Thursday, March 24, 2016

Things SLPs should always say {NO, NOPE, STOP} The Importance of Punishment in Speech Therapy


Well, this is the flipside - except I couldn't narrow it down :) 

There are so many things we should always say, and this might surprise you, but we need to say more negative things!  We need to say, "NO," "NOPE," "Eh," "nuh-uh," "Stop that," "No way; try again," "That's wrong," "nah," and "no way." 


Before you think I've lost my mind and click away, let me explain myself.  By punishment, I certainly do not mean we should punish children, be rude or mean to children, or make them feel bad about themselves.  If you know me, I'm all about the peace and love with my students. 




  Simply stated, punishment (in the behavior world) is a consequence following a behavior that decreases the probability that a particular behavior will occur in the future. 

As SLPs we are fan-flipping-tastic about giving positive reinforcement! 
Good job!  Great talking! Nice sounds! Good work!! 
I love your effort! Good try! I love your good speech! Keep up the good work!
That sounded awesome! Wow, you're so smart! Super talking! 

Positive reinforcement is so important!! Providing positive reinforcement following a desired behavior increases the probability that the behavior will increase in the future.

Did you know that negative words are powerful, too?  
They're especially powerful when trying to change a behavior, and after all, isn't that what we try to do in therapy?  We try to shape dysfluent speech into fluency speech. We aim to shape new articulation and phonological patterns. We strive to change communication habits. That's our business! 

When trying to decrease a behavior (a lisp, an articulation error, a phonological process, vocal abuse, incorrect pronoun use, poor eye contact, spitting or biting, inappropriate social behaviors, etc.) punishment is important.  Using punishment decreases the likelihood of the behavior persisting.  Isn't that what we want? 

In fact, there's plenty of research out there supporting that using positive reinforcement along with punishment is more effective in changing speech patterns than using positive reinforcement alone. 

Costello and Ferrar (in 1976) compared progress between students who received punishment combined with positive reinforcement and students who received positive reinforcement alone for the reduction of incorrect articulation.  

They used 3 different "punishers" (a buzzer, response cost, and simple verbal "No!" Their results indicated that:
1) punishment in combination with positive reinforcement was more effective than positive reinforcement alone. 
2) introducing punishment did not cause disruptions for children nor did it cause children to become upset or off-task. In fact, disruptive and off task behavior increased when the punishment was taken away. 


Each time I get a graduate clinician from a local university or model therapy for new SLPs, I always get the same response...

Grad Student:  "YOU TELL THEM NO!?!" 
CF-SLP:          "You tell them it's wrong!?"
Me:                  "Well, yes, of course." 

It seems that somewhere along the line, it has become unpopular to tell students they are wrong. I see it in classrooms, too. When I was in grad school I had several wise professors who were adamant that we use a very firm, "NO" for all incorrect responses. It's just science; the child is less likely to make that same mistake again. I've refined my verbal punishment since then, and I provide more specific feedback that equates to "NO." Some are those are shown at the top in the speech bubbles :)  
Sometimes it's just the ole stink eye or grimace or a simple but firm "Uh-uh" or "Eh!" 

I mean, shouldn't we be honest with our students?  How will they know they are doing something incorrectly if we don't tell them?  If they were already capable of self- monitoring their speech, they wouldn't be therapy. If we don't tell them what they are doing wrong, how will they know what to change? 

Don't get me wrong, I would never plunge into therapy with a new student using punishment.  It's important to establish a relationship with a child and show him that therapy is a positive and safe place before using punishment.  It varies with each child, but that trusting foundation can be laid rather quickly.  Once the child understands that you're on his side, and you're there to help him/her, it's time to start being honest (but kind) with our feedback.  

Even though I use punishment (in the form of words or body language), I feel confident that my students still know I care about them. Additionally, they know to try something different than what they just tried.  

(I should note:  if you observe that punishment causes anger, sadness, aggression or self-esteem issues with any of your students, you should stop and consult with the rest of the child's IEP team or behavior experts at your disposal.  Also, never use strategies that may conflict with a child's behavior plan or established plan of reinforcement without consulting with the child's team.)

TIPS for using POSITIVE REINFORCEMENT & PUNISHMENT: 

1) Always use BOTH!!  How depressing would it be if a child only received punishment!? Therapy would be a beat down for both of you!  On the other hand, if you only use positive reinforcement, progress may be slower because your student may not have a clear understanding of what changes he/she needs to make with his/her communication. 

2) Always be sure to only positively reinforce behaviors (communication habits) that you want to strenghten! Likewise, always be sure to only punish behavior you want the child to decrease! Don't let any of those correct responses get by without at least a nod of approval, and don't let the belly flop responses get by without correction.  I see my fair share of SLPs doing drill silently-  tallying away but not giving feedback to the student.  All the while I think, "I wonder if they think they're doing well or not?"  How will they know what to KEEP doing if the therapist doesn't make it completely clear!?  How will they know what to STOP doing if they're not told!? 

3) Vary the type of positive reinforcement AND punishment! Saying "good job" 100 times will surely lose its impact on a student.  Likewise, "that's not right, try this" will also lose its mojo! Change it up to keep your reinforcement and punishment powerful! 

4) Consider each student! If verbal positive reinforcement isn't enough, pair it with high fives, stickers, tangibles, etc.  Positive reinforcement isn't reinforcement at all if it isn't something a child wants. Find out what motivates each child, and remember that reinforcers don't always maintain their power.  Some children lose interest in what you may be providing so you need to keep re-evaluating what's really reinforcing for a child.  In the same way, they may get "immune" to your stink eye or thumbs down punishers.  Change it up! Little Bee Speech got it right with its Articulation Station Pro app which allows SLPs to give a lovely "ding" sound when a child says a speech target correctly and an aversive buzzer-like "bomp" sound when he/she gets it wrong.  That's such a simple but effective form of punishment and positive reinforcement in one place.  (By the way, I don't get anything from that company for saying that! It's just my honest opinion) 

5) BE CONSISTENT and keep your expectations high.  Children thrive with consistent expectations. They will be less confused when you give them clear positive reinforcement for desired behaviors and clear punishment for undesired behaviors.  It's important for all of us not to lose sight of what the real desired behavior is. For example, if a child has a lateral lisp, and suddenly it is less distorted, it's very tempting for us to start packing on the positive reinforcement because...  

It's better!! Hooray!! 
Uh, Oh....

be very careful, because that behavior is likely to increase, and better doesn't mean correct. I recently observed a therapist who was marking all distorted /s/ productions as correct. Soon after, she told me how much better his lateral lisp now was.  Hmmmm, yes it's better, but now he thinks it's spot on! YIKES!  Let's keep our ears and brains finely tuned and expectations high- and let's communicate honestly with our students and clients. They deserve that. 

I admit, I am no expert on this subject; it's just something I have used in my practice for the past 20 years. If you want to read more from the real experts, check out this interesting 2010 article by Anne K. Bothe and Janic Costello Ingham about Using Responses Contingencies in Evidence-Based Treatements for Children's Stuttering. 

Do YOU say NO & NOPE in speech therapy, too?  I want to know that I'm not alone :) 

Be sure to click on the links below to read all about what my cohorts, The Frenzied SLPs, think SLPs should always say! 






Sunday, March 6, 2016

5 things SLPs should never say...




Being an SLP and talking go hand in hand.  
I have met SLPs who aren't big talkers, but I think that variety is few and far between. 
As a rule, WE LIKE TO TALK.  
I, for one, am a major league talker.  In fact, I even talk in my sleep. 
I joke and say that one day my mouth will get me in big time trouble.
It has come close a few times.  
Even more than that, I'm a truth speaker.  Too much truth can rub others the wrong way sometimes.  

I'm not much into censoring myself....
BUT many times, to be the empathic professionals that we are, 
we have to. 

Along with my cohorts, the Frenzied SLPs, I want to share with you...

FIVE things SLPs should NEVER say


You know...lazy.  
Do I think that some students are lazy? 

YES.

We probably all think this now and then. We can vent and rant and rave in private if needed, but we should never ever say it to them...or their parents. 

WHY? 

First, telling a child he/she is lazy won't help anything; it won't fix the problem.  In fact, it would likely do more harm than good.  Saying it out loud would likely embarrass/offend/anger the student (and/or parents) and alienate you from him or her when you actually need to be a team. Secondly, the fact is that we can't prove it.  Maybe what we perceive as laziness is actually hopelessness, depression, apathy, fatigue, etc.  The list could go on and on.

I've heard the "L" word said in IEP meetings, at parent-teacher conferences, in classrooms and in hallways.  It makes me cringe. Frankly, I think it's just plain mean and feels dangerously close to name calling. Kids come to us with many complicated factors, and it's our jobs to treat them as they come- with all their baggage and blessings alike.  It's also out jobs to find a way to motivate them. In most cases I'm all for calling a spade a spade, but in this case it's best to fight the urge.  


When there are 2 or more children together - big or small - stuff happens. 
Schools (and therapy groups) are jam packed with students, and they don't always get along. To be honest, as a young therapist, my immediate response to any conflict (name calling, hitting, mean remarks, snatching toys from each other, you name it) was to say "Why did you do that!? At some point during my career it dawned on me that it was just a stupid question. Yes, I said stupid. Boy, would my little students would be all over me for that! We should never say "Why did you do that" in response to bad choices. 

WHY? 

Well, primarily because asking for a reason implies that there actually is a good reason. There is no acceptable reason for being hurtful to someone else - no matter how much a child may feel justfied.  Instead, we need to verbalize that it was unacceptable.  How will children know that if we don't teach it? 

Also, the chances of a child you have in therapy being able to express, at that moment of frustration or anger, any reason for having done the dirty deed he did, is slim to zilch.  Still, I hear this from the mouths of educators all the time. I've said i which is how I know what an automatic response it can be, but it is never a good one! 


Soooo when scenarios like the ones mentioned above happen, this is another common phrase we hear. 
Don't say it, and I'm sure you can guess the reasons why.  

It's part of our job to teach about expressing feelings, about repairing social breakdowns, about communicating empathy, but we shouldn't force students to apologize for the sake of apologizing (often so we can move on with our lesson).  We can suggest an apology, but if it's forced, it's no good. Also, the moment we say it, we are giving the "hitter," (for example), more attention than the child who was hit.  Also, when we spout off, "Say you're sorry," any sympathy they might have been feeling for their peer will likely be replaced with humilation. We may even get into a power struggle. Instead, tend to the other child and give the child who behaved poorly some time to feel remorse and accept responsibility on his own.  If it doesn't come, later we need to teach that what he/she did was wrong/hurtful/harmful/unacceptable, and even why it was wrong. Explain that part of repairing mistakes is making amends by apologizing.  We can tell about how we had to apologize to someone one time, and we should model it. An apology should be expected AND shoud happen, but only when the child is emotionally ready to remorse regret to his "victim." Otherwise, it's empty.

This, for me, is a biggie.  I've said it.  Then I quickly regretted it.  I would never say it again, and I don't think any SLP should.  No matter how easy I think something is or how much I think "they've got this" it might just be hard for one of my (or your) students.  If we say it, how in the world would a child not feel inadequate/dumb/worthless/humiliated if they can't do it? What if it's not easy for them?  I would be devastated to know that my words caused feelings of failure.
 Let's erase this phrase from our profession altogether.  It's just too risky to say out loud.

(or some variation of that)

As SLPs, we've probably all felt this way at one time or other.  
Some students have big, even seeming unsurmountable problems, and sometimes what we are doing doesn't result in progress. Sometimes we feel hopeless, and that there is nothing else we can do for a child.  I once heard a teacher say, "we have exhausted all means of helping your child." 

I thought....really???? No we haven't.  It might feel like that sometimes, but it's not true.  There is always something else to try. We may not know what that is at the moment, but it's our job to find out.  Consult with other SLPs, research, pick the brains of mentors, harass your supervisor for assistance, beg for help from your resources, try something out of your comfort zone, email your former professors or even strangers at the local university.  Go in search of answers and input. We might be the only person in this child's life going to battle for him or her.  If worse comes to worst, get the child assigned to another therapist. 

Can you think of more!? 
I want to know! I'm still learning. Aren't we all? 

To read more posts on the topic, check out my SLP friends below! 


Jasper Roberts Consulting - Widget