[00:00:00] 

Intro

Kate Grandbois: Welcome to SLP nerd cast your favorite professional resource for evidence based practice in speech, language pathology. I'm Kate grant wa and I'm Amy 

Amy Wonkka: Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast. Each 

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Episode

Kate Grandbois: Hello everyone. Welcome to SLP Nerd Cast. We are here today with two repeat guests. Um, we are very excited to be discussing a topic that is near and dear to our hearts. Amy and I, as many of our listeners know, have worked as quote unquote a, [00:02:00] a c specialists for quite some time. Uh, and we're thrilled to welcome back Dr.

Kathy Binger and Nancy Harrington. Welcome, Kathy and Nancy. Thank you so much. It's great to be back. Thanks very much. Now you guys are here today, uh, to discuss Down Syndrome and generative language intervention with a EC. But before we get started on the really exciting stuff, can you please tell us a little bit about yourselves?

Cathy Binger: Go ahead, Nancy. Okay. I am a speech language pathologist, uh, specializing in a a c um, four. Many, many years, let's just put it that way. We're, we're over 40 years. I'm an employee of the University of Central Florida, um, where I'm a senior clinical instructor and I'm also project manager for our NIH funded research.

Nancy Harrington: Um, I've experienced working with, um, [00:03:00] a c users across the lifespan, um, in New York, in Ireland and in Florida. And I'm Kathy Binger. I am a professor at the University of New Mexico and I have been here for over 20 years now. And, uh, I also am, am an A a C, um, researcher, and that's what I spent my career researching and also, um, was a practicing speech language pathologist prior to that.

Kate Grandbois: We're so glad to have both of you here. Again, every time you come onto the podcast, we have a lot of fun and we learn a lot, so this is gonna be really great. Before we get into the good stuff, I do need to read our learning objectives. After listening to this episode, participants will be able to self-report knowledge gains related to reasons why a a C should be considered for young children with Down syndrome.

Participants will also be able to self-report knowledge gains related to [00:04:00] describing three main components of a a c, gen A, a C, generative language instruction, as well as describing the grammar findings from the A-A-C-G-L-I Down syndrome study.

For anyone who is interested in using this course for ashes, CEUs, the link to take the post-test is in the show notes. It's also available on our website. If anyone listening would like to learn more about the financial and non-financial disclosures of the speakers during today's episode or any course disclosures, that information is on our website as well.

Okay. Administrative stuff is over, over. We are excited to learn more about a a C, and I think I said, I said A-A-C-G-L-I, but you said A, a c, glee, which, which way should I say it? Glee 'cause it's the happy, joyful intervention. I love it. That's a great, that's a great note to start on. It makes us, makes us happy.

Amy Wonkka: Yes. As we want all of our interventions to be, um, especially with young [00:05:00] children. Keep it happy, filled with glee. Um, and I, I guess my first question to both of you is, why don't you tell us a little bit about this project and specifically you looked at the population of children who have Down Syndrome, uh, and I was hoping you could tell us a little bit about why you chose to focus on this population, um, and why you chose to focus on a, a c and generative language intervention for, for that group of learners.

Cathy Binger: Yeah, I'll, I'll start off, but then I want Nancy to definitely talk about this too. I'm gonna start generally. So, um, the big reason from my perspective that we wanted to go down this road is that so much of our research, especially the slightly larger studies that we've done, we've tended to focus, especially with the grammar intervention stuff that we've done.

We tended to focus on kids who, um, have typical or. Moving toward typical receptive language skills. So kids who don't have, um, [00:06:00] intellectual disabilities. And every session we go to and every time we do talks on those findings, people are saying, but what about all the other kids? And it's always been a valid question.

And we've had kids with Down syndrome and kids with other types of, you know, multiple disabilities and intellectual disabilities in some of our studies in the past, but we've never studied them as a population before to see how do these things behave with this type of a population. So, um, and we definitely have always believed that what we do is really relevant for those populations with a few kids here and there.

We've done this with, we've seen solid findings from them, but we wanted to really do a study where we got to delve in a lot deeper with this population. So for me, I think one other thing that's worth saying about this is, um. Down syndrome. You know, we, we often, they, we don't, they don't often get considered for, or they often [00:07:00] do not, I should say, get considered for a a C and to me it's, even though the study that we're gonna talk about today is about Down syndrome, to me it's more generally about children who tend to have, um, intellectual disabilities.

Um, so I think what we're gonna talk about today doesn't just apply to Down Syndrome. It applies to a range of children who have, um, various types of inte, inte, intellectual disabilities. 

Nancy Harrington: Yeah. And what we see is that children with Down Syndrome, um, very often their intellectual abilities, they're receptive language abilities, are far superior than what they're able to express with their natural speech.

But very often then as a result, they're underestimated, um, by all those around them, including, um, within the educational realm. So by introducing another modality, it's giving them the opportunity to. Have a medium for developing language to the level of what their comprehension is. It's giving an opportunity to [00:08:00] participate more actively in varied communication contexts, um, both at home, in school, within their community.

And it's also supporting the spoken language, you know, time and time again. And we, we see it, we see as we're promoting the language development, um, of children using a a c, we see that hand in hand. And the research, you know, bears this out. Um, it supports the growth in the spoken language. You know, how often, you know, parents are saying, oh, they're saying this word now that they've learned using the device.

Um. They're using longer sentences. Oh, this is, we, I saw you do this during your intervention session. Um, so it's, it's very much a supportive role for these young children with Down syndrome. And some of them might be longer term AC users and some of them are not. And it's bridging a gap and giving [00:09:00] them access to the language that they need that's more comparable with their receptive and intellectual abilities.

Cathy Binger: And I'll throw in a couple of, uh, I wrote down a couple of statistics before we started, so I'd have them at hand that that directly speaks to what Nancy's talking about. We have some research, not our research, but there's research that shows that preschoolers with Down Syndrome are difficult to understand.

An average of 67% of the time. Difficult to understand an average of 67% of the time for preschoolers. And to me, this next statistic is even more compelling. This remains over 50% across the lifespan. Um, and people, adults with Down syndrome and older folks with Down Syndrome are on average only 50% intelligible.

So, you know, a, the role of a a C may change over the course of a lifespan, right? Where kids may, early on when they have very little intelligible speech, use a, a c as a primary communication mode, and then [00:10:00] over time they may use it more, um, as a backup that use it for communication breakdown. So the role may change, but it can and should have a role for individuals with Down syndrome, many individuals with Down syndrome for, um, potentially a, you know, a lifespan.

Um, and I think one, one final point I wanted to make about this, in addition to, you know, Nancy had mentioned that cognitive abilities often exceed speech abilities. So. Um, so I, I'll actually talk about this. And then one other thing. So, cognitive abilities do often exceed speech abilities. And so their cognitive and their linguistic competence is masked by their poor speech, right?

So if we can't understand them, people make assumptions, um, about what their cognitive abilities are. And people make assumptions anyway about what somebody's cognitive abilities are if they have Down syndrome, because Down Syndrome is such a, a recognizable, um, kind of a, um, a syndrome. Um, so there's [00:11:00] already that, that, that tends to be there in people's minds.

And then they talk and then they're very unintelligible. And then, so this is a compounding kind of thing. And so being able to, just like with lots of our other clients who use a a C. It demonstrates confidence when you, um, can use a, a c, um, to show people, Hey, I actually have the ability to, to do a lot of things and can say a lot of things.

And then, um, I just wanted to point out one other thing with this, that we now have research finally from Marianne Roski and colleagues in 2023 that shows that a, a c use doesn't just support the language itself, which is what Nancy and I are really gonna talk about today. A a c also supports spoken language.

Now those of us, the four of us in the Brady Bunch scenario here, have all known this for a long time from personal experience, but we now finally have the good solid research data coming out, showing that when we use a a c, and [00:12:00] Kaiser did a study a while back showing that and Connie Kaari that, you know, with kids with autism, this is true and we now have data with kids with Down syndrome as well, that A A CU supports spoken language as well.

So there are all kinds of reasons to use aided a a C with this population. 

Kate Grandbois: As you were talking, I'm kind of, you know, sitting here reflecting on my own a a c experience, asking myself questions like, I wonder why, you know, I wonder why this particular population is overlooked or not considered. And I think the reality is, I don't think we're gonna answer that question today, but there are so many barriers for a a C in general.

Um. Areas of the country or where there isn't a provider available or a lack of understanding about how to do a funded evaluation. Um, and I, I think what's really interesting about what you shared is you're describing kids who may be multimodal communicators [00:13:00] and the perhaps persistent thought of, well, they'll develop speech, or they have oral speech, so they don't, they don't need it.

Right. It's not necessary. It's a, it's a barrier because then they have this thing that they have to kind of lug around. And I appreciate the, the shift in lens and perspective, um, that it isn't a barrier at all. Right? It's, it's something that we should be considering.

Amy Wonkka: I love having you guys on, 'cause as you were speaking, I was just like, yeah. All the things that they're saying. I mean, first of all, I am one of those people who would sit in your session and be like, but what about my clients with intellectual disability? So thank you. On, on, for me anyway, but probably also for many other listeners who are like eager for more and more of this research to come out that sort of reflects our populations, who we are supporting.

You know, I'm in a school. Um, but I think regardless of where you're working, if you're working, um, with people who are using a, a c, some of the people in your caseload probably also have intellectual disability. [00:14:00] And I think that that is always a challenge. Um, and I think it's, it is an extra challenge when your client has pretty solid unaided communication skills.

So I almost feel like that is harder for other communication partners, for families, and perhaps even for the client themselves when, like my oral speech does work sometimes and I have really good, uh, conventional gestures and unconventional gestures and I like do a pretty good job getting my needs met.

Um, so I'm excited to hear you speak more about, 'cause Nancy, you mentioned like they may. Our clients might not even use the aid at a c long term. It could, I mean, it could be across lifespan, like you were saying, Kathy, it could be a short term, um, support. But I, I'm really excited to hear more about your study, specifically looking at building some of those expressive language skills.

Yeah. That we can sort of get it, that like sometimes there actually is a mismatch and we think that our clients are, [00:15:00] you know, have a pretty, have a pretty solid batch between receptive and expressive when in actuality they don't. But we don't know that because we didn't give them an alternative modality.

Um, so I don't know, I know you talked already a little bit about why we should be thinking about a EC for young children with Down Syndrome, but I don't know if there's anything else you wanna kind of put on top of that. 

Cathy Binger: Well, I think what I wanna make sure, and we're gonna get into this a lot more as we go along, but there's a reason why we're calling this intervention a a c, generative Language Intervention.

It's a EC Glee Generative Language Intervention. And it's because for, for this study and for this line of research that we do, we're really focusing on grammar, right? This highly under this highly neglected area of a a c intervention research. And so what you said that made me think about this, Amy, was you said, Hey, like these kids, these kids with Down syndrome or people with Down syndrome, [00:16:00] they are multimodal communicators.

Hey, between this, that and the other thing, they may be getting their needs met, right? Their immediate, they may be getting their main point across, however. They, many, many, many, um, folks with Down Syndrome have the capability to learn how to put clauses and phrases and sentences together. They know they can learn grammatical rules, they can learn, you know, the syntax.

And, um, many people with Down Syndrome are readers eventually. Um, and they can develop language skills over the long haul. But what happens early on with them is that that's very neglected because they're, they're, they tend, on average, they tend to be quite delayed with their first words. They're quite delayed.

Even more so like with putting two words together. They, this is an interesting fact about Down Syndrome, um, that I read a while ago. That was one of [00:17:00] the, anyway, I'll just throw it out there. So. In typical development, kids have about 50 words when they start combining words, right? But with kids with Down syndrome, they tend to have a hundred words before they start combining words.

So there seems to be, I've always wondered this, and I don't know, even with our new data that we definitively have, I don't think we have a definitive answer to this, but I've always wondered how much of that, like that's always been measured with spoken language. So how much of that has to do with the fact that their speech and their.

Phonology and motor speech, 'cause they have both, they have speech sound disorder and motor speech. It's kind of a double whammy that's affecting, you know, all kinds of things that are going into their speech development that's making their speech so unintelligible. They have a really hard time saying more than one syllable at a time.

So how much of their speech. Not just their underlying language skills, but how much is, are their speech skills interfering with their ability to put words [00:18:00] together? Right? So a a d bypasses that. Um, and so, you know, what we're seeing with some of our findings that we're gonna get into here in a little bit, even with these, you know, we're, we're starting with some of them at age three, is that they are combining words and they're doing so remarkably quickly for people who ha tend to have intellectual disabilities.

Um, so this area, you know, when we're talking about the intervention itself, it's really important as we talk to, to know that the work that we're talking about today is not just designed to build. Um, basic requesting skills or other early semantic skills. It, it does like, and, and it can fill those roles and we're looking at some of the data for that now.

But the main thrust of it is actually to work with them on learning how to combine words and how to combine words that follow, in this case the rules of English grammar. Um, because it's just been [00:19:00] so overlooked all these years.

Nancy Harrington: And there's, you know, you mentioned before they're getting their needs across, so they may be, um, using sign, or they may be using their single word approximations, but it's so much more limiting than when you're having, you know, a broader range of vocabulary. We're able to combine words or symbols in order to.

Communicate much more than needs. You know, think about all the functions of speech that any 3-year-old is going to communicate about, and we need to give our kids with Down syndrome that same opportunity. 

Amy Wonkka: Yeah. I, I love that distinction that you're both making so very, very much. And I think, you know, we've talked before, we've had you on, I know that we also in this whole Brady Bunch agree with the importance of paying attention to developmental norms and all the things like, even like early present, progressive verb tense.

That happens way earlier than we [00:20:00] tend to think about or prioritize, particularly for a EC users. Um, and, and, and as you're speaking, I'm thinking about, like, Kathy, you mentioned the literacy piece. You know, all of these generative language skills also come into play when we're trying to generate a personal narrative or retell a story or tell about something that's not happening in the here and now, you know?

So there's, yeah, there's, there's a huge, there's a huge place for this. I'm very excited for you to speak more about the work that you did through this research.

Kate Grandbois: I think that's a great segue to hear a little bit about the study. 

Amy Wonkka: Yeah. 

Cathy Binger: All right. Um, well, uh, how about we, um, I'm looking at the learning objectives here. I see that the second one is describing the main components of a a c Glee. So maybe we should start with the intervention itself before we get into the nitty gritty about who was in the study and what we found.

Yeah, I saw a thumb. I 

Amy Wonkka: like, I like that plan because I always love, like, selfishly as the listener, I'm like, [00:21:00] I wanna know what I can do differently tomorrow at work. 

Cathy Binger: Well, you, you personally, I don't know how much we can teach you, Amy, you've been doing this for a long time too, so, but we've, so we've been, we have not always called this intervention a, a c Glee.

We've been very slow to name what we do. So finally caught on somewhere along the line and, um, started calling this a a c Glee. But, but in, in our work we've been doing roughly. We've been doing very similar stuff for a long time, to be very honest about it. And the, the three main components, um, that we always think hard about, um, have remained the same.

So one of those components is the intervention techniques. Uh, another one is motivating context and activities. And then the third one is the technology. So we can break those down. I'm gonna talk about the first two a little bit. Nancy, please jump in. I definitely want you to take on the technology piece, if that's all right.

Nancy Harrington: Mm-hmm. 

Cathy Binger: Um, [00:22:00] so the intervention techniques we actually have in our Down Syndrome article that's now published. Um, and that you guys can, uh, we can figure out how to get it to whoever, whoever wants it. Um. We have an appendix in that article that lists a whole slew of intervention techniques that we use.

So it's not just, of course, we use aided modeling. Right. That goes all the way back to, you know, 20 some years ago. And for me, with my dissertation, I, I did, I studied that specifically and people were doing that long before I came along. Mm-hmm. So that's a piece of it. But there are lots of other things that we do that are, um, basically exactly like what you do for kids who don't use a, a c Right Wait time.

Like lots of kids need wait time. Kids with Down syndrome really need wait time because they tend to have processing delays. So they, they need that wait time not [00:23:00] only to help them. Understand what you've just said to them, but also to then formulate their message. So that wait time's really critical. Um, we have all kinds of other techniques that, you know, the SLPs listening, they know the terms like, um, recast expansions, extensions, like all the things that we do when we respond to the communication attempts that the child has.

Um, and then. Lots of other things to elicit the language as well. So, um, things like presenting a choice of two things. Do you want the red duck or the blue duck? Um, and even when I said that you heard me do something else, I didn't just say, do you want the red duck or the blue duck? I said, do you want the red duck or the blue duck?

So vocal emphasis is a part of it too, of highlighting whatever feature. So they said duck, I want them to add something to it. I'm going to show them with my voice as well as with the items that I'm showing them. Like, so they get an [00:24:00] auditory cue with the vocal emphasis. They get a visual cue by me showing them a red duck and a blue duck, um, to try to really highlight for them, Hey, there's something else here that you need to add on, and it's meaningful and it's gonna get you something fun.

So this motivating context piece. So there are a whole bunch of intervention techniques, which, um, a lot of you're gonna be familiar with most of them. Um, and they're in our, not only are they in the appendix that we have, they also, um, within that appendix, there are hyperlinks with short video clips that Nancy put together of these intervention techniques of us working with these kids.

And I say us meaning, you know, mostly not me. Um, but, um, Nancy, her students, my students, um, with examples of all of the different intervention techniques. So there are, there are a lot of them. Um, one of the things that I. I say quite frequently about, um, intervention research, about my intervention, me being an intervention researcher, [00:25:00] is that I'm still figuring out what my intervention consists of.

Um, because I, there's so many things that we do as clinicians that we don't necessarily, or even conscious of once we, you know, get good at it, right? Like, you learn about it in school and then you go off and you do it, and, um, you keep doing it and doing it, and then it just becomes so ingrained. So we're trying to be as thoughtful as we can about making that stuff as apparent to others as, as we can, so that others can then go and do it if that's what they want to do.

So we have a really nice table with lots of examples and video examples that everybody can access. And then, um, so that's the intervention technique piece. Um, and the second piece is the motivating contexts and activities. These can be all kinds of things, right? We've done in the past, we've done a lot of storybook reading studies.

That's a great context for communication. And also it serves as a beautiful bridge into, um, narrative skills [00:26:00] as well spoken narratives, um, and eventually written narratives too. Um, the main context that we used in this study for the intervention kids was play. Um, these were all, uh, three to 5-year-old kids with Down Syndrome and we used play context with them.

We use all kinds of different play routines. I think we had nine, I don't know, nine or 11. Nancy would know, um, of them from vehicles to, you know, playing with little cars and trucks and the like. Um, we had a dessert one with the Melissa and Doug Wooden toy sets and cutting the cookies and, you know, doing and baking the cookies and all that kind of stuff.

So we had all these beautiful toy sets that we put together. It doesn't matter you, like, you don't have to take your own special thing, just use whatever the parents have or use whatever's in the school. Like that's why we wanted to use the variety. It doesn't, it doesn't matter what the thing is. It matters that you do it and that it's motivating for the kid.

And we let the kids pick to some extent what they got to play with and we could change things up when we needed to for them. [00:27:00] Um, so. Yeah, and certainly we haven't done any studies with ADLs, but it can be activities of daily living as well. So getting dressed or bath time or whatever, as long as the kid has access to whatever form of a c is appropriate, where you can work to, to build those skills.

Like you could use, you know, our, our intervention a a c glee really is, we always use the high tech stuff, but man, like, you know, we've worked with families in the past where the bathtub is a great time and you have laminated pictures in the tub and you can talk about the red duck and the blue duck in the bathtub too.

Um, so there can be different, um, different components to that. And when we're working with little kids, we really wanna make sure these are, um, age appropriate and highly motivating context. And then Nancy, I'll let you talk about the technology piece of the intervention. 

Nancy Harrington: So for this particular study, all the children used iPads.

So we had iPads set up with, uh, activity specific displays so that we [00:28:00] could really focus on the LA language. And we were minimizing the navigation so that we're focusing on the children being able to produce the language without having to think about navigating, um, to different pages. We started off with less symbols, so our initial displays had about 12 symbols.

Um, but the key thing about that is we made sure we had multiple word classes available. So, you know, we might, we had a pronoun and agents we had. A selection of verbs and adjectives and prepositions and some objects so that even if there were only 12 symbols on that display, um, it was a 42 location display where we had a number of the symbols hidden.

They were still set up so that they could produce those multi symbol utterances so they could produce that language. And then we had a protocol. So if, if they were using, you know, a certain number of symbols across Word classes, [00:29:00] then okay, we'd bump up and we'd increase the number of symbols that were available.

And to be quite honest with you, with these kids with Down syndrome, it was usually only a couple of weeks and we were bumping up. It did not take very low at all before we bumped up to, and 

Cathy Binger: we were seeing them twice a week. So we're talking, you know, three, four or five sessions and we're going from four symbols to whatever it was, 20 symbols or, you know, 

Nancy Harrington: yeah.

Cathy Binger: Essentially doubling as we, as we went along. Um, yeah. So it didn't take, it didn't take long. And, um, Nancy, no, I do want you to keep talking, but I just, I want, really wanna stress this word class point or parts of speech point. I think our initial displays, and there are images of them in our paper as well, so you can see them.

Um, I, I don't know that I've seen displays much at all out in clinical practice that look like this, where. Yeah, I've seen plenty of displays where lots of things are hidden, but not displays where you're very, very intentionally making sure that you have not just [00:30:00] one or two, but four or five parts of speech always available from the very, very beginning, you know, of, of, um, and a lot of these kids, they had never had access to a a c before.

So there's just this bias that I really wanna make sure we talk about. And maybe I'll let, let Nancy finish up with the technology first, but there's, there's such a bias towards certain. Um, types of language that we focus on, especially nouns with, um, in, in some cases. And we wait way too long, like way beyond typical development.

And this goes back to a former podcast that Nancy and I did with you guys where we talked about typical development and how kids are learning those grammar skills, um, and, and those grammar meaning syntax and morphology. Um, they're starting to learn those syntactic skills when they're 18 months old in typical development, and they just start, that's when they start combining words.

Kids only have 50 [00:31:00] words in typical development when they start combining words. Um, and so we've gotta give our kids words that they actually can combine. Um, and why would we wait for them to work on grammar skills and give them the opportunity to say Red duck and blue duck, and get to pick which duck they actually want and, and learn how to, you know, combine those symbols in rule-based ways.

Um, when that's not. Why would we wait when that's not following typical development to wait. So, um, Nancy, I'm sure you had more to say about the technology. 

Nancy Harrington: No, that's okay. And we tied it very much into the context as well. When you talk about what, um, typically developing children are talking about in the fun things that they wanna talk about and emphasize.

You know, for example, for one of the first adjectives was dirty. Oh my goodness. The children had so much fun saying, you know, this dirt dirty cookie, or dirty cupcake or dirty tractor or dirty, it was motivating. It was just so motivating, [00:32:00] you know, and making sure that we had those adjectives available. Um, as well as.

You know, the prepositions. So, you know, we may have had under, so we'd play hide and go seek and they'd have, have an opportunity to put things under or, you know, then contrast or is it or is it in? And then we had these puppets that were set up with, um, happy and sad faces. So they had so much fun with the emotions as well, and describing that.

Hugging them, of course, was one of our, our verbs. So we really, we, when we designed the technology and the layout and the vocabulary across the different semantic categories, we really tried to think about the context as well to make it motivating and fun for the children. Um, and we, 

Cathy Binger: if I can jump in for one sec, Nancy, I just wanna make sure I point this out.

So, Nancy's describing all these kind of specialized materials that we made because it's a research study, but you guys don't have to do that. Like, you know, it's not necessary to go out and spend money and, you know, like whatever. [00:33:00] Find what's motivating for the kids you're working with and do it. The point for us was about making sure that, 'cause we, because it was a controlled research study, we needed to do the, have the same materials.

Um, we, we decided to have the same materials across kids, so we needed to build in some of these things. But that's not, you know, I don't consider that to be an, an essential. Kind of component. I wanna more make sure that our interventions are flexible. And so we had all this range of vocabulary, um, that is available.

So the point wasn't, you know, the happy, sad, dirty. And I'm not saying Nancy was saying that at all. I just wanna make sure I point out the point wasn't that we specifically had happy, sad, dirty, and hug. The point was we had, oh, you know what I forgot to talk about Nancy was your favorite intervention technique.

Repetition with variety. Mm-hmm. Mm-hmm. Um, we're trying to teach underlying grammatical structures. I don't care if they can say Happy Dog and Sad Dog. I care if they can, if they know adjective plus [00:34:00] noun. If they know that that adjective comes before the noun in many contexts, right? So, uh, we have this variety of vocabulary that within the technology and within our sessions as we're teaching them.

So we're not training narrowly in for our intervention. We're not training narrowly at all. Now, we have in some of our past studies, but for this study, we had these kids an intervention for four months. They came in twice a week and they got different targets every single time. Like we're te and we were teaching agent action object or, you know, subject, um, verb object.

Um, at the same time we were teaching adjective plus noun, and at the same time we were teaching prepositional phrases. At the same time we were teaching possessives, like those were our four main underlying targets, and then we were combining them. So it's not just. Dog drives a car, it's red. Dog drives a car.

So we have the adjective in there too, right? So there's, there are these things that we can combine and do so much with just, [00:35:00] you know, 12 up to 42 symbols on a page. 42, 48, I don't know, 42, 42 symbols on a page. Um, I. And so the, the bigger underlying point is to teach this repetition with variety, knowing that this was a really risky thing for us to do in a research study, it's easier to teach my narrower sorts of targets with very specific vocabulary.

But we didn't want them memorizing, you know, I hit this button and this button. We wanted them to learn the underlying grammatical rules. And so, um, we took this risk in making sure that we gave them the vocabulary they needed for repe and that, and that so that we could do this and that, um, all our, our posses of clinicians who were in, um, involved in the study all learned how to do this repetition with variety.

So they didn't ever hear just red duck, blue duck. It was Red Duck and Dirty Cow, and you know, big [00:36:00] Lion all in the same session. Um, so different vocabulary, but the same adjective plus now together.

Amy Wonkka: So I, I have like disjointed talking points, but I'm gonna throw 'em out there anyway, um, this goes way back to earlier. I just wanna say the appendix that you guys were talking about that has the video links in it that has, um, the examples in it. The other thing I really liked about it is somebody who, in my job I work to support other communication partners is you also talk about why you're using the strategies.

And so that's helpful. So if you're listening, um, to this and you're thinking like, maybe I'll check out that appendix, you should, because not only are there nice, like concise explanations of like what recasting is and how it might look, it also tells people why you're doing it. And I think that's very helpful for communication partners, especially like classroom paraprofessionals or something, to not just be like, do this thing, but to say do this thing because this is why we're doing it.

Um, I noticed, 

Cathy Binger: right? Like, do it. Yeah. Because 

Amy Wonkka: [00:37:00] yeah, 

Cathy Binger: you need to add more information and do it because, yeah. So that part, and 

Nancy Harrington: that's empowering not only to the, um. In our case, you know, we had graduate student clinicians that we're training. But if you're training school personnel and also for families, 'cause if everybody understands why, then they're going to be able to independently make those decisions and transfer the for them to the other contexts.

Kate Grandbois: That's what I was gonna bring up, just reflecting on everything that you've shared so far, uh, and the idea that it's very hard to operationalize or clearly describe these things that we might do naturally when working with a child. Uh, and some that those things might come more naturally to some of us who maybe have been around kids or have nieces and nephews versus maybe a family whose parents don't have a lot of that exposure, and those things don't come naturally to them.

So how helpful it is to see not only the list, but video they to, to model how it's done and then why it's so [00:38:00] important. I, I think that that is like a. A ripple in a pond, kind of of of just, you know, sharing best practice and, and what can be helpful for people who might not have had that exposure. I think that's awesome.

Amy Wonkka: I had another like, thought slash question just looking at the article. Um, there are pictures like Nancy said, of the displays that they used. I noticed that as you went from like the 12 to the more complex you didn't like for people listening, the display did not change. No. So the words that were there in the 12 are still there in the whatever the next 

Cathy Binger: level and they're in the same place.

They're there in 

Amy Wonkka: Exactly. That was my, 

Nancy Harrington: in exactly the same place and across different, um, 'cause you don't see all the different play routines there necessarily, but um, across all the different play routines. So any of the common vocabulary Yeah. Whether we were baking or we were playing with the farm or we were playing with vehicles.

It was all the same in all the same place. 

Cathy Binger: Yeah. So the nouns, you know, the [00:39:00] specific nouns for baking versus farm are gonna change. But the animals we played with, you know, were, were the same and they stayed in the same place. And some of the grammatical, the, especially things like some of the adjectives that we use, like we did use dirty across different play routines, so that always stayed in the same place, um, across all of the displays as well.

Nancy Harrington: The pronouns, the, 

Cathy Binger: yeah. 

Nancy Harrington: The attribute, the size big and little and, and all those. 

Cathy Binger: Yeah. And I just, Nancy, I'm gonna say this because of the conversation you and I had yesterday about displays, we were looking at displays on other types of, um. Let me tell you the side, the, the side note first is we are continuing this research right now and we're doing a longitudinal study with kids.

We're following them for two years. Um, and it don't get, you know, it, it'll, it's great, but it's, it's for other purposes it'll talk about on another day. Um, but we're having, they're very small groups of kids. So we'll [00:40:00] have, ultimately, we're shooting for three kids with Down syndrome that we're following for two years.

Three kids with CP and three kids with childhood apraxia of speech. So there was a reason why I brought this up. Oh, it had to do with what Nancy and I were talking about yesterday. The displays that we're using with those kids are a little bit different. Um, and they're, you know, they're, they're not just our self created, um.

Displays that you could put on any device. They're we're using whatever the kids came in with, if they had something. Um, so there, different kids are using different things and um, but we're still using these same principles and Nancy was schooling me yesterday on, no. Like, even though it's not just this single display where things never move, things may move and change somewhat, but see this word, this word go no matter where you are, the word go is in the same place or the, you know, whatever it was.

So [00:41:00] you can use a lot of these principles, even if you're not using displays that look identical to the kind of displays that we're using. 

Amy Wonkka: I think that's such a good point. I appreciate you bringing that up. And I guess a question that I would have is also like, you could do it even if you don't have access to a high tech tool.

Sure. Potentially. Absolutely. Right? Like you could do this with a printout. 

Cathy Binger: Yeah. 

Amy Wonkka: Um. So, 

Cathy Binger: which we've done in the past, 

Amy Wonkka: right? 

Cathy Binger: It's been, we've done that in the past for sure. Yeah. 

Amy Wonkka: Yeah. And I, I had an old boss once who said, you know, don't let the perfect be the enemy of the good enough. And I think that that's a really nice, like way to, like, sometimes we wish that we had access to like all of these tools, but if you're excited and you're, I don't know, in ei and you have a young like kiddo who you're working with, a family who you're working with, you don't have access to high tech tool right now this minute.

Like you could potentially like print something out and give that a try to, um, as like part of your step on. 

Cathy Binger: Yeah, and I think one of the things I found when I, you know, when we've done this in the [00:42:00] past, just as a another relevant side note talking about low tech stuff, is if you're gonna do that and use a printout display or a series of printout displays, you have to be the voice.

The voice output is you, so that if the child points to duck. You say duck. It can't just be silent. And when the child points to red, you say red. So you don't have that automatic voice output. So you need to be the voice output so that you know, and they know what it is that they're pointing to, and that you can help them build from there.

Nancy Harrington: One of the important things that was part of, um, the intervention as well is because, you know, we're recognizing that the comprehension of these children is greater than their expressive output is. Um, we used grammatically accurate natural speech models. So yes. Maybe they're only putting two to three symbols together.

So it might be I eat cookie, but then we might say, oh yes, I'm eating a cookie [00:43:00] too. Or you're eating a cookie. So that we are, we're ensuring that we're using those grammatically accurate natural speech models. So we're feeding that those receptive language abilities that the children that we work with have.

Cathy Binger: Yep. And we know from, uh, the spoken language, not the a DC language, um, literature that, I mean, there's been back and forth about this for a long time, but in overall, in general, the jury seems to have come back and said, Hey, like what we need to be doing for input for kids with all kinds of intellectual disabilities is.

Grammatically complete utterances. Don't speak in telegraphic speech to these kids like they need it. They need the, I always call it the grammatical glue. They need the grammatical glue to understand what the heck you're trying to tell them. Um, and they need the grammatical glue because they're learning language.

So don't use telegraphic speech. It doesn't make things easier. It actually seems to make things harder. So we, even [00:44:00] though we may be modeling non grammatically, we get this question a lot. Why, you know, why aren't you modeling grammatically complete utterances on the device? And it's because for us, and we may be wrong about this, you know, the literature, we don't know the answer.

So the literature may, may, we may be doing something different five or 10 years from now, but it's just so much to constantly be modeling. I am eating a cookie. Right. And it's like where's is the kid getting lost in all of that? And it's a lot of processing that they have to do visual processing as well as motor processing.

And what do they imitate and which words do they imitate? So we are highlighting the key words when we're starting out, but we're also always giving them the grammatically complete spoken utterance that goes with it. So we're not just saying I, um, or we're not just saying Eat, cookie, eat and then modeling eat cookie.

We're saying, I'm eating a cookie. I eat cookie. You know, that way mod, you know, on the device we're doing, I eat cookie and saying the whole thing grammatically [00:45:00] complete. 

Nancy Harrington: So, and the other thing we do is, um, we make sure that those aided models, even though they aren't as complex as the natural speech, we're making sure that we're one to two symbols beyond where the child is in terms of their expressive output.

We're really looking at their zone of proximal development. 

Kate Grandbois: I just wanna say how much I appreciate that explicit description. Uh, having worked in a a c for a long time, I think one of the questions that I see clinically so frequently is, how do I do this, right? So we know that talking to kids with symbols is important, but what does it look like?

How do you move your body? How do you move your mouth in conjunction with your finger? I just, it was a, I think that description, uh, highlighted the importance of, um, just the duality of what we're doing really, really well. So thank you for sharing that. Before we talk about the outcome of the study, are there any other highlights about a a c Glee that you would like to go over?

Cathy Binger: Nancy, you have [00:46:00] anything? 

Nancy Harrington: Well, I just think, um, and this is more anecdotally, but, um. What we've heard from the parents, um, as very much so, and how appreciative they were to be able to learn from us. You know, they saw what was happening during each session. They might, sometimes, some were in the room, some were watching through a video feed.

But, um, they really appreciated learning. They really appreciated the opportunities for their children to use more language than they were able to, um, use with their natural speech alone. Um, and they really appreciated that. We respected the multiple modalities of communication as well, and I think that's, that's important.

Kate Grandbois: Thank you for sharing that. I would love to hear about the findings of your study. Well, maybe we should go over the methods first, if you wanna talk to us about, [00:47:00] you know, you specifically, how you went about measuring this. Um, in, this was a randomized control trial study. 

Cathy Binger: It was, and there are very, very, very, very, very few randomized can count.

Uh, basically on one hand the number of randomized controlled trial studies that are intervention studies for kids who use and need a, a c. So this was a really rare study. Um, unfortunately this study got smacked right over the head with COVID, uh, with the pandemic. So our numbers aren't what we ultimately wanted them to be.

But even with all of that and the complications with all of that, um, we still ended up with, you know, a relatively large study for our, um, you know, given what we're we typically compared with what we typically see. So we started out with. 22 kids in the intervention group and 14 kids in the control group.

[00:48:00] Or it's more complicated than that because of COVID and what we did before and after. And I'm not gonna get into all that, but that's, that's basically, you know, if you look at the graph and the published paper, that's what you see is we had, we had 22 kids in intervention in 14 in control. There's a reason why there are way more kids in the intervention group not gonna get into that.

If you want the details, they're in the paper. Um, but they're co it's COVID related. Um, so all the kids when they started were between, were betwe had to be between three years. Old and five years, 11 months. So they were all somewhere between three and five when they started the study. Um, most of the kids we screened with Down Syndrome who were between those age groups qualified for the study.

Um, we had a couple of kids who were too intelligible, um, and that the a c just really wasn't gonna be appropriate. But everybody else was certainly unintelligible enough and, and most of them, there's even numbers. We have a little table [00:49:00] in the paper that shows you exactly what their intelligibility scores were and they were low.

Um, and they stayed low, as you might expect with this particular group of kids. Um, we did the usual sorts of tests in the beginning. We looked at the receptive language skills. We looked at a whole bunch of things and we compare the groups to see are these roughly equivalent groups. And we found that they were, there were no significant differences between the groups.

So we had some, a nice, a nice group of kids here. Um, who were comparable to each other in all of the key skills that, that, um, you'd wanna have them to be comparable on like things like their receptive language levels and things like that. So, um, so the, the, I'm not gonna get into too much nitty gritty. I don't wanna bore you guys to tears and make you turn off the podcast, but I'll give you some of the basics of how we set all of this up.

Um, so we, first, we assessed them for eligibility. Um, and then after [00:50:00] that they were randomized. So well actually we assess them for eligibility and then we gave them a four hour workshop. Everybody, the control kids as well as the intervention kids. So before they were randomized into their control group versus intervention group.

The parents received a four hour workshop that Nancy did, if it was at the University of Central Florida where she is or someone else did, if they were here in the, um, Albuquerque, New Mexico site. So, um, everybody had this workshop and it was a really lovely workshop that Nancy put together and has done many times even prior to this study, has done similar things with families to get them up and going with an a a c communication app.

And it was a very hand, it was a very much a workshop where it was a hands-on workshop. So part of the reason that we did that, um, was that we really wanted to show. That that's not enough. Like even that, a lot of families don't get that. And then we sent them home with the iPad, so they had a really [00:51:00] solid workshop under their belts.

And so we did see a bump with the kids, um, the control kids, because the parents, we think, we think that part of that reason that we saw Bump in their, their skills was because of that, that the family had been given some information about what to do, but then they couldn't sustain it. The kids couldn't sustain it.

And we were, you know, the families don't have the supports that they need if they don't get ongoing intervention. So anyway, everybody got this workshop and then they were randomized to control group or intervention group. Um, and then what happened was the control kids came in once a month, um, and we measured them once a month.

So they'd come in the, um, I'll talk about the measurement in a minute. So they did their measurement sessions, and that was the only time we saw them was for their once a month measurement sessions. The intervention kids also had those once a month measurement sessions, but they also had intervention. So they came in twice a week.

Um, and [00:52:00] then at the end of the month, they would have, um, the measurement session. So as I talked about earlier, the intervention consisted of play, these play routines that we did. The measures were actually, the measurement sessions were different. We used this, um, uh, uh. Wait, this is Down Syndrome kids.

Nevermind. So they're still play sessions, um, but they don't get as many supports in the measurement sessions. So we're not doing co-construction with them where we're jumping in and filling in words. And we're not doing a lot of teaching or really, we're trying to do as little teaching as possible during the measurement sessions to see what the kids are basically doing on their own.

So in a nutshell, like that's what's happening, um, during those measurement sessions. Um, and then we also did, when, when we could, again, because of COVID, we didn't have as much data as we wanted to, but we did generalization, or sorry, we did, um, maintenance measures as well. Um, I think it was [00:53:00] one month and three months after, um, after they finished the intervention.

So Anything else you guys wanna know about the methods? 

Kate Grandbois: No. I think you've told a, you've painted a really nice story of, of, of, you know, what you all went through. Sounds like COVID was kind of a bummer, um, to say the least. Um, sorry, Amy, go ahead. 

Amy Wonkka: Sorry, I don't, I don't know where it fits in the paper, but I did want you to talk a little bit about calculating how you did MOUs 

Cathy Binger: that I'm gonna do next.

Amy Wonkka: Okay. Sweet. 

Cathy Binger: Alright. Okay. So that gets into our results and, and all, you know, how we did our measures. So, um, we have concocted over these last few years a new measure, um, in a a c that we think and hope, um, is gonna be influential in the discipline. So we all know MLU in spoken language being length of veterans.

Okay. Anybody who's an SLP who's listening to this podcast, I'm sure you know what an MLU is. Um. [00:54:00] What we used to do, and I don't mean we meaning me personally, um, but I mean as a field, sometimes in the very few studies you'd see where people were focused on grammar, they might just use MLU but do it in symbols instead.

Right? Like, just basically use that mean length of veterans and use it, um, for the aided language. But we also know from the literature from ages ago, um, people have looked at this starting a long time ago. We know there are problems with using MLU in aided language. So two of the, well, one of the big problems is co-construction where people jump in all the time to try to help.

A kid says blue, and you say you blue, you want blue. Well, you want, what do you want? You want a blue what? And the kid says, dog, and then you finally get blue dog. Um, we didn't have to worry so much about the co-construction because we were the ones doing the intervention and we were the ones doing the measurement and we didn't allow co-construction during the measurement sessions, so that took care of that problem.[00:55:00] 

So if that was the only problem, we still could have used MLU. But there are other problems too. Um, one of them is word order. So we know that kids tend to have. With certain types of structures. We did a study on this a while ago showing that this is more of a problem with certain types of structures, but they tend to have issues with word order when they are learning to use a a c.

So instead of saying, um, we had this in a study a while ago, like, um, dog chase, cat, they might say Dog, cat, chase, um, or they might put the chase first and put the verb first, and then list who is doing the chasing. And so getting that straightened out, um, takes a while with kids, um, when they're using a a C and they do things that they don't do in spoken language very often.

Um, so this is more of a unique aided a a c kind of issue. You can teach 'em Correct. Word order, which is what we aim to do. Like, we're not [00:56:00] so interested in a theoretical perspective of. How frequently do kids do that if they're left to their own devices, blah, blah. Our interest as researchers and as clinicians is to teach kids to follow the rules of, in this case, English, um, or whatever the language is.

So, um, so one of the things we wanna account for in our MLU measure, um, is those difficulties with word order. So what the, what we do for that piece of things is that every utterance, um, gets a word order score. So I'll stick with my cat dog, chase, cat, chase, dog, um. I like the cat chasing the dog. So we'll say that's our target.

So in many, many people that's actually a reality. Um, so many animals. So anyway, so our, we've got a cat chasing a dog. Um, if the child says cat chase dog on their a c [00:57:00] device, that's a, the word order's fine. They get a score of one. But if they say, um, chase, dog, cat, there's no discernible word order there.

That's not the syntax that we would expect to see. So it gets a zero. Um, and then if it's in between, so like if they started with Cat, they were supposed to start with Cat and they did start with Cat, but the chase and the dog are in the wrong order, then they get a 0.5. So it's just a, every utterance gets a one, a 0.5 or a zero.

And so it's called a, we call it their, their, it's just their word order score that they get. Um, and then, so then for their score, you would multiply that times the number of relevant symbols. So I'll come back to that in a second. This, so the one component that's different with weighted, we're calling it weighted MLUN symbols with our weighted MLUN symbols.

It's weighted based on the word order. Um. So different waitings for different word [00:58:00] order. And then the other piece of it that's really important is the relevance of the symbols. So as you guys know, especially when kids are starting out using a a c, they may be selecting all kinds of symbols that aren't really relevant to whatever it is you're talking about.

They have this ability to basically push buttons like crazy if they want to, and they may have lots of things or one, one word or lots of words, one symbol or lots of symbols in a given utterance that's not relevant. Um, and so we only, when we calculate our, using our weighted MLU and symbols, we only look at the relevant symbols.

Um, determining that is something we don't have time to get into today. But that's, you know, we have our operational definitions for that. So then for our, to go back to our cat chase dog example, um, if the child says Cat chase dog. That's what we're going for. That's what we think there is. That's [00:59:00] perfectly fine utterance.

Then all of those symbols are relevant, so that's fine. And then the word order's fine. And that's, so that would get a one. So it's three symbols, three relevant symbols times one that utterance gets a score of three, just like you would with regular MLU. However, if they say Cat, dog, chase. You still have three relevant symbols, but it only got a word order score of 0.5.

So three times 0.5 is 1.5. They only get credit for 1.5 utterance, uh, 1.5 symbols in that utterance. So every utterance gets awaited, MLU Sims score. And then once we have a corpus of utterances, like with a language sample, then you add them up and you divide by the number of utterances, just like what you would with a regular MLU.

So that's how we measured their performance, um, with the down syndrome study is, um, using that weighted MLU SIM score. Was that, did that all make sense? [01:00:00] 

Amy Wonkka: It did. I'm gonna hold my 5,000 really like niggly questions that I have about it to like a different time when we're not on a podcast. Uh, but I think that was really helpful and I think it was very, very helpful in the context of thinking about grammatical intervention for a population of students or clients or patients who are working through an aided a UC system.

Because I feel like that is, it's a real challenge. It's, and I like the idea of giving credit both for being on topic, but then also weighting it depending upon the grammar piece, which is part of what you're trying to get at with the morphemes in the MLU. But it's like tricky. 

Cathy Binger: And I'll tell you another quick side story here 'cause I know you'll be, you'll be interested.

Um, and Nancy and I and Jennifer Kent Walsh can certainly come back, um, time and again if you'd like us to. The big study that we're doing right now is all about measurement and that's just one of 13 measures that we're looking at and seeing how they behave and how do they [01:01:00] behave at different points in time.

And because this measurement issue we've never developed as a field psychometrically sound measures in a a c and that doesn't even touch what happens with multimodal communication. Like that's another whole ball of wax that we need to, um, certainly like I beg researchers who are interested in this kind of stuff to please, you know, get into that or contact me.

Um, 'cause we have, we have all kinds of data that we could use to start to look at that, but, um, we need more AC researchers to do that kind of work. So anyway, um, it's just one of many measures that, that we're, we are actually looking at right now. 

Amy Wonkka: We're definitely, we're gonna take you up on that supremely nerdy conversation to be held at a future date.

I'm very looking, very much looking forward to it. Um, I was hoping you could tell us, I, I, I'm going, I'm going put my MLU questions in my thought bubble, um, and hang on them, but, um, what did you find? What did so 

Cathy Binger: guess what? [01:02:00] Nothing. No, I'm just kidding with that. 

Amy Wonkka: Oh my gosh, you really had me there for a minute.

I 

Kate Grandbois: was like, wait a minute. I read the paper. Was it nothing? 

Cathy Binger: No, no, you said that with such podcast after I said, I hope nobody shut it down after I said that. No, we found we had some really nice findings. Um, it would've been nice if we had more kids, but, um, we, we saw that our intervention kids were producing, you know, they were always producing literally more, you know, their m weighted MLU score on average was more than the kids in the, in the control group.

So after three months. So all the kids, you know, roughly, actually I should pull my graph back up, but I'll tell you where they were after three months. So the control group, their weighted MLU in symbols was at 1.09, which means if you understand what MLU means, they're doing single symbol utterances and that's it, right?

They're still after three months and after four months, that control group was 1.01. So they even dropped a little. They are [01:03:00] basically, they're just doing single symbol, you know, relevant, single relevant symbol utterances. The control group after three months, was it 1.32? Now you gotta remember, 

Nancy Harrington: intervention group 

Cathy Binger: did I say control intervention?

Thank you, Nancy. The intervention group was at 1.32 after three months and 1.37 after four months of intervention. So that may not sound number wise, like if you're just looking at that as a number, like it's a big difference, but it is a big difference when we're talking a about MLU. B, that we're talking only four months of intervention.

And three, these are kids with Down syndrome and we don't expect them to be making huge gains with how quickly they're putting, um, utterances together. Now, our kids with typical receptive language that we'll come back and talk with you about another day where we did a similar study, they had much bigger gains.

Um, but the fact that we found something here in this short [01:04:00] period of time with these kids, you know, that, that, um, weighted MLU of 1.32 and 1.37, um, that's showing these kids are pretty consistently putting two, and certainly we know from the data some three word utterances together after coming in to see us for, you know, not very long period of time.

So we saw generally consistent gains in that weighted MLU sim for the intervention kids, but we did not see that for the control kids. And these certainly our substantial gains for only four months, three and four months of intervention. 

Kate Grandbois: Well, that's means, so nothing. 

Cathy Binger: Hey, 

Kate Grandbois: that 

Amy Wonkka: I'm so 

Kate Grandbois: excited for longer 

Amy Wonkka: study.

Kate Grandbois: Sorry. That's very exciting. That's wonderful.

Amy Wonkka: I'm, I'm pumped for your longer study. I think it's gonna be awesome. 

Cathy Binger: It's gonna be interesting to see. Yeah. Nancy's taken charge of these, all these kids and seeing how far we can get them in a two year period and that those kids were really focused with the new [01:05:00] kids who were following for two years.

We're really focusing on, um, the measurement development stuff. Um, so we don't have any control kids. We're not doing that part. We feel like we already showed that we know that this intervention works, but let's see how far we can get them and what that looks, what their developmental trajectory looks like, um, over a longer period of time.

Kate Grandbois: I wanna just highlight one really important point that. I think we shouldn't take for granted as, as working clinicians. When we hear about research like this, there is so much information out there that we can't apply in our regular jobs. Um, you know, the intervention is too time consuming. It wasn't well defined.

It requires materials we don't have access to whatever. But this sounds very doable. It sounds very applicable. You've created this beautiful chart that, that describes, you know, exactly what you know is it needs to go into it. Um, and I also feel like so [01:06:00] often when we're talking about kids who have, you know, who are multimodal modal communicators or, um, they have complex communication needs, we might feel, I've heard this from a lot of clinicians that I've worked with over the year, over the years of, you know, four to six weeks of therapy goes by and we're not really seeing the, the needle move or, you know, what do I do?

What do I try? So I, I guess I'm reflecting back to you that that is a decent, it's wonderful to see movement in such a short period of time with an intervention that is. Feasibly implemented within a regular context. I think that 

Cathy Binger: that's, and these were really 

Kate Grandbois: powerful and not to be taken for granted.

Cathy Binger: Well, and what I didn't mention that I should have mentioned is the length of the session. So Nancy, how long were the sessions? 

Nancy Harrington: The sessions worth 30 minutes. 

Cathy Binger: And that includes doing a symbol review. Yeah, 

Nancy Harrington: that included symbol review. So it was five minutes symbol review and 25 

Cathy Binger: minutes. That's full [01:07:00] whole, you know, a typical, you know, pretty typical sort of session like now these were, it's not perfect.

I don't, um, not to end on a downer, but, you know, it's not perfect. These were one-on-one sessions. Um, and that doesn't always happen for sure. We ha need tons of research on how do we do this sort of thing in, in group intervention. And this was not, even though a lot of our past research and our future research will be on communication, partner instruction, they're, they're showing these gains without us.

Teaching the parents explicitly how to do this at home and you know, to do this sort of thing off and on during the day and or teachers or anything else. This is just, these results are really just from them coming in and showing up and working with us a couple times a week, 

Kate Grandbois: which is amazing because that's the, that's very well aligned with the infrastructure that we have available to us as clinicians when we are on a service delivery grid of two times 30 or, you know, what, you know, whatever the 

Cathy Binger: reality is.

We wanted to did that intentionally. I mean, [01:08:00] also it's not practical to have families. We've had, you know, we tried to do it in the past with three times a week and family. It's too much for family. But yeah, I mean, why, why would we develop interventions in our practical, what's the point of that people?

Kate Grandbois: Great question. Agreed. Great question. 

Nancy Harrington: The control group emulates, um, uh. Where, say you have a parent who decides to get an iPad and download an app and maybe do a training online or go to a training and um, off the go, and we kind of mirrored that with our control group, um, to show that it, it makes a difference.

It really does make a difference to have that skilled intervention. 

Amy Wonkka: That's another really good point too. I, this is a tiny question, but you mentioned the symbol review that takes place at the beginning of every session. Can you just tell us what that is, what that looks like? 

Nancy Harrington: So we did that because these were very activity specific displays that were being used during our sessions, so we wanted to make sure they [01:09:00] remembered where the symbols were and we changed, depending upon what play routine they chose from the week before they, they may have changed.

So we wanted to remind them where the symbols were. So that, um, they were set up then to create those multi symbol utterances and use them appropriately. 

Cathy Binger: And what did that look like, Nancy? So I, it's been a little while now. Um, 

Nancy Harrington: so it, there were two options. Either the child could select the symbol, um, you know, said, oh, let's find all our animal friends, you know, wheres Hippo and Dog and Duck, and Oh, where's I in you?

Because we had pronouns on there as well. And so we might do that. Or sometimes the children just didn't, they weren't feeling it, they didn't wanna do that. So then the clinician might say, oh yeah, well I'm gonna help you. Look, here's I, for me and you for you, and here are our friends, hippo and Horse and Duck, and these are all the things they do.

They eat and they drink and they hug and you know, and we just, so [01:10:00] if the child didn't feel like selecting it, then the examiner just selected it to make sure that they. We're all reviewed, all the symbols were reviewed before we began the actual 25 minute session after symbol review. 

Cathy Binger: That reminds me of something else I really wanna mention if we have time about this.

That's just a really fun detail, um, that we came up with and I, it worked beautifully. So for INU, why would you represent INU using anything other than the words INU? Like, let's use the letter I and let's use YOU and keep in the same place. That's a bias that I have. Like why teach 'em one abstract symbol when they need to learn this one?

Um, so, but what we did in intervention to teach them and work with them, with INU is we had all these, um, little Doug and Melissa wooden figurines and we put our faces on them and we put the kids' faces on them and then. I could go in the car like, and I am in the car and now you [01:11:00] are under the car and no, I didn't run you over.

Uh, so like, but we, we really thought about how like, there's always this pronoun problem of how do you teach pronouns and man using, we had great big ones and we had little ones, so little ones could fit. Oh, they 

Nancy Harrington: loved 

Cathy Binger: it far and the big ones could do, could do the cooking or whatever else, and they worked.

So it's just a little trick for a, a c or spoken language or whatever, if you're working with kids who you need to work on with pronouns. Man, that worked really 

Nancy Harrington: well. No, it, it, it worked really well and we've actually extended it for the next project with family members, um, so that they can talk about mommy and daddy and siblings and everything during the session.

So then they have more follow through for home. 

Cathy Binger: And it's, you know, it's cheap and easy to do. Really. Like you could use cutout dolls if you want to from cardboard. I mean, they don't, they don't have to be fancy. It's just fun to stick yourself in a car and off you go. 

Kate Grandbois: So fun. What a great idea. I love that.

Um, I really appreciate [01:12:00] everything that you guys have reviewed. This sounds like a, like I said, I don't wanna, um, take for granted the power of a study like this and the impact that it can have on us as clinicians, as our, in our last couple of minutes, I wonder if you have any clinical takeaways that you wanna share for any SLP listening who is excited about this as an intervention that they can try in their classrooms?

Um, anyone who's new to a a c and wants to give this a spin, what do you have to say to, um, people who are curious to learn more about this?

Nancy Harrington: Well, I think. Di dive right in and, and remember typical language development because we always have that in mind when we're looking at the way we were setting up the grids. The functional and fun play routines, um, ensure there's access to the range of parts of speech [01:13:00] for creating, generating utterances with a diverse vocabulary and, um, parts of speech just and have fun.

It's a a c glee. 

Kate Grandbois: I love that so much. That's so great.

I don't know if there's anything we can, we have to end it with that statement. A I think you have 

Cathy Binger: to end it with that statement. Yep. 

Kate Grandbois: Well, thank you so much both of you for being here. Um, as always, we learn so much from both of you. For anyone who is listening, we will link all of the references and resources in the show notes, including the reference for this article.

A quick thank you to our production team who makes this possible. Dr. Anna Paula Mui, who makes our ashes EU possible, Tegan or her and our production manager, Darren Lopez, our production assistant, and Tracy Callahan and Dr. Mary Schmidt, who assist with our, um, our peer review process. And last but not [01:14:00] least, thank you so much Kathy and Nancy for being here.

We hope you'll come back. It is very, it's abundantly clear that you have a lot more to teach us so. Hopefully we'll see you back here again soon. 

Cathy Binger: Oh, we're, we're so, um, blessed and honored to have you guys out here doing this great work, and we will always come back. So we really appreciate the work that you're doing and, um, this dissemination service is invaluable, so, absolutely.

Nancy Harrington: You 

Cathy Binger: too. 

Nancy Harrington: Thanks for inviting us. 

Amy Wonkka: Thank you for sharing your time and all your knowledge. Appreciate it very much.

Outro

Announcer: Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study.

Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be [01:15:00] listed in the show notes. And as always, if you have any questions, please email us at [email protected]

thank you so much for joining us and we hope to welcome you back here again soon.

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