Each year, ASHA's Convention Program Committee, Special Interest Groups and Specialty Boards invite a roster of speakers representing the finest the professions have to offer. These "invited sessions" focus on the latest innovations in the professions to educate and inspire participants.
The Leader spoke with three of this year's invited speakers—René Gifford, Carol Westby and Diane Williams—to find out what drives their clinical interests, and what knowledge they hope to impart to convention attendees.
A Child, Not a Checklist
René Gifford advises looking beyond guidelines when making decisions about cochlear implants.
by Carol Polovoy
Audiologists are absolutely not technicians, says René Gifford, director of the cochlear implant program and pediatric audiology at Vanderbilt University's Bill Wilkerson Center, and children with hearing loss are more than items on a checklist. That's why she wants audiologists to look at the whole child—not just at eligibility guidelines—when they help families make a cochlear implant decision.
"If a child has appropriate amplification, intervention and services, and the family is compliant with recommendations, but the child is not making progress in speech and language development, we must consider cochlear implantation," Gifford says. "We have to look beyond the audiogram and how many boxes we can check on the eligibility list."
Gifford wants audiologists and speech-language pathologists to come away from her convention presentation on timing for cochlear implantation with this message: "Guidelines for cochlear implant eligibility are in place for a reason, but you've got to do what's best for the child."
As an example, Gifford cites the candidacy guideline of 30 percent sentence comprehension. "But if a child has 50 percent comprehension in a quiet listening environment, does that really cut it?" she asks. Many implant centers would reject that child, "and then at age 6, that child is way behind in language development."
Cochlear implant teams may go outside the eligibility criteria, Gifford says. "Just about every medical device and drug is used off-label [outside of Food and Drug Administration rules], so much so that the FDA has guidelines for off-label use." To do so, clinicians must be well-informed, make decisions based on firm scientific evidence and keep detailed reports on the outcomes.
"We have firm data—from clinical practice and peer-reviewed literature—that children who don't meet the eligibility checklist are deriving significant benefit from cochlear implants," Gifford explains. "Speech and language progress for children with severe-to-profound hearing loss who don't receive implants is much slower."
An entire team typically manages the care of a child with hearing loss: audiologist, otolaryngologist, SLP, deaf educator, social worker and pediatrician, she says. "So it comes down to this: Who has more information on a child, the team managing care or indications for implantation developed more than a decade ago?"
Gifford has been exposed to hearing loss throughout her life. She was raised by her grandmother and her grandfather, who had hearing loss from World War II injuries. She learned at an early age to develop communication strategies that compensated for his hearing difficulties, which were exacerbated by generational differences. "I learned pretty quickly that you just do what you have to do to communicate," she said.
But it wasn't until she became disillusioned with her pre-med college classes that she considered audiology. In retrospect, she says, it was a no-brainer, but by the time Gifford made the career choice, her grandfather had passed away. She earned a master's degree from Vanderbilt, and a doctorate in psychoacoustics from Arizona State University.
A three-year postdoctoral fellowship with Michael Dorman at the ASU cochlear implant research laboratory turned out to be the "slingshot" for her career, the place where she learned to combine her love for basic science and long-held desire to restore hearing, especially for young children.
Since then, at positions at the Mayo Clinic and Vanderbilt, she has helped "hundreds of kids" gain hearing through cochlear implants. At Vanderbilt, she and her team routinely implant 70 or more children a year.
Gifford firmly believes that the earlier the implant, the better. "Language-learning opportunities are critical and fertile in the first year of life," she explained, "in every moment of every waking hour. Even when an infant is just sitting there looking at a light, that infant is taking in all sorts of information that contributes to language development. A baby who has hearing loss misses out on that critical window of opportunity."
René Gifford, PhD, CCC-A is an assistant professor at Vanderbilt University and director of the Cochlear Implant Program at the Vanderbilt Bill Wilkerson Center.
Carol Polovoy is assistant managing editor of The ASHA Leader.
Brain Gains for Kids on the Spectrum
Diane Williams hopes her research will convince you of the brain-changing power of language enrichment.
by Bridget Murray Law
When Diane Williams encountered children with autism during her postdoctoral fellowship back in 2001, she realized she'd found her calling. "These kids were such a puzzle to me," says Williams, who thrives on a challenge and was ready to take on this one.
"Their language-learning often works really well, but then they have this struggle with communicating with others," she explains. "I decided to focus my research and clinical practice on what we can do to help." So that's exactly what she did as she completed her postdoc with autism researcher Nancy Minshew at the University of Pittsburgh.
And—as she'll share with attendees in her invited presentation at ASHA's 2013 Annual Convention—her recent research findings indicate just how much SLPs can help.
In this research, Williams, an associate professor of speech-language pathology at Duquesne University, has analyzed brain scans of children and adults with and without autism spectrum disorders, taken as they perform language tasks. Participants have mild to moderate ASD, with IQs greater than 70. Overall, she finds that the ASD group show significantly different brain processing compared with the non-ASD group. Those with ASD use the same language network as the neurotypical group, she explains, but it's a smaller version with the central areas not as well synchronized, so it doesn't work as efficiently when demands increase.
But the finding that fascinates Williams most is this: The language processing of participants with ASD grows notably more sophisticated in adulthood, to a large extent resembling that of the neurotypical children.
"What this finding suggests is that the environment and experiences are making a big difference in these kids' brain processing," Williams says. "Adults with ASD do seem to have learned from their experiences. There are indications that they are more skilled in some areas than non-ASD kids are."
Williams hopes to convince convention attendees that this brain malleability shows how much speech-language and social-skills intervention matters. "I want them to take away that this research is highly supportive of what they do as SLPs, that environmental input can affect brain development even when children have a developmental disorder like autism," says Williams. "Now what we need to get better at is providing the right high-quality input to produce the most beneficial brain changes."
To that end, SLPs will naturally want to know which sort of intervention makes the most difference in ASD. And while Williams can't yet provide research-based answers to this question, she's working on a grant for investigations that would do just that. Meanwhile, she says that, anecdotally, her own clinical work points to big gains from providing explicit communication instructions and augmentative and alternative communication.
"Before AAC, when presented with a nonspeaking child with significant problems, it was very frustrating because you couldn't get spoken language going," Williams says. "But once SLPs started implementing AAC, it opened up a whole new world."
Williams eagerly anticipates the convention, not just to share her findings but to enjoy her professional colleagues. "One of the big things about ASHA is how open and collaborative and congenial folks are," Williams says. "You can strike up a conversation with anyone on the escalator, and that is not typical of most professional conventions."
She's been to just about every ASHA convention since her first one in 1977, when it took place in several hotels in Chicago. The buzz there was all about the controversial new Public Law 94-142, which set new individualized education program guidelines affecting SLPs.
"I remember people being upset about all the paperwork, but it did incredible things for the profession in terms of being better recognized for what we contribute, and opening up employment and professional development opportunities," Williams says. "It's been an exciting time to be an SLP."
Diane Williams, PhD, CCC-SLP, is an associate professor of speech-language pathology at Duquesne University and an affiliate of ASHA Special Interest Group 1, Language Learning and Education.
Bridget Murray Law is managing editor of The ASHA Leader.
Knowing Others, Knowing Yourself
Carol Westby found her cultural competence using ethnographic interviewing techniques.
by Kellie Rowden-Racette
If there is one thing Carol Westby wants participants to know after her presentation on working with children from diverse cultures, it's that you don't have to speak or even understand their language—but you do have to empathize with them.
"It's important to understand how you see the world, and how they see the world, and how those might differ," Westby says. "It's all about the clients—what do they want from these treatments? What's important to them?"
It's not an easy task in our highly diverse society, but the key, according to Westby, is ethnographic interviewing principles. "We, as SLPs, have a lot of understanding of the nature of language, even if we don't speak a language," she says, and with the Internet's help SLPs can learn enough about phonological differences to be able to give guidance. "Don't be so quick to assume you can't evaluate a child if you don't speak the language," she adds.
Westby has been attending—and often presenting at—the annual ASHA convention since 1975, and this year marks her 38th convention. Much has changed since those early years, she says, both in what attendees expect and why she keeps coming back.
"In the beginning it was mostly about the sessions, sure, but now it's more about seeing the people I've connected with over the years—I've made so many friends in the field since I started!" she says with a laugh. "I guess I'm supposed to say it's all about what I learned, but I think ASHA convention is now more about the interpersonal contact. And as for the sessions, with the technology available, people now want high-quality presentations and high-quality information—there's no getting around that."
Westby has a lot of information to offer the speech-language pathology community. Although her work with cultural competency and childhood language has been widely followed for years, becoming an SLP was not even on her radar as she grew up in Pennsylvania. Westby came from a family of Eastern European immigrants and was the first of her family to go to university—at Geneva College.
Her strong interest in the sciences and languages led her to a PhD in speech-language pathology from the University of Iowa. She began working with children, and a pivotal experience came when she was volunteering at Unity House in Troy, N.Y. The program offered free speech-language services to children—many of them African American—and she became interested in working with children from cultures other than her own.
The next step in her professional evolution came in 1977 when she moved to New Mexico and began working on childhood assessments in rural areas with American Indian communities. Within a year she noticed that "no one was listening" to her, and she realized it wasn't because she didn't have anything to offer. It was because she didn't know enough about the culture of the children she was trying to assess. To remedy that problem, she took some anthropology courses and made becoming more culturally competent a personal goal.
"It was a major changing point for me," Westby says. "I learned how to synthesize ethnographic information and I began to learn how to look at cultures and understand how they worked. I also learned how to look at my own culture and learn more about myself."
In her Chicago convention presentation, Westby will cover the ethnographic approach to becoming more culturally competent. She hopes attendees will feel empowered and confident that they can provide services to the wide array of languages and cultures they are bound to face. "Learning how to 'read' cultures adds to your skill set," Westby says, "and also allows you to learn more about yourself."
Carol Westby, PhD, CCC-SLP, is a consultant for Bilingual Multicultural Services in Albuquerque, N.M., and an adjunct professor at Brigham Young University in Provo, Utah. She is an affiliate of Special Interest Groups 1, Language Learning and Education; 14, Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations; 16, School-Based Issues; and 17, Global Issues in Communication Sciences and Related Disorders.
Kellie Rowden-Racette is print and online writer/editor for the ASHA Leader.