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Introducing the Listening and Spoken Language Series: Strategies for Children with Hearing Loss and their Families

Helen M. Morrison, Ph.D., CCC-A, LSLS, Cert. AVT
Contributing Author, Recipe SLP
First Things First: Ensuring Auditory Access (Book 1)

Hello. I’m Helen McCaffrey Morrison and a new author for Recipe SLP. I’m grateful to Maria Munoz for inviting me to join this group. It’s especially exciting to be writing with a focus on applying evidence-based intervention strategies in every-day settings. The Listening and Spoken Language Strategies Series is created for professionals (speech-language pathologists, educators, audiologist) and students who work with children with hearing loss. The Series is intended to serve as a resource for parents as well.

The Listening and Spoken Language Series offers a contemporary approach to intervention strategies that help young children with hearing loss acquire listening and spoken language developmental benchmarks in conversational contexts. My goodness, what a collection of buzz-words in the previous sentence! Let’s break that down. . .

Contemporary approach: Intervention for children with hearing loss has a long history, with accounts appearing as early as the early 1500’s when a Spanish monk developed one of the first manual alphabets for deaf children. Advances in the 21st century, however, have ushered in a new era for children with hearing loss. Newborn hearing screening, early fitting with digital hearing aids and cochlear implants, and early intervention enable children with hearing loss to hear spoken language and acquire the listening skills that underlie spoken language communication. Intervention strategies from the past that utilized alternate sensory inputs such as vision or touch are no longer relevant for the majority of children with hearing loss. We have a responsibility to ensure that our intervention is compatible with unprecedented early auditory access. This series will help you design contemporary intervention that aims toward helping children realize their potential to acquire spoken language through listening.

Contemporary intervention does not necessary mean that established intervention strategies have no relevance. Rather, we must test our underlying assumptions for the use of an established strategy against the 21st century reality that auditory access to spoken language is a likelihood for the majority of children with hearing loss. We are challenged further by the rapidity and frequency that hearing technology and medical innovations arise. We must understand these innovations in order to exploit their potential.

Developmental benchmarks: Today, children with hearing loss who are fit with hearing technology and receive intervention at young ages acquire listening and spoken language in synchrony with other developmental domains (Yoshinaga-Itano, Sedey, Coulter, & Mehl, 1998; Yoshinaga-Itano, 2003). Listening and spoken language acquisition often follows a typical developmental trajectory with benchmarks attained at ages equivalent to typically developing peers (Davis, Morrison, von Hapsburg, & Warner-Czyz, 2005; Morrison & Russell, 2012; Eriks-Brophy, Gibson, & Tucker, 2013). Contemporary intervention for children with hearing loss requires that the professional have both a clear understanding of typical development and use strategies that ensure that input and interactions can guide the child’s development along a trajectory that mirrors typical development. Intervention strategies from the past that were devised to remediate atypical language and speech are no longer called for as the first course in intervention. Nevertheless, remedial strategies continue to be relevant for those children whose development is atypical. This Series gives focus on contemporary developmental strategies while also providing information about remedial strategies that can continue to be useful.

Conversational contexts: Young typically developing children learn to listen to and use spoken language in interaction with others. They rarely learn language by looking at pictures or cards or imitating syllables. Today, children with hearing loss can benefit from opportunities to learn to listen to and use spoken language in the same rich conversational contexts as do typically developing children. The strategies in this Series include many that can be applied in conversation with young children with hearing loss to ensure learnable input, guide conversations to encourage vocal participation, and respond to children’s contributions in ways to continue learning.

First Things First: Ensuring Auditory Access is the first volume in the Listening and Spoken Language Strategies Series. First Things First describes six strategies that share the common purpose of ensuring that ensuring that a young child with hearing loss is receiving auditory access to spoken language with his hearing technology. Listening and spoken language intervention cannot proceed without optimal auditory access. And it is the daily, hourly, responsibility of parents and professionals to make sure that this happens.

Future volumes in the Series will address the application of speech acoustics to intervention, assessment of auditory function, providing learnable input, guiding conversations, responding purposefully, speech production and guiding and coaching parents. Stay tuned!

Davis, B. L., Morrison, H. M., von Hapsburg, D., & Warner-Czyz, A. (2005). Early vocal
patterns in infants with varied hearing levels. The Volta Review, 105, 151–173.

Eriks-Brophy, A., Gibson, S., Tucker, S. (2013). Articulatory error: Patterns and phonological
process use of preschool children with and without hearing loss. The Volta Review, 113, 87-125.

Morrison, H. M. & Russell, A. (2012). What is meant by a “developmental approach” to speech production in auditory-verbal therapy and education? In Warren Estabrooks (Ed.). 101 Frequently Asked Questions about Auditory-Verbal Practice, Washington, D.C.: A. G. Bell, pp. 437-441.

Yoshinaga-Itano, C. (2003). From screening to early identification and intervention: Discovering predictors to successful outcomes for children with significant hearing loss.
Journal of Deaf studies and Deaf Education, 8, 11-30.

Yoshinaga-Itano, C., Sedey, A. L., Coulter, D., & Mehl, A. (1998). The language of early- and
later-identified children with hearing loss. Pediatrics, 102, 1161–1171.


Choosing pictures for discourse sampling

Maria L. Munoz, Ph.D., CCC-SLP
Founder and Contributing Author, Recipe SLP
eBooks are available at all major eBook distributors such as Amazon.
PDF’s an other formats are available through Smashwords.
Print-on-demand is available through Amazon.

As Hispanic Heritage Month draws to a close, I thought I would highlight the work of Carmen Lomas Garza. Her paintings are beautiful depictions of scenes familiar to many Latinos. Scenes depicting family gatherings, community events, tamale making, pinata breaking, and healing practices will strike a cord with individuals who grew-up in traditional Latino homes.  I have often used pages from one of the “children’s book” to elicit narratives from our Spanish speaking adults with aphasia.

When choosing pictures to elicit discourse sample, it’s important to choose scenes familiar to the client. Familiar scenes tap long-term memory and engage established schemas thus providing cognitive support for language. Familiar scenes and themes result in richer language samples and will help you capture the client’s best efforts. If you aren’t sure about the client’s cultural experiences or interests, keep a set of pictures handy and let the client pick the one(s) that that he/she wants to talk about.

What is Recipe SLP?

Maria L. Munoz, Ph.D., CCC-SLP
Founder and Contributing Author, Recipe SLP
eBooks are available at all major eBook distributors such as Amazon.
PDF’s an other formats are available through Smashwords
Print-on-demand is available through Amazon.

It’s been a little over a year since the publication of the first books in the The Aphasia  Series: The Clinicians Guide to Semantic Feature Analysis, The Clinicians Guide to Response Elaboration Training, The Clinicians Guide to Reducing Aphasic Perseveration, and The Aphasia Series Volume 1 ( a compilation of the first three books in the series). We are days away from announcing the publication of First Things First: Ensuring Auditory Access, the first book in the Listening and Spoken Language Strategies for Young Children with Hearing Loss series authored by Helen M. Morrison, Ph.D. CCC-A, LSLS, Cert. AVT. After some delay, I’m diligently working on The Clinicians Guide to Promoting Aphasic Communicative Effectiveness and it will definitely be out this Fall. My plan is to then turn to writing the first books in a series focused on cultural and linguistic diversity.

I wanted to take a few minutes to reflect back the vision for Recipe SLP.  I started this company as a way to address a big problem facing students and practicing speech-language pathologists; namely, where to go to learn how to implement specific interventions. ASHA has good resources that provide an overview of intervention strategies and the evidence to support them (such as The Practice Portals) but details on implementation are lacking. There are many excellent textbooks in our field but they generally don’t provide detailed instructions for clinical implementation and can be expensive.

I created Recipe SLP to publish affordable, evidence-based how-to materials. When writing a Recipe SLP book, we start by reading the literature to understand and summarize the theory and scientific evidence behind an intervention. We take the understanding of how and why an intervention works, as well as the how-to elements scattered throughout the literature, and translate that into a guide for implementing the intervention and making clinical decision. We establish an understanding of the core intervention that serves as a foundation for creative implementation and modification of the intervention to meet the needs of different clients and target a variety of goals.  Additionally, we provide links to on-line resources to encourage further study by the reader.  Personally, I prefer the eBook versions because tapping on a linked reference or resource will open the text in the app or reader making follow-up easy (as long as you have internet access).

Now that Helen Morrison has joined the Recipe SLP team, I’ve been thinking about what I want Recipe SLP to mean to our contributing authors. After careful consideration, I decided I wanted to think of Recipe SLP as an author co-op; a place for authors with a shared vision to have support for publishing their work while maintaining the bulk of the royalties. This approach makes books affordable for readers and profitable for authors. I am excited to see where this growing vision for Recipe SLP leads us during the second year.

The response from readers of The Aphasia Series has been extremely encouraging. If you have read the books and have an opinion about them, please consider posting a review on Amazon. I am extremely grateful for all the support provided by friends, family, beta-readers, Facebook and Twitter posters/sharers/likers, blog readers, and the Recipe SLP team that makes publishing each book possible.


Maria L. Munoz, PhD, CCC-SLP

Reciep SLP, your source for evidence-based how-to books.

Purchase The Aphasia Series at Amazon (kindle, print-on-demand), Barnes and Noble, iBooks, and Smashword (pdf).

June is aphasia awareness month! Learn about aphasia by visiting the website of the National Aphasia Association, a great source for and local and national resources for anyone with a professional or personal interest in aphasia.

I have worked, in some form or another, with individuals with aphasia and their families for over 20 years. I have learned about the power of resilience and how families pull together when faced with a life-changing event. As a speech-language pathologist, I have sought to support client’s goals and priorities.  One of the most important things I can teach graduate students is how to listen to their client. What matters to the client? What about their communicative life do they want to change?

My students need help learning how to listen to someone whose speech output is limited or constrained so I’ve devised these quick tips for counseling adults with aphasia.  At your next session, give these strategies a try and let me know how they worked for you.


1. LISTEN. Many times you can provide the most support by simply listening to the person’s concerns. Active listening involves eye contact, non-verbal reinforces, and supportive body language.
2. PAUSE. Give the person time to express his/her concerns. Individuals with aphasia will likely need extra time to formulate sentences and words.
3. OBSERVE. Look for clues to what the person is feeling in his/her body language, facial expressions, and intonation.
4. LABEL. Use words to express what you have understood to be the person’s feelings and concerns (“You feel sad.”). This gives the individual words he/she may not be able to access. It also allows you to confirm that you have understood correctly.
5. RESTATE. Restate the feelings and concerns that individual has expressed (“You are concerned about your family”). This encourages the person to continue talking and allows you to check your understanding.
6. AFFIRM. Validate and normalize what the person is feeling. Do not say “I understand how you feel” because you really can’t understand.
7. AVOID. Avoid yes/no questions. Avoid asking a series of questions to obtain an increasing number of details. In fact, questions should be kept to a minimum. When asking questions ask open-ended questions that will expand the discussion.
8. RESERVE. Reserve reassurance and problem-solving for the later half of the discussion. Your first goal is to allow the individual to express his/her feelings and concerns. Your job is NOT to fix the problem. Only after the individual has worked through the emotion should you work on solutions. Be careful not to provide false reassurance.

A review of the Batería Neuropsicológica de Funciones Ejecutivas y Lóbulos Frontales (BANFE-2)

Maria L. Munoz, PhD, CCC-SLP

Recipe SLP, The SLP’s source for affordable evidence-based how-to books.

Join us on Facebook, Follow us on Twitter (just search Recipe SLP)

Read about the aphasia series at Smashwords and Amazon.

One test I have recently discovered is the Batería Neuropsicológica de Funciones Ejecutivas y Lóbulos Frontales (BANFE-2) which assesses executive dysfunction and frontal lobe syndrome. I was excited to find this test as I have struggled with the best way to asses Spanish-speaking individuals with traumatic brain injury.  Having had a chance to examine the BANFE-2, I am confident it will fill our assessment needs.

The BANFE-2 is a standardized test designed to assess performance on cognitive tasks dependent on the function of the pre-frontal lobes for Spanish-speaking individuals 5-79 years of age. The BANFE-2 includes 14 tasks:

  • Card sorting
  • Verbal fluency
  • Stroop
  • Mazes
  • Gambling task
  • Serial verbal learning
  • Serial visual learning
  • Sorting by semantic category
  • Idiom interpretation
  • Tower of Hanoi
  • Self-directed picture pointing
  • List alphabetization
  • Serial subtraction
  • Serial addition

Additionally, the BANFE-2 includes a questionnaire to examine frontal lobe functions in the following areas: self-awareness, behavior, emotional regulation, and executive functions. The patient and caregiver separately rate the patient on a scale from 1-5. Discrepancies between the two ratings give an indication of the patient’s self-awareness.

What I like:

  • The BANFE-2 provides a strong theoretical rationale for the design of the test and the tasks selected.
  • The test is standardized on 450 non-impaired individuals ranging in age from 6-80. The standard scores are stratified by age, and, for adults, by years of education.  Both of these factors have been shown to correlate with cognitive performance.
  • This is the only comprehensive formal assessment of executive functions for Spanish speakers which I have encountered.
  • The instructions, directions, and scoring procedures are fairly easy to follow.

Limitations I see:

  • The manual and all forms are in Spanish which may present some challenges to clinicians assessing patients using an interpreter, and some Spanish-speaking bilingual clinicians who have not been educated in Spanish (I had to look up some words!).
  • Administration is complicated by age-specific instructions on procedures.
  • The country in which the norms were obtained is not specified.  I assume the test was normed in Mexico based on the authors’ work settings. The norming sample appears to be composed of monolingual Spanish speakers so use of norms with bilingual speakers in the USA many not be appropriate.

Test: Batería Neuropsicológica de Funciones Ejecutivas y Lóbulos Frontales (BANFE-2)

Purchase: Pearson Clinical

Cost: $307.50 for a kit which includes 10 record forms, rater forms, and profiles

Supporting Novice Clinicians

Maria L. Munoz, PhD, CCC-SLP

Recipe SLP, The SLP’s source for affordable evidence-based how-to books.

Join us on Facebook, Follow us on Twitter (just search Recipe SLP)

Last week I attended the Texas Speech Language and Hearing Association convention in San Antonio, Texas. I had a wonderful time meeting new people, seeing colleagues I haven’t seen in some time, and attending some really informative sessions. I love attending sessions that challenge my thinking and my approach to teaching.

One such session was “Supervisor Strategies for Managing Cognitive Load in Student’s Clinical Learning” by Dr. Lynnette Austin from Abilene Christian University.  Dr. Austin presented cognitive load theory as an alternative to the “sink or swim” or problem-based/discovery method of clinical instruction.  Clinical load theory models how information enters working memory, becomes organized in schemas, and is stored in long term memory (Austin, 2013).  To create schemas, students must manage three types of information: intrinsic load (the content to be learned), extrinsic load (how that content is encountered by the learner), and germane load (what is actually learned) (van Morrienboer and Sweller, 2010 as cited by Austin, 2013).  She emphasized the importance of scaffolding learning to help students manage these cognitive loads, and how student needs change as their knowledge and skills increase.  Providing adequate scaffolding and support is particularly critical in helping novice clinicians manage cognitive load.

I have a lot to learn about cognitive load theory.  I am intrigued  because it speaks to the goals of Recipe SLP. “The Clinician’s Guide to…” books are designed to help clinicians develop schema for how and why specific treatments work. Additionally, the books use a foundational understanding of the treatments as a springboard for implementing modifications and client specific adaptations. I’m going to keep exploring the literature to see if we can improve the scaffolding and supports inherent in our how-to guides.

I hope you are finding these books helpful!


Additional Readings:

Austin L. (2013). Scaffolding early clinical learning for students in communication sciences and disorders. Perspectives on Administration and Supervision, 23, 86-91. (Remember, if you are a member of one SIG you can access articles from any SIG!)

van Merrienboer, J. and Sweller, J. (2010). Cognitive load theory and health professional education: Design principles and strategies. Medical Education, 44, 85-93.