As a new SLP, I must have asked the question “why” a thousand times. My clinical fellowship year, a requirement for all beginning SLPs, I felt as if I couldn’t learn information fast enough. I was constantly trying to understand the big picture, what was at the root of what I was seeing with my clients. Why certain type of therapies worked, why I was suppose to use one method over another, why my supervisors preferred particular goals, why did some kids never seem to make progress. Sometimes the answers I heard or used or researched made sense, but other times I was left with more questions. My list of ‘why’ kept growing, especially with certain clients where I felt that I was missing something critical. Even if I was doing the “right” things, it still felt I had too many questions, I was treating the surface of the issue but I still couldn’t see the roots.
Why is also one of the hardest questions I am asked as an SLP. Why isn’t my child speaking in sentences? Why do they get so upset at bedtime even though we do the same thing every night? Why won’t my child follow directions? Why won’t my teenager do something as simple as clean their room when I know that they can do much more complicated tasks? Why is this so hard?
These questions are the key. So often we talk about the what, in reports by SLPs or doctors or parent teacher conferences. Parents hear about the what or the symptoms we are seeing - your child can’t focus, your child doesn’t complete tasks, your child talks too much, your child isn’t talking, your child won’t listen. And sometimes it’s followed by some really well intentioned but ineffective advice. Not because anyone is trying to make things harder, but because so many of us are taught to look at the surface. We are told that it’s impossible to see the roots.
When I first joined the seeds of learning community in the summer of 2021, I wasn’t sure what to expect. I had been trying to learn more about executive functions (EF) for a while, but so much of the literature in my field wasn’t written as it related to kids. There was information about EF skills for adults recovering from stroke or TBI patients, but there was limited information on how to assess and teach executive functions to children with developmental disorders. I had a solid foundation in language learning and acquisition, but I still felt I was missing pieces of knowledge. I was holding these chards of information that I knew made a picture but I didn’t have a way to glue them together.
Over the two years I’ve finally be able to start gluing. Learning to see not only see the ‘what’ but getting better and better about seeing the ‘why’.
When children are struggling with increasing their expressive language, I can make them repeat me until I’m blue in the face. But if the child doesn’t have a picture in their mind, an anchor to hold information, then they will continue struggling to build their language skills. Nonverbal working memory, referred to by neuropsychologists as the visuospatial sketchpad or simply what most of us refer to as our imagination, often needs direct explicit teaching. If a child is struggling to acquire language at the same rate as their peers, there can be a variety of reasons but a solid imagination is at the root of so many other skills. This ability to make pictures from the words we see and hear can be taught and strengthened. However, many SLPs, myself included, aren’t taught to target this directly. Or to break up working memory into verbal and non-verbal. Or to teach kids not just what to say, but how to make pictures in their heads to anchor information.
When a child is running around the room touching everything, approaching it from a pure discipline stance of “don’t do that or else” won’t stop them from running around. Though it may stop my ability to build rapport with a child if I’m only telling them what they can’t do. Often a child like that is struggling with inhibition, attention and self awareness. This one behavior can be caused by several different foundational executive function skills. Which means we have to work to build up their awareness, ability to self monitor and ability to pause and inhibit. We also have to tell them what they can do, give them a plan for when they are disregulated in their body while building up their other EF skills. As I’ve learned about how to treat executive functions through the seeds of learning community, as well as other educators/researchers in the field of executive functions and ADHD, having set plans in place allows a child to know what to expect. The plans have to be explicit, practiced, and then reviewed to be effective. Simply telling a child “don’t run” doesn’t give them a way to change their pattern.
When a child with ADHD has a brain that is neurodivergent, their strengths and weaknesses may not look the same as many of their peers. Children with ADHD do not have a lack of attention, but an abundance of it. ADHD is an issue with attention regulation and so many EF skills are going to be effected with a brain that is always on the move. So it’s not about figuring out how they can fit into the “normal” box society has made for children, but how to help them build their own box. A box that is unique to them, a box that isn’t built around them, but instead built with their strengths in mind.
I started Bloom because targeting speech and language from an executive function cognitive framework is still challenging for SLPs. Insurance companies and school districts may not always approve of the goals or therapy, because they have guidelines about what SLPs can and cannot treat, often based on outdated research or misinformed beliefs of our scope of practice. I wanted to be able to treat anyone who might benefit from executive function services, not only those who scored a certain standard deviation below what we consider “normal”. I’ve seen so many students not qualify for services in the schools, because they scored well on one standardized test, but they still struggled to learn in an environment designed for neurotypical peers.
I also want to be able to work with schools and school districts on how all classrooms can be better designed for different types of learners. Some of my favorite jobs have been in the schools, I love collaborating with other professionals, especially teachers, OTs, PTs and psychologists. There is so much I didn’t know about the brain and executive functions before a few years ago, so I understand most of us are doing our best with the information we have. My goal is not to make anyone feel they are doing something wrong, but to use the knowledge I’ve learned (and am still learning) on how we can better support all of our learners. How we can help all kids love to learn.
I have always loved helping people figure out how amazing they are. My favorite part of therapy is when I see my students or clients start to feel confidant, feel smart, to believe in themselves as much as I believe in them. I want to bloom all the wild brains out there. To meet each kid (or adult) where they are, help them where they are struggling while showing them all the gifts that can come when your brain is different. That all brains are beautiful.
I still have questions. My list of whys has changed, has evolved as I have, but I still don’t have all the answers. Which doesn’t feel as overwhelming as it once did. I know that the only way I could have all the answers is if I decided to stop learning. Which isn’t who I am. It’s also one of the reasons I named my practice Bloom Wildflowers Therapy. To bloom is not something that happens once, it happens over and over. It requires support, attention, encouragement and belief. Belief that something will thrive, even if you can’t see it yet. But you know, you believe, that there is so much beauty, just waiting for someone to help it grow.
Photos curtsy of Pexels and my own photos
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