School Speech-Language Pathology Exits of SLI Children

What keeps SLPs from exiting more children in a timely fashion?

We all go to our closets in the morning to get ready.  For many, we hate to look for something to wear.  Everything is crushed into the small space.  We swear we are going to clean out that closet.  It’s insane to fight it every day!

We try. But we just don’t know where to start.  When we start to clean out things, we have excuses.  Like “I have never worn it!  That was a gift.  That’s my favorite. I don’t have a matching piece without it.  I will wear it when I drop a few pounds.  That was expensive.”

There is a psychological barrier to letting go. 

Lion on top of cabinet, moved to Paris, Place Herbert

Exiting SLI children is similar.  “A journey of a thousand miles begins with single step.”  Odds are there are too many non-disabled children in the typical caseload.  Pick one child and start.  Listen to all the excuses.  “He’s still working on the vocalic /r/.”  “His mother wants him in.”  “I only see him once a month.”  “His IEP is not up for another six months.”  “He’s such a sweetheart.”

Ethics of course.  But get it done!

Once we can do one, we can “let go.” 

We can see the larger picture of special education stigmatization.  We can accept “good enough” for his general education. 

When we can let go of one child, we can let go of many, and end up saying, “Why didn’t I do that years ago!”

Graduation Rates of SLI Pupils

Graduation Rates, by State and Race – NYTimes.com

 

The Center for Public Education has published a full report on special education statistics presenting information on performance by categories of disability. Included are graphs and data on SLI children in relation to other categories.

Special education: A better perspective (full report)

Autism	9.06	26.60	57.20
Deaf-blindness	9.22	14.18	65.25
Visual impairments	11.32	14.03	71.94
Orthopedic impairments	11.77	19.31	61.46
Hearing impairments	13.19	16.45	68.99
Traumatic brain injury	14.76	16.54	65.00
Multiple disabilities	18.71	25.64	43.82
Mental retardation	22.26	35.61	36.81
Speech or language impairments	22.60	9.26	67.45
Other health impairments	23.41	11.74	63.37
Specific learning disabilities	25.02	12.53	61.67
Total disabilities	26.20	15.37	56.55
Emotional disturbance	44.88	9.96	43.43

Role-Gap for School Speech-Language Pathology

We have taken up the topic of the changing roles of the American school speech-language pathologist.   (cf.   The “New Role” of the School Speech-Language Pathologist!)  A gap is a lacune in current thinking, a kind of unfilled space. 

The history of the school SLP has been conceptualized as “service delivery.”  It is telling to read these two words.  It suggests a kind of passive role to help others, such as “service to mankind.” 

Over the last 100 years SLPs have demonstrated the important role they have in schools, far beyond just correcting speech sounds on a pull-basis.  The U. S. Department of Education recognizes SLPs as key evaluators in the assessment, placement and dismissal of special education children.  Not all school administrators value SLP treatment as much as they do knowledge application to questions about child development and learning.

SLPs cling to “artic” and their small treatment rooms.  They complain about paperwork as though it is a distraction.  IEP meetings steal time from treatment.  Parent and teacher conferences add to workload.  They convey the impression they think direct intervention is what school practice is all about.

Perhaps the “workload problems” are simply nudging SLPs to see their changing roles and opportunities for school leadership.

School psychologists skillfully have avoided over-commitment to treatment.  They advocate for leadership and program management roles for psychologists as well the traditional evaluator roles.  They do not give learning disability lessons and see emotionally disturbed children for therapy.  They now advocate for key roles in programs like Response to Intervention.

School SLPs need to see themselves as leaders and evaluators.  It is being pushed on them.  Right or wrong, administrators believe speech therapy can be purchased at a lower cost, and it can be done by less qualified personnel.  But it is clear they cannot get along without the vast diagnostic knowledge and skills SLPs have. 

There is no leadership in the field of communication disorders and sciences for a serious change and upgrade of the role of the school speech-langauge pathologist.  Old thinking is represented in the choice to refer to “speech therapist” and “speech therapy.”

From prior posts the modern school SLP needs to be taking the lead in many areas of school development.  An example is preschool education and prevention.  But SLPs who cling to pull out and a large treatment load do not have time for role growth and leadership.  They see paperwork as a barrier rather than an opportunity to  build competence and acceptance as school leaders.

SLPs should take more responsibility for school-wide evaluation on a par with school psychology.  They can evaluate autism and learning disability cases, and make placement recommendations.  If they are true language specialists, there should be a much broader role for SLPs.  Strength in cognitive science and learning should help them lead in reading management. 

How as the field lagged so far behind the changing times?  “Speech therapy” is alive and well in American schools and holds back professional growth and development.  Public policy advocacy should tell a  new story to the American public.

Financial Incentives for Special Education Placements

Greene & Forster (2002) have reported on one “cause” of the exceptional growth of special education enrolments — financial incentives: “This report examines the effect state funding methods have on the number of students enrolled in special education. It finds that states with “bounty” funding systems provide financial incentives to schools to increase the identification of students with special needs by paying schools more for each additional student in special education. The authors find that those incentives are responsible for 62% of the increase in special education enrollment in those states over the past decade. Nationally, the report shows that this has led to roughly 390,000 children wrongly placed in special education programs at an annual cost of $2.3 billion. The authors also find that high-stakes testing, which has been suggested as an alternative culprit for the increase, has no significant effect on special education enrollment.”

Market in the 18th, Paris

This is a big picture report. How do financial decisions trickle down to school psychologists and SLPs? They maintain professional standards and bring these standards into eligibility and IEP meetings? No one tells them, “The district needs money?”

It is unclear as to the roles local school superintendents have along with school boards in signaling to special education workers that they should liberally accept children into special education. Almost certainly this is an implicit communication process. Special education directors somehow might facilitate over-placement for financial gains. No LEA educator would ever admit to being a part of a “bounty system” as Greene and Forster call it. No professional organization would advocate for increased growth of pupil placements for financial reasons. A pupil must have a disability to qualify for special education.

IDEA 2004 included provisions to address the issue of unfortunate financial incentives for placing at-rist children in special education (Alliance).

Misdiagnosis

Misdiagnosis plays a role in the over-subscription of special education children. Take the dyslexia diagnosis for example: “Although dyslexia may be the most common learning “difference” or disability, in our practice it is one of the most commonly misdiagnosed conditions that leads to school struggles” (Eide Blog, 2007).

Dyslexic children are perceived by teachers as lazy, careless and sloppy. They have misunderstood reading and writing problems. Their problems are confused with attention deficit disorder, where “… ADD or ADHD may be the only other practical alternative on a teacher’s, parent’s, or physician’s list of possibilities.” Dyslexic children have information processing problems and not attention deficits.

“Children with dyslexia may also be misdiagnosed with Aspergers, usually in the setting of sensory sensitivities, shyness or gaucheness, and late talking. Even some of the gifted traits may work against them, as clinicians or other professionals may mistake talent development for a “restricted pattern of interest.”

Children with dyslexia are also diagnosed as depression cases, or even mentally retarded.

Teachers, SLPs and school psychologists are key to the misdiagnosis of dyslexia. SLPs will pick up on the phonological processing aspects but not dysgraphia. Teachers will pick up on academic problems but not the underlying processing problems causing reading, writing and spelling difficulties. Psychologists make interpretations based on standardized test scores where processing problems are understood as confounding test scores. Learning disability is the default diagnosis.

Misdiagnosis is not always a significant problem where relevant instruction is given (e.g., spelling instruction for dyslexia). It becomes a significant problem when non-disabled children are placed in special education (e.g., limited English children).