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Intro

Kate Grandbois: [00:00:00] Welcome to SLP Nerd Cast, where we review resources, literature, and discuss issues related to speech and language pathology. To learn more about us, listen to our first published episode. Who are we anyway? Who are we? That's a big question. Very existential. Who are we? Anyway, uh, before we begin today's topic, we wanted to give you a quick reminder that you can receive a certificate of participation for listening to this podcast that 100% counts for as certification maintenance hours.

Just go to our website, www.slpnerdcast.com. Click on the episode, follow the prompts to take a quick three question quiz, and purchase your certificate. There's more information about CEUs and our services on our website under the how it Works. Uh, that is [00:01:00] www.lpnerdcast.com. So now that that is done, what are we talking about today?

Aim 

Amy Wonkka: Today we are talking about aided language modeling and preparing for this podcast is pretty eyeopening. 

Kate Grandbois: I agree. So I, um, for those of you who don't know, I am employed as an a, a C specialist, a quote a, a c specialist. And, uh, as Amy and I discussed this topic further and read some of the literature, I was totally intimidated.

I had a little bit of imposter syndrome. Imposter syndrome is real. It is a real thing. And I found myself asking Amy lots of questions, needing to go back and reread the articles to define all the different terms. There's so many different terms. This, there are a lot of terms in this topic, 

Amy Wonkka: I think. I think also a lot of us in the field tend to err on the side of perfectionism, my, myself included.

And I think there is just this level of discomfort that comes with knowing that you can't know everything 

Kate Grandbois: and there's so much to know. There's so [00:02:00] much to know. It's really sort of unsettling 

Amy Wonkka: and it can be challenging to keep up on it all. 

Kate Grandbois: Yes, especially in the area of A a C where technology is changing all the time.

Amy Wonkka: Technology is changing, but intervention strategies have remained pretty consistent. So when we think about aided modeling interventions, I mean some of those have been. In the literature for many, many years. I think that they've come back up in the literature. More recently there have been more, um, systematic reviews and meta-analyses, and we'll talk a little bit about that today.

Kate Grandbois: Uh, and I think that's another reason why we chose this topic 'cause it is sort of a. Hot topic. 

Amy Wonkka: It is a hot topic there. Hot topic. Hot topic. That was a 

Kate Grandbois: reference to Hot Pockets. Yes. In case anyone has ever heard Jim Kin's. Hot Pocket. Hot Pocket reference. And if you haven't, then you need to go listen to it.

Anyway, moving on. So, um, so let's talk about the structure of today's episode. So first we are gonna talk about what aided language [00:03:00] modeling is and what does the literature say. Then we are gonna talk about clinical applications for this intervention. Um, what does the intervention look like? What are some things to consider when using the strategy?

And lastly, we are going to maybe talk briefly about some, uh, training and communication, training communication partners. But that is another really big topic that could be a future episode. 

Amy Wonkka: Mm-hmm. And that's another area where there really is a lot of literature. So I think, you know, I'm interested in doing a deep dive at some point in that content.

Just, just to refresh my memory. 

Kate Grandbois: Okay. Excellent. Okay. Excellent. Um, so what is aided modeling Intervention? 

Amy Wonkka: So, I think starting right here is a good source of confusion. If you look in the literature, I mean, there are a lot of different words that are put together to talk about this idea of providing some type of modeling input on an aided a a c [00:04:00] system.

And when we think about a a c, there are two big clumps that a, a c sort of falls into. So there Yeah, I was 

Kate Grandbois: gonna say maybe we need to define some of those things. For those of you out there who are not heavy in the a a C intervention as your regular day to day, like the difference between aided and unaided.

Amy Wonkka: Right. As a reminder, starting right there, when we think about unaided communication, we all are using a combination of aided and unaided communication throughout our daily practice and interaction with others. So unaided communication is anything that doesn't require something else external to your body.

So that would be gestures. Mm-hmm. Facial expressions, speech, oral speech. Speech approximations, and then aided systems. You need to sign. Sign language. Sign language. Yep. Yes. You need to have a thing. When we're thinking about aided. There's some thing. So if that's written communication, you are, you know, you need some type of writing implement and something upon which you will write.

Mm-hmm. [00:05:00] Uh, texting. You need a phone typing, you need a keyboard. Uh, symbolic communication. You might have a speech generating device or a low tech, uh, paper-based system or a mid tech tool. So all of those are an extra thing that you have to carry around with you. 

Kate Grandbois: Um, and you have found some really good online resources to point our listeners to for this in terms of the ASHA practice portal.

Yes. 

Amy Wonkka: At the ASHA Practice portal. So I am still. Learning my way around the new redesigned ASHA website. I don't know. I used to, it's immense. It's, it is and, and some of the things that I used to know where they were and what they were called, I feel like the knowledge and skills documents have now sort of merged into this practice portal.

So for those of you who are also having trouble navigating and finding some of those documents, the ASHA Practice portal for augmentative and alternative communication has a lot of really helpful resources where they break down different types of a a c systems. They talk a bit about [00:06:00] interventions, they talk a bit about assessments.

So there's a lot of helpful information on there. Excellent. Um, so back to aided methods. Yes. 

Kate Grandbois: Aided methods. Let's talk about aided methods. So 

Amy Wonkka: aided methods. So when we think about modeling the modeling. That was my chair. I swear. Look, I can do it again. Okay, that was my chair. So back to aided methods. When we think about aided methods and aided modeling interventions, those are ones that involve some type of communication, partner input using the aided a a c system.

And we remember aided a C system is using something external to your body. When you look at the research, it gets a little bit confusing because it is called many different things. Uh, just a couple of things. Terms you might find if you do a search for aided interventions, you might find, and this 

Kate Grandbois: is where my eyes glazed over little 

Amy Wonkka: bit, little bit.

Don't 

Kate Grandbois: tell my employer no, but this was, this was a very, well, [00:07:00] I'm self-employed. I guess I can tell myself I can, you did. I can accept myself for not knowing all of these terms, but. This was a really dense, um, component that I think was very intimidating. Mm-hmm. At least for me personally, anyway. 

Amy Wonkka: Well, and it makes it, it makes it challenging to know how long these interventions have been in the literature.

Right. So we can go all the way back to aided language simulation that was reported by Goins in 1989. Um, and then even up to the present day, we see a lot of meta-analyses, which we'll talk a little bit about in systematic reviews. So that's people who have gotten together and read all the research so that we don't have to read all the individual articles.

And they sort of report on the trends for us, which is very helpful. Very helpful as a clinician who is working during the day, um, and doesn't have time to read all the research, but it aided interventions. That incorporate modeling have been called anything from the system for augmenting language, um, augmented input, aided language [00:08:00] stimulation, aided language modeling, natural aided language.

So there are a lot of terms out there. And are there differences 

Kate Grandbois: between these terms, or is it just that, you know, someone wrote an article in 95, someone came along later in oh three and decided to call it something completely different. 

Amy Wonkka: So that was one of the things that came up in both of the big kind of review articles that we read for this podcast, that it's different.

It's everybody's doing things a little bit differently, and in some of the papers, they're not reporting all the details, so you're not entirely sure how they're, how they're using the intervention. So what that means for us as clinicians is that it's hard for us to draw firm conclusions around what is actually best for the individuals with complex communication needs with whom we're working, right?

Mm-hmm. So some of these interventions focus really heavily on. The comprehension, they focus on modeling one or two words, which is 

Kate Grandbois: something that I, again, learning moment I hadn't considered a lot of, and a lot of my students [00:09:00] and clients. Um, and I think that that's a really good point that we'll talk about later.

And just for the sake of saying it, um, when you go to our website, there will be a handout available for purchase and all of the, um, all of these references will also be listed under the episode description. Um, if you are an ASHA member, you should be able to get most of these articles. Yes. Um, because most of them are published in the ASHA Journals, isn't that right?

Amy Wonkka: Yes. Okay. Most, but not all. 

Kate Grandbois: But we will have references available on the, on the website. Correct. Perfect. Um, so what do all these articles say about this intervention? 

Amy Wonkka: Well, they say a lot of different things. So when you look at the, the research question for each of the different authors, they're all looking at different things.

Some people are looking at, does it change, um, an individual's ability to express. Or understand mm-hmm. A specific, uh, grammatical morphine, right? Mm-hmm. Are, are we, are we able to, does it have 

Kate Grandbois: impacts on syntax? Mm-hmm. Semantics, social [00:10:00] exchanges, all of those kinds of things. 

Amy Wonkka: Yeah. Um, the other big piece that comes up is the actual groups who are used in this studies.

Sometimes the, the groups who are in the study are people, um, who have typical oral speech. Mm-hmm. So that's, that's a little bit tricky to translate to the people who you may actually have on your caseload. 

Kate Grandbois: I also thought it was interesting that a lot of the research was focused on communicators who have more intact, receptive language skills.

And I think for those of us using a a C and, um, a, a c interventions for more complex learners or people who have cognitive disabilities, um, who, or people who have low to little receptive language skills, there is not a lot of literature. At least that we know of on the effects of aid language stimulation on those learners in particular.

That's what I took away from it. 

Amy Wonkka: Right. And I mean, I remember back in grad school and you made the same, that, you know, one of the takeaways [00:11:00] with research in our field is that the lower incidence your population is the Harvard is Yep. To get, you know, kind of randomized controlled studies. Mm-hmm. Because we don't have huge cohorts of people who present with very similar characteristics.

Mm-hmm. You know, we have these very individualized, you know, heterogeneous groups of people even within a same, you know, diagnostic category, that doesn't necessarily mean that there's much at all. Mm-hmm. That is in common. And I agree. One of the points, um, in the Allen article, Allen et al, which is going to be up at our website, uh, they did a systematic review of the literature and found.

You know, a lot of the studies that were in their review that met their inclusion criteria, their subjects had scores on receptive language measures that were low average to one standard deviation below the mean, which isn't necessarily representative of my 

Kate Grandbois: eyes. GLO just glossed over a little bit. I mean, some of this is, some of this is so dry.

It really is. I mean [00:12:00] this, I think that there is something very specific about this intervention that becomes so technical. 

Amy Wonkka: Yes and no. Right? I mean, I've point counterpoint because I think that that what it does for me when I read, when I read things like this, it just makes me think about the need to integrate the evidence.

So another great resource on Asha, uh, is where they talk about the different levels of evidence and be, and because so many of our, can you tell me a little bit about that? So when we think, because I am not as familiar with that as you thinking about evidence-based practice, uhhuh, and if you go on their practice portal and look under evidence-based practice, you'll see a lot of information about, you know, sort of the gold standard, which would be a double-blind placebo control, 20 years of recent.

Kate Grandbois: Right, right, right, right, right. 

Amy Wonkka: That, does that even happen in our field? I don't know. Right. Perhaps it does. I can't recall any studies that I've heard. I think that's a medical 

Kate Grandbois: standard for medication. It's like 20 year studies 

Amy Wonkka: and that's, that's like the gold standard. Right. Okay. 

Kate Grandbois: I'm sort of making that up.

Please don't anyone Google that. No, [00:13:00] I mean that might, I, I preface this podcast with, I don't know everything, so neither US knows, 

Amy Wonkka: um, all the things at all. Back to the topic, Ann. Anyway, it's back to the topic. So, so from there there are different levels kind of in descending levels of stringency Okay. Of evidence.

Yep. And clinical experience is, is part of that, right? So you should be integrating your clinical experience and expertise, the clinical experience and expertise of your colleagues. That's part of your decision making process with evidence-based practice. But a portion of that is, is reading the literature.

So when we, when we look at the literature, I think knowing things like that very dry statement about the majority of the studies are, you know, that your nerd voice that is, that's also my, can you push your glasses up with your finger when you do it? Yes. Can you say it again? So the majority of studies anyway.

Yeah. We think about people who are in the low average to get less than one standard [00:14:00] deviation below the mean. As as people who administer standardized tests, we, we understand the mean. We understand what one standard deviation below the mean means. We understand what it means to be an individual who's able to participate in a standardized, receptive language assessment and receive a standard score.

Kate Grandbois: Right? 

Amy Wonkka: So. For me as a clinician, that just helps. It's an additional piece of information that helps me know how much and how likely the results of this study may or may not translate Okay. To the needs of the individual person that I'm working with. Got it. Okay. So 

Kate Grandbois: sort of taking a bird's eye view of all of this literature, what does the literature say is, I mean, in terms of using, and I'm, I have to say for those of you out there who, um, are working with other professionals, I have heard insane things being said about aided language stimulation, like it's not evidence-based practice.

And there is a clinician out there who's had this at a conference recently and her name will remain in my thinking bubble. I [00:15:00] will not say it out loud, but there is, I don't wanna say a controversy, but there are individuals out there who question whether or not aided language modeling is an evidence-based practice.

Um, I have worked with BCBAs who have said, oh, but you're just giving them the answer. You're, you know, modeling is a kind of prompt, which is true in the a BA world. So, in terms of the body of literature that we've reviewed, would you, I'm gonna ask you a yes or no question, and then we'll elaborate on it a little bit more.

Would you say that aided language modeling, or aided language stimulation or whatever acronym you or you know mm-hmm. Name you wanna call it? Is it evidence-based practice? 

Amy Wonkka: I think that, I think they would classify it as with a qualifier. Right. Okay. So it's not something that is Yes, very clearly.

Evidence-based practice, everybody should do it because that highest 

Kate Grandbois: tier of stringency, oh, it's definitely not. Right. Okay. It's definitely 

Amy Wonkka: not, but that doesn't mean it's not something that a clinician can incorporate [00:16:00] within the construct of an evidence-based practice approach. So just like any other practice really, I mean, speech pathology is an art and a science.

Oh my gosh. I say that all the time and it's, I mean it, did you steal that out of my brain? Probably. Did I say that to you? One? I'm true. After you have. 

Kate Grandbois: I say it all the time after you have. That's so funny. I had a professor that said that to me. 

Amy Wonkka: Shout out to you, Betsy 

Kate Grandbois: Ucci. You're 

Amy Wonkka: out there. Good job. But I think it's, I think it's so true, that phrase that I stole from your, his historical mouth, um, historical mouth.

Because when we think about it, you know, it's not, it's, it's not a, a definitive plus minus, right? I didn't swap your throat and yes, you tested positive for strep bacteria. I should give you these antibiotics. It is, you know, your, it's a, it's a dynamic process. It involves interaction, communication between two people.

So I feel like what every clinician should be doing is forming their own clinical questions, collecting data, [00:17:00] teaser. We'll have a podcast about collecting data. Oh 

Kate Grandbois: yeah. We have a data podcast coming up an episode, but, 

Amy Wonkka: but collecting data and then using that data to inform future decisions. So in the constellation of that, I think, yes, it definitely can be a component of evidence-based practice.

Kate Grandbois: So just sort of recapping it is not the highest stringency of evidence-based practice, however. It is still considered effective and clinicians should consider using it as a tool in their intervention. 

Amy Wonkka: Yes. And you should consider how you're using it. So when you look at those big reviews of the literature mm-hmm.

And see what they found, some of the people we're looking at, does this aided input help with receptive language? Mm-hmm. Does it help with your ability to comprehend somebody's spoken output? Some of the studies are looking at expressive use. Does aided modeling result in an [00:18:00] increase of expressive use of specific vocabulary or, you know, target structures?

Mm-hmm. So, form your own question as a clinician about how you think. You would like to use aided language stimulation with your client and think about, you may have two clinical questions, and that happens for me sometimes, you know, as somebody who also works with a, a c, you'll form a question and say, all right, I'm curious about whether or not this aided input will help you, uh, more independently follow one step direction, let's say.

Or I'm also curious about, will this aided input increase the likelihood of you using these specific target vocabulary words? Right. Or, you know, 

Kate Grandbois: and not to do a shameless plug again, but data, data, data. I mean, when you're looking at mm-hmm. You know, when you're looking at whether or not that intervention has an impact on those specific variables, you're really looking at how the numbers, you know, how how does it [00:19:00] infect Im impact, impact the, the output.

Um, and I just wanted to go back quickly to something I see. I'm reading over her shoulder here, looking at her notes. Um. The word dosage. That's an interesting word that I don't think I have used often ever in terms of my, my intervention, how much of an intervention I use. Um, I don't know if that was used in the Binger and light article or not, but which of, in terms of the word dosage, what is the, what does the literature say about how much of the intervention you're supposed to use?

Amy Wonkka: Okay. So this was one of the coolest things for me about reading these articles. Uh, when I read the, the Allen article, Allen Etal, which was a review of a lot of different articles, they referenced this article from Binger and Light 2007, where they talked about their aided language modeling intervention, which is one of the.

Names for it. And in this study they looked [00:20:00] specifically at, you know, what is the ideal dosage? So this was very interesting to me, having, have you ever used the word dosage? I mean, I've, I've used it in life. I know don't like me, like I've said that word before. When you're, 

Kate Grandbois: no, like, when you're, like, when I'm training a team, I don't say, okay, so the recommended dosage of aided language modeling is blah, blah, blah, blah, blah.

I just, I, and it's a great word. I really liked it. It was very medical, very like clear 

Amy Wonkka: cut and dry. I loved it. I thought it was such a good, um, it was, it was, it made me think about things in a different way, which is really. Back to that evidence-based practice. That is why, you know, as clinicians who've been in the field for a bit, it's really great to go back and read these articles.

Mm-hmm. Because it gives us new ideas and new thoughts about practices that we've already been doing. 

Kate Grandbois: So, and as a, I mean, just pause for a second. Amy and I have this discussion a lot. I think it's really hard to consistently read literature when you have a full-time job. I mean, going back to the literature is something that we do, I think a lot of [00:21:00] people do when they have a contentious situation or they're faced with a client or a student where they're totally lost and they don't know where to go.

But when you're using some of these things in your everyday practice, the motivation to go back to the literature is low. So this has been a really, at least for me, a really helpful experience. 'cause I don't read literature for fun, but now you do, but no. What you do, I guess I do now. Okay, okay. It's fine.

It's fine. I'll admit it. It's. Amy's always saying you had that tie, you know when you read an article and then it makes you wanna read another article to which I have a plan. No, I read a half of an article and then I wanna take a bath or, or go do anything else other than read another article. Except it happened to me just once when we were, when we were preparing for this podcast.

So anyway, total tangent, but let's go back to the concept of dosage here for a second. 

Amy Wonkka: Yes. So thinking about dosage, this was, this was a new idea for me as well and I thought it was very cool. [00:22:00] So what they looked at was this very structured definition of what aided language modeling was. And they said, you know, when you're providing aided language modeling, your guideline is you are shooting for at least 30 models within a 15 minute session.

Kate Grandbois: 30 models within a 15 minute session. Mm-hmm. So that's 

Amy Wonkka: a ratio 

Kate Grandbois: of one to two. Two to one, 

Amy Wonkka: yeah. Two to one. 

Kate Grandbois: Interesting. 

Amy Wonkka: Which is dense is dense. Is dense. And I think when I reflect on the aided modeling that I see that, that seems more most likely to happen in a highly structured and sort of directive setting.

Which, you know, to, to disconnect from the literature a little bit. I think there's also this piece of thinking about how you're using the information that you learned in the study. So obviously these guys are, are doing a formal study. 

Mm-hmm. 

Amy Wonkka: I'm not doing a formal study. I'm, I'm a general practitioner, you know, I'm a speech pathologist, um, work, working in the wild.

And so in [00:23:00] a wild, we don't have the same, the same level of stringency because we're not obviously conducting a research study. So thinking about times mm-hmm. In your day, you know, I'm in a school environment. So in a school day or in your clinic setting, if you're outpatient or private practice, are there certain activities where you can approach that, that density of dosage?

Mm-hmm. You know, and then are there other times I'm thinking of more naturalistic opportunities where that almost. I, I'm not sure what that would look, look like. Well, and it 

Kate Grandbois: can be cumbersome too. You've got a device maybe, or a piece of paper or whatever the materials are that you're carrying around.

You might be interacting with an individual who has other complex medical equipment or behavior. I mean, providing that density can be physically difficult and very unnatural. 

Amy Wonkka: But I think it's interesting, right? Like right. We think that, I don't even know because I've never had this concept of dosage.

Right? Right. Yeah. So now with this new idea, it's going to inform the choices that I made. We learned something forward, learned something. We learned something new and cool we did. So we are gonna try, you know, I'm gonna be curious to see [00:24:00] what does that really look like. I think the other big piece that they mentioned in the study that I thought was very interesting was that if you're doing a multi symbol message, so if you are modeling more than one word at a time, or you are, you know, whether that's high tech or low tech, there should be no more than a two second delay between.

Between reference between or pointing to reference. So if you're combining symbols, so if I'm saying, um, I want to go outside, okay, yeah. Then I'm gonna want to activate those speech chunks with no more than a two second latency between them. Or if I am working with you and say we are doing some early joint detention work and I am pointing at a reference and then I'm providing you a model on the device.

Mm-hmm. I want there to be no more than a two second latency between when you point to the cookie and say, or and 

Kate Grandbois: use the symbol cookie. Mm-hmm. Point to the actual cookie and then use the symbol for cookie. 

Amy Wonkka: Mm-hmm. And that was interesting for me because it [00:25:00] made me think about back to incorporating your clinical experience, just all of the individual variation and heterogeneity between.

That's a big word. The people co differences, differences, uh, with between the people, you know, with whom, with whom we're working. Because first, you know, I've definitely had clients where a two second latency is un unrealistic. You know, you, you, if you have a complex body, you might not be able to reorient.

And again, I 

Kate Grandbois: also think that it's just a, it is, it come, becomes a question of management, physical management. Like how are you physically going to be doing this throughout your intervention? So for example, in one of the settings where I consult, the staff carry iPads because they take data on iPads.

Mm-hmm. So they've got their data collection iPad, they've got the student's iPad, they've got the visual supports attached to a lanyard for behavior modification. Joey is, you know, you're trying to prevent him from flopping on the floor. And then you're also being told by the speech pathologist to provide a two to one ratio of aided language stimulation within [00:26:00] two, within two seconds.

I mean, that can be a real, that's a real challenge. I mean, that presents itself with some logistical. Challenges. 

Amy Wonkka: Yeah. Yeah. I think it's important to incorporate all of the variables that you know about your environment, the communication partners and the communicator when you're making a plan so that everybody can feel successful.

Kate Grandbois: Yes. And enter the importance of an implementation plan. Mm-hmm. Which is probably a plug for another future. Right. That is a future podcast. Future podcast, future episode. 

Amy Wonkka: Mm-hmm. 

Kate Grandbois: Um, 

Amy Wonkka: I know I realized that one thing that we didn't do is we didn't talk about exactly what it looks like. Mm-hmm. So that's another piece that I talk about a lot with people.

I didn't find really clear definitions in the literature again, 'cause it sounds like there's a lot of variation. 

Mm-hmm. 

Amy Wonkka: What does it look like when you do aided language simulation? Like what does that look like for you? Like, do you say the whole sentence and then model one or two words? Oh, that's a really, really good question.

Do words same time. And I think 

Kate Grandbois: the answer to that question depends on the language level of. F [00:27:00] the, the individual I'm working with. Mm-hmm. So if they're a super emergent communicator, it will, I, I really can't speak to what quote dosage I'm using because I had never thought of it in terms like that, but I no idea.

I have recommended doing it as often as, as possible. So prevent, you know, presenting them with high rates of a, you know, high frequency within high rates of a word. Um, using really a, a potent language, the things that are important to them, things that are really reinforcing because my population is more of the complex emergent communicators.

Um, and I would usually do, I wanna say another ratio of one to one. So like, single word, single symbol. Single spoken word. 

Mm-hmm. 

Kate Grandbois: And, and the reference that's, you know, that's available. Um, I think for individuals who have higher language levels, who are maybe using two word utterances, um, I would say, you know, I, I really, I really don't, I haven't thought about it before.

Um. It's probably a lot of the [00:28:00] same. I mean, it's probably the same density of verbal to symbol. I think I always say it at the same time. I'm not silent. Is that sort of what you're getting at? 

Amy Wonkka: Yeah. I feel like that's something that comes up a lot and I, I've given it some thought because as I've provided, you know, consultation and training to different groups of people, it's a question that comes up for me.

So it's made me think about it. 

Kate Grandbois: Okay. What are your thoughts? 

Amy Wonkka: I have noticed, because I've been thinking about it as I'm doing it and trying to better qualify what I'm doing so I could share that information with other people. If it's a low tech tool, so let's say a paper core board mm-hmm. With some fringe vocabulary with no voice output.

No voice output. Mm-hmm. I tend to reduce my rate of oral speech. I tend to, like you, I, I sort of think in terms of brown stages. Mm-hmm. So if you're a single word communicator and you're not yet combining into two word combinations, I am typically modeling. One word at a [00:29:00] time, but my oral speech may be slightly longer than that.

So if I am using oral speech to say, let's say a two to four word phrase, I would model the key word or maybe two word simultaneously. Mm-hmm. I tend to do it simultaneously. Again, if there's no voice output, if there's voice output, I tend to say it with oral speech and then model the one or two word combination using the voice output 

Kate Grandbois: follow up question.

Mm-hmm. Now, because there is so much variation and from clinician to clinician. Mm-hmm. And which is good because you're probably making choices based on the individual client that you're working with and their language level and presentation and social tolerance and all of those kinds of things. What do, does the literature say anything about those qualitative differences?

Amy Wonkka: It's varied, right? So that's, that's the conundrum. And that's why in part, I think that this isn't a highly recommended strategy. Mm-hmm. Mm-hmm. Because we have a lot of, we have a lot of research that's out [00:30:00] there, but it's on very different groups of people. People are using different intervention methods.

So for me, I try and standardize an intervention method myself because I am working with lots of different communication partners, typically who, who support one student. 

Kate Grandbois: That's what I was just about to say. Not to, not to put you on the spot aim, but you have been doing this, you've been working in a, a c specifically for a long time, a while.

A long time, a while. Um, and, and just as a side note, this episode is about something that Amy and I both do in our jobs. So we have a lot more personal experience to bring to the table with this and, and future episodes. We may be relying on others for these kinds of things, but. In terms of, Amy, your personal experience, what, what is your rationale for that ratio of saying things more with a light tech tool?

Like is there some, when you've had that conversation with yourself, how is it that you've come to those decisions? 

Amy Wonkka: [00:31:00] Uh, I would say it's less of an overt choice that I've made myself. It's been more of an observation of my, what I end up doing. 

Kate Grandbois: Okay. 

Amy Wonkka: So I've paid more attention to it in recent years because people have asked me questions.

Mm-hmm. And 

Kate Grandbois: like this just now, when I put you on the spot in like this, just now, the middle, 

Amy Wonkka: a live recording. And I feel like it's something that, yes, thanks, you buddy. Welcome. You're the best. So I think, I think it's, we, we become automatic with different things and then when somebody asks you how you do it, you have to really step back and think about well about it.

Well, even just now, 

Kate Grandbois: when you asked me that question, I'd never thought about before. 

Amy Wonkka: Hmm. But I think that that's an important piece. Being more effective in working with other people, right? Mm-hmm. So outpatient, which is where Kate and I met when you're working outpatient, there's a lot of family involvement, which is one of the things I love about outpatient.

Um, and you, and you have families coming in and you wanna help support them in understanding the strategies that you're using with the clients so they can follow through. But part of being able to [00:32:00] share that information with other people is being able to dissect it down to its most, uh, simple components to make it accessible, 

right?

Amy Wonkka: Mm-hmm. So in order to make it accessible to people, you really do have to be able to step way back. It's like tying your shoes. Mm-hmm. I am, I props to all the OTs out there, but I don't know that I could. Without explicit thought. 

Kate Grandbois: I thought you were gonna say that. You can't tie your shoes. No. I was like, where's this going?

I see you wearing boots. I understand the boots. Boots with a zipper. Do you really thought how to tie your shoes? Anyway, 

Amy Wonkka: go on. But I don't think, I don't think without sitting back and reflecting on it, I could tell you the exact steps to tie your shoes. Right. Could I teach? Yeah. No, I couldn't. Could you tie your shoes?

No, but it's something I, I can do, 

Kate Grandbois: right? You can tie your shoes. That's great. 

Amy Wonkka: Yes. Don't worry. Everyone, Amy can tie your shoes. I can. Um, so I think it's the same thing. I think that as a speech pathologist, especially somebody who's been doing something for a while mm-hmm. Sometimes we forget that at some point this took explicit thought for us.

Right, right, right. Totally. And [00:33:00] we expect communication partners to, we habituate to it. Mm-hmm. Yep. Totally. And when you expect other people to do something without giving them enough support, it just becomes frustrating for everybody. And that's unfortunate and not what we want. 

Kate Grandbois: So the concept of input, output, mismatch.

Mm-hmm. 

Kate Grandbois: What is that? What is that related to? That was something that came up in the O'Neill Light and Pope article. Um, and I don't know what that is. 

Amy Wonkka: So that is another, if, if you're only going to read two articles from this talk, I would recommend the Allen Etal and the O'Neill et al articles, which are both big reviews of lots and lots of studies.

I love 

Kate Grandbois: those. I I am coming to love those articles because you read one Yeah. And not five, and you get like a really nice takeaway of the bigger picture. 

Amy Wonkka: Well, and as a person who's not a researcher, I'm not a researcher. I went to grad school, I read research, I learned about it, but I'm not skilled right.

In research, but I want, as a clinician to be able to feel like I'm, I'm using what's best practice. [00:34:00] Those articles are so helpful. So what they're talking about in that article is, is just the difference between if, if the expectation is that the client is going to use aided a, a C as all or part of their output method.

Mm-hmm. 

Amy Wonkka: None of their communication partners are using that as part of their input method. There's, there's a mismatch that 

Kate Grandbois: that's the mismatch, right? So 

Amy Wonkka: when we think about typically developing individuals who are using oral speech, they're provided the input, 

Kate Grandbois: matches the output. Yes. 

Amy Wonkka: Right? 

Kate Grandbois: And I think that's an, that's a really important cornerstone of, um, of the theory of aided language, stimulation of why you would use it to begin with.

So I think there is this comp, and I have this conversation with BCBAs all the time, why should I be using aided language stimulation? What is the literature about? Um, you know, you're just, you're giving them the model, you're giving them the answer. It's a prompt, et cetera, et cetera. Um, but there is this theoretical component of, well, you [00:35:00] wanna provide the same language learning opportunities that a speaking child has and a speaking child has having.

Verbal speech modeled for them. I, I mean, I have two children. I spoke to both of them the day they were born with no expectation that they were gonna speak back to me. Right. So, you know, you have, you're in, there's that theoretical component of providing the same language, learning experience by giving aided input so that you get aided output.

Amy Wonkka: Well, and there's the Jane Corsten quote that I don't have in front of me, but I use in almost every training I ever do. I don't know that quote it, I am gonna get the math wrong, but it, it's basically making the point that, oh, I know what you're, yeah. Somebody who's using oral speech, who's going to be an oral speaker, has received, you know, 10,000 or something.

Right. It, I thought that it was like 4,200 hours or something. Oh, yeah. And, and the mismatch is that in order for somebody who's an augmented communicator using aided a c to receive that same amount mm-hmm. As an 18 month old child 

mm-hmm. 

Amy Wonkka: They, [00:36:00] if their only exposure is, you know, twice a week during a 20 or 30 minute speech and language session, it takes them 84 years just to receive that same level of input.

Um, so if you're ever doing a training, look up the Jane Corton quote because it's really impactful. And that's, that's part of mm-hmm. I mean, that mm-hmm. Whether we have hard data or not. It, it's something that makes sense and sometimes things that make sense aren't real. Right. Well, I was just about to 

Kate Grandbois: say, but sometimes things that are logical and make sense are a great gateway to get buy-in from the individual's communication partners.

And in the, again, this is sort of looping back to our first episode on collaboration, but if you have someone, a parent or um, another person on the team who doesn't want to use this intervention method, that's, you know, maybe that's okay. But by providing that very logical theoretical framework mm-hmm. It doesn't make it seem like a huge red light procedure of, oh, there's no evidence for it, and all of that kind of stuff.

Amy Wonkka: Well, and another big piece that I didn't read in the articles, [00:37:00] but that makes sense to me, just kind of as a general practitioner, when people are using some type of aided modeling intervention. Mm-hmm. It also helps everybody recognize what needs to be in the device. Mm-hmm. Yes. Right. So even if you have a very robust device that's filled with all sorts of core infringing vocabulary.

We still probably need to customize it. Yeah. And a great way to understand that is through using it 

Kate Grandbois: when Nana goes to find the birthday cake mm-hmm. Icon and it's not there. Right. Oh wait, we need to find, we need to put in an icon for birthday cake 

Amy Wonkka: or Nana's not there. Oh, poor nana. I know. Let's put Nana in the device.

Nana needs to be in there. Everybody loves a nana. Right. So there are a lot of kind of operational mm-hmm. Benefits as well. 

Kate Grandbois: Um, so the first half of this podcast or episode I keep saying podcast. It's an episode in a podcast, has been very literature heavy and I think it would be a good idea to talk about the implementation.

So now that we know that it is a valid [00:38:00] form of intervention, it, there's a very, a big gray area in terms of what it looks like. How, how, you know, each clinician does it. There is varying evidence in the literature on different. Ways in which it can be beneficial for syntax, semantics, you know, all receptive, all of those kinds of things.

I think it would be a great idea to talk about physically, what it looks like and what, what components you should consider when designing your implementation plan. Unity, using aided language simulation. Um, and you have a few notes here about Ash's Guide to evaluating clinical evidence, um, which I think might be really helpful in terms of the importance of using existing research as your starting point.

So maybe you use some of this literature to inform why you might use your ratio, for example, or your dosage, you know? Mm-hmm. You know, so then, then, you know, using that as a jumping off [00:39:00] point to fine tune things for specific clients. Does that make sense? 

Amy Wonkka: Yes. I mean, I think that, that, that's what it looks like a lot for me is, is we read something like one of these.

Systematic reviews of the literature, it raises new points, perhaps. Mm-hmm. Things that we haven't thought about and makes us think about, okay, so how could I modify my practice to see if this is potentially more beneficial to what I'm currently doing for these clients? Mm-hmm. And so you're, so you're getting your information from something that has been somewhat established through research.

Although as we know, it's not, it's not as clear that as that, I think what the research tells us is this might be helpful and we need more research to be done. 

Mm-hmm. 

Amy Wonkka: So, knowing that it might be helpful, I think it helps us to form a clinical question around, you know, for instance, when you read the systematic reviews, you find out that receptively a lot of the information.

When you see studies that have shown that it did help. [00:40:00] The clients acquire a broader range of receptive vocabulary. Usually that's looking at single words. 

Mm-hmm. 

Amy Wonkka: But in real life, you know, a lot of my students, it's, it's more, it's more naturalistic than that. It's not, can you point to the mm-hmm. Blah, blah, blah.

When I also give you aided language input. It's more, can you follow this classroom direction mm-hmm. More successfully. Right. 

Kate Grandbois: Functional. 

Amy Wonkka: Mm-hmm. And so, knowing that right away, we know that I'm, I'm hoping that this intervention might help in a way that it hasn't s really been demonstrated in the literature.

Mm-hmm. So I wanna collect, I wanna form that question and collect data to kind of get a feel for that. Because we also don't want data, data, data. Right. Right. I mean, it all comes back to the data. Well, because, 'cause we don't want people doing things. That are extra work. Mm-hmm. So I think that that's another thing that sets apart clinically.

Mm-hmm. Right. A lot of our interventions, I say all the time, a, a C intervention is the same as language intervention. Right. You're just using this tool. I think that aided [00:41:00] interventions, aided modeling interventions feel the most different to people. Mm-hmm. Because you have to learn this different set of skills.

Kate Grandbois: It's bulky and unnatural. Mm-hmm. You know, we spent however old you are as a clinician speaking with your mouth. 

Mm-hmm. 

Kate Grandbois: So you have that many years of learning history to communicate with verbal speech and then all of a sudden you're being asked to communicate a whole different way. You're learning at the same rate as your student a lot of the time.

I mean, I think it's a lot about your own behavior change 

Amy Wonkka: and people get like uncomfortable about it. They're like, it's uncomfortable the of pressure. 

Kate Grandbois: And I, you know, I've had that same reaction myself when I started doing this. And I had the same, I, I've had a lot of parents have that reaction. Mm-hmm. Um, so I mean, thinking, and this is sort of a nice segue into one of the first components to consider when you're designing your, um, intervention using aided language modeling is what is the environment like?

So are you trying to use this intervention in a busy classroom with, you know, X number of other kids or in a classroom with a particularly loud group of [00:42:00] other, of other kids? Is there a lot of clutter around? Is it like the classroom I described earlier where there are, there is extra equipment, um, medical or, and you know, educational equipment around that you have to deal with?

Um, and how do you navigate through those things? And I think that's a really important conversation to have with the team to try and find a way to make it. It's, this is an a b, a term but low response effort. You don't want to have, if you have a team that's saying that they are totally overwhelmed by aided language stimulation, you wanna find a way to make it seem as reasonable and as feasible as possible, navigating through all of those different environmental factors.

Mm-hmm. 

Kate Grandbois: Um, and I think you all, you brought up another really good point when we were talking about this before, um, before we started recording about joint attention. So a lot of times I'll walk by a classroom. And, you know, one of the, um, teachers or staff members who I've trained is [00:43:00] doing this amazing job of provided, aided, providing aided language input.

They're, you know, either asking the student what they wanna earn for a break, or they're providing, they're asking a wh question using aided language stimulation. And I look over in the student's eyeballs, you know, they're stimming looking at out the window, or they're not paying attention at all. Mm-hmm.

And my heart sort of breaks because the staff is, they're doing what they're supposed to be doing, but joint attention is a huge component to this intervention that I think, at least in the sum of the settings I've been in, gets taken for granted. 

Mm-hmm. 

Amy Wonkka: I, I would completely agree with that. I think that.

I also think that back to the idea of unaided and aided communication. Mm-hmm. I think that there's a lot of input that people can provide, and this was, this isn't in the studies that we're looking at aided input, but I also feel like unaided aided communication. Mm-hmm. Or unaided [00:44:00] modeling. Right. Okay.

Modeling is, is really important. Right. So those early gestures mm-hmm. When we think about joint attention skills, joint attention skills form the foundation of communication, if I am not looking at what you're looking at, if you're modeling something that that disconnect is not gonna facilitate optimal learning.

Right. 

Amy Wonkka: So there is a piece of, you know, you need to be in the moment together. And that's why for a lot of early communicators, we start with things like requests because that's what's interesting and motivating to the client. And we all learn best. When we're interested and motivated. I mean, yes, I, a medium nerd.

I do sometimes read research articles for fun. She does. But I read them in areas of interest to me. Right, right. I'm not reading research articles on particle physics. No offense to all you particle physicists. 

Kate Grandbois: The Wikipedia page is on what's happening at certain. Really interesting. There are multi universes.

Oh, it's okay. [00:45:00] Multi. Yeah, I read. That's good. But I read that that's good because I think that is really, really interesting. Mm-hmm. For me. But you couldn't make me read anything about, I don't know, the Kardashians, no offense. Right. No offense. That's just not my jam. Mm-hmm. But you know, they're awesome.

They're cool. Not not digging on anybody and what you're into. But I guess the point is, um, the point is you. You naturally engage with things that you find reinforcing in, and that is an incredibly crucial component to your communication partners and your clients. 

Amy Wonkka: I and, and if you read the literature, they do talk about that a lot of these aided modeling interventions take place specifically within the context of a motivating and naturalistic routine.

So those are pieces to think about your environment, but also the individual, like who is the individual and what are the environmental impacts for that individual. Some clients who I've worked with are, are, are right there with you. And joint attention [00:46:00] is a strength. They're very motivated socially. And so it doesn't matter, you know, if you're at a circus, they still, you know, we are, we are sharing that moment, we're sharing that moment together.

Um, we are able to shift our attention together. Mm-hmm. We're able to shift topics together. And so for those individuals, you know. I think it may still be a variable for the communication partner, but for those individuals, whether you're providing that model in a crowded, busy classroom environment with lots of visual stimulation and movement and auditory stimulation, doesn't matter.

Kate Grandbois: Mm-hmm. 

Amy Wonkka: For other people it does. Oh, right. 

Kate Grandbois: Yes. I, I'm just thinking about my own particular students, that that's a game changer. I mean, they're not gonna be paying attention to whatever you're modeling for them because they're gonna be attending to all of the extraneous noise. 

Amy Wonkka: So if you're trying to answer back to, you know, we formed a question about is modeling, let's say our question, back to making the question.

Let's say our question is, does this modeling intervention help our client better follow one step directions? You may wanna collect some data [00:47:00] across those different environments and get a feel for maybe right now, at this moment in time, we do see a difference in. The quiet outpatient environment, right?

Mm-hmm. So when they go after school, they've had a snack, they're an outpatient, they've got some fun toys and games, we really see a difference. 

Mm-hmm. 

Amy Wonkka: Then we wonder, do we also see that difference in, in a busier environment or in a novel place? 

Mm-hmm. 

Amy Wonkka: Um, and it helps us better focus the communication partner.

Mm-hmm. Back to what you were saying about like, don't ask people to do too much. Mm-hmm. Think about, you know, if we know right now that these quieter times are better times, maybe those are the times we focus on 

Kate Grandbois: to begin. Right? Right. Um, so sort of recapping the environmental variables are really, really important to consider when trying to design an intervention with this, with aided language modeling.

Um, another important variable to consider is content. So what exactly, and this is, I think you said it so well a few minutes ago, a a c intervention [00:48:00] is language intervention with materials. Yeah. So what is your student working on? What are your language goals for that student? And that should guide. I know we have talked about this dosage with a two to one ratio of 15.

15, oh no. 30 models in 15 minutes. No, no. 15. 

Amy Wonkka: No 30. 30 and 15 minutes in. 

Kate Grandbois: 15 minutes. Um, so two a minute for a second, I roughly, I got nervous. It was 15 seconds. I was like, no way. That's insane. So fast. That's totally crazy. So fast. So fast. Um, just rapid fire just on the, I think then you, then you purge on like socially inappropriate and it becomes weird.

Okay. Anyway, sorry. Scrap that. It is 13 models in 15 minutes, so. You're, you know, trying to consider that. Is that single word utterances, is that a two word phrase? You know, are you working in that student zone of proximal development? Mm-hmm. Are you trying to provide this target because eventually you wanna integrate it into a behavior plan where you're using that as functional communication and the absence of a wanted behavior.

What [00:49:00] are your goals? Right. In terms your linguistic and functional communication goals for that student. When you're designing, I think that's an, something that's just really important to consider and something that the teams you're working with or the other collaborators or other communication partners that you're working with might not either have the background information.

You know, you might be saying a parent, A parent that says, well, I want them to say a full sentence. Mm-hmm. Maybe that's not quite where they are. Or the BCBA you're working with, and I always use that example because that's who I work with, so forgive me, but you know, the BCBA saying, well, I want them to use this word because it's part of the behavior plan.

Yeah. So. Trying to take inventory from all the different stakeholders, consider what their learning experiences are, what their areas of strength and weakness are, and then deciding on what those content variables are when you're design and writing it all down. I mean, I think, again, plug for an implementation plan episode at some point in the future when you have all of these pieces written down and you can distribute [00:50:00] it because, let's be honest, you can provide aided language modeling as an intervention in your pullout sessions in school, in your 30 minute speech sessions in an outpatient facility.

But when you get the communication partners on board, they can bridge that input output gap. 

Amy Wonkka: Well, 'cause then we're back to that Jane Corsten quote, right? Right, exactly. Because if, as the speech pathologist, so where all the speech pathologists who are listening, there really is, and I think that that that's a piece for all speech language pathology, but it's particularly true for a EC because of the input output match that there is this.

Kind of double burden to really spread what you're doing and make it accessible for all the other communication partners so that that client is receiving that input across their day. 

Mm-hmm. 

Amy Wonkka: And I have found a couple of strategies, just back to practical implementation. I find, you know, I think back to when I first started working with aid communication and [00:51:00] back in the day of much larger, heavier devices, feeling overwhelmed.

Just overwhelmed that like, how do I find the words? And I don't wanna look like, I don't know what I'm doing, but I don't know where any of these words are in this device. And they say 

Kate Grandbois: that's a good thing to model because nobody's ever gonna know everything. Right? So when you make a mistake, you're showing someone, oh, it's okay to make mistakes, 

Amy Wonkka: but it's, it feels uncomfortable.

Yeah. In the moment. It's intimidating. One thing that can be helpful is just making a sheet. Of of words. Right? And that could be, you know, these are the, these are the five or 10 words that you're working on this week, and share that with people because that's going to help people use those words. Mm-hmm.

Instead of other similar words. So it's nice because your client is getting a lot of kind of auditory bombardment, sort of mm-hmm. Of similar terms over and over again, across multiple environments and communication partners. And we like that because that's consistent input. Mm-hmm. Um, and it, it gives people a little bit of permission to just focus on a few things and [00:52:00] feel a little less stressed out.

Sometimes we even, you know, print out the actual icon sequence, like, you're gonna press this button, this button, this button. 

Kate Grandbois: You have to meet the communication partner in their zone of proximal development. Yeah. So, you know, making sure that you're breaking it down into more consumable, you know, less, you know, stressful pieces for them.

Well '

Amy Wonkka: cause back to working out. Right. I wanna work out. I wanna work out. If somebody came to me and said, I need you to work out, we're gonna start with running a marathon. 

Right? Right. Yep. It's, it's just, it's 

Amy Wonkka: not gonna happen. But if somebody said, okay, I mean, it's the whole couch to 5K thing. Mm-hmm. Right.

We're gonna, we're gonna walk, we're gonna walk a lot. You're gonna run a little little bit. We're gonna walk, you're gonna run a little bit more. We're gonna walk, you're gonna run a little bit more. Right. That's basically what we're doing with communication partners. Mm-hmm. I find that to be more successful and just feel better mm-hmm.

Too, then, then people feel positively about it. You're more likely to do it next time. It's not this thing that makes you feel uncomfortable and like a failure. 

Kate Grandbois: So, I mean, just again, recapping, providing. A [00:53:00] written plan to people can be really helpful making the, um, list of content or, you know, writing down the content that you want them to work on.

So maybe just pick one word, pick a small number of words, show the communication partners where those words live so that they don't have to, they don't feel like they have to find them on the fly. Um, and I also think giving a, giving some boundaries around where someone can or when someone should be doing this.

So I've had parents say to me before, I can't possibly do this all day long. I cannot provide aided language input all day long. That is I, and I know you're telling me that that's what's best for them, but I can't do that. And they just shut down and it's totally stressful. Mm-hmm. Um, and so, you know, home environment's really busy.

They're totally different than every other environment that, that child or, or communication the student is in. So giving them parameters around when they could try. So meal times tend to be more structured or maybe the family has a nighttime routine that's very [00:54:00] structured, talking with the family about what parts of their regular life, they feel that they could include it at a small, reasonable amount without totally shutting down and you know, feeling like it was way too overwhelming.

Amy Wonkka: Well, and I think you make a great point about, I noticed that you didn't say give them an activity that they can add into what they're doing. You said find out what they're already doing. Yes. 

Kate Grandbois: Because I used to, before I had my own children, I would make these insane recommendations to families. And now that I'm a mother of a working mother of two, I think if somebody told me I had to do something, I would punch them in the face.

I would, I don't wanna do that while I'm cooking dinner. The everything's burning, the kids are screaming at each other. And you know, these parents, they have a child with a communication difference. And so they're already dealing with a lot of other extra things and we know that their stress levels are higher and we know that they also eat dinner.

Yes. And everybody's eating dinner. Right. So talking to them about what they think, and this is just a counseling component, [00:55:00] how, what do they think is reasonable for them mm-hmm. Instead of telling them what they should do. Um, and I think, oh, go ahead. 

Amy Wonkka: Oh, I, I wanted to get in, I, we've talked a lot about using aided modeling interventions and sort of the impact receptively.

Mm-hmm. And in part, so, so what a person understands instead of what a person is saying. Mm-hmm. And a part of that is because one of the things that came up in the Allen et all article was the mismatch, right? Mm-hmm. So, and I've, I've seen this happening. I see it sometimes in goals and objectives, regardless of the setting.

If somebody is. Somebody who's using a a C for expressive output for all, or part of their expressive output. Sometimes you see goals and objectives that are only expressive. 

Mm-hmm. 

Amy Wonkka: And unless that person has receptive language skills that are completely within normal limits, we as clinicians need to be mindful and aware that that's a really important piece, just [00:56:00] because we're focusing on your expressive output.

And obviously we want the most, you know, the highest degree of expressive communication possible for all of our clients. Receptive language is super duper, duper important. Mm-hmm. So it's really important that we're working on that, and I think that was a big takeaway for me. We really should strive to keep it balanced.

Mm-hmm. So back to it is really just language intervention. Mm-hmm. It's language intervention. If you had somebody come to you with a significant expressive. Deficit and a receptive deficit, you would not only have expressive goals for them, you would have expressive and receptive goals for them. 

Kate Grandbois: Mm-hmm.

That's a very, very good point. 

Amy Wonkka: The other awesome point raised by that article was just the potential impact on grammatical output expressively for that individual. So thinking back to the amount of input that oral speakers get at a young age, when we think about brown stages, you know, I think it's brown.

Stage two starts the early acquisition of the morphine in. So [00:57:00] we are, if a, if a, we're having somebody who's working on oral speech, we are working on the inclusion of that present progressive marker. Are we also doing that expressively for our individuals who are at a brown stage two? Mm-hmm. Um, so just 

Kate Grandbois: making sure there's still that connection between language intervention and what we know about language development.

Mm-hmm. And it shouldn't be any different because you're a device user and 

Amy Wonkka: it, I mean, it doesn't always follow. There. Definitely differences. It doesn't always follow. You know, the, the strict developmental hierarchy. And I know that there's been some, I heard a, a couple ashes back. I guess there was a talk about brown stages and whether like how much those are applicable to typical development.

Uh, but I think, you know, we referenced the Raya Paul book, like that inside cover of the Raya Paul book. Oh my gosh, yes. Just acquainting yourself with Oh yeah, that's right. This is also happening. This person's skills are clustering around a 24 month level expressively. They should also, we should be working on mm-hmm.

This, this syntax and grammar component as well, not just vocabulary. Mm-hmm. So I think just keeping all of the pieces and not [00:58:00] letting. All of those other pieces of language intervention fall off your radar is important. 

Kate Grandbois: Um, yes, totally. I think those are really great points. And I think the only other thing, um, just looking at the time, we did wanna touch, touch a little bit on, um, partner training, um, and different strategies for partner training, which is a massive, massive, massive topic in and of itself.

Yeah. Um, but are there tiny bits of information that we can loop into aided language modeling? I know we've talked about it a little bit in terms of making sure you're taking into account what the communication stake, what the stakeholders, what they value. Mm-hmm. Um, what vocabulary is reinforcing for them.

Um, but training people in how to use aided language modeling is, is a whole, it's a whole ball of wax. 

Amy Wonkka: It is. I think it's certainly a, a talk for a later time. I will say I was hopefully like, you know, how you, like I am. I'm sort of a fan [00:59:00] girl for certain, certain people's research, so that's, that's pretty nerdy right there.

Um, fan girl. But there was a while that every time I went to, no, I can't even say that. It's still, it's still happening. Anytime that I go to a conference and Jennifer Kent Walsh or Kathy Banger are speaking these people, they, you don't know me, but I'm always there. Um, I, I go to see them because they do such great work on partner training and it was an area in my current role, I, I am consultative, so I, I'm working always to do a better job with this piece and so I read a lot of their research and I thought, oh, they did a great job.

They broke down all these pieces. They're awesome. So they are awesome. Jennifer, Kent Walsh, Kathy Binger. Look 'em up. They do great work. And I think this is a shameless plug for 

Kate Grandbois: a future episode mm-hmm. On partner training. Mm-hmm. Um, so stay tuned for that. Um, we will also put up a few links to some resources related to that Sure.

Since we talked about it a little bit. And [01:00:00] that way, um, if you're dying to learn about it before we have a chance to get an episode together around partner training, you can do your own, you can do your own research, do a little bit of your own nerd, nerd reading. 

Amy Wonkka: Mm-hmm. Why not stop 'em at a conference, but not in a creepy way.

Just like a, you wanna learn the things way. 

Kate Grandbois: Oh my gosh. That's really funny. So, um, just to sort of close up shop here a little bit, um, as a reminder, you can go to our website and, uh, find this episode, um, www.slpnerdcast.com. You click on the episode and follow the prompts to take a three question quiz and purchase your certificate.

Um, there is more information about us and our CEU process and what services we offer on our How It Works page. Uh, the website is www.lpnorthcast.com. Again, just in case you didn't get it the first 40 times I said it, and thanks for listening. Yes, thank [01:01:00] you.