[00:00:01] Speaker A: Welcome to Shiny through Inspiring Voices of Autism with our show host, Jennifer Dantzler. My name is Kal, starts with a C, not K, and I'm on the autism spectrum and also TikTok Spectrum. Find my place called Calion Disney Head D. Thank you for taking the time to learn more about the world of autism. If you enjoy what you hear today, don't forget to subscribe to this podcast. Hey, everyone, this is Jennifer Dantzler, and I'm the executive director and founder of Inspire nd, a nonprofit whose mission is to create truly inclusive communities through education and engagement. The goal of this podcast is to shine a light on real people and their stories in hopes of inspiring others who are on this journey of autism. Either themselves, their child, their loved one, their co worker. I truly believe ignorance is not bliss and we cannot be inclusive communities if we do not understand the people in the community.
With autism now affecting 1 in 31 people, we need to get louder about this topic. We recognize that autism is a spectrum. There are a lot of of people with a lot of different needs, a lot of resources available or none available. And we know that in every episode we can't meet everyone's needs for their specific interest.
However, we hope that in each episode you do gleam some kind of insight as to how you can help your child or yourself be a better advocate. And as we go through our podcast, our goal really is to address the entire spectrum, the various needs, the various environments that we're going to be in. And we hope that there's something in every episode for each one of you. So let's get started.
I am here today with another very, very special guest, my friend, Melanie Johnston. I've known Melanie now for 30 years. We think it's been a really long time. We've been colleagues in the field. She is, at the very least, a speech pathologist, among many other things. So we have a lot to talk about today. So, Melanie, thank you so much for being here.
[00:01:53] Speaker B: Thanks for having me.
[00:01:54] Speaker A: Okay, so as I mentioned, Melanie is a speech pathologist by trade, but she also runs a therapy center called Bright Success. Take a second to talk a little bit about Bright Success and the services that you offer.
[00:02:05] Speaker B: We have been offering a range of Services now for 28 years, primarily speech language pathology and augmentative communication is the top of the list of what we do. But we also provide services for going into schools and having someone go in and advocate for children. We do educational consultation for children with disabilities. Then we also work with young adults and transitioning students that are going into adulthood that are going to be leaving school and then adults in general that have developmental disability, the focus being on vocational placement, positive placement in day programming, so they have meaningful lives. So just through an entire lifespan, anyone with a developmental disability, we also do consulting, behavioral services, some occupational services. We have groups that we work with to make sure that all of those needs are met.
[00:02:58] Speaker A: Wonderful. So that's a lot of what I want to talk about today because I think you're the epitome of collaboration and I think often there's this misnomer that all these different services need to work in isolation or that they compete against each other.
So I want to try to pick apart a little bit today about what you do and all the things that you do offer our community. Why is speech therapy so important for people with autism and other related diagnosis?
[00:03:22] Speaker B: My personal belief since I first was in college in my undergraduate degree, is that anybody that is awake, regardless of their developmental level, regardless of ambulation, if you have the ability to be awake and aware, then you should have a voice. And that's really where it starts. It doesn't matter if autism is the diagnosis. What matters is everybody needs a voice. Even if it's an eye blink or a gaze or the movement of a finger, whatever it is, if that's the way you are trying to get someone's attention and communicate, choice, preference, you start there and you move forward. We all start there as infants. Why should we discount someone because they grew up and got bigger but didn't find a better way to communicate?
[00:04:10] Speaker A: I know one of your passions is transitioning to adulthood. And at any age, if they don't have a voice, they need to learn how to get one right. If you have a parent of a newly diagnosed child sitting here, or the parent of a 23 year old sitting here who might be nonverbal or emerging verbal, like when should someone get speech therapy?
[00:04:29] Speaker B: So there's two things. So the first one is there's no magic age for someone to become number one verbal or number two, to communicate with some form or fashion that gives them the ability to connect and have their needs met and their thoughts accepted to that fact. I've had parents who've come to me and they have an 8 year old and they'll say, well, you know, everybody's told me they, they're eight now and they're not talking so they're not going to get language. I have had individuals in their 20s who started verbalizing and talking in their 20s, so who am I to say what's the right year and the right time. So that's one thing. You know, when you think about what happens when someone leaves school and now we're gonna talk about going into adulthood. Well, if they've been in programming, whether it's in a private placement like what you have, or in public school, the people who are with that individual have goals, objectives, and criterion to meet on a regular basis. And so that individual has a skilled person who knows how to prompt them to use the language, been really reinforced and worked hard on. But when they leave, this is not the fault of a family or a parent, but they are not the trained staff. Even if we've worked really hard to do some of that parent training, and you and I both know we have children, Daily life with your own kids is not the same as someone who has them five to eight hours a day. What I've had is parents come back to me and say, she used to, he used to. They no longer. Now all they do is they're not communicating this need, they're not doing that. And they give me this long list of things they no longer do. We take a look at what they had done, what all of the data and evaluation shows, what they were doing when they left their prior placement and what's now missing. And we start there, then we start with evaluation again and we get them going. And then the justification for those who need to continue long term, because I have some, not a lot, but some who may need to continue throughout their life is what we find is we give them break. We'll wait four to six weeks, we bring them back, we collect data again, and we try to see what kind of loss there is and how long recovery takes. That's a hard thing. It's so not just frustrating, but oftentimes terrifying for a parent to see their child, adult or small, lose a skill that they had and be fearful for them that they can't communicate need.
[00:06:45] Speaker A: It's also sometimes very environmental specific. So I'm thinking about a kid who's in school has to be taught how to raise his hand to say, can I go to the bathroom? Or wait for the teacher's prompt. Well, if you're eventually on a job site or even in a day program, like, there's no raising your hand and using those words. It's how do you initiate? How do you say, I'm going? Not, can I go? And there are skills that you need later in life that you didn't need earlier in life and to not be taught. And sometimes we have to intentionally teach those skills.
[00:07:14] Speaker B: Exactly. And like you said, it's setting specific.
And so we want to make sure that, number one, they're accepted, and number two, they're valued for what they bring to the table with and without language. So we want to make sure that they can cross that line and do it successfully wherever they are.
[00:07:31] Speaker A: Well, and I know you're a speech language pathologist, right. And I think sometimes people don't understand that there's speech. Right. Which is your verbal ability, and to your point, language, which is communication in whatever form they have. And many times we don't honor those other forms of communication, especially in if they take the form of an inappropriate behavior.
[00:07:50] Speaker B: Right. I've had this comment from parents multiple times in my career, and just recently, about six weeks ago, where I had a parent say, how did you know that's what she wanted? I said, because I'm a good listener, but she doesn't talk. I went, mm, she is communicating. She's communicating at a very high level. She said, well, she's been with other therapists, and they weren't ever able to keep her in a therapy session longer than 15 minutes. And y' all have had her 45. I said, we are good listeners here. We are looking at body language. We are looking at change in the overall ability to maintain your own behavior, the level of frustration, and what kind of vocalizations might be being made. And I said, when you look at all of that, then suddenly you may see your kids actually using something like a word that you've never interpreted as a word. And we can shape that, same as with using some sort of AAC augmentative device, a voice output, or just simple board with pictures on it, Choice boards. If you look at what they're looking at, listen to the sounds they're making, and watch their overall appearance and see, oh, my gosh, are we getting frustrated? Did I miss something? And when you tune into that and you respect that and you become a good listener, then we get communication on a very different level. And so we make progress in a different way.
[00:09:09] Speaker A: Well, and that's one of the things I remember early on where when I think I watched you. We have many mutual clients over the years, over the decades, and I think one of the very first sessions I watched you, I said, now she gets it. Because I can't stand when I go watch a speech pathologist who will sit there with the child and say, johnny, what's your name? And I know Johnny's sitting there saying, you just said my name.
Why are you asking me that question? They're working on their birth date, yet they can't communicate when they need to go to the bathroom.
[00:09:36] Speaker B: Right. And I remember so well in the very beginning of my career, Ivar Lovaas saying, it's one of those things you never forget. Nobody ever got killed by flying red. But if you run a stop sign, you'll get hit.
I remember thinking, that is so powerful. Why would we teach something that was not meaningful and going to get someone what they needed? Because nobody runs in a room and says red, red.
But we do teach them to say stop.
Totally different. Yep.
[00:10:05] Speaker A: Very functional and applicable.
[00:10:07] Speaker B: Exactly, exactly.
[00:10:08] Speaker A: So you just mentioned a few minutes ago about augmentative communic.
Talk a little bit about that, what the different forms are. There are many times I'll encounter parents maybe of that seven or eight year old, and we'll talk about whether or not they need augmentative communication. And the parent will say, well, no, but he's talking.
And then I'll have a conversation, say, but he's not able to still communicate his wants and needs, which is why he might be expressing it in the form of inappropriate behavior. So talk a little bit about augmentative communication.
[00:10:35] Speaker B: And when you use it, you know, it's really important. And I think if you stop and think about it a little bit, we all have a little tendency to use some form of augmentative communication. I have one of my children, personal children, who can't talk if her hands are tied down. Right. She is using her hands to illustrate. She is augmenting everything she says by moving her hand and pointing and gesturing. And if she's not doing that, she has a very hard time getting her thoughts together to get them out. So if you start there, it makes perfect sense. The thing that I hear from parents most often is, well, if they do that, then they won't talk, which is actually the opposite of what we know in our profession. So what we know is when you ask someone to use verbal language and it is stuck in a circle in their brain, that's the best way for me to describe it. They've heard it, they know what you've said, they know what they want to say. It's circling around, they're frustrated, they can't get the message back out. The more you push them to use those words, the less likely they are to come out. But if you give them something different, a different way of producing it, it takes the pressure off, the anxiety goes down. And my experience is, over time, those who can talk, those Words just start coming out. I mean, I'll have parents come to me and say, you won't believe what he said. Yeah, I will. Because now the pressure to say it isn't there. The thoughts were there all along. They just didn't have a way to get them out. This is something people don't always understand. Sign language is a form of augmentative communication, is an alternate form. It is another way of supporting communication. And if it's someone that has normal hearing or not horribly impaired hearing, then it gives them another way of saying things. It's so interesting that I have adults that I work with now that when they get stuck on something, they'll use a sign that they learned when they were in preschool and they're in their 20s now, and they'll do this sign and then they'll say the word.
It frees up your brain when you get stuck. I mean, it's such an easy thing.
[00:12:34] Speaker A: Yeah. So it's like it's the opposite of tough love where you know, sometimes parents will say, I just, I needed to push them because I know they'll say it. But to your point, if their brain is stuck and the anxiety is high and a lot of time, this augmentative communication can help just reduce anxiety enough to get out what they want to say.
[00:12:49] Speaker B: Right. And so then I also will tell parents things like, how do you know that he wants juice? Well, he takes my hand and takes me to the refrigerator, knocks on the door, I open it up, he points to what he wants and I give him. Hmm. Seems to me like that's sort of an augmentative form of communication. Not the most functional. We want to give something that's the most functional and the most acceptable across all environments. And grabbing someone by the hand or banging on what you want or pointing and screaming is not acceptable most places outside your home. Right. So let's give them something else that works better across the board.
[00:13:22] Speaker A: Yeah. And I know, I was so grateful, honestly, when like the iPads came out, because I remember our good old fashioned augmentative devices that cost $10,000.
[00:13:29] Speaker B: Oh, yeah.
[00:13:29] Speaker A: No one knew how to program and battle who's always dead. Right. And you're.
[00:13:33] Speaker B: You had to carry him in a wagon.
[00:13:34] Speaker A: It's four year olds to carry around this device.
[00:13:37] Speaker B: Right, right.
[00:13:37] Speaker A: That no one knew how to use.
[00:13:39] Speaker B: Right. Oh, yeah. When we do an evaluation, augmentative communication evaluation in our office, we use every tool available to us. We'll use picture symbols that are on Velcro that they can take off. We'll use a static picture board where they can point if they want to. We have books they call pods where we can turn the pages and they can see if they can find multiples. But we also have 55, 0, 50 different apps that simulate different kinds of communication boards with different language, with different numbers of characters, different pictures, different symbol sets to see what's the best match for this kid. What do they understand best? Which is easiest for them to access? Do they need something that's actually a button that clicks and pushes, or can they touch a dynamic screen? I mean, there's such a range. My biggest heartbreak comes when a mom comes to me and says, I bought this iPad and I paid for this app. So now we're talking. They're over a thousand into it. He won't use it. Can you teach him to use it? And my first thing I have to say is, maybe, but I'm going to have to do an evaluation to see is what is on here. Is that the match for the way he or she understands how to communicate? It's totally different.
Totally different thing.
And so people don't realize that all of the different developers of these communication apps have used a symbol set or some sort of a language that made sense to the person they developed it for. You and I both know if you meet one person with autism, you met one person. Amen. Same thing is true when it comes to communication. And so to put something down and say, I have 10 kids that I taught how to use this, so he should use this too, doesn't mean that that's the one that's going to make sense to this individual. We had a young woman who came in. She's on Spectrum, not completely nonverbal. She was in her late 20s and she had been given a program that's about $7,000 she wouldn't use. All she wouldn't do is put videos on it and show videos over and over again of going to the nail salon and to go get her hair done. I mean, she was a real girly girl. And the mom just wanted me to teach her how to use it because it was so expensive. And I said, let's see what we can do. It was not a match for her at all. She really did not understand it. My therapist will tell you it doesn't matter what she has set up for the objective for the therapy session that day. This young lady comes in and completely directs what she wants added to her device that makes sense that she can talk about. She wants to go to Macy's. She Wants to go to Walmart. She wants to go to all these different places. The girl is into designer clothes. She wants to talk about Gucci bags. And I love it. Okay, how do you know that? That's what her mom said. How do you know that? I said, because we're good listeners. I said, you give her a chance, she's going to show you. She'll come in pointing to people's shoes. What kind of shoes do you like? Put all the different kinds out there. She'll pick, oh, well, let's put that on your device. And so when you look at it like that, my heartbreak is to know that someone spent money on something that can't be used.
[00:16:39] Speaker A: So to that point, and I don't think many of our parents know as much as they should where there are specific augmentative communication evaluations. So if they're going to public school or they're in a private program, it's more than just a speech eval. It's a specific augmentative communication eval.
[00:16:55] Speaker B: Correct. And not everyone is skilled to do that. Within my clinic, there are two of us that will do a full augmentative communication eval. My other therapists are great when it comes to doing the therapy part, but to do that feature match is a really deep dive. It turns out to be almost a 20 to 25 page report.
It has graphs, how we chose what we chose, why we chose what we chose. Part of that is because in order to get insurance to pay for the things that the individual needs, we have to be able to say, we did all of this and this is how it looks. The other thing is, it's a marathon. It is not a sprint. It may take six months before we finally get to the right one. And we have relationships with different vendors. We will contact them and say, I have a client. I need to use this, your device, for this many weeks. We sign it out, we do what we need to and see if it works. I mean, because we actually deal with individuals who are completely quadriplegically involved, who need eye gaze systems and, you know, different things like that. So, you know, we'll bring those in and we make sure that we've used the one that fits them best. Because once again, it's not one size fits all. There's more than one vendor, there's more than one language. There's all these different factors that we really have to look at to be able to make sure that in the long run, the device is not abandoned. And without good assessment, the abandonment rate is 80%.
[00:18:19] Speaker A: I can imagine. I've seen that firsthand.
[00:18:21] Speaker B: 80% in the field.
[00:18:22] Speaker A: Yeah. So the moral of that story is, before you go buy some expensive device, you need to go get a real evaluation. Is there something specific parents need to look for or ask? Meaning a speech bath might say, oh, I do that. But how do they know that they really are qualified?
[00:18:36] Speaker B: You want to know, first of all, how many patients do you see that use devices? Number two, how many different devices and languages are you trained in? We spend a lot of money on our therapists getting trained in multiple languages. And because everybody's not the same. And you know, if you have five clients, you have may have five different languages, five different devices. And so you want to be sure that you've got the ability to program, to teach, to work with the families, to on the spot, on the fly, add things that need to be added. If you're a good listener, that's important.
So that's one thing. How many different devices and languages are you trained in?
[00:19:12] Speaker A: And so by languages, you mean the different style apps, the different symbols, not languages like English versus Chinese.
[00:19:19] Speaker B: Right. And so part of that, when I say how many different languages, one of the things is the way that the symbols are set up on a device. You can see, oftentimes they're color coded. Well, the color coding actually lines up to people who have developed these systems of communication. And so one that's often referred to as like the Fitzgerald key. And the Fitzgerald key wants all of their verbs to be green and all of their nouns to be yellow. But then we have systems of language. Like the Prenty Romit company has lamp. Well, that one uses a picture where if you use a lightning bolt, that takes you to action work.
So you touch a lightning bolt, takes you to action words, then it has all these different combinations of symbols. It's faster for people who understand it. Not all of our guys get it. And you would be shocked. The ones you think won't get it might get it. I mean, people who are considered, quote, lowest functioning oftentimes get it first and fast. That's why we have to do the testing that we do. And it's called. This is really important.
Parents need to say, do you feature match?
[00:20:26] Speaker A: Okay, feature match. That's.
[00:20:28] Speaker B: Do you feature match? It's super important because I find out what the individual knows. What is it we want them to be able to do? What do they understand?
What is their receptive language and expressive language? What symbol sets do they respond best to? Do they like photographs? Do they like line Drawings, do they like colored pictures?
Are they literate? Do they know their Alphabet? Is this someone I need to be letting type all of those factors come in. I had a young man who had been working with a speech pathologist for four years on a device with pictures. He wouldn't use it. The only time he used it was to push people down to get one little thing to run out of a room. I was interviewing the parent and I said, so how does he communicate? She goes, well, when he really wants something like a Coke, he'll grab my phone, go to the notepad and type the word Coke. And I just about fell down. I said, so you're telling me he's literate? She goes, well, I don't. But I said, no, wait, you're telling me he's literate. He knows the Alphabet, he knows how to spell, he knows what he wants. So I have an assessment which the other thing is we always video our assessments with permission from parents because we go back and we analyze what we've seen. So in the video, I have one device that has pictures of colors. I have one device that has the names of different candy. And then I have another device that is a keyboard, that is voice output. And I have four kinds of candy on my table. And I said, what did you want? He reaches out and he touches green, Green, green, green. Oh, from green. So that's nice. There's green right there. Yeah, but if you want candy, is there a green candy that you want? Reaches over and he touches Mike and Ike. I went, oh, do you like Mike and Ike candy? Well, just tell me right there and I'll be dead. Gum. That boy sat down and typed out I want green Mike and Ike. I was like, holy cow.
[00:22:17] Speaker A: Love it.
[00:22:18] Speaker B: Whole sentence. We've been pushing him to use a device that was really, for lack of a better description, stupid to him. He was insulted. He did not want those line drawing pictures. He knew. He knew what he wanted and nobody listened.
[00:22:31] Speaker A: It's much more complicated than I think we initially think. And maybe that the average provider offers as a service and says, oh, we need to get the app and get Proloquo2go or whatever the stand the latest and greatest is. But it's much more complicated than that.
[00:22:45] Speaker B: To be successful and no abandonment, it's yeah, yeah, okay. And to know that this is the other thing. Every four to five years you may go to a whole new system because they may have advanced to a point that where you had them and what was working for them has held them back a Little bit. And you'll start seeing frustration. So when we do a re eval, we do another feature match just to make sure it's still the right thing.
[00:23:10] Speaker A: Right, Good point. Excellent. Because we do tend to get stuck in our ways, and that's the way we've always done it, and it worked five years ago. But, you know, think about when they're 10, then when they're 15, they're completely different children. Right. And what they need and their environments might change, you know, and all. All of that stuff. Okay. And before we move on to next topic of collaboration, I do want to mention I know personally and I want to see what your thoughts are on this. When I have a client who is working with a communication device, I will then recommend they have two different devices, one for communication and one to do all their work.
[00:23:39] Speaker B: I was thinking the very same thing, and that's a real hard concept for a lot of our families. So I say, you know, two different colors, two different styles. One needs to be locked into communication all the time. It needs to be told to all the people around, this is his voice. No one else is to take your voice away. So don't take his voice away. And play is play and work is work. And so you have one that's for play and video and games, and the other one is never, ever, ever anything but communication.
[00:24:09] Speaker A: Yep. And I remember early on, I was working with a staff member, training them, and they had taken the child's communication device away. And I said, why'd you do that? And they said, well, because he was perseverating. And I said, well, you just put masking tape over his mouth.
[00:24:21] Speaker B: Absolutely.
[00:24:21] Speaker A: And they were like, what? No, I didn't. I said, yes, you did, because that is literally their voice. And you just took their voice away. Like, if they were perseverating verbally, would you put masking tape over their mouth? No. But you essentially just did that, taking that device away.
[00:24:33] Speaker B: Right. We have to remember that verbal perseveration is a normal developmental thing.
Now, can it be taken too far? Absolutely. And can it drive us crazy? Of course. But when children first learn words, they say them over and over and over. You know, I think about my own children and my experiment with twins, and I remember driving in the car and having one of them say, thank you, you're welcome. Thank you, you're welcome. Thank you. And I was like, oh, my gosh, please stop. But they were practicing language, and they were perseverating on a single word, each one different, but over and over and Over.
[00:25:12] Speaker A: Yeah, good point. Okay, so now let's move into collaboration, because, as I mentioned in the beginning, I think often there's this misnomer that these therapies compete. And I know you and I, I think, are testament to the fact that over the years, ABA and speech and OT and pt and it's all wonderful when it's collaborative. So talk a little bit about that. And that's so important.
[00:25:32] Speaker B: One of the most important things to me is professionally, we cannot know and see everything. And that, to me is like, the number one takeaway is I know there's behavior that's interrupting and interfering with the ability to communicate. And I know that I'm focusing on specific form of communication, but I can incidentally reinforce behaviors that are trying to be extinguished because, number one, I don't know what's being used. Number two, I don't realize that what I just did was reinforcing. And so having those things happen when I'm trying to do communication, I'm basically shooting myself in the foot. The actual same thing is true. If it's a behavior setting. You aren't expecting communication at the level that I'm getting it, but you've got your behavior beautifully under control.
So when we have individuals coming to the clinic and we know that behavior is part of who they are and often how they communicate, then the first thing we do is, if they don't have a bcba, we bring a consulting BCBA in. If they do have a bcba, we ask them to come to the session, and their job is to help our therapists correctly negotiate the behavior of the individual. Where do they sit? Where do I sit? How do I direct?
Is know a word that we can or cannot use? What's a favorite toy? What's highly preferred? What's something that they find aversive? If we don't know those things, we can't move forward. And as we move through therapies, that BCBA may come two times, three times, whatever. They train us, they work, they come back in and they observe. They say, do this, don't do that. And then in a couple of weeks, as we're making speech and language progress, we ask them to either video in or come back in. What else do we need to do? How else can we change? And you know this. You and I've done it together for a long time, in and out of clinic, but the progress we make is on both sides, right? Because now you know what to expect when it comes to communication, and I know what to expect and how to respond to behavior. So it's a win win. Right.
[00:27:42] Speaker A: So if a parent is being told by any one of their therapy providers, well, we don't collaborate or no, like we stay in our own lanes. That's probably a red FL for parents.
[00:27:51] Speaker B: I think so. And if you came in to our clinic and we said, don't worry about behavior, we've got this, you should say, are you the bcba? Because my response would be, oh, no, but I have someone. And the converse is true. If they come into your clinic and they say, we want to do speech, and you go, oh, no, we've got this. Their question should be, oh, I didn't know you were a speech pathologist. We do have overlap. There are things we do really well together, but we each have our area of expertise that we have to depend on one another to get the best outcomes. Same is true with occupational therapy. I've learned so much from the OTs that I work with. So much. But I'm not an ot. I mean, I've got a little bag of tricks that I can try. I know how to do little things, but I clearly don't know how to do a therapeutic intervention. I'm okay with, but not great at determining good sensory things. Oral, motor, I got that. But there are other sensory things going on, not my wheelhouse. And that's where I want a good sensory eval. And someone who can really instruct me on this will increase that, that will decrease that, you know, those kinds of things. It becomes super important.
I just feel like there's no reason to not collaborate. Why would we want. Not want best outcome?
[00:29:02] Speaker A: Absolutely. And there are times we've definitely, quote, collided. Right. It's like, oh, you want to do it this way? And I want to do it this way. But the whole point is the collaboration and discussion. Like, well, maybe in this setting or with this stimulus, we can do it this way, and in this situation, we can do it this way.
[00:29:17] Speaker B: Right.
[00:29:17] Speaker A: But yeah, the point is, one of my favorite expressions in life is, one plus one equals three synergies from Stephen Covey and Seven Habits of Highly Effective People. And it's just, I've seen it too many times where good comes in spite of us. Yes, well said, well said. Okay, so I know during COVID a lot of our things had to move to virtual, and it hadn't really been before. And so. But I think since COVID a lot of therapies have stayed or virtual is still an option. So how do you feel about speech therapy virtually? And is there an ideal client it works for and who shouldn't do it.
[00:29:52] Speaker B: You don't know until you try. One of my most successful virtual patients is my least likely candidate in my mind. I mean, I warned the parents up front. I just don't know if this is gonna work. But we will try. He's done amazing. And he still has one virtual session a week so that both parents can actually participate. It really increased their awareness of what he needed. And he loved being engaged for whatever reason through this screen. And he's not kid that does a lot of computer anything. You just never know. I have others who I thought would do great, who won't respond or don't get what you need. So like everything, it's not one size fits all. And you have to be really aware of who can do well and who can't. It has been wonderful for us to be able to collaborate with parents so that they can see what our expectation is. However, just because a parent collaborated with us doesn't mean the student, the patient, got anything out of the session. So we would not continue a session if it was really just parent training. I mean, we might a little, but not long term.
[00:30:58] Speaker A: Well, I actually was gonna ask that about how important do you think the parent training and whether they're a part of session or understanding what it is you're doing, like how important that it's huge.
[00:31:08] Speaker B: That's one of the things that I think we've always been really different with in our clinic. If it's not distracting to the patient, we'll leave the door open and the parent can sit outside. We do that a lot because they typically don't realize there's a mom or a dad sitting there. Always bring a parent in at the end of a session. And some parents get to sit through the entire session if the student is real tolerant of them being there. And if the parent is not constantly prompting. It depends on personalities.
They have to know what to expect.
They have to be able to see, wow, look what my kid can do.
[00:31:39] Speaker A: Yeah. And that continuity of care. I always, in the world of aba, I always say to parents, if you were giving up drinking and only doing it six or eight hours a day, or if you're trying to not smoke or you're trying to lose weight and you're only dieting six hours a day, how effective would it be? So why are we trying to teach these four year olds how to verbally communicate or potty train or learn anything if we're literally only doing it six hours a day? It's just it's going to be slow if no progress at all. And that's why these parents need to get involved. And usually I'll get a little bit more of an aha moment when it's like, oh, but if I was only dieting six hours a day, I wouldn't be losing much weight.
[00:32:16] Speaker B: Right? And that goes to how many sessions a week?
[00:32:18] Speaker A: Right.
[00:32:19] Speaker B: People ask that, well, how many sessions a week do you do? Well, I don't know. It depends on the needs of the individual. I have some that come one hour a week and that's all. I have some that come two hours a week. I have some that come three 30 minute sessions a week.
What do they need for continuity, for them to be able to maintain and come back and still be able to do so that they haven't lost the skill so that we know that we're moving forward. How well are the parents working with them when they leave? How confident do they feel and are we making the progress we want to see? And so it depends, you know, patient to patient. My preference is to push to an hour for every person that I see because Nobody communicates for 15 minutes and walks away, right? So if we can be aware and listen and work with someone so that they want to communicate with us for an hour and maybe take a five minute break here and there in between. But if they want to stay with me for an hour, maybe they'll stay with someone else for an hour and talk for an hour and try to communicate and find a stranger and all of those kinds of things. It becomes really important because, you know, I always tell my therapist, you want to pair yourself as the most reinforcing thing in this room. You want them to believe that no matter what happens, you're always going to let them leave with a really good feel, like you're the best thing ever. So when they come to our building, they want to be in our building. They don't want to drive by the building, they want to be in here, they want to find us, they want to see us, right?
[00:33:43] Speaker A: Well, because you're literally giving them their voice. When being done correctly, you're giving them.
[00:33:47] Speaker B: Their voice, which is more reinforcing than anything. And that's one of the things we've found is we'll have the favorite sensory toy, the favorite food, the favorite music. We'll have all of that when they start and within six weeks. We rarely use it because they just want to hang with us.
Like they want to see. What else do you have over there? What else is going on. That's how you communicate. That's what it's all about.
[00:34:09] Speaker A: Over sessions, over the years, you'd always bring that, like, mystery bag of surprise of things. It's like, what do you want to see? What's in there? Right.
[00:34:16] Speaker B: That's how we teach the word open.
[00:34:17] Speaker A: Right. Pique their interest. Exactly. Okay, so you've mentioned a couple throughout the podcast, but what would you say are one or two major victories that have really stuck with you over the years? Like client victories.
[00:34:29] Speaker B: To have someone who has been overlooked and everything that's been done for and with them has been behavioral, directed is probably what stands out the most. We had been working, working, working lots and lots of augmented communication and really trying to get sounds out and all of that. And we were playing Barbie, and I had all the Barbies, and I put her device in front of her, and I said, well, you're gonna need to tell me what you want. And she looked me in the eye and I could understand her. And she said, I can talk. I mean, I almost lost it. I mean, yeah, you can. That's like the day she was saying, I'd rather use my voice than this device. Which is beautiful, because the truth is, you can talk a whole lot faster than you can type and touch pictures.
[00:35:12] Speaker A: Yeah. Yeah.
[00:35:13] Speaker B: That was pretty big, pretty profound. Another client that we were using the Picture Exchange communication system, traditional PECs as it's been set up to be used, which is often not, but it's still a wonderful system. And we were using it with the hope of moving him maybe to something that was more dynamic, that he could carry with him. But he had a notebook with all of his pictures, and he loved them. They had a swimming pool at their house, and he wanted to go swimming. And when I got to the session, he had gone upstairs and put a swimsuit on, and his mom said, you cannot go swimming.
You have to go right now and put your clothes on. He came over to me, he sat down beside me in his little swimsuit, opened up his folder, and he wrote the sentence, I say yes to no.
And I remember thinking, this is the smartest kid.
[00:36:01] Speaker A: Yeah.
[00:36:02] Speaker B: And then we realized he'd been reading all along, you know, and you're like, wow, his world was opening up because we found the right match.
We found the right match.
[00:36:13] Speaker A: And to your point, we've sort of touched on it throughout, But I think for a lot of our parents also, especially of our adolescents and young adults like you, always keep trying, it might not have worked when they were 5 or when they 10 or even when they were 15, you need to keep trying because it is their voice. So you're never too old for speech therapy.
[00:36:29] Speaker B: Right, right, right. How are they communicating? And what's the best avenue to replace communication that doesn't look appropriate across settings?
That's really the key.
Use your voice. What is your voice?
[00:36:42] Speaker A: Right, yes.
[00:36:43] Speaker B: Find your voice.
[00:36:44] Speaker A: Doesn't have to be just the voice.
[00:36:45] Speaker B: Find your voice.
[00:36:46] Speaker A: Yeah, really good point. Okay, and the last that I ask every one of my podcast guests, what's some advice you would give to the parent of a newly diagnosed child?
[00:36:55] Speaker B: You may find this interesting, but when I have parents come in and tell me, and there's always.
There's a lot of sadness, there's a lot of fear, there's a lot of regret, they'll say things like, I wish I'd known sooner. Have I done all the right things?
And I tell parents, and I mean it with my whole heart, you are only guilty of conception. This is your child, and you are doing everything you can to move them forward. And I am not their parent. And nobody knows your child better than you do. And you found me because you want the best for them. So if you'll work with me, we can get them where they need to be.
So put the past in the past and open up your eyes and then move forward.
[00:37:43] Speaker A: Wonderful. Wonderful. Well, Melanie, I so appreciate you being here. Where can people find you? And if they want, you know, services from you or more advice from you, where can they find you?
[00:37:53] Speaker B: Well, Bright Success is located in Kingwood. They can always email me at Melanie. M E L A N I E at Bright. B R I T E success S U C C E-S S.com all you have to do is say, heard you on podcast. If you put that in the subject line, then I'll not think that some weird person's trying to scam me. Yeah, right. So, yeah, that's probably the easiest way.
[00:38:19] Speaker A: Okay. Well, we are so grateful that you were here. You do have wonderful insight, and I think that we can't do enough to educate our families because I think sometimes there's misconceptions out there and not all of the facts. So, you know, I think if nothing else, what we got today was it's way more than just speech therapy. Right. It's about communication, lifelines to the world.
[00:38:38] Speaker B: Absolutely.
[00:38:39] Speaker A: And thank you so much for being here.
[00:38:40] Speaker B: Thanks for having me.
[00:38:41] Speaker A: If you need help or resources, whether you're a parent, someone on the spectrum, a business or a community organization who want to know more or need help or want to share resources, please reach out to
[email protected] thanks for joining us on Shining through inspiring Voices of Autism. If you enjoyed this episode, be sure to subscribe, leave a review and share with others who want to celebrate neurodiversity. Until next time, keep Shining.
