This is a transcript from our podcast episode published November 8th, 2021. The podcast episode is offered for .1 ASHA CEU (introductory level, related 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.
Kate Grandbois: We are so excited for today's episode because we get to basically hang out with two authors of literature that we have read many times over. We're so excited to welcome Cathy Binger and Jennifer Kent Walsh. Welcome Cathy and Jennifer.
Cathy Binger: Thank you. It's such a pleasure to be here.
Jennifer Kent-Walsh: We're we're super excited about this.
Amy Wonkka: Um, you guys are here to discuss language development and AAC, which are two topics near and dear to our hearts. Um, before we get started, can you please tell us a little bit about yourselves.
Cathy Binger: Sure. I'm Cathy Binger. And, um, I, my history, I won't [00:03:00] go through all of it, but briefly, um, I went straight through school to get my master's degree in speech language pathology, thanks to career counseling, figured out what I wanted to do fairly early in my college career.
And, um, after that, I spent eight years in lots of different places doing lots of different things, but a lot of that time spent in preschools and that's really, my love is doing, working with those little kids, birth to three and three in the preschoolers. And then, um, I returned to Penn state eight years later, where I got my PhD and where I met Jennifer Kent Walsh.
And we have been working together now, since that time. So it's been, we've known each other for, um, over 20 years now and have been close colleagues and good friends for all that time. Um, and so we really, we focus on two main lines of research. One is partner instruction, which I know is another topic near and dear to your hearts, Kate and Amy, and also language development and AAC, which is what we're going to talk about [00:04:00] today.
And clearly those two lines of research overlap, but the studies we've been working on are, um, some are more focused on one and some more focused on the other. Um, and that's where we are right now.
Jennifer Kent-Walsh: Cathy set things up. Well, um, as she said, I did start to roll back the clock to think. Yes, that's right. 20 years that we've been working together in one way or another. So we're excited to be here together today.
It's a little bit on my background. Um, I started out as a public school classroom teacher, um, and then became a speech language pathologist. So my clinical work before, uh, returning to school to do my PhD was in public school and preschool settings. Um, and as Cathy said, I met her at Penn state when we did our PhDs, uh, overlapping in the same time period.
And that was really an opportunity, um, for me to start delving into these [00:05:00] topics that we're going to be discussing today in much more depth. Um, since coming to the University of Central Florida, I've been here for what is getting close to 20 years now, um, as well as which is hard to believe. So we do actually, house, uh, house an assistive technology demonstration center with which is associated with our communication disorders clinics.
So I'll have the pleasure of collaborating with many clinical, um, faculty and instructors, as well as students as we're providing, um, AAC services and other assistive technology services to individuals on a, a daily basis. So lots of, um, informed opinions and, um, input that we're able to get in that content.
Kate Grandbois: That's awesome. This is going to be such a good conversation and I'm like chomping at the bit to get to it. Uh, but before we get into the good stuff, the powers that be require that I read our learning objectives and, um, financial disclosures. So let's get that over with as quickly as possible, uh, learning [00:06:00] objective number one, discuss the importance of applying a developmental model to aided AAC language learning; learning objective number two, list the language domains that should be considered when providing AAC language intervention; and learning objective number three, describe evidence that supports an early focus on semantic and grammatical development for preliterate children who use aided AAC. Disclosures, Cathy Binger’s financial disclosures. Cathy is employed by the University of New Mexico. She receives grant funding from the National Institute on Deafness and Other Communication Disorders that support her work on the topic that we will be discussing today.
Cathy does not have any non-financial relationships to disclose. Jennifer Kent Walsh, financial disclosures. Jennifer is employed by the University of Central Florida. She receives grant funding from the National Institute on Deafness and Other Communication Disorders that supports her work on the topic that we will be discussing today.
Jennifer does not have any non-financial relationships to disclose. Kate that's me. I'm the owner and founder of Grandbois Therapy and Consulting LLC, and co-founder [00:07:00] of SLP Nerdcast. My non-financial disclosures. I'm a member of ASHA, SIG 12, and serve on the AAC advisory group for Massachusetts Advocates for Children.
I'm 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.
Amy Wonkka: Amy that's me, my financial disclosures are that I'm an employee of a public school system and co-founder of SLP Nerdcast.
And my non-financial disclosures are that I'm a member of ASHA, SIG 12, and I serve on the AAC advisory group for Massachusetts advocates for Children. All right now onto the good staff. Um, Cathy and Jennifer, why don't you start us off by telling us a little bit about the first learning objective. Why should clinicians consider typical language development within the context of AAC interventions?
Why is that important?
Jennifer Kent-Walsh: Sure. Well, that, that is a very broad topic. Um, lots to think about here, but I think as, as [00:08:00] clinicians, sometimes we can get separated from that concept, um, and really, uh, focus on more about what might be different when we're working with kids who are using, uh, aided AAC to communicate as opposed to what is similar to any child that we're working with, uh, and looking at helping them with a communication disorder.
So as opposed to focusing solely on the actual, uh, technology perhaps, or whether it be high-tech, whether it be low tech, et cetera, um, we need to focus on what are we trying to accomplish. So how are we trying to help these kids be able to communicate? So if we even track back to if we were looking at a typically developing child and when we would be excitedly anticipating their first words, um, and supporting and encouraging that and moving on from there to starting to put words together into short phrases, moving up to [00:09:00] sentences, et cetera, all of that can remain and should remain within our framework.
As we are setting goals and looking at where we want to go with these kids and how we want to help support them, get there step-by-step, to be able to be independent communicators who are able to put together their own thoughts, their own sentences and their own wording so that we know their personalities as well.
Amy Wonkka: I think you make such a great point as somebody who has worked in the, in the field as a clinician, um, with folks who have complex communication needs for such a long time. Um, I think you're right. I mean, often we do, we kind of turn AAC into this special, separate different thing and disconnect from everything else we know about language development, um, and you know, clinically that's not serving the best interests of our clients.
Kate Grandbois: And I see that throughout, I agree, Amy. And just to piggyback on that thought, I see that as a common thread, [00:10:00] across a variety of different aspects of AAC. So I see it as part of the evaluation process. I see it as part of, um, implementation, um, as part of my job, I train a lot of SLPs in AAC implementation.
And often a question I get is so, so how do I do this? How do I do language therapy like that? Because there's this extra thing. All of a sudden it becomes a different task that we, you know, well, I, I'm a speech pathologist. I know how to do language intervention, but not with AAC. Well, it's still language intervention.
A lot of the skills that we have as SLPs still apply. But for some reason, because there's this extra tool, there's extra thing. It becomes this very intimidating foreign alien activity.
Jennifer Kent-Walsh: I think that's a really good way of putting it. When you mentioned the extra thing, that that's where we tend to shift our attention for, for whatever reason and, and get a little [00:11:00] hung up on that, as opposed to really looking at how are we setting up this interaction or how are we helping to facilitate an interaction between the child and someone else?
What is the purpose of this, as opposed to just, what do we do with this tool?
Cathy Binger: Yeah, those are all excellent points. And one of the things I, um, when I give talks, one of the things I tend to talk about a lot early on in my talks is what are your goals and objectives and are your goals and objectives that the team has set for the child?
Do they look like the same kind of goals and objectives for the other children on your caseload who don't use AAC? And if they look wildly different, that's something to re-examine. Um, because the focus is, should be like big C on communication in AAC, right? Like I even put that in my PowerPoint notes, I do two small A's and a giant C, right.
The focus is communication. And to just remind SLPs that we know a lot about communication, we know a lot about [00:12:00] language and that I think that can help be a doorway to help them kind of get over the technology a little bit. Like it's not about the technology, it's about communication. It's about language in whatever ways we can put together to help make that happen.
But, you know, for starting with goals and objectives that are similar, or, you know, even exactly the same with possibly the addition of in whatever communication mode versus, you know, via speaking, right? Like the child will do such and such with her speech rather than the child will do such, or will do you know, will do you can accomplish this language goal using any form of communication, um, rather than just spoken language, then hopefully that helps keep that frame and that focus for the whole team on the language itself. Um, which is where it's all about.
Kate Grandbois: I can agree. I couldn't agree more. And as you were talking, I was thinking about all the different aspects of technology and how they [00:13:00] sort of remind me of a phrase my husband says all the time, which is don't be distracted by the shiny penny, meaning, you know, the technology that we use might be capable of a whole bunch of different things that we want to participate in, or we want our student to be able to access. And that distraction might not be in line with the, I'm just thinking about, you know, this idea of the developmental language and the developmental model, those shiny pennies, those features might not be in line with the what, with what exactly what you said.
The C the big C the communication goals and the goals and objectives and example that comes to mind is something I see a lot, um, where there might be an objective written for a two word utterance, because the way the buttons are programmed, you have a, you know, the initial words such as eat automatically directing you to a second page.
So there's this, there's this feature of linked icons that are going to, [00:14:00] auto-generate a two word utterance, but is a two word utterance actually appropriate from a communication objective? Or do you have it in there because the technology is programmed that way. I'm not sure if that's a decent example, but, but the shiny penny can be really difficult to ignore.
Amy Wonkka: I was having kind of similar thoughts where.
Kate Grandbois: I feel awesome. It's very validating for me. Go on buddy.
Amy Wonkka: One obstacle, I think for, for clinic, I mean, I've been doing this a long time and one thing that's challenging for me is that depending upon, you know, thinking specifically, I guess, about high-tech aided systems, right?
So for people who are listening, you know, those are kind of what you think of as your, as your standard communication device, you press an icon or a sequence of icons and a device speaks out loud. Um, I think one deviation from using a system like that, like an aided system is that it does have capabilities that are, you know, [00:15:00] natural or oral speech doesn't. You don't necessarily have, you know, a two-year-old who's able to generate a multi-award phrase.
Motorically, they're just not doing that yet, but with certain aided systems, you can do that. So I think that can also be a confusing factor, um, for the clinician. And you're trying to balance all of these different pieces in your therapy, trying to think about the pragmatic piece. You're trying to think about the reality of these like operational demands, which, you know, kind of talks about needing to push the buttons or do different things to make the device say things, you know, those are things that are kind of unique to an aided system that's using something external from your body, but you know, it is kind of confusing because you can do that. You can, you can ha I guess maybe it's the shiny penny example, but there are some shiny penny aspects to speech generating devices.
Cathy Binger: Yeah. That's I think all of that, um, that's one of the [00:16:00] reasons why we just come back constantly to a typical developmental model because for most of the kids we work with, if not all, I mean, even, yeah. Okay. I mean, yeah. Well they'll just say all kids we work with, I don't know the better model that we have to work with and to look at what is it that happens in typical language development and what is it that's going, where, where does this child I'm working with, where are they fitting into this? And this is getting into the second learning objective a little bit. Where does this fit into in the semantic domain and the syntactic domain in the morphological domain. And let's not forget narratives too. I mean, little kids start storytelling really early on. So getting beyond that utterance or sentence level and into how the sentences linked together. Um, you know, again, we're all of us here. We're all speech, language pathologists. And focusing on that language piece, we need to understand where they fit into all that. Now is that [00:17:00] easy with a kid who's got all kinds of stuff going on.
The may have motor issues, sensory issues, cognitive issues, et cetera. No, but, um, there are certain things that I think we can do to help us figure that out. Um, one of the things that we do all the time, and this is what the giant caveat that I know you can't do this kind of thing with all of the kids who need AAC, but whenever it's possible, we always test their receptive language.
Um, now you have to think about whether or not, those test results are going to be valid, right? Like some kids, you may be testing behavior more than you're testing their language. So they, you know, using standardized testing, isn't going to be valid for all kids. But whenever we can, um, actually for every kid who walks through our door, we at least attempt and we usually finish, um, attempt, uh, testing their receptive language.
So, um, this is like, there's a thing out there in the world with people who've gone through [00:18:00] masters programs of don't use age equivalent scores. And I think that the reasons why we shouldn't be using those scores and reports and, um, for other purposes, those are really valid reasons. However, I think there's one really, really valid reason for using age equivalent scores.
And it's for the purpose of helping us figure out where approximately should we be aiming for, with expressive language. Okay. So let me pull that thread and explain that a little bit. So, you know, let's say I test a child with down syndrome and test that child's receptive language and the child is six years old and his receptive language is going to come out at, let's say, you know, below the first percentile you use the usual scores, the standard scores, and they're all going to be way, way, way low, right?
They're going to be less than first percentile and a standard score of, you know, whatever they're going to be really low and not, and everybody's going to say, yeah, this kid's really [00:19:00] low. What did that tell us? But if you look at the age equivalent score that child's age equivalent score, who's below the first percentile, it could be at a two year old level.
It could be two and a half year old level. It could be three-year-old. It could be three and a half. Right. So because their raw score is different, but there's also low compared to a normal six-year-old with normative table that there's still like there's variability in that functioning. And that's really useful information.
And the age equivalent score pulls that out for you and helps contextualize that. So if that child is a six year old, who's got the receptive language skills of a three-year-old. I'm like jumping up and down for joy, because think about what a three-year-old does. Right? And again, we're going back to our typical model of language development.
A typical three-year-old is using approximately a thousand words expressively. A typical three-year-old is putting together grammatically complete sentences, [00:20:00] simple, but not always simple. A typical three-year-old has a range of early grammatical morphemes. Some of which are mastered and some of which are emerging and, you know, establishing, but most of them are coming in, if not all of them by then.
So there's this, you know, and then if I look at, okay, so then what does a child actually dom child with down syndrome who's relying on his speech? Well, he may only be speaking in two word utterances. Well, that's a total mismatch with where my expectations should be for that child. Um, given his receptive language ability.
And so, you know, we know with Down syndrome that kids tend to have speech skills that are significantly lower than their cognitive skills. And that's really getting in the way, it's not just their cognitive skills that are driving that limited language. It's also on top of it additional speech disorder.
That's probably keeping [00:21:00] that kid from reaching their expressive language potential, and that's where AAC can really come in and fill that gap semantically and grammatically, when I say grammatically, I mean, both semantics and syntax. So all of those things are like that using that developmental model, using your tests for the particular purpose of helping you frame, where you are in space and what kinds of language goals you should be setting all that kind of stuff.
It's really useful.
Kate Grandbois: I think that's true for a variety of different, if you're looking at, you know, the student that you're working, whether the client that you're working with, looking through that lens is applicable across the board, too. So thinking about our more emergent learners, um, who may or may not have complex needs, they may or may not have complex presentations of how they're communicating in terms of behavior or in terms of, um, persistently asking for the same thing.
You know, I think a lot of times our, you know, these [00:22:00] kinds of students can get miscategorgized. As, um, you know, because there's an AAC device there, we're not really looking at it through that developmental lens. When in reality, an emergent, typical peer is going to tantrum and they are going to persist and, and ask for the same thing over and over and over again.
And I think we often forget, at least, you know, in my, in my clinical world, forget. Oh, but you know, constantly having that backdrop and comparing to the backdrop of what you would expect in typical development at a certain level can really change the way you problem solve when, when you're trying to either write goals and objectives or train communication partners.
Um, it's a really good check and balance. At least I think for me in my clinical work, in terms of problem solving, when, you know, there are other ancillary issues related to the expressive language stuff,
Amy Wonkka: I just wanted to comment on the receptive language [00:23:00] piece. And I'm going to say I'm one of those people who was, who was told don't use the age equivalent.
And I think that that's such an interesting point number one. So that's probably going to shape my practice moving forward. So thank you. Um, but, but also just don't forget about receptive language and that's something that I have been guilty of and I'm sure there are other people listening to this podcast who, when we, when we focus in on AAC, it becomes like 80, 20 expressive emphasis.
Right. So, so kind of back to Cathy your earlier point, look at your goals and objectives and see are they in line with what you would be targeting? You know, if you, if you didn't have this AAC layer on top of it. And I think that's another piece where we may see that mismatch. We might see, oh geez. Of course we would have receptive goals and objectives because when we did our receptive language assessment, we identified all of these areas that, you know, we [00:24:00] want to target.
Um, and we sort of forget to do that. So I think that that's another piece, just kind of back to that first learning objective. It's not a developmental model, just in terms of expressive communication. It's a development, it's a developmental approach for language umbrella.
Jennifer Kent-Walsh: I think that time that's taken and really looking more depth at the receptive language.
So whether that be through a standardized test or further probing, um, et cetera, that that really can push us away from just focusing on the vocabulary, excuse me, that the child is using for example, and really forced us to think about all of those domains of language and how we're going to help these kids transition and continue to progress.
So if we just take it from, for example, sometimes what, um, might be shared with us about these are the words that the child uses, for example, which is very helpful, but that's not the full picture. So if we take that [00:25:00] time to delve in a little further, as Cathy was mentioning, in terms of the actual assessment of the receptive language, we start to immediately sort out and look at, okay, what are some appropriate goals?
And next step in all of these different areas.
Cathy Binger: And just to piggyback off of that, um, the, there are lots of ways to look at, as Jennifer was saying, there are lots of ways to look at receptive language. So I talked a lot about those normative, the not using normative data, but yeah, there's all kinds of, you know, you can make your own probes up.
You can use dynamic assessment which you guys have talked about in the podcast a few times previously, and we've done a little bit of work in dynamic assessment as well. And it's really informative to do that. You know, basically using a teach test, teach, test approach, to see and get a feel for where kids are.
And you have to be really careful with that with our kids who use AAC. I mean, we need to do it, but there's gotta be teaching in there and not just the testing because. [00:26:00] You know, kids, aren't walking around seeing lots of people using AAC all the time and it's, it's new to them. And even if it's not new to them, it's still, they're not getting the same kind of input.
You know, it's just, there's a lot of different stuff. So we need to be doing teaching with them to make sure that again, like, are we measuring behavior? Are we measuring unfamiliarity with symbols or are we really measuring receptive language and expressive language? So having enough exposure, interactions, prompting, et cetera, and taking the time to, and, you know, using it, not just as an assessment session per se, but throughout intervention that we're constantly assessing.
We're constantly learning something new about these kids, these complex kiddos, um, to see where they are and make sure that we're have a good understanding. And how many times have we all been surprised at, oh my gosh, I had no idea this kid could do this. Right. But we need to be open to that and looking for that, um, all the time.
Kate Grandbois: And what you're saying is making me think about you sort of going back to an earlier point in the [00:27:00] conversation, the, how this ties back to our goals and objectives and how we write our objectives. Um, in term, you know, objectives are really that connection between our measurement, our assessment and our intervention.
And, um, you know, how looking through that lens again, having that extra thing there on the table, how is that going to impact your objective writing and your goal writing for both short-term and long-term
Thinking about goals and objectives and our second learning objective, what are the language domains that you think really need that clinicians really need to reflect on when they're considering both short-term and long-term goals and objectives?
Cathy Binger: So one of the things that, um, we've seen so much, and I think others have as well is the fact that, um, there tends to be a really heavy emphasis on pragmatic skills and, you know, and all those [00:28:00] social skills and those, those things are really important.
Things like turn-taking and, um, and all the rest. And, um, and the, and that's both in clinical practice. And we also see that in the research literature, that there's been a lot of evidence showing, you know, different ways that we can enhance those social interactions using AAC. And that's all really important.
And there are also, again, going back to that typical model of language development, um, the other domains come in really early on. Right. Um, so pragmatics comes first long before kids say their first words. They're refusing things by throwing things they're, um, showing interest in things by smiling or reaching out.
They comment by holding things up and vocalizing, they hold up something fun and look at dad and want to, you know, as they have early joined attention and want to have a shared point of reference and kids do that [00:29:00] sort of stuff, um, without words, and then also requesting of course, too. And that's probably the, the, um, pragmatic area that people tend to hit up the most in AAC.
Um, I think for lots of reasons, um, but that's just one piece of things. So, you know, within pragmatics we need to be looking beyond requesting very early on for a lot of the kids we work with. Because again, in typical development, kids are doing those things before they ever even say their first words. So one point of it is blowing up the pragmatic realm.
Um, and then, okay, let's look at the, at the next domain that comes in. Well, the next domain that comes in is semantics. When kids start saying their first words or, you know, understanding their first words, we were talking about receptive language and then using their first words. That's the semantic domain and this amazing, amazing vocabulary explosion that kids have.
Again, both in terms of receptive and expressive language. Um, kids just [00:30:00] love learning words. It’s so fun and exciting to have new words for things. Um, I used to have this great video of this kid who was going through a grocery store, just like pointing and everything, and he's in the cart and mom's pushing him and he’s saying, what that, like, what's that what's, that what's, that what's that and wanting labels for everything. They want to know what these things are called. They don't just want to use general words. Um, you know, kids playing with vehicles and the two cars are running into each other. Is it fun to just say go, no, it's fun to say crash, like crash is a really fun word and being able to have that word and use that word is really inherently motivating for kids.
And they're just sponges for vocabulary. And, um, it's easy to, you know, so, so that's, that's a whole do-, huge domain in and of itself. Like all the different parts of speech and kids are using all the different parts of speech very early in development, even things like articles. [00:31:00] Um, you know, people tend to throw those out and not worry so much about words like a and the but the next book you read, try either deleting every, a and the, in the sentence or switch the words a and the, in the sentence, and you will realize very quickly how important the articles are.
They're very important to communication. They specify definite versus indefinite references. Um, and kids use those super early in development. Um, so you know, so that's semantics. And then when do we hit syntax? We hit syntax and typical development at about 18 months. When kids start combining words, 18 months.
Right. We're talking about babies here and they’re combining words. And, um, so that's, and then very quickly learning, you know, that kids tend to combine words and rule-based ways very early on. I mean, right away, they, they, they are using rule-based utterances. They don't tend to mix up word order and spoken language and they get that and they start learning [00:32:00] those underlying rules of how can you combine words?
And it means something different to use these two words, three words in this order versus that order. Um, I'll give you a quick example from a study that Jennifer led where, um, we taught kids to use sentences such as, um, she's in Orlando, so they were Mickey mouse characters. So like, um, Mickey pushes Goofy versus Goofy pushes Mickey.
Those are two completely different things. Two completely different propositions there. I think they were. Um, is Mickey singing. Mickey is singing. They're the same three exact words, but one's a question. One's a statement. That's syntax. Like you're not, if you have the same three words, but you order them in different ways and it means something different that’s not semantics anymore. The kid knows is and making and sing, but learning that when you put words in a different order, it means something completely different. That's really important. Like again, kids are doing that really early in development. So focusing on [00:33:00] syntax early, um, is important. Okay. So we've got pragmatics, which we need to look at broadly.
We've got semantics, which is super exciting and really important with all parts of speech. We have syntax, which is building those utterances and learning how words should words behave and what they mean in different placements within the sentence. And then we have, um, morphology and specifically gram, um, specifically grammatical morphology, right?
Um, bound grammatical morphemes in English like plural S third-person singular S possessive S progressive ING past tense, E D and then the ones we don't talk about as much, ER, and EST like fast, faster, fastest. Those kids are using those really early in development too. And, you know, they are super important, like the verb morphology in particular, it sets a place in time.
Am I talking about now? Or am I talking about something that happened in the past? Am I talking about something that's happening? That's in progress or something that's more [00:34:00] static. And though that verb morphology or is huge, those are huge cues. And the thing I think about one of the things I think about a lot, is why is it the kids get these so early in development, they get them because they're useful, right? Nobody's teaching them on a meta level. Oh, you just use a present progressive ING now that's, you know, like, no, like that's not what a two and three year old is doing. They're using it because they hear it.
It's meaningful and it's important. And it shares critical information. And again, when we're having to make hard decisions about what words we're giving kids access to, what morphology, we're getting kids access to when there's limited real estate, right. And limited number cells on a display, they're hard decisions to make.
Like there's no two ways about it. If a kid's got motor, motoric issues and it's only cognitively so far and can't have access to a hundred pages navigate, you have to make some hard decisions with the team. And we also have to keep all these things in mind while we're making those choices. And, um, just blanketly saying, [00:35:00] oh, like we don't have room for any of that.
So we're not going to deal with any of that. I think we really need to get away from that and keep these domains in mind, keep normal language development in mind and keep constantly. One of the things I've been talking about a lot recently in talks is I'm never going to get it all right, I'm going to miss something.
I'm going to be missing something a hundred percent of the time. The thing is, I want to know what I'm missing. I want to be referring to that normal developmental model, know exactly where the strengths are of the approach that I'm using, know exactly where the weaknesses are and be thinking constantly about how am I going to start plugging in those things in the missing, how am I going to plug in those things that are missing and not just get stuck in one approach?
Um, you know, one approach is always going to get you into trouble in the long run. Um, so that wasn't one, but there you go.
Jennifer Kent-Walsh: Well, I think you're, um, if we just go back to earlier in the conversation, when we were talking about not [00:36:00] getting distracted by the shiny penny or the technology, et cetera, but what, what you're getting into there, Cathy is really the magic of leveraging.
Then some of those features of the technology to be focusing on all of those domains that you were just discussing. So the technology allows us the opportunity to do that. If we're talking about high-tech and again, I want to circle back to it. We're not always using high-tech, but when we are, uh, we can really maximize, uh, those features to ensure that kids have access to all of that, those useful components of language that inherently make sense to them to use.
And in many cases, it really doesn't take that much to get them over the hump to start using them up through the technology.
Cathy Binger: Yeah. And one more piece to tap on to that is what I call the both and approach, right? Just because I'm using, um, one approach, uh, for a percentage of the [00:37:00] day, because it's easy, it's useful. Everybody knows how to use it. I can train a whole bunch of people how to use this one approach, right?
That, that makes a lot of sense from a partner perspective, et cetera. That doesn't mean that's all we're doing. Right? So if that approach is limited, let's say in terms of semantics that their kids only has got at the only kid only has access to so many words. There may be other specific times when we're making sure that we're also working on vocabulary expansion.
Right. And giving kids access to those things. So it's again, it's I get worried when I see folks locked into one and only one approach and not using the technology as Jennifer was saying for all its power to bring in all of those other pieces as well. Um, so I just want to make sure we're keeping in keeping an open mind, looking back at normal development, looking where we're doing a good job and looking where the holes are and, and working toward ways to [00:38:00] fund into fill them in.
Kate Grandbois: One thing that I was sort of reflecting on when you were talking, when you were, you know, reminding us of how much development happens in such a short period of time and how these linguistic constructs are being used, because they're useful. Not because someone taught them how to do things. It reminded me of how messy that period of time is and how many mistakes kids make, um, my son would ask me to spoon things for him and I couldn't understand what, what you want me to spoon your, your, your milk. He wanted me to stir it, take a spoon and spoon it mom. Right. It made no sense, but I figured it out and he made that error for probably longer than he should have. But, but it's fine. And I think sometimes at least in my experience when there is a system, we sort of tend to expect perfection. Um, an example that [00:39:00] comes to mind is recently one of my, uh, students who is an emergent learner, um, relatively small vocabulary size, maybe 25 words kept asking for soup and soup meant cereal and soup meant chili. It was the bowl and the team was, This is an error. This is making a mistake. And I was like, hold the phone, guys. Let's think about this where this child is in their development and kids make mistakes. I also think this speaks to the nuance of the environment when kids make when, when they do make mistakes. So I didn't see my son making a linguistic error and then drill him at the desk with a whole bunch of, well, that's wrong.
And this is how we say no, I modeled it for him. And we talk, you know, we use natural language, um, discourse and modeling and all of those kinds of things and how some of those components and AAC intervention are so important. Not only acknowledging that kids do make mistakes and that's [00:40:00] totally okay, but using those nuanced opportunities to recast and to model and to create opportunities for exposure and pairing symbols and all of those kinds of things, instead of expecting this perfection, you know, because there's an icon for chili, you should know a hundred percent of the time, the difference between chili bean, chili and beef chili and Turkey chili.
Well, that might not be developmentally appropriate. I've sort of gone off on a tangent about my example, but I think I hope that sort of illustrates it.
Cathy Binger: I think that's a great example and it shows this progression of vocabulary development, right? Kids um using that spoon for stir. They're not using the word filing cabinet for stir.
They're using the word spoon for stir. They're using something that is semantic related and they're actively very actively building those semantic networks, which are crucial. Right. Um, you know, linking all those words [00:41:00] together. And how does this word link to that word? Okay. We've got spoon, fork knife, but we also have bowl and we also have eat and we also have lunch and breakfast and dinner.
And we also have mom and dad and sister, cause they're usually around when I'm eating like that, you know, are just so many ways that, that we're we're and we have to, you know, find those contexts, link those things, et cetera. When we, um, don't give kids access to rich vocabulary. And I'm talking, you know, rich forbs, rich nouns, um, as well as the closed, um, parts of speech, like the articles, um, we're potentially stunting their growth, like stunting their semantic development, um, as well as making them want to sometimes, you know, throw their device across the room because they just know they just don't have access to the word that they actually want to say.
Um, so you know, all those things are, are really important to, to keep in mind. Can we, again, the [00:42:00] expectation is not perfection it's expectations. Not that we're going to get it all right. We're not going to get it all right. We're not be able to do everything at once. Um, but knowing where, knowing that the importance of those things, remembering that and seeking ways to bring that into our practice and using the way that, like we see this so much, right.
With our kids who are over, um, using, uh, it's showing, um, good capacity when a child is using a word, that's not quite the right word, but they're still trying to tell you something with their AAC device. Right? You guys you're both have big smiles on your faces. Cause this happens to you all the time. That's like, ding, ding, ding.
Here's a word I need to make sure this kid has. I hadn't thought about this before, but I need to make sure the kid has access to the word stir. Um, because Kate, you eventually, as your child's mom figured out what that was, I mean, you know, is everybody else gonna figure that out? Like, no, they're not. And it may make it's makes for commun, it makes for communication, breakdowns and all that stuff, [00:43:00] as well as, um, not supporting the child's semantic development and there. So I'm going to tell you one quick story about this because this one just like I can get, we'd be thinking about it. One of the, one of the kids I worked with early on, it was actually my dissertation.
Um, he had, uh, yeah, and, um, uh, DiGeorge syndrome. Um, and he was just, he was so bright and he had so much to say, and he just had no way to say it. He was almost completely unintelligible. And his, um, there was someone in his life who drove a tractor trailer truck, and he used to go and he was three and he would go riding around and his relative would talk to him all the time about, about all the trucks.
And he, this kid was so interested in vehicles and all the big, big vehicles, the front end loaders and the bulldozers and this and that. So I went home one night and I made him a page. And I tell you, I learned a lot that day. Cause I didn't know, there was such thing as a sleeper car. I made him a page with all these different vehicles and I didn't know [00:44:00] the difference between a front end loader and a bulldozer.
And at this point I can't say that I do anymore either, but anyway, um, you know, I had all these other vehicles on it and I took that, that display and to him the next time I saw him, I have never seen a happier child in my life. I mean, I thought he, he just came jumping. He was like jumping around the room.
He was so excited and, and his, uh, one of his family members was in the room and he was just like hitting the buttons and, and hitting the cells and making them talk and looking at his grandma and jumping up and down. I mean, vocabulary is exciting and motivating for children. He had been trying to tell stories and wanting to differentiate at age three, between a sleeper car and a bulldozer.
And all he had was. Like he couldn't do it. And so it's limiting his narrative development, right. Wanting to tell these stories. So that stuff is so, so, so important,
Kate Grandbois: But also hats off to you for identifying vocabulary that was meaningful to that little person's perspectives and values. [00:45:00] And I think sometimes we get stuck in this.
Well, these are the top 25 words that you need to know, because I say so, or these are the classroom words that you need to know, because I say so, and then we so quickly fall into this trap of, because there's this extra thing that we need to teach you in this really structured way. The thing becomes, becomes equivalent to sitting down and working in my classroom or sitting down and working somewhere else instead of language, which is fun and socially connected.
And, you know, I think that at least in my experience, I see, I see that a lot and this tendency to choose vocabulary. That we have assumptions about instead of axle wheel or I don't know, brakes, other, whatever, you know, vocabulary is relevant and reinforcing and empowering to that individual,
Amy Wonkka: Which is what we would do again, just going back to, if we saw [00:46:00] a student and we were working on their oral speech, um, those are some of the same principles that we would use to guide our sessions.
So it's kind of just this continuous theme. Uh, you know, I think in listening to everybody. Another piece that's important for me is just thinking, not only in the moment of where you're writing the school and objective for right now, but also part of how we learn and develop these bigger concepts. Like I, you know, I think about just temporal relationships.
How do you learn about and develop a construct around temporal relationships? If you don't have any morphology or words to talk about time, how are you going to better able to refine your ability to generate a narrative or, you know, answer questions about time? Um, similarly back. Cathy, you were just talking about the importance of incorporating all of these different domains in our consideration of our goals and objectives [00:47:00] that also connects completely to literacy.
If, if we're not working on these skills, now, if we're not teaching you that you can invert your syntax and create a question, then how are you going to be able to do that when we're asking you to do it in literacy, if you can't do it in your oral speech and Kate and I have had a number of really super interesting conversations on this podcast with folks about literacy, but you know, a prevailing theme is that we typically see those skills in oral communication before you're able to demonstrate them through literacy activities.
So all of these skills, aren't even just about like the here and now in this moment as a clinician, they're also important for future access for our clients. So just, it's just such cool stuff.
Cathy Binger: Yeah, all this stuff, excuse me, all this stuff builds on each other. Of course it cause, cause that's what happens in development.
That's what happens in life and remember literacy development as part of language development. Um, so we, this is just the [00:48:00] progression of, of how it goes in the, if we're going to violate that normal developmental model and leave off something completely, we better have a darn good reason for it because typically, developing kids do all these things because it's really useful because it's really important because it's meaningful to their lives because it's a way for them to connect more with, with everyone. And, um, I think one of my prevailing thoughts when I see a three-year-old kid walk in the door, the first time is how can I help this kid go to college?
If he wants to go to college. Right. And that means building those early language skills, um, to the best, that child's ability, helping them to meet their potential wherever they are. We're not just talking about kids who are intact, receptive language and not everybody wants to go to college. So, you know what I mean, though, like really to just help them meet whatever their potential is instead of shortchanging them.
Um, and I just time and time again, I just find coming back to that developmental model, being a great driving, [00:49:00] driving force.
Kate Grandbois: I have a question that's sort of, um, it's, I'm wondering if it's going to transition us into our third learning objective just about the evidence for this. So, you know, I know you guys are researchers, you’re PhD, you know, you've spent the last, however many years reading and submersing yourself in, in the literature for these kinds of things.
What can you tell us about the evidence, um, and reasons for semantic and grammatical development?
Jennifer Kent-Walsh: Well, as Cathy was saying, the, the literature is, um, has been far more focused or there's a history of it being more focused on the pragmatic types of outcomes that relate to intervention. But now we're seeing more of an explosion, um, in this area. And we're looking at interventions that really can help these kids to continue to progress in all of these areas.
And of course, we're, we're spending a lot of time right now, focusing on, um, [00:50:00] grammatical, uh, interventions and in our research. And we are seeing young kids and kids with varying receptive language profiles, continue to make progress. Um, so we can do this through some focused interventions in working on, and you all talked about all of the different types of, um, cueing and modeling, et cetera.
You know, all of those techniques that we use to make sure that these kids are getting illustrations of what is the next logical step, um, in their, in their expressive language development as well.
Cathy Binger: Yeah, we do see this growing literature base and, um, there've been a couple studies done with kids with really significant impairments and teaching them how to combine. Um, Chris and Tom seems done some of this work where she's from South Africa and teaching kids to combine, um, early two word utterances who have really significant impairments and his was really truly complex communication needs and, um, you know, teaching them [00:51:00] the difference between, um, or that it's important to put the action before the object in English, for example.
Right. Um, and, uh, and then some of, you know, some of our work doing similar stuff as well, and then we've done some work looking at, um, it was a little bit older kids looking at grammatical markers in particular. We did a study a number of years ago now with elementary school aged kids and teaching them to use each of them to use three different grammatical markers like plural S, or ING, et cetera.
And nobody had expected them to do it. So it didn't really take that much intervention to teach them how to do it. Um, so, so a lot of this is about expectation. Um, some of Gloria Soto's recent work, um, on narratives that's come out and just the past few years has really, I was just looking at this literature recently.
And, um, to me, one of the underlying messages of that work, where she focuses on kids, I think maybe starting at six up to maybe [00:52:00] 21, I might be getting that wrong. But you know, there are a lot of older elementary school aged kids, as well as middle and high school aged kids. And, um, they're teaching these kids to not just, you know, well, they're looking at narratives, but they're also looking at causal structure and, and to see the changes that these kids.
In the short amount of time that they're doing their intervention, just screams to me how these kids have been underserved. If they can do it today, they would have been able to do it yesterday and nobody had this expectation for them. So there's a strong growing literature, including the work that Jennifer and I have done with our colleagues that time and time again, shows that with, you know, we're talking about kids who are symbolic, we're talking, you know what I'm talking about, kids who are pre intentional, who are trying to throw a bunch of symbols at and who don't have joint attention yet.
Um, we're talking about kids who are, who are symbolic, um, who have good, you know, um, receptive symbolism [00:53:00] and with access and some instructions, some growing, um, expressive symbolism. So, you know, our three-year-olds with down syndrome who we're working with right now. I mean, these kids have so much potential to learn so much more language than we're giving to them.
And we're talking about kids often, especially the kids that, you know, Jennifer and I work with. These kids are a ways from being literate enough to use their literacy skills to achieve these ends. Right? Like, you know, they're a ways from being able to type out a sentence letter by letter saying, you know, Mickey is singing is Mickey singing, but they need these things early on in development.
Again, back going back to typical development, kids are doing these things long before they have enough literacy skills and, you know, second, third grade, if they're typically developing to be able to have enough of those skills, to really use language in that flexible way, this is happening way, way, way earlier in development.
And what we're finding is that a lot of kids can [00:54:00] use picture symbols and learn what they are and learn, um, I want to talk about the theory here for a, for a minute, cause I think it's really important like that. Um, with a lot of the kids that we're talking about here. And again, I just want to stress, we're not just saying that kids with normal and receptive language with kids with impaired, receptive language as well, who need a, who have profound speech impairments.
They have a lot of language in their heads. There's a lot of stuff that's gone in that they have locked inside their heads. And this is in a way as much as the bigger point is look, you know, it's really helpful to go back to what we know about language and using normal language, developmental model, blah, blah, blah, blah, blah.
Um, that what we're actually trying to teach these kids in some ways is quite different. And it's much more efficient because with kids with spoken language impairments who have intelligible speech, and we're just working on spoken language, we're teaching them these new structures, right? They're not using progressive ING or past tense D because they have a language impairment.
That's your kids with [00:55:00] spoken language impairment. Our kids may well have been using past tense ED and progressive ING, but they're not because they can't say it and they don't have another way of getting out. And so a lot of these kids have a lot of this language in their heads. And so the task isn't to teach them a structure that they don't know how to use necessarily the task is to take the language that's in their head and to give them a communication mode where they can get it out.
Right. And if that's the case for some of these kids, if we give them access and proper instruction, they should take off pretty quickly. Um, and, and we've seen kids take off incredibly quickly. Um, we published a study a few years ago, um, where we had, uh, worked with 10 kids who are three and four years old, um, mostly four, but a couple of three-year-olds and we're teaching them these specific linguistic structures.
And one of the ones we were teaching was, um, possessives. [00:56:00] And so there was a, you know, there was an S on the display for them to use. And so we would do, you know, I always use, I don't know why I always say mom shoe, but, you know, dogs, dogs, bowl, dogs, shoe, whatever. Um, it doesn't matter. But, you know, the only expectation I had initially was for the kid to say dog bowl, right.
And not with the apostrophe S in there. And these, especially the four year olds, they didn't like the way it sounded. They were getting the voice feedback. And it would say dog bowl, they found the S and they started using the S with zero instruction from me, I think all the four year olds, at least once use that S appropriately before I ever showed them one single time, how to do it.
And they, and once they did it, they were like, oh yeah, finally, it sounds like what I wanted to sound like that til they have this. Um, notion in their head, this, um, uh, the right term for it, but they, they know what it is that they want to say and that they haven't ever had another way to say it. And now they finally do with [00:57:00] this device and they're seeking it out and finding it and doing it.
So now that's unusual. I mean, you don't see that a ton. We do need to do all together instruction with the tons of modeling and all the other great things that we do, but it's just like that story to me, the lesson in that to me was kids want things to sound the same way that everybody else sounds right.
They want to put those markers in. They want to be clear. They want to, they want to have access to those things so that they can get their point across. Clearly.
Jennifer Kent-Walsh: It's another illustration of underlining the expectation for, um, continued growth and in their expressive language use. And just, we can be surprised, um, others who we're working with their, their, um, other therapists, family members, et cetera, they can be surprised as well.
Um, and sometimes it'll take more work than others, but we really limit ourselves when we don't have that expectation consistent in our minds.[00:58:00]
Amy Wonkka: I also feel like for me listening, it just brings back the importance of kind of doing that ongoing assessment component too. Um, you know, as someone who's, who's done a lot of work with AAC clinically. I think that. You know, it, it feels, I don't want to say easier, but it, but it feels more predictable that transition that you're making, looking at those early pragmatic functions and moving from a pre linguistic, um, to early symbolic communication.
Right. And, and sometimes what you guys are talking about is like that next step jump is a bit more challenging as a clinician sometimes to remember, oh yeah. Now that we can do all of these things, we need to continue to push forward in all of these different areas, whether that's syntax, morphology, vocabulary, really, it's all of those things.
Um, but keeping all of that in mind. And it does, you know, as the communication partner, especially maybe if you're someone who isn’t super [00:59:00] familiar with the aided system that you're using. That also feels a little bit scary. So I think there's, you know, for the clinician takeaway, there's the piece to be aware of how impactful this is, whether your client is someone who can maybe just pick it up and run with it, which is super exciting in your stories or someone who you're going to need to do a little more instruction, but also don't let maybe your discomfort with knowing the best way to navigate the system or knowing where to find those morphological markers or whatever.
Don't let that be a barrier either, you know, get comfortable with those pieces yourself. So that once you've made that transition from those early symbolic communication skills, you're ready to move forward with your client into the next kind of phase.
Cathy Binger: Yeah. And, and to me, Amy, um, one of the things I think is really comfort, can be comforting for SLPs is, is that we know language like when we come back to this, um, it takes some of the [01:00:00] pressure, hopefully off of that thing, off of that device. And let's when we have our starting point, the language, this kid in front of me, just like every other kid I've worked with. Right. They're not so different in what we're going to do is not so different. How, okay. I got to figure out the technological stuff.
Not, I don't mean to just poopoo that and say like, that's not, that's not a challenge sometimes. Of course it is. Um, but that's the, that's not the point. The point isn't the learning of that is that I really, you know, we know language, we know language development, we know goals and objectives for kids who have language impairments.
And so by bringing all of that into my practice with my kids who need AAC hopefully a big part of that burden of this is so different can start to fly out the window and oh yeah, I do know this. We just got to figure out how to access it, but that's an access issue. But gosh, yeah, there's actually a lot here that I do now.
And I think that's really, that can be really empowering.
Kate Grandbois: I, we've [01:01:00] covered so much throughout the course of this episode. And I wonder in our last minute or so, if you have any parting words of wisdom for our audience, I feel like what you just said was very empowering and inspiring. Do you, and I'm 1000% sure you have some more nuggets in there.
I just want to make sure you've been given an opportunity to get them out.
Cathy Binger: Well, uh, I guess the last thing I would say it's more in synopsis, which is, um, a framework that I find to be super helpful is looking at what are we doing well in terms of language development right now with this child, looking at it from a broad, developmental perspective across domains, what are we doing well, and what's this child doing well.
Where, which domains have we not been thinking about? Where have we not incorporated enough? So where are the gaps? So what are we doing [01:02:00] well, where are the gaps and how can we start as a team to fill in those gaps so that we can provide children with the rich language experiences that they deserve so that they can achieve their full communication potential.
Kate Grandbois: We're air, high-fiving you through the, through the video screen. Um, Jennifer, do you have anything to add?
Jennifer Kent-Walsh: I think that's the perfect summation right there. I mean, we're, we're really looking at that functional communication as, as the outcome, not checking off boxes on a standardized test, et cetera.
It's really, how are they able to communicate in their everyday environments and how are we able to facilitate those every day? Changing in an appropriate way and then becoming increasingly independent in those environments.
Kate Grandbois: Thank you guys. And more air high fives, just all the air high-fives. [01:03:00] Um, thank you both so much for joining us today.
We, as we always learn so much from, from both of you in your written work, and we learned so much from you both again today, um, here. So, um, if you are listening and you would like to use this episode for ASHA CEUs, you can do so at our website, just go on over to www.slpnerdcast.com and find the episode page.
There is also a link to earn CEUs in the show notes. We mentioned a couple of studies today, um, and a few, um, bodies of literature. We will have links to all of those in the show notes as well. So if you feel like doing some additional nerdy reading, they will be easily available to you. Um, thank you again so much to our amazing guests and it was lovely to see you guys.
Cathy Binger: Thank you. Thanks so much. We really appreciate it.
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