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Kate Grandbois: [00:02:00] Hello everyone. Welcome to
SLP Nerd Cast. Today's episode is part of our SLPD on Demand series, so for anyone who is new to our podcast. Occasionally we answer questions from our audience. So, um, if you are an an SLP Nerd cast member, either our basic membership or our all Access membership, you can write in your questions.
And our resident doctor of speech language pathology, Dr. Anna Paula Mui, who is here with me today. Does some research about your clinical question and we review the research together here on the air. Uh, today's question is a really, really interesting one related to stuttering, uh, and I'm very excited to get into it.
But first, uh, welcome Anna, Paula. Thank you. I'm excited to be here. So, um, I'm always excited to have you here for, uh, any new listeners, do you wanna tell us a little bit about yourself?
Ana Paula Mumy: Sure. I, um, [00:03:00] haven't been in SLP for 25 years and, um, stuttering is my area of passion at this point in my career. And I'm, uh, in a university setting.
I'm the program director and an associate professor of speech language pathology in, uh, small private university.
Kate Grandbois: Awesome. I feel like that was a very humble, uh, review of yourself or a humble description of yourself. I feel like every time I talk to you, I learn something new, so we're so happy to have you.
Thank you. Uh, before we get into it, I'm gonna quickly read our learning objectives. For anyone listening who would like to learn more about the disclosures for this course, including our financial and non-financial disclosures, please uh, see the show notes or follow the link in the show notes to the course landing page.
All of that information will be there for you. Learning objective number one, explain three treatment approaches for addressing both stuttering and phonological disorders and learning. Objective number two, describe at least two ways to foster healthy communication [00:04:00] attitudes towards stuttering while addressing phonological concerns.
Now that we have our learning objectives, I wonder if it's a good place to start for us to, for you to read the question. So who wrote in, what was their question? Uh, set
Ana Paula Mumy: the stage for us. Sure. So this clinical problem comes to us from Tracy. Um, and the question was pretty simple, just what is the best course of action when stuttering meets phonological articulation or motor speech concerns?
So. As with other areas when it comes to stuttering, um, there's generally not a ton of research that is available to us. Um, but there is a little bit of, um, research that I was able to tap into. Um, one thing I'll start by saying is it's not uncommon for children who stutter to have co-occurring.
Um, challenges. So, um, one study showed that children who stutter are far more likely to have a phonological disorder, um, than their peers who don't stutter. [00:05:00] And you'll see other co-occurring, um, challenges, whether it be language-based or sometimes it could be, um, um, other conditions like A DHD or, um, you know, something else.
So that is not uncommon. We see co-occurring, um, challenges happening often. As far as, um, the research pointing to, you know, what is the best course of action when you have co-occurring things happening? Um, Nan Burstein Ratner, she wrote about this very early in, um, the 1990s. Um, and some suggestions, um, that she offered, I'm gonna touch on today, but there's really just not much research to date that really talks about.
Um, whether or not there's one treatment model, um, that's gonna be more effective than another, when we're talking about co-occurring communication challenges. So what I'm going to reference today is by, um, Dr. Kenneth Logan, and he discussed three possibilities, um, back in the early two thousands, [00:06:00] and it kind of, um.
Parallels, uh, speech sound disorders when we think about, um, goal attack strategies when we talk about vertical versus horizontal versus cyclical, where you're either doing something that's, um, sequential or something that's simultaneous versus a cyclical where you're kind of revisiting things. Um, so this is kind of the same idea here.
And, um, so what he offered was, um, these three models of sequential, cyclical, and concurrent. So within a sequential model, um, what he showed is that it's best suited for cases where, um, maybe one disorder or challenge has relatively, um, little impact upon the child's daily functioning. Um, and maybe the, there's one that's just more predominant where you see like, this is more of a struggle, this is more, um, really what's impacting them on a day-to-day basis.
Kate Grandbois: I have a question. Yes. I'm sorry. I'm, I just spoke over you. I have a question [00:07:00] for people who are new to this area, like myself. Mm-hmm. So I am, I know very little about stuttering. I've learned a lot from you, um, and some of our other guests. But my understanding of stuttering is that it is a, it is a specialty within our field clinically.
Mm-hmm. Um, based on this, these modules of these models of sequential, cyclical and concurrent, how do you piece it apart,
like how do you determine which, which features are, are standing out more? Is there like a way, like a differential diagnosis kind of way to go about that?
Ana Paula Mumy: Well, I think. What I'm referring to is more like, once you've already established that the child does have an articulation disorder and that they are also a child who is stuttering.
So you've already made that determination that, you know, with articulation, it could be that, you know, they can't say they're ours or they're, um, know, struggling with S or L or whatever it may be. Um, and then they also, you already have this established diagnosis that [00:08:00] yes, they, they do stutter. Um, you're.
Um, fairly confident that the dis fluencies that are present are stutter, like dis fluency. So they're either blocking or they have those repetitions or they have the, um, prolongations and it is, um, actually stuttering. Not just, you know, normal dis fluencies that. Typical, um, gotcha. Speakers may have. Right.
Okay. So I think where this falls into play is the, um, then deciding, okay, so I know that these, um, things are co-occurring, like there's already these two diagnoses. Mm-hmm. Um, so now I have to decide. How do I approach it? Like what is right more important to address at this point? Right. Gotcha. So that's where this, um, falls or, or, or where we have to make a decision.
Right. Gotcha. About which direction do I go. Okay. And so with this, with the sequential then, like I said. Then you have to decide, okay, is the articulation issue more prominent because maybe they are very [00:09:00] unintelligible, or maybe that's what's creating the frustration. Or maybe that's what's creating, um, the, you know, communication breakdowns in the classroom.
Or that's where, um, the child feels, you know, the most self-conscious, um. Then maybe you would address, you know, the articulation first and not necessarily touch, um, the stuttering or the, the, the fluencies, um, that are present, because that's really not, um, maybe as worrisome, you know, for the child. Um, with the cyclical model, it's more suited for cases where, um, they, there's, you know, two things happening and then there's.
Essentially negative impact happening simultaneously. Um, so you might, um, focus on one thing per activity, but then you are cycling through, um, different, uh, aspects of therapy where, um, stuttering might be the focus for one session. And then the, um, phonological targets might be the [00:10:00] focus for the next, you know, one, and then you decide what that looks like and you're gonna cycle through them.
And then with a concurrent model, then you're simultaneously working on both. So. What that might look like, let's say in an activity is, um, maybe you are tackling the sounds that the child is struggling with articulation wise, but then you're also working through some kind of strategies to make that approach easier for the child, where, um, they might need, uh, to, um, reduce the tension that's present because they are struggling to even.
Um, approach that word. Or maybe that's, you know, a problematic sound that they've identified like, oh, or they've built some fear right around that sound. And so then you're kind of working on the sound, but then you're also working on the aspects that make them afraid to approach those words. Where then that's more tied to the stuttering.
They're [00:11:00] afraid to approach because they're afraid they're gonna stutter. Right. So then it's trying to gauge like. What, where is the impact that they're feeling? And then, and I think fear is a huge factor here to think about. Like, are they afraid to talk? Are they afraid to say those words? Mm-hmm. Are they afraid to approach?
Um, and so if there's fear involved, then certainly there is an impact there when that's tied to the stuttering. Right. So, and I'll just give an example, just I'm working with a child right now who, um. Struggles with particular sounds and, um, but he's very unfazed by his stuttering and actually, um, isn't exhibiting a lot of tension.
So there are repetitions, there are prolongations at times. Um, and. It can at times impact his communication clarity in the classroom, but he honestly doesn't care. He's like, I'm good. You know, and, and it's just not really something [00:12:00] that he is self-conscious about. And, and he is in a small school, so it. I think there's a little bit more grace maybe, or, or like the kids aren't, you know, making fun of him or it's not something that's really standing out.
So the centering piece is really not an issue, or at least at this point it is a non-issue. So we're not really even touching it. I'm just cycling through the sounds that he's struggling with. So we've addressed it. Um, kind of in a sequential way, but with the articulation sounds not necessarily the stuttering.
Right. So does that make sense?
Kate Grandbois: It does, it does. It really clarifies it. And I, I actually have a follow-up question. So I assume you're using a lot of clinical judgment to decide which one of these models to use the sequential, cyclical, or concurrent. Um. When you're using the, is there any guide, are there any guidelines in the research about when one approach [00:13:00] might be better or, or not?
In terms of like, like I imagine the concurrent model, you're working on two things at once. That could be pre, that could, it sounds like it could be a lot for the, for the kiddo. Mm-hmm. Right. So I'm sure there are, are personal idiosyncratic things about the client that you might think on and reflect on, is that, is that a
Ana Paula Mumy: right assumption?
Sure, because you're gonna be placing different demands right upon the child, depending on which model, um, you choose. And so absolutely you're gonna have to take into account, you know, are they ready to work on two things at the same time? Or, or how do you scaffold that in a way that doesn't feel maybe overwhelming or where they are not overloaded?
So you certainly have to think about the child and you know, where, um, they are. I would say in terms of like probably the biggest, for me anyway, the, the biggest deciding factor is really the impact. Thinking about, you know, how is. Each thing impacting the [00:14:00] child. And then how do you help them become the most effective communicator?
Um, so that they are confident addressing either or, or both? Right. So whether it's the articulation piece, whether it's the stuttering, um, generally I would say most of the research is pointing to a blended approach where you are thinking about it co um, concurrently. So I think it would be, um, more. Or I, I can't think of a situation where I'm probably not thinking about both at the same time, you know?
Mm-hmm. And just always having that lens of like, okay, how is this impacting them? Um, but regardless of the approach that you choose, uh. You have to, um, think about, you know, functionally, like how is this helping the child in the classroom? Mm-hmm. How is this helping them? Just their overall communication?
How is this helping them be able to do the things that are being demanded in the classroom? So whether that's reading aloud or whether it's, you know, participating in discussions, whether [00:15:00] it's. Um, presentations or, you know, whatever it might be that they're being asked to do, um, how can I best prepare them?
Um, I think if they're afraid to talk and they're afraid to stutter in front of the class or in front of their peers or in front of their teacher, then you're gonna have to build in some component of. Working through the stuttering, working through the tension, helping them, like how do you approach these words that seem difficult for you, or where you might block, or where you might just wanna swap the word because you're afraid of what's gonna come out.
So I think there are always the, you know. Some component of addressing the, the psychological or like emotional aspects or reactions that the child has when they stutter. Um, but like I said, with this particular child that I'm working with right now, there really is almost none. Um, and I think part of that relates to his parents have been so [00:16:00] supportive and almost like not, it's not an issue for us, you know, they, they just haven't put a lot of.
Weight on the fact that he's stuttering or, or I say weight in the sense that. It's not like they're appalled or feeling like, oh my gosh, this is happening. Right? Or, you know, like they're just, they've been very much like, it's just a part of him, you know? And so he has never felt this sense of like, I need to do something different, or, um, this is a problem, or like, my parents are unhappy with me because I'm stuttering.
Or, you know, like there hasn't been that pressure from hi the, the home perspective. And so he's come into school like, okay, I'm, I'm good. You know? And, and that's. His perspective now, not to say that that can't change over the time and where he could become self-conscious, or if children started to tease him or if, you know, if he had some traumatic experiences around his stutter.
It doesn't mean that that couldn't potentially, um, start. But [00:17:00] right now he feels fairly confident in who he is. Mm-hmm. As a talker. And, and really the only thing is he's struggling with ours and Ls, you know, our, our. Sounds that so many kids, you know, struggle with. Mm-hmm. And so it's like, okay, let's, let's just get you confident to make these sounds and, and to be able to produce them, um, consistently and accurately, um, as much as possible.
Right.
Kate Grandbois: And I, I love that you mentioned the parents and the counseling piece of this, because I have to imagine that the client perspectives and values are a very big deciding variable in terms of which approach you use. How you're gonna, you know, differentiate between not only the approach, but. Uh, to use your word, the weight that you place into, into each goal, you know, when you're, when you're writing mm-hmm.
Your goals and kind of moving through therapy. Um, do you have any suggestions for how you communicate this to parents, if you know, let's say the parents. [00:18:00] Have, you know, strong feelings that they want you to work on the stutter, but the kid isn't bothered by the stutter and is really would like to say there are sounds or there are t sounds or whatever.
How do you balance communicating around these difficult clinical decisions?
Ana Paula Mumy: Mm-hmm. You know, that's a, a very valid question because of course, parents do come to us often with. What, what's important right. To work on. And, and, and oftentimes there is that desire that they, or, or not even, I wouldn't say desire, but almost like this expectation that therapy is going to give them fluency, right?
And so that's kind of the expectation that they're coming into treatment with. And so it's a lot of counseling, um, the family to understand that, you know, for kids where stuttering persists that maybe. The outcome of complete fluency isn't necessarily realistic [00:19:00] for that child. That if it is something that they're going to continue or that's going to persist into adulthood, that then how do we help them become the best communicators they can be.
Um, and I have just conversations with parents about, um, you know, genetic factors and the hereditary. Components or the neurophysiological aspects of stuttering. So a lot of it is really just, first of all, family education. Like what is stuttering? Why does it happen? Why does it persist at times, and why does it resolve other times?
You know? And so particularly if there is a family history, right? So helping them understand like no one is at fault, right? It's no one's fault. But there are things that tend to. Lead sometimes or that contribute to when it does persist. So, you know, we talk about risk factors, we talk about, you know, gender.
It happens more frequently with boys than it does with girls, you know, so just [00:20:00] a lot of it is just education and helping them, um, understand. First and foremost, it's no one's fault, right? You didn't do something to cause this. And then saying, okay, so now that here we are, um, the stuttering has persisted for 2, 3, 4 years, um, it more than likely is not going to resolve.
Um, if it gets to that point where you're fairly confident like this. A part of who they are. Um, and then just having those open conversations. Um, and also giving the family space to come to terms with that, right? Because if you have this expectation like, oh, it's gonna resolve, or, I mean, I worked with a teenager who he thought, well, by the time once I'm an adult, it, this will be gone.
Right? Like, this is gonna resolve. And just help helping him understand like, well, you know. Because you are a teen and you've been stuttering for quite some time, it's probably a part of your makeup. And helping him come to terms with that and then [00:21:00] helping family come to terms with that. So, so much of it initially deals with that counseling piece of mm-hmm.
Understanding the diagnosis, coming to terms with it, giving them room, um, and even, you know, for some parents giving them room to. To grieve in a sense, right, of like this idea of like, oh, this is a challenge that's not necessarily gonna go away. Um, and that sometimes can be hard and we have to help walk parents through that as well, right?
Of just this expectation of what they thought was going to be. And now like, oh wait, it's not what I thought it was gonna be, you know? But. Giving them hope to face like, oh, but he, you know, your child has an amazing future ahead. That this doesn't have to hinder their success or their potential, or, you know, what they might do with their lives, you know, um, moving forward.
So I think we start there, you know, with education and then, then it's really like talking to the [00:22:00] teachers, talking to the child, and, and really trying to gauge. What is the impact? You know, so going back to, um, thinking about like, how is the stuttering manifesting itself? Is it, does the child stutter fairly, um, uh, easily, you know, is there, uh, forward movement in their speech, or are they blocking every other word?
Right? Because that would of course impact the child's clarity or their confidence. So what does that stuttering look like? And then, you know, how is the child reacting to the stutter? What are their responses to it? What are the teacher's responses to it? What are the peer's responses to it? Right? So what does that look like?
Um, so doing classroom observations, talking to the teacher, you know, those were be, would be factors that would be important. And then. Thinking about, um, how is it impacting, of course, you know, their overall communication and participation in class, is the child choosing not to raise their hand or answer the question or whatever because they're afraid or are [00:23:00] they still participating even though they stutter and, and they're perfectly okay, um, stuttering through their response?
And that's no big deal, right? So. And kids will fall on different ends of that, right? Where you might see that they just completely shut down and don't say a word. Or you might see them just go ahead and put themselves out there. So thinking about, okay, what does that look like? Um, and of course talking to the teacher, trying to understand from the teacher, what do you see?
How is this, um, playing out in the classroom? And then. And that's where you, um, gauge the impact. So then if there is significant impact, then of course you would have to address it sooner than later. Right. But then if there's not, then maybe you could focus on some of the other things you've mentioned A very long-winded way to answer your question.
Yeah, no,
Kate Grandbois: it was, it was really great. And I, I appreciate, um, I really appreciate how you talk about. Where they are with their stutter across so many [00:24:00] domains. So where they are emotionally, where they are with self-acceptance, where they are with fear, where they are with the physical. Mm-hmm. Aspects and manifestations of their stutter.
Um, where the parents are, where their whole villages with these kinds of things, where their teachers are right. There are so many. Uh, so many things to think about. I see in your notes that this is somehow related to the international classification of functioning model that's been put forward by a few researchers.
I wonder if you could tell us a little bit about how that is related.
Ana Paula Mumy: Sure. So when we think about the ICF model, um, it's the model where you're, you're looking at the child's functioning, um, in different ways. So you're looking at, uh, you know, what is the impairment or the, the challenge in body function or structure.
So, um, of course with stuttering, generally those. Primary characteristics are, um, or at least what's reported right, is that sense of loss of control or the feeling of being stuck. [00:25:00] That's what a lot of people who stutter will report that. That's the, um, so it's not even the. The dis fluencies themselves is that feeling of loss of control that's so impactful.
And then you think about, you know, what are their personal reactions to the stuttering? That can be behavioral, that can be affective. So, um, how they feel about it. It could be cognitive, what they think, like what. Oh, if I stutter, they're gonna think I'm stupid. Or if I stutter, they're gonna think that I'm not intelligent, uh, or prepared or whatever.
Right. Fill in the blank. Um, and then the other aspect of the ICF model is also looking at the adverse impact, which is essentially what we've been talking about, right? What, what are the activity, excuse me, activity limitations, um, or the, um, participation restrictions. So. How is it changing their decision making right at school?
Like, are they choosing, um, not to do something because they stutter? So an example of that, like from an let's say, [00:26:00] extracurricular standpoint might be, um, they wanna be a part of the play, right? The school play, but they're gonna choose not to because they're afraid that they stutter and they're not gonna be able to do it.
Right? Or, or maybe it's, they wanna do the spelling bee. They're a wonderful speller, but they're not gonna do that because. They don't know how. Right. Or even for teachers, like how do you accommodate that Right. To where the child who stutters might still be able to participate in the spelling bee and they are be, um, will be able to stutter without it being, you know, um, without being penalized for, right.
So. Um, thinking about it, you know, from different aspects, um, not just academically, but also like what are the other things, um, that children who stutter maybe, um, may want to do or be expected to do in a, in a school environment, um, where the stuttering could, um, create some challenges. And then, um, the contextual and environmental factors is another component of the ICF model where, um.
It's more about, you know, listener [00:27:00] reactions, you know, what is the environment like, right? So are listeners patient, are they giving them room to talk? Um, or is there stigma right associated where, um, the people around them are pointing to this idea that stuttering is bad or stuttering is wrong, or they shouldn't do it right?
Um, where there's just an overall, um, sense of. Stuttering is not acceptable here. Or would the opposite be true where it's, where they feel like, no stuttering is accepted here. I'm okay. Um, to just go ahead and stutter. Right. Um, and then other things might be, um, just thinking about like situational differences where, you know, stuttering may be not an issue if they're just like.
At lunch or you know, at recess, or it's more of like a socially less demanding, you know, situation, but then situations where. [00:28:00] Stuttering may be really difficult, um, or unpleasant or feel, you know, hard because it's more formal. Or it could even be sometimes, um, related to the speaker. Like, oh, if they have to talk to the principal, or if they have to talk to, you know, X person, then it's gonna be maybe more stressful or, um, anxiety producing or something like that.
Right. So you're looking at all of these different factors, um, to really determine, um. What is the impact? So the ICF just helps us to really look at the entire condition of stuttering, not just the visible stuttering behaviors, because it's so much more than that, right? It's not just the, the, um, the fluencies, it's everything else that relates to it.
Kate Grandbois: And I have to imagine that so many of those variables outside of the physical manifestation of sit cetera, are going to be the. Data collection points that we use as clinicians. Mm-hmm. In our clinical judgment. Just going back to what you've shared with us about the research, those are the [00:29:00] variables that are going to point us likely to whether or not to use a sequential model or a cyclic model, or a concurrent model.
Just trying to gauge, you know, kind of back to my original question, like how do you, how do you parse it out? How do you, how do you determine, yeah. What is, what is causing the most fear? What is, you know, the, the largest quote unquote problem? Not, either, not that either of those things are, are problems, but Right.
How do you determine what's of the highest priority to the kiddo and the family? It's, it's through all of these other variables. It's outside of the actual mm-hmm. Manifestation of stuttering and I, I so appreciate the. Calling out context and environment, because those things are so important and they're measured often with qualitative measurement strategies, right?
Interviews, observations, absolutely. Connecting with people, and those are things that are hard for us to fit into our schedule sometimes, you know, I mean, unless you are in private practice and can do whatever you want, um, mm-hmm. You know, and I, and they're undervalued. [00:30:00]
Ana Paula Mumy: Right. And we actually, um, like I use different questionnaires.
So one example, um, there's one on, uh, Sparrow Centering's website where it's just gauging the non-academic needs or aspects. So you're. There's just a, a, a set of questions, some prompts that just help you as the SLP to be able to ask the right kinds of questions or to approach the teacher to say, Hey, you know, what do you see in this area?
Or, um, or even things like. You know, do you notice even like absences, right? Like if there's days for presentations where um, the student just happens to be sick every time there is a, uh, some kind of, you know, forward facing, um, uh. Opportunity, right. Speaking opportunity for them in class or something, you know?
So it just helps you think about what are some different questions? What are the, the different things that I need to be considering when I'm talking to, um, a teacher, when I'm doing a classroom observation, it's more than just, [00:31:00] are they stuttering, right? It's all these other things, like, do you notice?
Right. So it's helping us to just to become better observers of what we, um, like being able to notice, like, what do I see beyond the surface level?
Kate Grandbois: I love that. I wonder in our last minute or two, you know, you've reviewed some of the literature that's out there for anyone listening. The references will be in the show notes as well as on the course landing page.
Uh, you've already mentioned one resource that's on the Spiro Stuttering landing page. We will include that link as well. But in our last minute, are there other resources like, so I'm just thinking of someone who's listening and thinking about a kiddo on their caseload. Wanting to apply some of these things maybe is new to the stuttering world or, uh, what are the resources are out there that, um, a clinician might want to look up to further their learning?
Ana Paula Mumy: I would say, um, stuttering therapy resources has a lot of free, downloadable, um, resources [00:32:00] that, you know, could relate to this. Um, I. Also, um, I know they have a blog that addresses some of these issues. Um, Sparrow has a blog that also addresses like eligibility criteria and just thinking about, you know, what are some of the holistic, um, tools that we could use, um, questionnaires and different qualitative tools that might be accessible for.
Thinking about, you know, different aspects of stuttering beyond just Suter, disfluencies. Um, so I would say definitely check those out. Um, but really, you know, there's nothing magical about any of these tools. It's really just asking questions, right? Like being curious. To learn more. Um, and just diving a little bit deeper than just the surface level and, and just being able to talk openly, um, about it.
And, um, and also I think for the teachers is. Helping them know, like, how do I help my students who stutter in the classroom? Um, so I'll just give a, a [00:33:00] quick example. There was this one, um, team that I worked with and he said sometimes I would raise my hand to, to answer a question, but I would block and then she would just go on because she didn't know what to do.
Right. So he, and I don't know if she thought he was just being funny or just like being flippant or whatever, but then it, it just took him having a conversation to say, if I raise my hand, it's because I know the answer, but it might take me a minute or two to get it out. So don't pass me by. Like just persist and be patient.
You know? But the teacher didn't know that. Right. She didn't what? Great self-advocacy. That's awesome. Right. But it took. Us chatting about it, him realizing like, yeah, teachers don't necessarily understand stuttering. They don't know what to do. It's not because they're mean or because they're ignorant, or they just really don't know sometimes what to do in that moment, especially if there's a lot of tension that's, you know.
Mm-hmm. Physical, visible tension. And so it's just having those conversations with a teacher to [00:34:00] say, here's what you, here's what to do, here's what not to do. And that is. Also variable based on the child, like what a child might want them to do in that moment. Maybe they do wanna be passed by, maybe they just want you to go on and pretend like nothing ever happened, or maybe they just want you to persist.
You know? So that could vary depending on the child. So it's just really about open communication and conversations about, you know, what this might look like. And one more point that just, um, I remember just talking about teachers is, um. Sometimes speech work. So if you think about articulation, um, if you are doing and addressing the articulation piece itself, the motor work could sometimes.
Exacerbate the stuttering because of the hyper focus that you are actually placing on production and accuracy. Right. So sometimes it's also just setting realistic expectations, um, so that teachers know and parents know, like you might hear a little bit more stuttering for a while, and [00:35:00] that's normal. Why?
Because we're putting so much emphasis right now on the production aspect of talking. Mm-hmm. So the more. Of that intentional focus that you place that could sometimes make the Sutter a little bit more maybe pronounced. Right? So just talking through, again, communication about that could happen and that's normal.
It's not like they're regressing or you know, that that something that they would necessarily be like worried about. So just being, um, upfront about that possibility I think is important because parents don't know and teachers don't know
Kate Grandbois: either. Mm-hmm. Thank you so much for sharing all of your wisdom with us and doing all this research.
Every time I talk to you, I learn something new. Uh, we, I really appreciate just your time and your expertise, and for everyone who is listening, everything that we mentioned today will be in the show notes. All of our resources and references will be there as well. Anna, Paula, thank you so much.
Ana Paula Mumy: You're welcome.
Thank [00:36:00] you.
Outro
Kate Grandbois: Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study.
Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at [email protected]
thank you so much for joining us and we hope to welcome you back here again soon.
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