Clinical Decision-making in Speech-Language Pathology Graduate Students: Quantitative Findings

Clinicians’ decision-making skills are the foundation for the development and implementation of evidence-based practice to provide high quality clinical care. It is proposed that these skills are a result of hands-on clinical experiences (Crebbin, Beasley, & Watters, 2013). Yet some researchers contend that the development of clinical decision-making skills requires direct instruction in critical thinking (Abrami et al., 2011; Finn, 2011). The aim of this study was to explore if and when clinical decision-making processes of speech-language pathology (SLP) students change during graduate study. Web-based case simulations were used to elicit and measure clinical decision-making in eight graduate students at three stages in their training. Participants were evaluated on four clinical tasks including (a) formulation of hypothesis, (b) selection of appropriate evaluation instruments, (c) diagnosis, (d) recommendations for therapy. Quantitative analysis revealed limited changes in SLP graduate students’ clinical decision-making skills over their course of study, as a result of clinical experiences. Participants did not demonstrate change in the skill areas of forming hypotheses and selecting appropriate evaluation measures. However, they did become more accurate in identifying a correct speech-language diagnosis. This study suggests critical thinking, a necessary process for developing clinical decision-making, cannot be an assumed outcome of graduate training programs

Enriching Pre-Clinical Education with Near-Peer Learning Experiences

The purpose of this mixed methods study was to examine the outcomes of two instructional methodologies (traditional and peer-assisted learning; PAL) used in a clinical methods course for undergraduate speech-language pathology (SLP) students. The sample included 53 undergraduate SLP students (near-peer learners) as well as 27 graduate SLP students and 7 clinical fellows (near-peer tutors). Traditional instruction was used during the first half of the course and PAL was added during the second half. The undergraduate SLP students’ weekly written reflections and grades (mid-term and final) were collected for analysis. Students demonstrated a preference for peer- and near-peer learning experiences and commented positively on learning via stories throughout the course. They exhibited more positive attitudes during PAL instruction. Further, students reported less clinical confidence and more confusion as the course progressed and they learned more about the demands and expectations for clinical practice. Implications and recommendations for SLP students’ clinical training are discussed

A Practice-Based Interprofessional Emergent Writing Intervention: Impacts on Graduate Students and Preschoolers

Despite the importance of collaboration in schools, few studies have examined interprofessional education (IPE) interventions for graduate speech-language pathology (SLP) students designed to prepare them with the skills necessary to effectively work on school-based teams. The current pilot study implemented a five-week practice-based IPE intervention with six SLP graduate students and three occupational therapy (OT) graduate students. Three SLP students were randomly assigned to the ‘unpaired’ condition and delivered emergent writing activities independently to a small group of preschoolers (n = 10). The other three SLPs were each randomly assigned an OT student to collaborate with in a ‘paired’ condition and conducted the same activities together with their assigned small groups of preschoolers (n = 11). Graduate students’ emergent writing knowledge and interprofessional competencies were supported throughout the study by facilitated discussions and structured debrief sessions with their clinical educators using the DEAL model of critical reflection. Results indicated that SLP students from both conditions demonstrated positive gains in emergent writing knowledge, but the paired SLP students had a greater gain in self-reported interprofessional competencies. Preschoolers in both conditions demonstrated improvement on emergent writing tasks. Implications of practice-based IPE interventions for both graduate students and children are discussed

Prevalence of Gastrointestinal Symptoms Among Autistic Individuals, With and Without Co-Occurring Intellectual Disability

Gastrointestinal symptoms (GI) are very common among individuals on the autism spectrum. Prior research reports mixed findings regarding whether individuals with autism and co-occurring intellectual disability (ID) have elevated risk of gastrointestinal symptoms relative to individuals with autism alone. GI symptoms can be challenging to assess in individuals with autism spectrum disorder (ASD) and/or ID given challenges with language, communication, and interoception. Prior research has tended to only include individuals with documented presence or absence of GI symptoms or conditions, that is, to exclude observations in which there is uncertainty regarding presence of GI symptoms. Therefore, none of the prior autism studies reported the association between ID and the certainty regarding presence or absence of GI symptoms. The objective of this study was to examine differences in parental certainty and odds of reporting gastrointestinal signs and symptoms among children on the autism spectrum, with and without intellectual disability. Participants were 308 children (36% ID) with a clinical diagnosis of autism spectrum disorder (6-17 years). Parents endorsed whether their child had experienced or displayed a range of signs or symptoms related to GI problems in the past 3 months. Parents of autistic children with ID were less certain about the presence of more subjective symptoms, including abdominal pain, nausea, and bloating. Conversely, certainty regarding more objective signs (e.g., constipation, diarrhea, spitting up, etc.) was not significantly different. More accurate measures for GI signs/symptoms are needed for this population

Analysis of Race and Sex Bias in the Autism Diagnostic Observation Schedule (ADOS-2)

Importance: There are long-standing disparities in the prevalence of autism spectrum disorder (ASD) across race and sex. Surprisingly, few studies have examined whether these disparities arise partially out of systematic biases in the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), the reference standard measure of ASD. Objective: To examine differential item functioning (DIF) of ADOS-2 items across sex and race. Design, Setting, and Participants: This is a cross-sectional study of children who were evaluated for ASD between 2014 and 2020 at a specialty outpatient clinic located in the Mid-Atlantic region of the US. Data were analyzed from July 2021 to February 2022. Exposures: Child race (Black/African American vs White) and sex (female vs male). Main Outcomes and Measures: Item-level biases across ADOS-2 harmonized algorithm items, including social affect (SA; 10 items) and repetitive/restricted behaviors (RRBs; 4 items), were evaluated across 3 modules. Measurement bias was identified by examining DIF and differential test functioning (DTF), within a graded response, item response theory framework. Statistical significance was determined by a likelihood ratio χ2 test, and a series of metrics was used to examine the magnitude of DIF and DTF. Results: A total of 6269 children (mean [SD] age, 6.77 [3.27] years; 1619 Black/African American [25.9%], 3151 White [50.3%], and 4970 male [79.4%]), were included in this study. Overall, 16 of 140 ADOS-2 diagnostic items (11%) had a significant DIF. For race, 8 items had a significant DIF, 6 of which involved SA. No single item showed DIF consistently across all modules. Most items with DIF had greater difficulty and poorer discrimination in Black/African American children compared with White children. For sex, 5 items showed significant DIF. DIF was split across SA and RRB. However, hand mannerisms evidenced DIF across all 5 algorithms, with generally greater difficulty. The magnitude of DIF was only moderate to large for 2 items: hand mannerisms (among female children) and repetitive interests (among Black/African American children). The overall estimated effect of DIF on total DTF was not large. Conclusions and Relevance: These findings suggest that the ADOS-2 does not have widespread systematic measurement bias across race or sex. However, the findings raise some concerns around underdetection that warrant further research

Profiles and Correlates of Language and Social Communication Differences Among Young Autistic Children

Delays in early language development are characteristic of young autistic children, and one of the most recognizable first concerns that motivate parents to seek a diagnostic evaluation for their child. Although early language abilities are one of the strongest predictors of long-term outcomes, there is still much to be understood about the role of language impairment in the heterogeneous phenotypic presentation of autism. Using a personcentered, Latent Profile Analysis, we first aimed to identify distinct patterns of language and social communication ability in a clinic-based sample of 498 autistic children, ranging in age from 18 to 60 months (M = 33 mo, SD = 12 mo). Next, a multinomial logistic regression analysis was implemented to examine sociodemographic and child-based developmental differences among the identified language and social communication profiles. Three clinically meaningful profiles were identified from parent-rated and clinician-administered measures: Profile 1 (48% of the sample) “Relatively Low Language and Social Communication Abilities,” Profile 2 (34% of the sample) “Relatively Elevated Language and Social Communication Abilities,” and Profile 3 (18% of the sample) “Informant Discrepant Language and Relatively Elevated Social Communication Abilities.” Overall, young autistic children from the lowest-resource households exhibited the lowest language and social communication abilities, and the lowest non-verbal problem-solving and fine-motor skills, along with more features of attention-deficit/hyperactivity disorder and atypical auditory processing. These findings highlight the need for effective community-based implementation strategies for young autistic children from low-resource households and underrepresented communities to improve access to individualized quality care

Interprofessional Practice in Schools: A Survey of Speech-Language Pathologists

Purpose: The purpose of this survey was to examine SLPs’ engagement in interprofessional collaborative practice (IPP) in schools during assessment and treatment. Significance: Effective IPP is a necessary component of school-based practice. For example, ASHA includes working interprofessionally with classroom teachers in planning and implementing curriculum-relevant language and literacy programs as part of the roles and responsibilities for school-based SLPs (ASHA, 2010). Additionally, the Individuals with Disabilities Act (2006) requires collaboration among qualified professionals and parents when determining whether a child has a disability. While the ASHA 2017 Interprofessional Practice Survey gave a broad overview of the current state of IPP in the field of speech-language pathology, a more targeted survey was needed to address school SLPs’ practices more specifically. Although this survey provided some indications of IPP in school-based settings, it is limited in that it did not inquire about setting-specific interprofessional behaviors. Methods: A national web-based survey was distributed to school-based SLPs by email, ASHA Special Interest Groups, and SLP Facebook groups. The survey was open for the months of May and June 2017. The survey focused on the eligibility, evaluation, and treatment phases of the Special Education Individualized Education Program process. Questions were scenario-based to minimize misinterpretation of collaborative models. Specific behaviors of the interdisciplinary, multidisciplinary, and interprofessional collaboration models were provided as response choices for each scenario. Items were based on the Inteprofessional Education Collaborative’s four core competencies of roles and responsibilities, teams and teamwork, values and ethics, and inteprofessional communication. Results: A total of 550 school-based SLPs from 48 states completed the survey. Only 44% of respondents said they have received training on how to work on teams with other professionals in a school setting. More interprofessional collaboration behaviors were reported during the eligibility and assessment processes than during treatment. SLPs reported collaborating with many of the same education professionals during the assessment and treatment processes including occupational therapists, special education teachers, and classroom teachers. Time constraints were cited as the biggest barrier to participation on teams, followed by resistance from professionals of other disciplines. A majority (51%) said a smaller caseload would increase their engagement on teams. In addition, 99.5% said they would participate in collaborative training, with 48% preferring it to be done during school district-sponsored training events. Conclusions: While ASHA emphasizes the importance of engagement of SLPs in IPP, less than half of school-based SLPs surveyed said they have received training on how to work on teams with other professionals in school settings. Currently, more IPP is taking place during the eligibility and assessment processes than treatment

The effects of an interprofessional emergent writing intervention for preschoolers

This pre-post design study explored the effects of an emergent writing interprofessional education (IPE) experience for preprofessional speech-language pathology (SLPs) and occupational therapy (OT) students. Six preprofessional SLP students and three preprofessional OT students participated in the study, which had two conditions: (a) unpaired SLPs, and (b) SLP and OT pairs. The preprofessional students delivered 8-10 emergent writing interventions to preschoolers in small groups. The preprofessional students’ learning about emergent writing concepts and interprofessional collaborative practice (IPP) was supported through structured debriefs with their clinical supervisors after each session, as well as facilitated discussions to discuss supplemental readings and their preschoolers’ progress. Self-report measures of IPP competencies using the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) showed more gains in the paired condition than the unpaired condition. The participants in the paired condition also demonstrated more understanding of the Interprofessional Education Collaborative’s (IPEC) Core Competencies during post-interviews. Further, eight of the nine participants increased in knowledge of emergent writing concepts over the course of the study. Additionally, the preschoolers in the paired condition made statistically significant gains in two of the three emergent writing tasks: Write Name, Write CVC Words. In conclusion, IPE experiences with a variety of education professional students are needed early and often in preprofessional training programs to prepare them for working on teams in schools

Enriching Pre-Clinical Education With Near-Peer Learning Experiences

The purpose of this mixed methods study was to examine the outcomes of two instructional methodologies (traditional and peer-assisted learning; PAL) used in a clinical methods course for undergraduate speech-language pathology (SLP) students. The sample included 53 undergraduate SLP students (near-peer learners) as well as 27 graduate SLP students and 7 clinical fellows (near-peer tutors). Traditional instruction was used during the first half of the course and PAL was added during the second half. The undergraduate SLP students’ weekly written reflections and grades (mid-term and final) were collected for analysis. Students demonstrated a preference for peer- and near-peer learning experiences and commented positively on learning via stories throughout the course. They exhibited more positive attitudes during PAL instruction. Further, students reported less clinical confidence and more confusion as the course progressed and they learned more about the demands and expectations for clinical practice. Implications and recommendations for SLP students’ clinical training are discussed

Accessing Research Beyond the Paywall

How can clinicians incorporate the latest research evidence in their practices if they can’t access research articles? The reality is that clinicians’ ability to access the latest research is a key factor in bridging the research-to-practice gap. Consider the sizable, 17-year lag between publication of research findings and actual application of those findings in clinical practice. One likely contributor to this lag is new clinicians’ loss of free, easy access to research articles when they leave graduate school. However, while paying per article is one way of accessing journal articles, there are several other free and legal ways to obtain them. Here we share several resources and tips to help you access published research