Prologue: combining research and reason to make treatment decisions.
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Decision Making↗
Biomedical subjects
Alan G Kamhi
Publications and source records attributed to Alan G Kamhi.
Treatment decisions for children with speech-sound disorders.
PURPOSE: In this article, I consider how research, clinical expertise, client values, a clinician's theoretical perspective, and service delivery considerations affect the decisions that clinicians make to treat children with speech-sound disorders (SSD). METHOD: After reviewing the research on phonological treatment, I discuss how a clinician's theoretical perspective influences goal selection. Five perspectives are considered: (a) normative; (b) bottom-up, discrete skill; (c) language-based; (d) broad-based; and (e) complexity-based. The literature on treatment efficiency is then considered, followed by a discussion of service delivery factors, client values, and clinician factors. IMPLICATIONS: I believe like M. Ylvisaker (2004) that treatment decisions are influenced the most by the changes that occur in client behaviors. These changes must, however, be experimentally validated, which is not always easy to do. M. Ylvisaker suggests that validation could take the form of trial therapy, diagnostic teaching, or dynamic assessment, but it may also be important to show that the treatment provided, not some other variable, was primarily responsible for the behavioral change (A. Tyler, personal communication, January 11, 2006).
Articulation Disorders↗
Epilogue: some final thoughts on EBP.
PURPOSE: In this afterward, I will offer some final thoughts on this clinical forum by considering a central question of EBP--how experimental validation is defined--to illustrate the difficulty involved in implementing EBP. METHOD: The comments draw on critical reviews I have received on my article in this forum and conversations I have had with professional colleagues about EBP. CONCLUSION: Like most scientific constructs, EBP is open to different interpretations. At their worst, these differences have the potential to polarize clinical practice. The hope, however, as Kent and Fey have expressed, is that articles and commentaries such as these will serve as the basis for discussion and even argument among clinicians and researchers as we attempt to define a philosophy and implementation of EBP suited to our profession.
Evidence-Based Medicine↗
A meme's eye view of speech-language pathology.
In this article, the reason why certain terms, labels, and ideas prevail, whereas others fail to gain acceptance, will be considered. Borrowing the concept of "meme" from the study of evolution of ideas, it will be clear why language-based and phonological disorders have less widespread appeal than, for example, auditory processing and sensory integration disorders. Discussion will also center on why most speech-language pathologists refer to themselves as speech therapists or speech pathologists, and why it is more desirable to have dyslexia than to have a reading disability. In a meme's eye view, science and logic do not always win out because selection favors ideas (memes) that are easy to understand, remember, and copy. An unfortunate consequence of these selection forces is that successful memes typically provide superficially plausible answers for complex questions.
Aphasia↗
Two paradoxes in stuttering treatment.
UNLABELLED: The premise of this article is that effective communication should be a central, overarching goal in the treatment of stuttering. Not focusing on communication may have some unintended negative consequences on treatment. The negative consequences are the result of two paradoxes that confront clinicians and clients: the listener paradox and the communication paradox. The listener paradox concerns the different ways that typical listeners and clinicians respond to stuttering. The communication paradox concerns the use of treatment procedures that may have negative consequences on communication. Clinicians and clients need to evaluate treatment procedures in terms of the effect they may have on communication. Understanding these two paradoxes and making effective communication the focus of treatment may improve the long-term treatment outcomes of people who stutter. EDUCATIONAL OBJECTIVES: The reader will learn about (1) why effective communication should be the central goal in the treatment of stuttering; (2) how the listener and communication paradoxes may negatively impact on communication; and (3) how understanding these paradoxes may improve the long-term outcomes of people who stutter and also improve the comfort level clinicians have in treating individuals who stutter.
Communication↗
The use of think-aloud protocols to compare inferencing abilities in average and below-average readers.
In this study, we examined whether think-aloud procedures would uncover differences in the kinds of inferences generated by average and below-average readers. Participants were 40 third-grade children who were divided into groups of average and below-average readers. All participants completed measures of nonverbal IQ, reading, language, and working memory, and a story comprehension task that consisted of two conditions: listen through and think aloud. The major findings in this study were that (a) average readers generated significantly more explanatory inferences than below-average readers, and (b) comprehension performance as measured by story recall was significantly better for both groups in the think-aloud condition than in the listen-through condition. The discussion addresses the implications of these findings.
Child↗