have a really good quality /r/ until the age of eight. And I would never let anyone go that long with a, with a poor production of /r/, because it makes the child look very immature and they could be teased and whatever we have to gain that placement as early as we can get stimulability for it.
But, um, they might be dropping it out. They might be producing it very much in a distorted manner. I would actually replace it with a [00:37:00] w um, I would rather them say I, I won. I re I wan the race. I wan the way, rather than I am the ace or whatever they're doing. That's a little bit less accurate. We, adults can decode baby talk.
And, um, I'm not saying that we're actually teaching baby talk, but we are teaching what younger kids that are just learning to speak would do naturally. And if the person who, if the child who struggles to speak, isn't doing what we would expect them to do naturally, and they're doing something odd. Then we're going to think about that.
The phonological processes that we would replace these things with. I had a child the other day that was, um, um, deleting all devoiced consonants in the initial position. I'd rather that child say, but on my goat, mommy, than ut on i oat. [00:38:00] So I'm teaching voicing and that's erroneous, but he's not stimulable for devoiced consonants and the initial position just yet.
And I will say though, that voicing errors are terrifying. We're really difficult to change. Would you agree, Amy?
[00:38:21] Amy Wonkka: I will. Am I shaking my head enthusiastically? I would. And I would say too, from a, like a kind of comes back to the earlier idea of the photo tactics is important. Right? So, so when you're taking sounds out, it makes it so much harder when you did the example.
Um, oh, that is hard. If you don't have the context as a listener, that's really hard to figure out what that child is talking about, whereas substituting something that's, uh, that is a more traditional error pattern that we would see really helps the listener and that translates to the [00:39:00] child also feeling more effective as a speaker.
So just getting back to that functional use, um, it, it makes such a difference in their experience as a speaker and using their oral speech.
[00:39:11] Nancy Kaufman: Yeah. As soon as they are successful, it gives them more motivation and they want to learn more. They're going to use more words spontaneously, and the listener is going to give them reinforcement by understanding what they said.
[00:39:26] Kate Grandbois: And again, as I think it's impossible for me to take my behavior analyst hat on sometimes, but I'm hearing this is a shaping procedure. This is, and it makes a lot of sense. Um, we've talked about shaping on this podcast for a variety of different topics for treatments and interventions for selective mutism, for AAC and, and button icon selection, um, another com components of motor planning.
So I, I think it's really, really interesting that this is, that's such a, uh, a component of this.
[00:39:56] Nancy Kaufman: You know, shaping [00:40:00] procedures have been done since the fifties. We all talk about BF Skinner's work and that, um, there's always, um, controversy about speech and language pathology. First of all, we're a young field.
But, there just simply, can't be enough research to answer every question that we want to have answered so that we can move ahead and provide our therapy with all of that backup information. And the thing is though, is that shaping has a lot of research behind it.
[00:40:35] Kate Grandbois: We do it a lot in speech pathology without realizing it
Nancy Kaufman: exactly.
Kate Grandbois: And I mean, not to get on that soap box and totally derailed cause I, I do, but I, I just think it's, it's interesting. Um, and if anybody is interested in learning more about shaping or what shaping. The quick and dirty definition is it's providing reinforcement for successive approximations of a target behavior.
And we can list more information [00:41:00] about it in the show notes. Um, I wonder if we just sort of getting back to this compensatory placement idea, um, we were recently came to our attention as we were researching for this episode that it's somewhat controversial. And I don't, I wonder if you could tell us a little bit about that?
[00:41:20] Nancy Kaufman: Well, I didn't read probably what you did, but I'm guessing that the thought is is that if you teach a compensatory placement that it will stick and that it will never then continue on to the full adult form of an accuracy of the word. But, you know, um, I mean, I could tell you all sorts of things that people like to criticize, um, [00:41:44]
Kate Grandbois: me too, but that's fine. That's another podcast episode.
[00:41:48] Nancy Kaufman: The thing is, is that if you only teach words that contain the child repertoire, you're not going to be teaching very much and they are not going to be [00:42:00] moving ahead on therapy and moving into expressive language well.
[00:42:04] Amy Wonkka: and back to your earlier point about, it's not just, you want the repeated practice, but it's not just drilling a set of flashcards.
What if you get to know your client and all of their interests incorporate sounds or word shapes that aren't in their repertoire.
[00:42:20] Nancy Kaufman: Exactly. And not to mention, I might say after a while, Hey, now let's try to move your tongue back a little bit. Yeah, for sure. I'm going to, I'm going to try to gain accuracy as soon as possible.
But, you know, if the child says, um, ook, ook at E and then they can say look and, you know, it's interesting because in terms of auditory and that's what we're trying to do, we're trying to give a compensatory placement that in an auditory manner, it's understood by the listener. If I said like, like, [00:43:00] like, like an I'm alternating my tongue movement, I don't think that you could tell that I changed it.
[00:43:07] Amy Wonkka: And it's certainly clearer as a listener than if you say Ike,
[00:43:12] Nancy Kaufman: like type in the word, know, I, lot of kids have no, because it's more of like an automatic kind of knee jerk type of word. But if they don't have an n in their repertoire and I can't gain it, anchoring of dentalize it and then we'll get no.
And all of a sudden that nis there. And that opens up a world of more words that are acoustically accurate for the list of.
[00:43:35] Amy Wonkka: Well, and I have like, no, I have no evidence to back this up, but just thinking about it logically a lot of your examples regarding compensatory placement are about dentalizing sounds.
And a lot of the errors are either about omitting those sounds or doing a further back production of the sound. So in some ways, I wonder if by dentalizing something that the child isn't yet [00:44:00] stimulable, like the adult alveolar production. Maybe if they're doing a back production, you're kind of overshooting that like desired motor movement anyway.
So it, it just helps make that contrast better. I don't know if that,
[00:44:13] Nancy Kaufman: like the kids that guy gah go go goo gug go gogay, you know, and they probably passably had pacifiers for quite a lengthy amount of time and learned to talk that way with backing. Um, but yes, you're right. Then we're pushing the tongue more forward where it belongs.
[00:44:32] Kate Grandbois: Sort of happening on the same theme of, um, controversial components of this. I, uh, one of our advisory board members, um, who helped us, who is, who specializes in motor speech disorders, sort of had a meeting with us to sort it, to come up with to help guide our questions when we chatted with you. And he mentioned, he's wonderful.
Um, he mentioned that there were myths about [00:45:00] the KSLP approach, and there was a component of your website that debunked some of these myths. And I wonder if you wanted to take a minute and, and verbally debunk these myths for our audience.
[00:45:12] Nancy Kaufman: You know, I, I went back and looked at them. Um, I just don't think about these things, you know, um, currently, but, um, I mean, certainly one of them is that you should never teach an approximation to a child with apraxia of speech.
And I get all sorts of criticism about that, although, um, I think that the people that understand it and implement the techniques are, are more in number than the naysayers or the critics. But, um, yeah, I just, uh, I think that I've learned through my own clinical experience, my [00:46:00] intuition, my, um, attempts at clinical excellence that shaping works.
And the outcomes are positive. Um, if they weren't, I wouldn't be talking to you today. Um, and, uh, part of that, um, evidence informed practice or evidence-based practice is parent input and it's also, um, clinical success. And so, um, I have been shaped to learn that these methods are very successful. Um, and I don't understand why anyone would actually come out and say that you shouldn't teach an approximation.
They obviously don't understand shaping and that we're always moving toward the target adult form of the word. We're not just stay [00:47:00] continuously reinforcing the approximation we're, we're working towards perfection and we will eliminate, um, the lesser approximations and only then reinforce closer approximations to the target and ultimately perfection.
[00:47:19] Amy Wonkka: And you mentioned just now that you're using your clinical data to make decisions about your actual clients and that's something else we talked, we've talked about quite a bit on this podcast is sort of that gap between the research of the research folks in their research institutions, and then the work done by clinicians who are typically not in those research settings and we're practicing and schools and clinics and all of these different places.
Um, and you know, ASHA has on their website. They have that triangle now diamond that talks about evidence-based practice and they acknowledge, you know, the [00:48:00] importance of us as clinicians, our clinical information in our clinical data. Um, What are your thoughts about evidence? Like how does a clinician determine that evidence?
Because it's not just reading. Well, this research paper told me, so there's an awful lot of weight that should be given to this is what seems to be working for my particular client or not working.
[00:48:26] Nancy Kaufman: Well, I'll be honest with you. And I am going to bet that many SLPs feel the same way as me. I find research very difficult to read and to comprehend, and I'll go like everybody else, right to the conclusions. And the conclusions are always inconclusive that, that, you know, we found out this, but we still need a lot more research is very costly. It's sometimes biased. Um, and there's [00:49:00] research being done on the KSLP right now, as we speak. And I, um, I I'm excited about it. I invite it, but this is what happens, especially about trying to research, uh, therapy approaches.
The KSLP is multifaceted. You have to know how to use reinforcement, strategically, gain, have motivation. You have to understand errorless teaching and error correction, which I know that you Kate would understand those terms. Um, you have to mix and vary your tasks so that you're not teaching overgeneralization.
Um, you have to gain a lot of mass practice to distributed practice. You've got to coach parents and caregivers to carry this over into the natural environment. You have to understand shaping techniques and what would be best approximations and be fully aware of phonological processes. You also have to have a fun [00:50:00] personality as well, and to be able to implement this, um, seamlessly, that's a lot to try to replicate.
And so what happens is when people do research on therapy approaches, they narrow it down into something that could be replicated and it just doesn't seem to equal what is really important within that particular approach. So I take it with a grain of salt. I'm interested to understand, uh, research that comes out, but I'm much more interested in clinical opinion.
[00:50:39] Kate Grandbois: And I just sort of piggyback on what you both said is the power there for internal data collection. I know that's sort of a repeat, but for people who are listening, who are feeling that they're doing all of those things at once, you know, they're trying, they're playing, they're being engaging. They're meeting their learners where they are.
They're they're, um, you [00:51:00] know, doing, they're making their best efforts to provide these shaping procedure procedures, provide that reinforcement, provide those error correction procedures, provide those, that, those feedback cues and at the same time,
[00:51:12] Nancy Kaufman: I forgot about cues and how to feed them.
[00:51:16] Kate Grandbois: Right. And, and, and problems and all of these things.
I mean, being a clinician is hard. Doing clinical work is hard. And if we can find ways to, like Amy said, and like you said, do our own internal data collection to make sure that we're measuring. What we're, that what we're doing is working, you know, conclusions and research articles, as you mentioned, are often written for other researchers.
So just because it's not in a research article, doesn't mean that it isn't evidence-based practice as long as you're relying heavily on your internal data collection and your client's values and perspectives. Remember, those are all, those are both components of our evidence-based practice triangle in conjunction with our clinical judgment.
So [00:52:00] I really appreciate those comments because I think often in the field, we assume that evidence quote evidence-based practice is a research article. That's that's not true. That is one of four components of evidence-based practice.
[00:52:15] Amy Wonkka: I didn't know if you could take a few minutes just because. You so nicely broke down all of those pieces that actually go into implementing an effective treatment package.
Um, I wonder if you could talk a little bit about fading cues, talk a little bit about maybe what clinicians should be looking for, the types of cues that you have used successfully, um, and just give our listeners nothing super in depth, but just kind of an overview about some of the questions you might be asking yourself as a clinician or some of the techniques that you found to be successful in your practice.
[00:52:54] Nancy Kaufman: Yeah. So that's a whole subject in and of itself. Right. And, [00:53:00] um, in the KSLP there's cuing and there's scripting. So there's queuing for speech, motor scripting for expressive language. And the thing about the KSLP is that the importance of it is that it moves directly into functional expressive language.
Um, so of course I've been where I've been using cues since the early eighties, and they're mostly visual. And by the way, I have hardly ever had to physically touch a person to provide them with a cue. That doesn't mean that you shouldn't, but I've never really had to, unless there's the child's minimally vocal and doesn't even hardly have any vowels or confidence in their repertoire.
But here at my office at the KCC, we tend to use internal cues to the oral cavity. For such as like Renee Roy Hills apraxia shapes to try to gain some vowels and consonants and then start to shape them. Um, but I will use some visual cues for each vowel each [00:54:00] consonant, and that they're different from each other so that they don't get confusing and I'll do them on myself as a visual cue, not on the child.
Um, but there are so many, uh, such as giving the first consonant and just oral posturing, the rest of the word, or giving the first syllable and oral posturing, the rest of the word, um, using fill in the blank cues so that the child's doing the work and you're not really giving them any piece of the word for them to retrieve.
You know, there's, there's just so many, I don't even have a list in my mind right now. Um, the ones that I tend to use the most are. Uh, visual cues, oral postural, meaning that your mouth is just making the shape of the sound, but you're not saying anything. Um, I might go to a whisper cue even though you run the risk of the child whispering back.
Um, and then I'll also go to, um, gestures. Um, so you want to fade from visual [00:55:00] auditory to visual only to no cues at all. And in terms of scripting, um, I might put the answer in my question. So I, if it were just naming, I'm going to say, baby, what is it? So I've said, baby, they already have that full cue. I, I push in a little bit of a question and then they will respond. Or I might say I'm walking the dog. What is the boy doing? Or tell me that the boy is walking the dog, the boy, and then I might give a cue for is, and then oral posture, the rest we want to keep the children supported to the level that they need.
And, you know, just talking about this today is making me realize even more how complicated everything is. And, you know, I'm only talking about children with CAS and most SLPs have to work with all disorders, [00:56:00] all age groups. My daughter, Carly Weberman is an SLP in the schools. And so, you know, she informs me of all those challenges and, um, it's a lot.
And then we don't have time to work with the children much, or they have to do groups only. There are a lot of challenges. Um, but yeah, it's, it's, um, there's a lot that goes into an approach and I've been trying to teach this approach, um, my whole career. And that's why I use numerous video examples when I do a conference.
And I also like to talk about what I'm not doing appropriately. If I might catch myself in a video making mistakes. And I think that that makes it really real world for all of us. Um, and I have a whole section in my conference about, um, mistakes and what the [00:57:00] consequences are and why we should think about not doing those types of things.
Um, and I think it's a really nice learning experience to talk about those.
[00:57:11] Kate Grandbois: We really appreciate all of your wisdom. I love the concept of embracing mistakes and, and having learning experiences. I mean, you can't learn without having those vulnerable moments and being able to self reflect. So thank you so much for mentioning that. I wonder in our last minute or two, um, if you have any, any words of advice for SLPs out there who are listening and maybe recent or recent grads, or going into the field of motor speech for the first time, um, any, any advice or words of wisdom?
[00:57:49] Nancy Kaufman: Well, I, I think that we have to be careful about only implementing, uh, approaches that so-called have [00:58:00] research behind them because then we're losing out on all of this clinical information that have been gleaned throughout a lot of years and a lot of different professionals. Um, and, um, and I think that that leads parents to want to only look for approaches that have research behind them.
Um, and so I would say that that's one piece, but to really look further for, um, more clinical information testimonials, um, outcome pieces, um, uh, people that like to do blogs or, or explain what, what their experiences have been. I think all of those things are going to be important to the new clinicians out there.
[00:58:46] Kate Grandbois: That was very good advice. Thank you so much for your time and being here today and sharing this with all of us where we're so great.
[00:58:55] Nancy Kaufman: You are so welcome. I really enjoyed this.
[00:58:58] Kate Grandbois: You're welcome back. Anytime. Open door [00:59:00] policy for you, Nancy.
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