Category: Speech Therapy


This post is hopefully the start of an open dialog among colleagues about Auditory Processing Disorders.  I have had this post in draft mode for some time and it’s almost the start of a larger post but due to the recent discussion on twitter about Auditory Processing Disorders I thought I would post this. ( I am by no means an expert in the matter and this  post is merely to get people thinking.)

I recently became aware of the controversy over Auditory Processing Disorder. Are you aware of this controversy? It’s apparently very similar to the argument against non-speech oral motor exercises. There are basically two camps on this topic- audiologists/slps that believe that this is a true disorder and SLP’s that insist that APDs simply do not exist and it really all involves a weakness in the individual’s language skills.

This past November at the ASHA convention I sat through two very different talks about Auditory Processing Disorders. The first talk was titled A Speech Pathologist’s Guide for Interpreting the Auditory Processing Evaluation and was given by Velvet Buehler who is a  dual certified Audiologist and Speech-Language Pathologist. She who discussed  how to properly interpret an auditory processing evaluation as well as what the course of treatment looked like. After this talk I felt good that what I was currently doing as far  as assessment and treatment was on par with what this speaker was presenting.  However I then walked into a talk titled What Speech-Language Pathologists Need to Know About Auditory Processing Disorders. The presenters for this session were Alan Kamhi and Geraldine Wallach.  Their stance on APD is essentially that it doesn’t exist and cite their research with the following quote:

“Because there is no evidence that auditory interventions provide any unique therapeutic benefit (Fey et al., 2011), clinicians should treat children who have been diagnosed with APD the same way they treat children who have been diagnosed with language and learning disabilities. The theoretical and clinical problems associated with APD should encourage clinicians to consider viewing auditory deficits as a processing deficit that may occur with common developmental language and reading disabilities rather than as a distinct clinical entity.”

They started their talk off with some real life examples that really made sense at the time. One of the examples was about a woman who who was in a German bar. She was learning the German language and could partake in general conversation however in the bar it was very loud and she was having a very difficult time understanding the other people speaking in German to her. She asked if they spoke English which they did and as they spoke to each other in English she found that she was able to now understand everything that she heard. So what was the difference here? Well the difference was that she had a weak foundation in German and had trouble filling in the parts that she had missed due to the loud environment  This makes lots of sense right? If she was weak in the language she was learning then she couldn’t keep up with the conversation as quickly as she would with her native language of English.  This whole example really started to make me question the earlier session that I had sat through. Was APD really based on some shotty research and questionable auditory intervention techniques?

A few weeks later I was at a  pizza place with a group of friends. This was a Friday night so it was busy and very noisy inside. A friend of mine was in line ordering the pizza for us. We ordered Sausage and Meatball pizza however the cashier taking the order was standing in the kitchen and was having difficulty hearing the order. She asked him to repeat himself a few times and finally questioned his order with “You want a sausage and people pizza?”  Yes you read that right, she asked if he had ordered a pizza with both sausage as well as people on it. Last time I checked  Soylent Green was against the law (Insert funny Charleston Heston joke here —>) So what happened here ? You would think a grown women would have at least the language skills to complete the auditory closure task of I’ll have a  sausage and ________ pizza, right? or does she really have some auditory processing deficits and instead heard people.

I’ll end with this blurb from a study that McArthur and Bishop conducted hinting at the fact that there are components of both language and auditory processing deficits in play.

“McArthur and Bishop (2004b) also found that a subgroup of children with specific language disorder showed difficulty on auditory discrimination (consistent with the view of APD as an impaired skill) and poor reading. Another subset of children inMcArthur and Bishop ’ s study had poor sustained auditory attention and/or auditory memory as well as APD.”

What are your thoughts?

Here are some t-shirt ideas for the upcoming ASHA convention-#asha12. I wore a #slpeeps t-shirt, similar to Design A, to last year’s convention. This is a result of a recent twitter conversation with various #slpeeps, so I decided to throw a few designs together using so we can take a vote on what designs we like the best. I went with long sleeve for the first couple designs because I figured we would be in Atlanta in November and chances are it will be pretty cold.

Design A ( I wore a black short sleeve version of this last year)

Design B

Design C

Speaking of Apps

I would like to invite all my readers to check out a new weekly blog that I am a part of!

About Speaking of Apps

This blog addresses the use of touch-screen technology for Speech-Language Pathologists working with clients of all ages. Learn about great apps for language, speech, cognitive-communication, and dysphagia as well as AAC and support apps for adults and children with acquired impairments. Reviews, therapy ideas and recommendations of apps are paired with tips and tricks for using the technology to enhance therapy and professional life. We can all learn from each other as we navigate this exciting new technology together!


Conversation Coach

Conversation Coach by Silver Lining Multimedia, Inc  teaches the user to understand the natural back and forth flow of conversations. Most communication devices typically only allow for one-way conversations, Conversation Coach fixes that.  Conversation Coach comes in a full version for $79.99 and a limited use lite version for $1.99.

Conversation Coach is set up up into three distinct areas:

Talk to a Friend

Make a Statement

Talk to the Computer

Throughout these three user areas the main objectives targeted will be:

Learning to Take Turns

Staying on Topic

Asking Questions

Listening To The Other Player

Expressing Thoughts and Feelings

Organizing Thoughts

Talk to A Friend

This mode is similar to Mobile Education Store’s Conversation builder.  What’s different is you are able to choose from preloaded conversations or create your own.  You can load your own pictures or choose from the picture library that comes with the app.  To “talk to a friend” you will most likely sit across from one another and with the iPad positioned in between.  The app is oriented so players on both side of the device are able to read the messages.  Here is an example of a simple conversation:

“What do you want to do?”

A coaching theme is used to ‘coach’ the conversation. A player selects the appropriate response and then passes the ball to the other player. A quiet symbol, a charter making the ‘shh’, sign prompts the other player to stay quiet while it’s not their turn to talk. These prompts can be turned off in the settings once the players understand the rules or simply do not need prompting any longer.  You can choose what the  background looks like as well as you will see later on in the post.

Conversations can be customized for each student’s needs. You can also select which conversations are available for a particular student.

Here is the main Conversation Topics Menu

This is an example of how you would edit the flow of the conversation.

Talk to the Computer

This mode allows a player to practice 2 way conversations against the computer.  This mode works pretty much the same  as Talking to  Friend does but the computer randomly selects questions to ask, then the player is presented with appropriate response choices. You can also choose the ‘conversation’ for your student/client. This mode is nice for teaching children with autism to script appropriate conversations. You can also use this mode for quizzes. Here is an example of a quiz.

Make a Statement

This mode is similar to using a communication device. Players are able make requests and comments. Statements can be any combination of text and pictures. Submenus can be programmed to appear after a player makes a selection. In this section you have a lot of variety you can choose from. You are able to use it somewhat like a traditional AAC device using category based menus, you can use it to make visual schedules, and participate in scripted conversations with your conversation partner or “coach”!  Here are some examples :

Initial Topics Menu

Preload Basic 2-way convo

Initial screen on basic 2-way conversation

Simple choice board option

Options to make visual schedules

If your work as a speech language pathologist involves children, you most likely spend at least 48 to 52 hours a year with each client and their family, depending on the setting where you work – school, clinic or in the home. Most families I work with have had their children in therapies for years and they know the drill and the questions to ask. But what about those families who are new to having their child in speech therapy, or parents experiencing therapy burnout? Here are five quick tips to help educate your families with children in speech therapy:

Get personal.

You spend time on building a case history for your client, but how often does a client inquire about you as a person or professional? Give them some details! Invite them into your world and hopefully they will do the same. Too often, I think parents feel they are on some sort of therapy assembly line. Help break this pattern for them!

Show your credentials.

Help educate families about your education. Some parents have drilled me on my experience and education before therapy begins. Others don’t ask a thing and blindly walk into the session because their doctor prescribed therapy. Don’t read off your college transcripts here, but help the family better understand what you are trained to do and why they and their child are there.

Explain educational differences.

Help educate caregivers on the differences between who could potentially be working with their child- speech language pathologist assistant (SLPA) versus an SLP. I have had parents who only want to have their child to work with “the SLP,” which is a valid request, as most times they are paying good money for therapy. So give them a quick breakdown on the main differences between the two.  The main one being the schooling for an SLPA, which can be an associate degree or a bachelor’s, compared with the SLP’s master’s degree. The second difference is what an SLPA can and cannot do, which may be news to parents. SLPA’s can perform screens, provide therapy following a written plan by an SLP, help document and schedule. SLPA’s cannot give tests or interpret results, write or change a treatment plan, counsel clients/families, provide treatment without access to a supervisor or work with dysphagia.

Let parents know you are a team!

Whether your job is writing an  individualized education plan (IEP), an individualized family service plan (IFSP) or just developing a treatment plan, let them know they are part of the team! Their input is greatly needed and appreciated and parents should be invloved in helping to tailor their child’s goals.

Expect participation.

SLPs do not possess a Magic Therapy Wand that will fix and cure all delays and impairments. We are certainly not glorified babysitters. Parents or caregivers should expect to actively participate in the child’s therapy session! We certainly cannot magically fix our clients, but we do offer our expert knowledge and training – that when paired with a parent’s hard work outside of therapy can come mighty close to a magic wand.

A few years ago if someone asked what type of speech-therapy tools I used with my patients, I would often tell them: dolls, blocks, bubbles, balls, flashcards and such. But now I typically tell them it’s the iPad. The topic of ‘iPad’ is currently huge among speech-language pathologists. Try reading through blogs or forums without seeing whole threads or discussions dedicated to using the iPad during speech-language therapy. So what are the benefits of using a tablet over the traditional materials?

10)  Developers are constantly improving apps, so the apps can evolve with your client.

9)   Regardless of the child’s age or ability level, the iPad can be accessible through voice or touch.

8)  Apps can easily be incorporated into playing, reading, writing, spelling, grammar, songs and video.

7) Many apps offer free or ‘lite’ versions, so before a therapist makes a big purchase they can sample the program’s features then determine if it’s worth the money.

6 ) There are many apps that offer the ability to record a child’s productions to save for later comparison. With this option, you can allow your client to do self-rating and go back to double-check their speech.

5) Parents can help their child participate in school lessons to reinforce education at home, and games and activities can draw in friends and classmates, eliminating isolation.

4) Apps that are skill-focused often make great tools for quick criterion-referenced assessments or dynamic assessments of a given skill, without needing to prepare lots of supplies ahead of time.

3) The data-tracking capabilities of app-compatible devices allow therapists to focus on the task at hand. You can then email the session data to the client’s caregivers or yourself to include in SOAP notes.

2) Apps can target apraxia, articulation, language, play skills, pragmatic skills, functional communication and more – all in one device. No more lugging around 12 different sets of flashcards.

1) iPads are cool! Many of my clients, children with autism, could care less if I took out scissors, paper and crayons – and most of the time these end up on the floor. Children are simply more motivated by interacting with the iPad than paper–and–pencil activities

Have other reasons?  Should this be a longer list? Please leave your suggestions  in the comment sections and I’ll make an updated list !

Become DJ SLP

Falling Stars by Trident Vitality

Here is an app that my mom, a COTA, recommended that I check out. I checked  it out and I have been playing around with it most of the weekend. It’s quite addictive and creates very catchy beats and of course the best part is that it is free.  It is app put out by Trident Gum, yes a gum company. It’s easier to actually show you what this app does than attempt to explain it to you so press play on the vid below and enjoy.


Therapy Applications:

I haven’t used this in therapy yet but I think my main use for it will be motivating my clients. I also think it will come in handy with children with autism and sensory needs. I can see it being used to rev a child’s “engine” up or down depending on what kind of sensory needs they have.  It would make a nice metronome-ish background music to keep a client on task. There are probably even some language applications like ‘long’ vs ‘short when making the different vines.  Occupational therapists can work on forming letters, copying patterns, etc..

Story Lines

Story Lines

Story Lines is the old fashion game of ‘telephone’ that has been appified with a pictionary twist to it.  Someone selects the word or phrase and then passes the iPad to the next player who in turn has to draw the phrase, they then pass it on to the next player who has to label it. The game can be played with 3 to 9 players which makes it a great app for use in language groups. I have been using this app with my older clients and esspecially my social group that has a few teenagers in it.

What can you target with this app?

  • social language- using social scripts and having them draw it out
  • figurative language- discussing what the literal and figurative meaning of the phrases are
  • vocabulary- using targeted vocabulary words in phrases or sentences
  • articulation- creating phrases or sentences with target sounds for them to draw and repeat

I have found that its a great tool for teaching that abstract figurative language.  The student has to interpret what the phrase means by analyzing the literal and figuartive interpretation and then has to represent that by drawing it.

Here is an example video using the figurative term ” It’s raining cats and dogs”

This is a free app that comes in two versions:  Story Lines and Story Lines for Schools.  The Story Lines for Schools has built in Suggestions- pulling ideas from Elementary Words, Intermediate Words, Quotes, and SAT Words.

The coolest thing about this App is that you are even able to use it as an “app” right from your Chrome Browser. So if there are still those of you out there that has yet to take the plunge and get and iPad  well then pull out your laptop because you can use this too!!

Chrome Link:

Upon entering the field of speech-language pathology, I certainly didn’t expect to become the next millionaire, but I did expect to be able to live very comfortably.

In a recent post on an SLP Facebook page, a young lady inquired about the average annual salary for speech therapists. She was inquiring because her parents were discouraging her from entering the field as they didn’t think she would make ‘good’ money once she graduated. Having spoken to a number of SLPs from around the country at the 2011 annual meeting for the Association of Speech–Language–Hearing Association (ASHA), the average salary seems to vary greatly from region to region and per setting.

So let’s prove those parents wrong and take a look at salaries. National surveys by ASHA break down salary information between two settings: healthcare settings and schools. Both reports look at salary expectations by region, setting and experience.

Key findings from the 2011 ASHA Health Care Survey:

  • Median annual salary was $65,000 for clinical service providers and $90,000 for administrators.
  • Median salaries varied by region; for example, $65,000 in the Midwest and $80,000 in the West.
  • Experience pays. The median salary with one to three years of experience was $58,048; $88,750 with 31 or more years of experience.
  • Median annual salary for private practice owners or independent contractors was $65,000.
  • Rural positions pay more than those in suburban areas.

Key findings from the 2010 ASHA School Survey:

  • Salaries for working a nine or 10-month school year averaged $58,000 in elementary schools; salaries for working an 11- or 12-month school year averaged $65,000.
  • Median academic year salaries for clinical service providers ranged from $55,934 in special day/residential schools to $61,000 in secondary schools.
  • Salaries increased with years of experience. The highest median academic year salary was $78,304 and was achieved by SLPs who worked in secondary schools and had 28 or more years of experience in the profession.
  • New Jersey reported the highest median academic year salary ($80,000); Missouri the lowest ($44,000).
  • Rural salaries tended to be lower than suburban or urban salaries.
  • The median hourly wage was $50.00.

Looking for Your First SLP Job

You have just completed what may have been the most stressful two years of your life – a graduate program in speech-language pathology and now it’s time for the real world. Looking for that first professional job, which in itself is another stressful experience, poses a variety of questions: Where to apply?  Who’s even hiring clinical fellows? What interview questions will be asked?

Seven years ago I searched for my first SLP job, and now I’m doing some interviewing of new candidates. From my real life experience, here’s some help for first-time job seekers:

Where to apply?

This question and your answer depend on the job market in your area as well as what setting you want to aim for. Odds are that if you are in a metropolitan area there will most likely be a variety of jobs open to you across all settings: school based, clinic/private practice, hospital/skilled nursing or home health.  Each of these settings has their own respective pros and cons.


Pros: Summers and holidays off; teacher-therapist collaborations

Cons: High number of meetings; high caseload with lots of paperwork; possible travel time; treated like a ‘resource teacher’


Pros: Enjoyment of working with adults; improved patient progress in an acute-care setting; clients have greater investment in making progress

Cons: Insurance paperwork; limited sessions with patients; low productivity in outpatient settings due to cancellations; long hours


Pros: Flexible hours; cross discipline opportunities; greater impact on client and family’s success; opportunity to specialize

Cons: Large numbers of cancellations/no shows; insurance/billing paperwork; travel time (if home health)

Interview questions to anticipate

Beyond the basic interview questions (such as, ‘what are your strengths and weakness?’) candidates for speech-language pathology jobs should anticipate specialized queries like the following. Also, some interviewers will present you with a scenario or mock client, and then ask for your input about what course of action to take, so be prepared for ‘what if’ questions.

  • What got you interested in speech-language pathology?
  • Tell me about your clinical experience. What areas do you enjoy most?
  • What type of client are you most comfortable treating? What type of client are you not comfortable treating?
  • What do you look for in a supervisor?
  • What level of supervision are you comfortable with?
  • What hours are you willing to work?
  • Are you comfortable conducting group therapy?
  • Are you willing to travel?

These questions are a basic outline of what could be asked and will be more specific depending on your setting, which means you may be asked about IEP paperwork, CTP codes, hospital billing and other documentation.

Questions to ask your perspective employer

  • How much supervision is offered? Do you offer mentors?
  • Is the job salaried or am I payed per visit?
  • Will I get paid for travel time?
  • Will I get paid for cancellations?
  • Is there dedicated time for paperwork? Billing? SOAP notes? Evaluation reports? Progress reports?
  • Do you take taxes out or am I responsible?
  • Is there a supply budget? What type of supplies do you offer?
  • Do I need to sign a noncompete clause?

Good luck finding that first job!

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