Transcript Chapter 14 Fads in speech-language pathology

Fads and
Controversial
Treatments in SLP
Chapter 14 Mareile Koenig & Cheryl Gunter
Lindsey Gallagher
Caldwell College
• Dr. Mareile A. Koenig, Ph.D. CCC-SLP, BCBA, earned her
doctoral degree from The University of Illinois in Urbana, IL.
She is a member of the faculty in the Department of
Communicative Disorders at West Chester University in West
Chester, PA, where she holds the rank of Associate Professor.
• Dr. Cheryl D. Gunter, Ph.D., CCC-SLP, earned her doctoral
degree from The University of Texas in Austin, TX. She is a
member of the faculty in the Department of Communicative
Disorders at West Chester University in West Chester, PA,
where she holds the rank of Professor.
Chapter 14
• Tharpe (1998) “the field of communicative disorders
sorely lacks systematic documentation of of clinical
outcomes”
• Enderby and Emerson (1995) similar claims
Examining these claims
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SLP’s scope of practice
Fads
Controversial Treatments
ASHA & treatment efficacy content
Contributing factors to fads and controversial treatments
Recommendations for SLP in the future
Overview
• Prevention, diagnosis, habilitation and rehabilitation:
• Communication
• Swallowing
• Upper aerodigestive disorders
• Elective modification of communication disorders
• Enhancement of communication
Scope of Practice
Evaluation and Treatment of
Speech & Language disorders.
• Speech disorders
• Impairments of articulation, sequencing, rule-based
production of speech sounds
• Language disorders
• Impairments of form (grammar), content (semantics), socialcommunication (pragmatics) in comprehension/production of
oral, written, and other communication modalities.
Cross-Disciplinary
Collabortation
• School setting, private, both
• Often leads to cross-disciplinary Collaboration
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Teachers
Reading Specialists
OT’s
BCBA’s
• “role sharing” “role release”
• Sharing of fads and misconceptions
• Depends on interests, agency strategies, client need,
school policy etc.,
• Influences intervention strategies
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Sensory Integration
Greenspan
Verbal Behavior
Functional Assessment
Post Graduate Training
• Treatments that are adopted rapidly in the absence of
validating research and fade just as rapidly in the
presence of a new fad or disconfirming research.
• Fads
• Facilitated Communication
• Whole Language
Fads
• Developed by educator, Bilken (1990)
• Presented to SLP’s at ASHA convention and in the
American Journal of Speech-Language Pathology
• After evidence surfaced that authorship was
questionable…
• ASHA, AAMR, and APA published statements that the
validity and reliability remain unproven scientifically.
Facilitated
Communication
• A very damaging, detailed criticism was presented on PBS's
"Frontline", October 19, 1993. The program was repeated
December 17, 1996, and added that since the first showing,
Syracuse University has claimed to have done three studies
which verify the reality and effectiveness of FC, while thirty
other studies done elsewhere have concluded just the opposite.
Facilitated
Communication
• http://www.theeway.com/skepticc/archives15.html
• There have been numerous critics of FC, including Gina
Green, Ph.D., Director of Research at the New England
Center for Autism
• http://soe.syr.edu/centers_institutes/institute_communicati
on_inclusion/Research/authorship_and_controversy.aspx
• http://www.skepdic.com/facilcom.html
Facilitated
Communcation
• Children & adults use the same strategies to read
• Learning to read is like talking
• Phoneme awareness, phonics, spelling and punctuation can
be learned “naturally”
Unsupported
Philosophy of Whole Language
• http://www.youtube.com/watch?v=_Kic9BF
W540&feature=related
• http://www.theatlantic.com/past/docs/issues/
97nov/read.htm
Whole Language:
The Reading Wars
• "Whole language" is the idea that children can and should
learn to read text in the same easy, natural way that they learn
to understand speech -- by being exposed to meaningful
communications in everyday situations.
Whole Language
http://itre.cis.upenn.edu/~myl/languagelog/archives/004261.html
• “There is no simple explanation of whole language… The
framework tends to be quite abstract” Farris and Kaczmarski
cited in Chaney (1990)
• “An instructional philosophy that recognizes the importance of
all areas of language in the acquisition of literacy.” Scholry
(1990)
• Meaning and purpose are the goals of WL
• Lack supportive evidence for many of its crucial components
Whole Language
• Sustainable popularity despite questionable
frameworks, inconsistent or absent empirical
support, limited evidence …”
• Sensory Integration Therapy (SIT)
• FastForWord
• Whole Language in Oral Language Instruction
Controversial Therapies
• “Based on unproven assumption that sensory integration
dysfunction contributes to delays in academic
communication development and that a “sensory diet may
attenuate or reverse a neurological disorder which would
otherwise interfere with learning.”
• Griffer (1999) and Maurer (1999) insufficient evidence to
support SIT as an SLP intervention
Sensory Integration
Therapy (SIT)
• http://www.youtube.com/watch?v=02JlnqUhXeU&featur
e=related
• http://www.youtube.com/watch?v=H0TcXVyORxg
Sensory Integration
Therapy (SIT)
• Auditory temporal processing refers to an individuals
perception of sounds (phones, phonemes, words) in time
• Temporal processing deficits underline
• oral language deficits
• subsequent reading problems
• (in children with specific language and learning disorders)
Based on this theory, Paula Tallal and colleagues at
Scientific Learning Corporation developed Fast ForWord
Fast ForWord
• To help children with language impairments learn specific
auditory or phonological skills that have been related to
acquisition of speech and language.
Aim of Fast ForWord?
• Auditory and visual stimuli
together.
• Seven computer games
(video-game style)
• 3- target discrimination &
memory of
phonemes/syllables
• 4- target vocabulary, syntax &
morphology
• Response based on judgments
of sound, sound sequence,
words, and sentences
What is Fast ForWord?
• Acoustic modification (prompt then faded so person is
responding to natural stimuli)
• Intensive, discrete trial format
• 100 minutes per day
• 5 days a week
• 6 weeks
• Until criterion performance levels are met
What is Fast ForWord?
Friel-Patti, DesBarres, & Thibodeux, 2001
• http://www.scilearn.com/ (overview video)
• http://www.scilearn.com/products/fast-forword-languageseries/language/ (demo)
Fast ForWord
• Research looks good on the outside
• Testimonials are abundant (professional and consumers)
• “This is the only training program I’ve seen in 30 years of
practice that is based in science.” Dr. Burns (SLP who
participated in field trial of FFW)
• http://www.neuronlearning.info/neuron/fast-forwordproducts/
Fast ForWord
Fast ForWord
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3061204/
• Systematic meta-analytic review of the Fast ForWord language
intervention program.
• http://www.txsha.org/_pdf/TEJAS/2009/Comparison%20of%2
0Fast%20ForWord.pdf (pg 56)
• Initial efficacy studies give important information they fall
short of confirming FFW as a effective intervention.
• A large scale randomized clinical trial is needed to assess this
intervention
FFW
• Introduced in 1990 by Norris and Damico
• Alternative to “behaviorism and its fragmentation
methodology”
• 5 “erroneous assumptions”
• 4 recommendations
• WL-O applies normal language development and
recommends that SLP’s use scaffolding strategies for
assisting learner to communicate more effectively
• Broad scope of possible target population although none
was defined
Whole Language in Oral
Instruction (WL-O)
1. Superficial forms of language (sounds, words, grammatical
forms, pragmatic rules) is the goal of language intervention.
2. Teaching parts of language will provide learners with the tools
for functional communication
3. Language must be systematically targeted and taught in accord
with a developmental sequence or a specific functional use
4. The role of the SLP is to enhance language development
through modeling, shaping, and reinforcing correct responses
5. Outward forces, such as secondary reinforcers motivate
learning and maintain a child’s attention to a task
5 “erroneous assumptions”
1. Opportunities for language should develop along the
general to specific, familiar and unfamiliar continuums
2. Theme-based activities to create repeatable contexts in
which learners are motivated to hear and use language
in the creation of meaning.
3. Collaborative activities = multiple functions of
language.
4. Scaffolding techniques
4 recommendations
• Controversial?
• Language is not always learned as a whole.
• Age appropriate vocabulary syntax, pragmatics while
demonstrated speech production that is not age-appropriate.
• One size fits all intervention is not appropriate
• The “erroneous assumptions” are questionable
• No studies have tested the whole language approach with
learners who have wide range of DD
Proceed with caution
• American Journal of Audiology (AJA)
• American Journal of Speech-Language Pathology
(AJSLP)
• Journal od Speech Language and Hearing Research
(JSLHR)
• Language, Speech and Hearing in the Schools (LSHSS)
ASHA & Treatment Efficacy Content
• Failure to adopt a scientist-practitioner model
• Absence of conventional clinical code
• Terminology
• Diagnosis (communication disorder)
• Social influences
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Folk remedies
Advertisements
“Headlines” & “Sound bites”
“Never give up”
Contributing factors to fads and
controversial treatments
• Adopt the science practitioner model
• Establish clinical code for SLP’s
• Embrace research
Recommendations for SLP in the future
• Green, Gina , Ph.D. “Facilitated Communication: Mental
Miracle Or Sleight Of Hand?,” Skeptic vol. 2, no. 3,
1994, pp. 68-76.
• Jacobson, John W., Richard M. Foxx, and James A.
Mulick, editors. 2004. Controversial Therapies for
Developmental Disabilities: Fad, Fashion, and Science in
Professional Practice. Lawrence Erlbaum.
References