Weak synchronization in toddler brains may be a biological marker for autism

A finding that ties weak synchronization in brain activity to autism could lead to earlier diagnosis of the disorder.

ScienceDaily (July 27, 2011) — “The biological causes of autism are still not understood. A diagnosis of autism is only possible after ages three or four; and the tests are subjective, based on behavioral symptoms. Now, in research that appeared in Neuron, scientists at the Weizmann Institute of Science, Carnegie Mellon University and the University of California, San Diego have found, for the first time, a method that can accurately identify a biological sign of autism in very young toddlers.”

Weizmann Institute of Science (2011, July 27). Weak synchronization in toddler brains may be a biological marker for autism. ScienceDaily.

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What I Learned at CSHA

2011 CSHA Conference

This post is by Presence TeleCare’s Chief Clinical Officer, Melissa Jakubowitz.

I just returned from CSHA’s annual convention in Los Angeles. There was great turnout and an incredible amount of energy flowing in the beautiful old Biltmore Hotel. I enjoyed reconnecting with friends and colleagues, and was really encouraged by the positive response to my presentation on telepractice.

Since I was asked several questions about client selection, I want to emphasize that telepractice sessions are not appropriate for all clients. After all, SLPs never have a “one size fits all” program for all clients with a specific disorder or disability. As clinicians, we must use all available information to determine which approach or therapeutic techniques will work best for each particular client. We consider everything from the client’s goals and values to the clinical evidence before us in planning an appropriate strategy. The same is true for telepractice.

There are a number of areas that must be addressed in order to determine client candidacy for telepractice. ASHA has issued a Technical Report and a Knowledge and Skills document that addresses these issues (available at www.asha.org/telepractice).

The client’s physical and sensory issues must be carefully considered:

Can the client sit and attend to the SLP on the computer for an appropriate length of time?
Are there sensory issues that may affect the client’s ability to use headphones?
Does the client need consistent sensory feedback from the remote SLP and is this possible or are there alternatives?

Cognition and behavioral issues should also be addressed:

Does the client’s cognitive, hearing, and visual ability support their participation in a telepractice session?
Is the client able to sit in front of a computer monitor with and without behavioral support?
What is the client’s manual dexterity for using the keyboard and/or mouse?
What is the client’s ability to follow directions?

Interview with Ellen Estomin

Ellen Estomin, former Special Education Director of Pittsburg Public Schools, recently spoke with us to share her perspective on telepractice. Read on for the full interview below:

What excites you about telepractice?
I think it opens an avenue that we haven’t explored before when we are talking about not being able to find someone on site. As a special education director, and as a former administrator for speech and language programs, I would definitely consider telepractice for positions when I could not find anyone. I would use it for substitutes, as well as full-time positions, in case I can’t find anyone.

How would you explain telepractice?
Telepractice is when services are delivered by a certified professional, but the person is not located on site. I would make the analogy to telemedicine in that both give you access to service through technology.

What would you tell speech therapists about telepractice?
It’s an option that they may never have considered before, can provide services without having to travel, and can be provided from home. The field of speech and language pathology has so many options and this just opens up another.

What would you tell special education directors about telepractice?
When they are unable to fill positions because of shortages, for medical leave or any other reason, then this gives them another option. I would also tell them that this is through technology and to make sure that they have the equipment hardware and software that they need. Certainly, given the shortages in SLP availability, it gives SPED Directors another option to make sure that services are provided.

Last question:
There are some things that schools need to consider. For example, who is going to be with the student? Schools will need someone to escort students to sessions and to monitor behavior while the student is participating in the session. They also have to figure out a way to connect the telepractice SLP with general education, special education, and parents.

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An Unexpected Success

: Image by Getty Images via @daylife

At the end of the school year, professionals working in education often recount their successes. Oh sure, we have the usual student “graduations” from Speech, a new school assignment, a hard-won new or improved employee benefit, or maybe even an expanded supplies budget. As long and as hard as I searched through my various sources, though, I just couldn’t find a report similar to one of my most prized successes, parental anger and derision for a job well-done.

My original success story unfolded in a medical setting – a TBI rehabilitation unit. A popular high school sophomore, actively courted by several prestigious universities for his athletic prowess, sustained life-threatening injuries in an accident with a Highway Department snow plow during a blizzard. Comatose for six weeks, a dedicated, organized and skilled treatment team worked diligently to create a new life for Tory and his courageous family whose entire lives were changed in an instant.

But as progress slowed and inpatient care came to an end, Tory still looked different, walked with an unsteady gait, and processed information at a kindergarten level. It was painfully clear to the family that the service team would not return Tory to his prior state of great expectations. It was at this juncture that the family’s grief manifested as anger toward those who failed to reverse the multiple and debilitating effects of his injuries. Though we did the best we knew to do, we just had not met the family’s expectations – we had not answered their most fervent prayers. The upside to the situation was sharing the experience with my colleagues, all of whom verbalized a conviction that we had served our patient and his family with the utmost professionalism.

But I faced the most recent circumstance with no such loyal and collegial support.

Brittany, a bright, creative 2^nd grade student being served in an educational setting, was dubiously identified as suffering from Reactive Attachment Disorder by the age of two. Sadly, Brittany’s adoptive parents were counseled to follow a verbally confrontational and physically coercive treatment regime that has been denounced by all leading medical associations, which they did with vigor and commitment. Once enrolled in the local school, a timid and ill-informed school team cow-towed to the unusual demands of the parents for unprecedented services and accommodations for Brittany who, quite strangely, was categorized as brain-injured.

Oh, had I known the true folly of contradicting control and fear with reason and evidence!

In both described situations, the emotional discomfort yielded an unexpected sense of success and a renewed commitment to render the best evidence-based, professional service. Our work is a discipline: we do the right thing to do for the right reason. We don’t work to achieve an emotional response.

Have you ever experienced an unexpected success?

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Changing your lot in life: 4 suggestions to impact caseload size

In our first post on caseload manageability, as proposed by Katz, et al (citation below) in a recent article in Language, Speech, and Hearing Services in the Schools, we discussed the identified factors that impact one’s perceptions of her caseload size and those that contribute to job satisfaction. The authors also shared several proposals to impose some controls on an unrelenting work situation.

Response to Intervention (RTI) – While RTI is inthe early stages of implementation, it holds promise for SLPs, especially those with unreasonable caseload sizes. RTI allows special education professionals to use their knowledge and expertise working with students and teachers not only in remediation,but also with prevention in mind.

Negotiate caseload/workload issues with school administrators -Document job responsibilities and share results fromthe Katz, et al, study and others related to SLP job satisfactionand burnout with your most insightful administrator. Inform administrators about thesignificant relationship between caseload size and perceivedcaseload manageability. Doing so might help SLPs make a case for expanded discipline-specific service and time to complete other workload demands in lieu of unskilledresponsibilities such as lunch or bus duties.

Inform administrators on the benefits and limitations of team collaboration – Mandated classroom collaboration could impactSLPs’ perceptions of caseload manageability. If an SLP is findingcollaboration to be a particularly difficult endeavor in hisor her school, based on substantial resistance among teachers, more reasonable and more familiar service options, such as more pullout services, could be proposed.

Alternately, SLPs could lobby for administratorsto lend visible support for classroom collaboration by allottingtime in SLPs’ and teachers’ schedules for planning meaningful and effective collaboration as well as supporting and encouragingSLPs’ efforts to participate in continuing education in howto create and maintain fulfilling collaborative relationships.

What could you add to the list of proactive solutions to merely succumbing to being perpetually overwhelmed? What has worked for you and your team mates in your district? We’d love to know. Please share!

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Katz LA, Maag A, Fallon KA, Blenkarn K, Smith MK. (2010). What makes a caseload (un)manageable? School-based speech-language pathologists speak. Language Speech and Hearing Services in the Schools, 41(2), 139-151.

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Caseload manageability and job satisfaction: Comments from the field

In an earlier post, we looked at research presented by Lauren Katz, et al, “What makes a caseload (un)manageable? School-based speech-language pathologists speak” (complete citation follows below), a discussion of the variables impacting a speech pathologist’s perception of the manageability of his caseload. Variables were divided into three (3) distinct categories:

demographics: who was more likely to feel like she was managing things well and enjoy a sense of job well-done;
job-setting: where one is more likely to perceive the ability to manage his caseload; and
job characteristics: team and time factors supporting job satisfaction.

Several of my colleagues responded to an invitation to comment on the research presented.

Eric, Director of Special Education (WI): Our team of four SLPs work together to organize the caseloads and work demands. We meet monthly to discuss issues and concerns, with the SLPs proposing the most reasonable options for dealing with the situation. We have two unfilled positions, but our Speech team makes the best of the challenges by actively supporting each other.

Gin, Speech Pathologist (IA): I’m nearing the end of my career in the schools. In my last assignment, no one got along. No matter what you did, it was never enough. Then my supervisor proposed a new assignment and I jumped at the opportunity. I love my new school. The parents are supportive and involved, and I have a chance to use my skills with a community grateful to have a speech pathologist back in the district.

Name withheld by request, Speech Pathologist (MN): As a private practitioner, I provide part-time service in both large and small districts. The larger districts seem to have a more “even” coordination of special education activities. Some of the smaller rural districts seem to be a bit more idiosyncratic. I was considered an “outsider” longer in the rural districts but once I was “in”, I was good to go.

Michelle, a new grad doing her CFY in a small town (MN): I don’t have any contact with the part-time SLP at the high school who’s been there a long time. We never meet to discuss what we do. The special education teachers send the LD kids down to my room and tell me I need to help them complete their worksheets or their homework. XXXX (the Special Education Director) stops by and answers some of my questions but I have so many of them! On top of it all, my husband’s ex- has been a real pain lately! I’m really stressed out.

While my colleagues report a range of experiences, interpersonal relationships seem to hold great value to each. It appears that even when work conditions are difficult or challenging, if you work with professionals who support you in explicit and ongoing ways, a speech pathologist could feel that the situation is almost quite manageable! Without that support, life can be miserable.

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Git ‘er done: Factors impacting perception of caseload manageability

In a recent LSHSS article by Lauren Katz, et al, “What makes a caseload (un)manageable? School-based speech-language pathologists speak” (complete citation follows below), the authors examined variables that contribute to a clinician’s perception of her ability to enjoy a job well-done.

Through an extensive literature search, the authors uncovered a few demographic variables for predictingjob satisfaction including:

the SLP’s highest degree achieved (thehigher the better),
gender (females over males), and
years ofexperience (the more years the better).

The most important job-settingcharacteristics for predicting job satisfaction included:

caseloadsize (in favor of smaller caseloads),
geographic setting (infavor of suburban settings),
permanent status (vs. itinerantstatus),
number of students served per day (in favor of servingfewer students), and
age level served (in favor of elementaryschools).

Finally, the job characteristics most important for predicting job satisfaction included

having friendly coworkers
having enough time to get the job done, and
working with a friendly supervisor.

Survey respondents to the authors’ questionnaire reported an average caseload of 49 students, with 60% of the participants finding caseloads of 41-50 students unmanageable.

How does this compare with your experience? We invite your comments!

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A Few More Summer Suggestions

We recently discussed creating a parent tip list to successfully navigate the unique rigors of summer break. Involving the special needs student in planning her summer of fun could build “buy-in” and yield some interesting ideas. Consider some of these additions to your parent guide:

Tips to Help Kids with Learning and/or Attention Problems:

1. Revamp — but don’t eliminate — your child’s daily routine. A daily routine provides a sense of structure and security. While certain tasks (like doing homework) may be dropped during the summer, new ones (like packing for daily swim lessons) may be added. Create a visual organizer to enable the young vacationer to track his activities throughout the day.

2. Prepare your child for her scheduled activities. If possible, visit the locations where she’ll be during day camp or day care in advance. Encourage your child to talk to camp counselors, caregivers, as well as other kids, asking them questions of interest about the site.

3. Have your child contribute to the family calendar. Together, highlight key summer events (e.g., community pool opens for recreation swim, July Fourth barbeque). Encourage your child mark these on the calendar, decorating the date field with theme-based cartoons.

4. Involve your child when preparing for family trips and activities. Depending on her age, she can help you map out driving routes, preparing a Google map or Mapquest directions from the Web. She could make a list of the clothing and recreational gear the family will need.

5. Encourage summertime learning. Summer outings may present opportunities for your child to learn about history, geography, and nature. Look for “teachable moments” and encourage her to listen, read, take photographs, collect postcards, and keep a journal of her adventures. This type of learning can boost the self-esteem of a child who struggles in school.

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The Good Ol’ Summertime

It’s important to recognize that the shift from the school year to summer vacation, regardless how welcome, can pose some challenges for the families of the special needs children you serve. Consider creating a “Sweet Summer of Success” handout for the parents of the kids on your caseload, including some of these ideas:

Tips to Help Parents:

1. Review the summer plans you’ve made to date. Where there are gaps in the schedule, brainstorm ways to address them, such as parents rotating days off work to stay home with younger kids on unscheduled days.

2. Post the family’s summer schedule. Mark activities (day camp, vacations, your teenager’s work schedule, etc.) on a “family size” calendar posted in a central location. Be sure to note blocks of unscheduled time as well; that way, you can anticipate free time to use as you wish – even if it’s just to enjoy a break in the action.

3. Plan to be spontaneous. Create a list of places and people to visit when time permits and the mood strikes. Summer — free from homework and tutors — is a good time to stop by the science museum, bike trail, or concert-in-the-park you can’t seem to get to during the school year.

4. If you and/or your child thrive on routine, build as much of it in to your summer schedule as possible. Even so, your routine may change every week or so; find ways to prepare for these transitions. This may be as simple as mentally rehearsing the new routine (including daily wake-up time and preparation) with your child before the week begins. Don’t forget to record those changes in routine on the family calendar.

5. Ask other people (spouse, family members, and neighbors) for help shuttling kids to activities and supervising them on their “days off.” Trade carpooling and kid-watching duties with other parents in your neighborhood.

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Good, Better, Best

Good, Better, Best

According to the American Speech-Language-Hearing Association (ASHA), May is Better Hearing and Speech Month. Better Hearing and Speech Month. Better than what? And, better how?

Many of us are blessed with “normal” speech, language, and/or hearing abilities. We chat with or text loved ones on our cells. We hear the baby wheezing or breathing peacefully in the crib. We understand a good joke and show our amusement with loud, guttural guffaws or with a raspy snort. We engage in life fully, calling on our “native” communication skills to serve us across our experiences.

So how can we “ramp up” our communication skills; how can we “better” them? Consider the following challenges:

- Understand how cultural differences might impact communication.

- Take a “vocal nap” every day, especially during periods of extended use. For instance, teachers could limit speaking during the breaks between classes and find quiet ways to spend their lunch break rather than talking in a noisy staff room with colleagues.

- Improve your vocabulary. Sign-up to be e-mailed the “Word of the Day” at any or all of the online dictionaries.

- Protect your hearing. The iPod/TV/car stereo system is too loud if you have to raise your voice to be heard.

- To enhance your own listening skills, tell your conversation partner, “I’m listening to you because I really want to understand what you’re saying.” Follow-up with questions on anything that still isn’t clear to you.

- Be attentive to the needs of users of assistive communication or mobility devices (hearing aids, communication boards, wheelchairs, etc). Ask what you can do to communicate effectively with them (e.g. “Stand to my preferred right side,” “Don’t make me look into the sun/overhead lights; please sit,” “Confirm that you understand what I’m saying.”).

Remember: Good communication skills – while completely acceptable — can always be better!

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