Fads and Controversial Treatments in SLPChapter 14 Mareile Koenig & Cheryl Gunter

Lindsey Gallagher

Caldwell College

Chapter 14

• 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.

Examining these claims

• Tharpe (1998) “the field of communicative disorders sorely lacks systematic documentation of of clinical outcomes”

• Enderby and Emerson (1995) similar claims

Overview

• 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

Scope of Practice

• Prevention, diagnosis, habilitation and rehabilitation:• Communication• Swallowing• Upper aerodigestive disorders

• Elective modification of communication disorders• Enhancement of communication

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), social-

communication (pragmatics) in comprehension/production of oral, written, and other communication modalities.

Cross-Disciplinary Collabortation

• School setting, private, both• Often leads to cross-disciplinary Collaboration • Teachers• Reading Specialists• OT’s• BCBA’s

• “role sharing” “role release”• Sharing of fads and misconceptions

Post Graduate Training

• Depends on interests, agency strategies, client need, school policy etc.,

• Influences intervention strategies• Sensory Integration• Greenspan• Verbal Behavior• Functional Assessment

Fads

• 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

Facilitated Communication

• 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 Communcation

• 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_communication_inclusion/Research/authorship_and_controversy.aspx

• http://www.skepdic.com/facilcom.html

Unsupported Philosophy of Whole Language

• Children & adults use the same strategies to read• Learning to read is like talking• Phoneme awareness, phonics, spelling and punctuation can

be learned “naturally”

Whole Language: The Reading Wars

• http://www.youtube.com/watch?v=_Kic9BFW540&feature=related

• http://www.theatlantic.com/past/docs/issues/97nov/read.htm

Whole Language

• "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.

http://itre.cis.upenn.edu/~myl/languagelog/archives/004261.html

Whole Language

• “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

Controversial Therapies

• Sustainable popularity despite questionable frameworks, inconsistent or absent empirical support, limited evidence …”• Sensory Integration Therapy (SIT)• FastForWord• Whole Language in Oral Language Instruction

Sensory Integration Therapy (SIT)

• “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&feature=related

• http://www.youtube.com/watch?v=H0TcXVyORxg

Fast ForWord

• 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

Aim of Fast ForWord?

• To help children with language impairments learn specific

auditory or phonological skills that have been related to acquisition of speech and language.

What is 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

Friel-Patti, DesBarres, & Thibodeux, 2001

Fast ForWord

• http://www.scilearn.com/ (overview video)

• http://www.scilearn.com/products/fast-forword-language-series/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-forword-products/

Fast ForWord

FFW

• 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%20Fast%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

Whole Language in Oral Instruction (WL-O)

• 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

5 “erroneous assumptions”

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

4 recommendations

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

Proceed with caution

• 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

ASHA & Treatment Efficacy Content

• 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)

Contributing factors to fads and controversial treatments

• Failure to adopt a scientist-practitioner model• Absence of conventional clinical code• Terminology• Diagnosis (communication disorder)

• Social influences• Folk remedies • Advertisements• “Headlines” & “Sound bites”• “Never give up”

Recommendations for SLP in the future

• Adopt the science practitioner model • Establish clinical code for SLP’s• Embrace research

References

• 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.