Classroom, Emotional regulation, Executive Function, Just for Students, self-regulation, Social Cognition, Uncategorized

7 Self-Regulation Tips to Reduce Homework Battles With Your Child

I originally wrote this post for Beyond BookSmart, and it appeared on their blog on October 17, 2016: http://www.beyondbooksmart.com/executive-functioning-strategies-blog/7-self-regulation-tips-to-reduce-homework-battles-with-your-child. For other GREAT resources on executive functioning, planning and prioritizing, improving confidence, emotional regulation strategies, and focusing and attention strategies, check out the rest of the wonderful blog posts: http://www.beyondbooksmart.com/executive-functioning-strategies-blog

screen-shot-2016-10-29-at-12-14-10-pm

Few tasks test self-regulation skills like homework time. Self-regulation is critical to one’s ability to manage challenging or complex situations, and homework time is no exception. Strong self-regulation is multifaceted; it involves regulation of one’s thoughts, emotions, actions, and motivation. Although these skills continue to develop into adulthood, building and strengthening them from an early age can reduce stress and provide the drive to attempt new experiences. Students can integrate practices into home and school activities that strengthen and support a foundation of self-regulation. Below are seven tips students can use in their daily routines to promote happier homework time.

1: Make a homework plan

It doesn’t always make sense for your child to start with the homework assignment from his first class of the day. Some students feel more motivated when they get the biggest assignment out of the way first, while others need to get started with a small task in order to avoid a state of emotional overload. Encourage your child to first make a list of all tasks on deck for the day, and then arrange them into an order that will promote success. Setting aside a few minutes to make a homework plan before getting started can save time, frustration, and stress in the long run.

2: Stock your homework space ahead of time

A quick trip to find a sharp pencil can easily turn into an hour-long distraction. Before getting started, consider what supplies are needed to complete the homework and stock the workspace. Some students benefit from a tri-fold poster board used as a makeshift study station to reduce visual distractions. Wherever your child plans to complete homework, make sure the area is distraction-free and that the necessary supplies are readily available so precious work time isn’t wasted looking for more graph paper.

3: Support basic (subcortical) needs

The brain’s sub-cortex involves the “downstairs,” lower-level brain structures that manage emotions and generate seek and avoid impulses. When the sub-cortex is dysregulated, the brain devotes most or all of its cognitive resources to those structures in order to ensure that we feel safe and comfortable. This leads to decreased cognitive energy reaching the prefrontal, “thinking” parts of the brain that students need to successfully complete homework. Your child can support subcortical regulation by ensuring that he/she has had enough sleep, hydration, food, and movement.

4: Know your triggers and plan ahead

If a certain type of task is a consistent emotional trigger for homework battles with your child, encourage him/her to pre-regulate. This might involve intentionally setting up the environment to be as calming as possible, using a favorite pen or pencil to add a little fun to the task, taking some deep breaths prior to starting, identifying a small reward for completing the task, or setting aside time for a break mid-way through the homework. Anticipating the likelihood of dysregulation and planning ahead helps to avoid the emotional hijacking that otherwise feels like it sneaks up out of nowhere when students are working through an assignment they don’t enjoy.

5: Use future emotion to motivate present action

Often, students get stuck in a “now bubble” about how annoyed, frustrated, bored, or overwhelmed they feel at the thought of starting homework right now. It’s no surprise that these uncomfortable emotional states don’t provide much motivation to get started. Encourage students to shift their focus from how they feelright now to how they will feel when the homework is complete. Proud? Relieved? Accomplished? Use this future emotion to motivate the present action of getting started.

6: Snack smarter

Not all foods impact the brain’s endurance equally, and choosing the wrong snack can lead to a major blood sugar crash mid-homework time. Fueling up for homework is a great way to support the brain’s sub-cortex, and students should consider snacks that provide consistent energy to the brain and/or feed their sensory processing needs. Snacks with complex carbohydrates and protein-rich foods provide slow-release energy for the brain without the intense low soon after consumption. Chewy foods (e.g., dried fruit) and crunchy foods (e.g., nuts, whole-grain crackers, raw veggies) can provide sensory input for students who might otherwise feel distracted by sensory-seeking impulses.

7: Plan breaks wisely

The brain is most attentive for fifteen to twenty-minute increments. While some students can make it through marathon homework sessions, many need to break up the time to give their brains a rest. Breaks can be wonderful, but only if the student can successfully shift back to the homework task. Avoid break activities that involve nebulous timing (e.g., playing outside for a while) or ones that can’t be easily paused (e.g., video games that require the player to reach the next level before stopping). To avoid the drama of transitioning from a break back to homework, consider break activities that have explicit start and end boundaries(e.g., a five-minute YouTube video, twenty jumping jacks, listening to three songs, etc.). If vague end times can’t be avoided, set a timer to create a strict cut-off time.

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Just for Students, Random SLP

Research Methods for the Common Denominator: Part 2

I have no doubt that part 1 of this (very) mini-series was one of the most exciting blog posts you’ve read to date. In fact, you probably walked away from your computer feeling 1.0563 ounces smarter (yes, intelligence is obviously measured in ounces). As I sit here writing part 2 of my research methods informational post in my new reading glasses, I know I already feel just a tad bit more brilliant (yes, the reading glasses definitely help).

In this post, I’m going to impart upon you some facts about the statistics that you’re likely to find in research papers. To start off, there’s an important distinction to make between descriptive statistics and inferential statistics.

Descriptive Stats: describe or summarize data about your sample/group of subjects.

Inferential Stats: uses what you now know about your sample (since you just performed research) to infer about the population that your sample represents. So, if you were testing a new treatment method on a subject pool of 30 children with Down Syndrome, you would likely be inferring something about that treatment method for all children who are similar to your sample (i.e., kids with Down Syndrome).

Within descriptive statistics, you will want to consider a handful of different specific statistical measurements, starting with distribution. A frequency distribution generates a curve that shows you the frequency of responses/scores at different levels (e.g., different ages, different severities, etc.).

from: http://www.sciencedirect.com

The curve might come out looking like a normal curve, which is symmetrical, has a mean, median, and mode with the same value, and aligns with 68.2% of the population being within 1 standard deviation of the mean.

On the other hand, your curve might end up being a skew curve (positive or negative) or a kurtosis curve (leptokurtic, or platykurtic). Regardless of how your frequency distribution curve turns out, it’s important to understand that different curves imply different things about the effect of the independent variable on the dependent variable. In addition to considering the frequency distribution, you may also have information about the central tendency: mean (average), median (half the values are higher and half are lower), and mode (value that occurs most frequently).

Variability is a critical factor of descriptive statistics. The standard deviation tells us the average deviation of scores from the mean, and this range of variability might indicate that most scores were similar to one another, and therefore the mean can be confidently counted upon. If the scores are all over the place, the mean might not be very representative of the actual range of scores received by the sample.

Inferential statistics begins by testing a hypothesis. The alternative hypothesis hypothesizes some kind of effect of the independent variable on the dependent variable (e.g., X treatment will benefit Y population). Often this is what the researchers hope to find at the end of their study. The alternative hypothesis cannot actually be proven by statistical tests (although it can be supported); rather the null hypothesis (which says the independent variable will have no effect on the dependent variable) is rejected when the alternative hypothesis is supported. In order to reject the null hypothesis and support the alternative hypothesis, researchers use a cut-off value, or significance level (alpha), to decide the point at which the independent variable was effective and statistically significant. Typically, the significance level is <.05: if the observed p-value is <.05, the probability of this result occurring by chance is less than 5 in 100, and therefore can be attributed to a real effect of the independent variable. Although <.05 is the most common significance level, it’s actually just an arbitrary number and, at times, may lead to Type I or Type II errors.

Various characteristics can affect whether the results of a study are significant (i.e., p = <.05). A bigger effect size (more difference between the treatment group and the control group) typically supports significance. Less variability (aka a smaller standard deviation) also supports statistically significant results. Finally, a larger sample size is more likely to support statistical significance.

With all this being said, statistical significance is just one piece of the inferential statistics puzzle. Other statistical outcomes that look at testing differences and correlations must also be considered. However, I’d like to think your brain has worked hard enough for one day, so I’ll leave those explanations for another time and another place!

Just for Students, Random SLP

Research Methods For the Common Denominator: Part 1

Raise your hand if you consider yourself up-to-date on the advances in your specialty of our big, wide, wonderful field of speech and hearing sciences. Now take your hand and high-five yourself for being one of the mighty who take the “current research” part of the evidence-based practice (EBP) triangle seriously (remember the other points: clinical judgment and patient/client values?). While it’s not always easy to generate high-quality data about human behavioral sciences (people and their behaviors are…well…messy), smart people around the world are constantly publishing fascinating research about the very topics and issues that comprise our field. Now if you’re like me, stats and research scare the bageezus out of you. There are lots of big words and tiny numbers and percents and charts and vocabulary I thought only lived in GRE study books. BUT, never fear! This is the first in a 3-post installment to help break down some of the mystifying elements of research methods so that you can cruise through those peer-reviewed journal articles like a pro.

Let’s start with quantitative studies! Quantitative designs can be broken down into 2 types of studies: single-subject designs and group designs. Group studies can be further broken down into experimental, quasi-experimental, or observational studies. Of these different subtypes, experimental designs tend to be of the highest quality of evidence. In order for a research study to qualify as experimental, it must meet 3 critical criteria: (1) there must be a control group, (2) participants must be randomized into groups, and (3) there must be manipulation of the independent variable across groups.

Now what, you may ask, is an independent variable? Well, you can thank your lucky stars that I define variables right here, right now! The independent variable is the thing being manipulated as part of the study (e.g., the treatment). The dependent variable, on the other hand, is the outcome measure. Therefore, the purpose of a study is to determine how the independent variable (e.g., the proposed treatment) influences the dependent variable (e.g., improvement in some skill, decrease in some negative behavior, etc.). Easy, right? Now that we have the independent and dependent variables figured out, it’s important to recognize that there are likely to be extraneous variables that should be considered and controlled. These variables are those that confound our understanding of the impact of the independent variable on the dependent variable. They can be intrinsic (e.g., demographic characteristics of the participants or disorder characteristics that were not controlled in the study) or extrinsic (e.g., time of day for testing and setting for testing). The more these extraneous variables are controlled, the better the study will be and the more you can trust the outcomes.

Unlike group research designs, single-subject studies are often more feasible to perform while completing clinical work. They can contain a single subject or multiple subjects, but the key is that each subject serves as his/her own control. The goal is to begin by taking multiple baseline measurements of the participant’s performance. The treatment is then introduced, and multiple measurements are taken during this treatment phase. The treatment is then withdrawn and-you guessed it-more measurements are taken. You can continue the pattern of reintroducing treatment and recording how that impacts performance. The expectation is that performance increases when treatment is applied and decreases when it’s withheld. Although a basic version of a single-subject design might be an ABA…BA structure (where A represents a period of “no treatment” and B represents a period of “treatment”), this can be varied to include additional treatment types (e.g., ABAC…).

Here are a couple more terms to get you off on the right foot:

Prospective Studies: A research question is posed and then the study is completed to answer that particular question.

Retrospective Studies: The research question is asked after data was already collected (often for a different purpose), so you then go back and reanalyze data in order to answer your new question. In these studies, it’s too late to control the methods and extraneous variables…you just have to work with the data that was already collected.

Ok, that’s it! Did you survive? If the answer is yes, then double-high-five yourself because you now have a solid (ok, ok…basic) understanding of research designs and how to identify the design of the study you’re reading! Go ahead jump onto PubMED or your favorite database and test out your new research methods vocab knowledge! Installment 2 will delve into understanding outcome measures, so don’t be afraid to get pumped!

A Good Laugh, Just for Students, Random SLP, Uncategorized

You Still Know You’re An SLP Grad Student When…

5. Your friends ask if you want to consider a Caribbean cruise in the fall and your response is: “Sorry guys, I’ve got ASHA…” (although let’s be honest, they were never going to pull the cruise plan off anyway!)

image from: cobusbahamas.com
image from: http://www.asha.org

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. You high-five the person next to you in the computer lab because your pediatric client’s final case summary for the short, 8-week summer quarter is only 12 pages long! FOR THE WIN!

3. The kids you nanny for decide to play “word association” in the car on the way home from camp and you subconsciously start taking an inventory of their semantic networking skills

2. Your initial reaction while watching The Dark Knight Rises is: “Holy mama, Batman is going to have some serious nodules if he keeps that phonotraumatic voice going much longer!” http://www.collegehumor.com/video/6643191/batman-chooses-his-voice (warning for one tiny quick moment of bad language!)

image by Warner Brothers

AND…

1. Listening to the following link is actually a legitimate part of studying for your AAC class final: https://faculty.washington.edu/dowden/sphsc540/Notes/TextSpeechSample.wav. I think we can all agree that NO ONE WOULD PICK WENDY!!!!!

Articulation Therapy, Just for Students, Language Therapy, Random SLP

How Do You Do Data-Collection? Tips and Resources!

It seems that finding effective, efficient methods of data collection is a task for seasoned clinicians and new graduate students alike. There are sessions when I can cruise through on-line data collection without a backwards glance, and there are other sessions where I get so caught up in a client’s complex issues that I find myself struggling to keep track of what kinds of prompts/support I had to give to elicit a target behavior. I used to throw together my own data sheets before sessions, but the time commitment that turned out to be was insane on the grad-student timeline! SO, imagine my joy when one of our fab UW clinical supervisors introduced us to some great data-collection resources from the Treatment Resource Manual for Speech-Langauge Pathology by Froma P. Roth, Ph.D. and Colleen K. Worthington, M.S. (at the University of Maryland). We were given a handful of pre-made data collection sheets included as appendices, and I have decided to share my all-time favorite (and go-to data collection method) with all of you!

Data Form 1

The form is simple: in the left hand column, you can write the name or description of a task you’re using during your session. In the smaller columns to the right of that, you indicate the accuracy (or lack thereof) of the client’s response to your antecedent during each trial. You can also track the prompts the client required for each triel. This sheet is a fast way to gather critical information in an organized fashion, AND it’ll be fast to find previous data if you know what your data collection sheets look like! Now that you have the basics down, here are a few tips for making on-line data collection simple, organized, and functional!

1. Make an “accuracy key” that’s functional for each specific client and write it at the top of your data collection sheet!!!

  • It might be as simple as + (correct), A (approximated), (incorrect).
  • OR, you might want codes for varying levels of prompting/support you have to offer each trial, especially if you’re working on fading prompts. For prompt codes, I tend to use: Rp (repetition of the initial cue), Ch (characteristic hint: a verbal hint about a characteristic/a descriptor of the target response to clue the client in the right direction), G (gestural pompt), Vs (visual prompt), Ph (phonemic prompt), IM (indirect model), and DM (direct model). Now, don’t get me wrong-I don’t necessarily use all of these for the same client in a single activity. BUT, it’s nice to have your own hierarchy of prompting down for when you need to keep track of it!
  • You might need to make your codes abstract if your client catches on to +/ types of coding. Consider things like: O (old)/T (target), or even just pick random symbols that you assign meaning to: ^/X. Just make sure your coding system doesn’t get overly complex (because then you’ll spend more time trying to remember how to use it than actually using it effectively). Data collection is supposed to be efficient!

2. If your client makes lots of approximations of the accurate response (more common in artic therapy), consider using a numerical scale to capture how close their approximations are to the correct production.

  • This way you can track progress even if the productions aren’t 100% correct. I like to use a 1-5 scale, where 1 is completely incorrect, 5 is perfect, and 2-4 are scales of accuracy in approximated productions. Then, write the number into each trial number spot on the data collection sheet!

3. Write an abbreviated version of your client’s behavioral objectives/goals at the top of their data sheets before each session.

  • Why? Because this serves as a fantastic reminder of what they are working on. I can imagine that goals start to blend together when you have lots of clients on your caseload, so this is a simple strategy to keep you on track and help you shape activities to the client’s individual goals when you’re using more client-directed activities in a session! You can write these down on a data sheet before filling anything in, and then just photocopy that initial data sheet to be used for additional sessions!

This last sheet is one option for aggregating your individual session data into a graph to track progress over time.

Percentage Record Form

Alrighty folks, I hope some of this resonated with you and potentially helps you out the next time you take some awesome, rockin’ on-line data!

Guest Posts, Just for Students, Random SLP

5 Ways to Set Yourself Up NOW for Private Practice Success Later: Guest Post by Jena Casbon

I am absolutely thrilled and honored to have a guest post by the wonderful, amazing Jena Casbon! She has a fabulous website about everything under the sun for private practitioners and those hoping to start their own practice, so I suggest you hurry (not mosey) on over to The Independent Clinician as soon as you finish reading!

Attention graduate students and new grads:

Are you interested in starting a private practice someday? If you’re anything like I was, I hoped to get my degree, work for a few years and then start my own private practice. I had fallen in love with the profession of Speech-Language Pathology and couldn’t wait to fix everyone with a speech, language, cognitive or swallowing disorder.

During my CF, I became aware of two colleagues who had their own private practices. They worked part-time at the hospital with me and part-time treating their own private clients. I longed for their freedom, their confidence, their status as private practitioners and their ability to earn double their hospital salary in half the time. In the year after my clinical fellowship, Rick and Kathryn taught me everything I needed to know about treating private clients. From what liability insurance to get, to how they documented, to their suggested fees and marketing strategies. Eventually I felt ready and started to treat my own private patients and I haven’t looked back!

If you’re still interested in becoming a private practitioner someday, here are 5 Lessons that Will Help YOU Start Your Own Private Practice Someday

1. Your Knowledge Must Be Valuable

Speech-Language Pathologists provide a service, much like a masseuse, a car mechanic or a realtor. In private practice, clients will either pay out of pocket for services or they will be reimbursed through health insurance. Make sure that you have enough experience and expertise before you start to charge people for your services. Although a bad massage or a half-fixed car would be a bummer, patients and families are trusting you with all of their heart to help their child or family member to become whole. Do not take that lightly.

2. Be Open to Various Forms of Private Practice

Many people think of “being in private practice” as leasing office space, having employees and a waiting room. The mentality is that you either have a private practice OR you have a regular job at a school or hospital. There is a much larger percentage of clinicians who have their own part-time private practices after work, on weekends or during the summer. Some therapists have private practices that do second opinion evaluations only. Others incorporate cool elements like pet therapy. One of the best things about private practice is that it’s yours to shape how you want to.

3. Have Multiple Streams of Income

This is something I learned from my mentor Kathryn. She told me, “Never become dependent on one income.” Now she took this a bit further by working at the hospital, having her private practice, owning rental property and teaching 14 spin classes at the gym BUT the principle is worth practicing and sharing. Working full-time at a “regular job” is typically extremely safe but layoffs do happen. Private practices can have a steady stream of clients and then a drop off. By flexing your schedule and adding extra income opportunities, you can keep yourself safe.

4. Become an Expert Something You Love

By this point in your early career you have probably started to figure out your interests. Maybe it’s with adults with aphasia. Or children with hearing loss. No matter what aspect of our field that you fall in love with, if you’re truly interested in helping people, become an expert. Read journal articles, ask questions, attend seminars/conventions/workshops, do research, give a presentation at ASHA. In general, the people who are most successful in private practice have become experts. People want their loved one to receive therapy from an expert. Become the expert and watch your practice grow.

5. Build a Network of Colleagues/Friends as Referral Sources

You may be too young to realize this but the therapy world is very small. The people you know through graduate school, clinical placements and friends of friends are all a part of your referral network. Embrace and cultivate those professional relationships as they will become part of the backbone of your success. Also, don’t limit your network to SLP’s only. You’ll want to add OT’s and PT’s, music therapists, pediatricians, social workers, special education instructors, neuropsychologists, etc. to your list of professional contacts. Engage with these people often and make sure they know what your professional interests are. Private practices often grow through word of mouth referrals. Personal referrals are often the most successful.

 One Final Note

One thing that amazed me about Rick and Kathryn was their willingness to teach me how to get started in private practice. My initial thought was, “Why would they teach me, their potential competition, how to enter the market?” The truth was, we weren’t competition. We had different interests, levels of expertise and years of experience. By supporting me, I was able to in turn help them. Collaboration always wins over competition.

Not everyone is lucky enough to have had that level of mentorship. This is exactly why I created The Independent Clinician, a website filled with resources to help SLP’s, OT’s and PT’s get started on their journey to private practice. Even if you’re not ready yet, go ahead and get on the mailing list. I am here to answer your questions and support you if or when you decide to start your own private practice.

Jena H. Casbon, MS CCC-SLP is a Speech-Language Pathologist in New Orleans, Louisiana and soon to be returning to Boston, Massachusetts. She is passionate about helping adult survivors of stroke and brain injury regain prior functions and be successful in their new lives. She has acted as a consultant for MTV’s True Life: I Have a Traumatic Brain Injury and Lisa Genova’s novel, Left Neglected. In addition to helping her patients, she has taught hundreds of SLP’s, OT’s and PT’s how to start their own private practices. She is the author of two books: The Independent Clinician Guide to Private Patients and The Independent Clinician Guide to Creating a Web Presence. 

Just for Students, Random SLP, Random Therapy Ideas

The Dysphagia Quiz

Spring quarter (fondly known among my classmates as “the quarter that broke our souls”) is finally over. Final case summaries have been printed and signed, ART meetings are done, and finals have been…well…taken (I wouldn’t go so far as to say “aced”). Among other things, we took the class that all grad students anticipate with bated breath: dysphagia. Ok, ok, in all fairness, swallowing disorders are a huge part of the field, but I can’t say that many students are jumping up and down to memorize the neural innervation for the muscles of mastication or characteristics of aspiration pneumonia.

Can you keep a secret? Yeah, I didn’t think so. But…I’ll tell you anyway, since I’m not sure how else to keep this post going. Despite my initial doubt, I was shocked to realize that I kind of sort of actually might have liked dysphagia. I attribute 79.24% of this to the sheer brilliance and power of our professor, Dr. Bob Miller, though there’s was a solid 20.76% that actually came from pure, unadulterated interest in this facet of the field. Don’t get me wrong, I’m still a ped’s girl through and through (and this wasn’t our pediatric dysphagia class), but the lectures got me hooked much like a Costa Rican soap opera: will Mr. Smith clear the thin liquids once they penetrate the larynx, or will he aspirate and and up with yet another bout of pneumonia? Does Mrs. Johnson have a stroke of the posterior inferior cerebellar artery, or could her inability to swallow be part of a darker, more disturbing conversion disorder brought on by the stress of watching her long lost brother find out about her grandmother’s uncle’s niece’s illegitimate child?

Anywho, since I just had to prove myself “worthy” through a somewhat horrific dysphagia final, I thought I would test all of you SLPs out there to see how sharp your assessment and diagnostic skills are these days. May the odds be ever in your favor:

1. Mr. Hughes comes to you complaining of severe chest pain that occurs frequently during swallowing. He says that solids tend to “stick in his throat” during meal times, but that liquids seem to clear easily. This patient likely has difficulty with which stage of swallowing? (oral, early pharyngeal, middle pharyngeal, late pharyngeal, esophageal). What is one likely explanation for his complaints?

2. If your patient has a hyperactive gag reflux (and other hyperactive reflexes), what kind of lesion does he/she likely have? (unilateral lower motor neuron, bilateral lower motor neuron, unilateral upper motor neuron, bilateral upper motor neuron)

3. Individuals with severe ataxia may experience nasal regurgitation during meals. Why?

4. What esophageal condition causes a “bird beak” or “funnel-like” appearance of the esophagus during imaging?

5. ________________(hot food/liquid OR cold food/liquid) can be a catalyst for esophageal spasms in someone with a history of esophageal spasms.

6. Explain the rationale behind the free water protocol.

Answers:

  1. Esophageal phase; esophageal achalasia or possible esophageal spasms
  2. bilateral upper motor neuron lesion
  3. These patients may have difficulty coordinating the raising and lowering of their velum during their swallow, so they may not achieve velo-pharyngeal closure at the right time during the pharyngeal phase of the swallow
  4. Esophageal achalasia
  5. Cold foods/liquids
  6. Oral hygiene is one of the biggest concerns for patients at risk for aspiration, since the cause of aspirational pneumonia is the bacteria that gets aspirated with the food/liquid and not the food/liquid itself. For some patients who are on thickened diets or are NPO in the hospital, it may be alright to allow them water to thirst, but only if there is extremely special attention paid to their oral hygiene. Even if they do aspirate small amounts of water, their lungs can reabsorb the water and there isn’t a great risk of developing bacterial pneumonia since so much care has been taken to maintain good oral hygiene.