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All About Speech Therapy – Episode 19

Welcome back to the All About Audiology podcast. I’m your host Dr. Lilach Saperstein and on this week’s episode today we are going to be discussing speech therapy and how audiologists and speech therapists work together. if you are a student of audiology or speech pathology, welcome to the podcast. We have a lot of exciting tips in here for you.

Before we jump into my interview with today’s guest, I want to tell you about something I’ve been working on for YOU. Something that I think is going to help a lot of parents of children with hearing loss, who are overwhelmed. Wherever you are along the process, I hear from so many of you that sometimes you just don’t know what to do next, or which professionals you should be talking to, or which appointments you should be making next, or how to keep organized all the different things that you have to do and all the things that come with having a child with hearing loss.

So whether you have just gotten a diagnosis and you’re in that state, where there is so much to do, it can be hard to know what to do first or what to do next, so this is the guide for you. It’s a five step guide to navigating your child’s hearing loss, it’s a PDF and you can download it for free at allaboutaudiology.com/guide. All you have to do is put in your email address and the guide will be sent straight to you. You’ll also be added to the mailing list to get updates about the podcast, but if you want, you can unsubscribe and that’s totally fine if you just want to get the guide.

It’s something that I’ve seen so many parents go through the process of getting a diagnosis and then years in still dealing with so many questions. Being pulled in so many different directions and being able to define what are the questions that you have. So I created the guide because I really wanted to help as many parents as possible. So if you can use that, head over to allaboutaudiology.com/guide. The link will also be in the show notes of this episode. And if you know someone who can benefit from it, please send it to them. Please help to spread the word. In my experience as an educational audiologist, working with many patients and many parents, I’ve seen that getting clear on what you know and what you don’t know yet or what you want to know or need to know, getting the distinction between what is known and what is unknown, helps you know what to do next.

Now we are going to jump in to the episode with a very interesting guest whose name is MariLouise Nichols. She’s a speech language pathologist who graduated from Purdue University and she works in adult in-patient rehab and acute care in Texas. We had a really interesting conversation that you are about to hear all about various areas that SLPs can be involved in, not just lisps or any kind of articulation disorder that you might be thinking about. So I wanted to spotlight my colleagues and talk more about the importance of speech pathology. So let’s just jump right into that interview. I remind you that I am always looking forward to your comments, questions and I can be reached at allaboutaudiology.com and on Instagram @allaboutaudiology podcast. I check all of my DMs. So I can’t wait to hear what you think of this interview. Let’s get it started!

Welcome back to the all about audiology podcast. Today I have a very special guest with us. MariLouise Nichols who is a speech language pathologist, or as some people call them, “miracle workers” who do lots and lots of amazing things. So I’m going to let MariLouise introduce herself and tell us about yourself.

ML: “So I’m relatively early in my career. I graduated from Purdue University in 2015 with my Masters in Speech and Language Pathology. And since graduation, I fell in love with the medical side of speech pathology and working with adults. So I’ve been working in in-patient rehab and acute care all over the country. I’ve worked at several hospitals. Currently I’m in Houston, Texas in a Texas Medical Center working in adult acute care and I absolutely love it so I’m so happy to be here and be able to share a little bit about what I do and what makes our profession so special.”

LS: “That’s amazing. Now tell me about adults. Was that something you were always interested in, working with adults?”

ML: “No, it’s actually a funny story. When I was in college, I did an Americore program. It was a two year service commitment where I worked in early education, early literacy programs for preschoolers in the greater Atlanta area, and I absolutely loved it. And I thought that I wanted to work with children because I was working with so many children who had speech and language needs. And that’s what initially got me into speech and language pathology. And then I got to grad school and I just fell in love with the adult side. I had a couple adult patients and a couple of medical placements and I knew that that’s what I wanted to do and I’ve just been focused on it ever since.”

LS: “One of the reasons I really was excited about having you on was because there’s this huge misconception that speech language pathologists are the speech teacher that helps if you have a lisp, or a stutter and that’s what a speech therapist is. And that’s the whole scope of what speech therapists are, which is such a disservice to this incredible profession and how wide the breadth is of what you do. So tell our listeners a little more about what speech pathologists can do, what kind of studies you go through, just to get a sense of the rigor of the profession.”

ML: “Absolutely. So I always have this joke whenever I tell people that I’m a speech language pathologist, the first thing they always say is, ‘are you correcting my grammar right now or are you correcting my articulation?’ And I’m like ‘No, I don’t do any of that. I’m actually doing the opposite. I’m not paying attention to that at all.’ So what I do on the medical side is I work with adults who have a wide range of diagnoses from strokes to traumatic brain injuries to neuro-degenerative disorders, from head and neck cancer, trauma, car accidents, gun shot wounds. You name it and there is a connection for speech therapy.

Mostly what I’m doing, I’d say about 80% of my job is swallowing. While we work on communication, we also work on, a large part of our job on the adult side, on the medical side, is swallowing. You think about after you have a stroke, just like your arms and legs might be weak, the muscles you work for swallowing can be weak so these people often have a hard time returning to oral intake and eating and drinking orally after a stroke or any other type of neuro deficit. So that’s mainly who I’m working with in the hospital. We also do your typical speech and language and we do a lot of cognition as well. A lot of it is cognition, orientation, reasoning, problem solving. Those all fall under our scope of practices. So that is not well-known but we do so much and I think my colleagues are just amazing when I look at all the things that we do in a day. So we’re kind of like the Jack of all trades.

So going back to your question about education and how do you get here… I actually took a non-traditional route to get here, to become a speech pathologist. Typically, you would do four years as an undergraduate and they have lots of speech pathology programs for undergraduates. And then after you are finished with your undergraduate studies, then you would go and do your graduate studies, which is your masters, typically a two year program in speech language pathology. In my case, my undergraduate studies were in psychology. I took a non-traditional route so I got my bachelors in psychology and then I went to Purdue which was a fabulous option for me because they have such a great three-year prerequisite program so instead of doing the traditional two-year masters program, I did a three year masters program and I was able to get my degree in three years and get all of the prerequisites that I needed.

Once you finish your masters, then you do your clinical fellowship, which is typically a nine month fellowship. It’s basically that you’re working and you are under close supervision under another speech language pathologist and you do that for nine months. And then after nine months, you get your “Cs”, the big Cs, also known as your Certificate of Clinical Competence. So you get your Cs, (CCC) and then you are able to become a licensed and full speech and language pathologist. So it’s a long road but totally worth it.”

LS: “So I have a question about the Cs. If you finish your masters degree after two years of graduate studies and you have a masters in speech language pathology, you actually can’t practice unless you have the Cs or is that a misconception as well?”

ML: “That is a misconception. So you actually can practice without your Cs, however more and more employers are wanting you to have them. I think it creates a continuity across requirements. The American Speech Language and Hearing Association (ASHA), that’s our professional organization and that is the organization that gives us our Cs have strict requirements in order to be qualified for your Cs so most employers are looking for everyone to have them, especially in the medical side. I don’t think that there is a medical position that will take you without your Cs, at least not very many. So the Cs are becoming more and more sought after, so if you are looking into going into this field, I would definitely recommend getting your Cs. It’s really not hard, there are some certain continuing education requirements that you have to do. And of course there is a membership fee but I would encourage everyone to keep your Cs because, yes you can work without them but they are so important as far as opening up a plethora of job opportunities for you.”

LS: “So the extra nine month placement is in order to get the Cs but you are already licensed to practice? Or maybe it varies state to state, I don’t know?”

ML: “It does. It does vary state to state. What I do believe what’s happening is a lot of state licensure is starting to overlap with the Cs licensure. So it’s almost worth it to go ahead and get your Cs because pretty much what you have to do to get your state licensure you have to do to get your Cs. So for example, you mentioned doing the nine month clinical fellowship. Yes, that is a requirement of ASHA (The American Speech Language and Hearing Association) to get your Cs but I believe a lot of states are moving towards doing something similar. They’ll call it a limited license where you have to have it for nine months before you’re able to apply for your full license.”

LS: “I see. So with audiology, it’s different and I’ll just tell our listeners a little bit about that. It’s a four year degree, and it’s a doctoral degree now, which it wasn’t like that in the past. It’s three years of intense graduate studies and then one full year, a 12 month placement of a residency and so during that residency year, that’s where you get a job, not all paid. So many of them are either not paid at all or minimum wage, or some sort of stipend. And during that time that’s when you get all the hours that you need in order to get licensed. So it’s a little bit more of an intense and lengthy process to be an audiologist. But the great thing about speech pathologists and audiologists is that we overlap so much with our case load and with what we do and what we work on. I think the collaboration is one of my favorite parts of what I do and why I have so many great friends and colleagues who are SLPs. Big fan! (laughing).”

ML: “Well thank you!”

LS: “Also a lot of people who are students that are listening who are maybe an undergrad and undecided which way to go. Which branch, should I go with the SLP branch or the AUD branch??? I’d love if you wanted to give advice to some of the students who are looking at that decision.”

ML: “That’s a hard one because I think it’s kind of a decision based on what you like to do. I know in my case going into graduate school I obviously knew I wanted to do speech and language pathology but I took a lot of audiology courses when I first got started and I think that most undergrad programs will require you to take those speech and language pathology courses as well as audiology courses. So that’s really a great time to decide which one you would prefer. I know I took a few audiology courses and I just didn’t feel like it was for me, while it was very interesting. And I know audiology is also a field where you can go in many different directions but I really liked the speech and language and cognition portion of our field. And being able to take more of a creative side and express more of my creativity. Going into speech and language pathology, I found that audiology was very number heavy, haha…Numbers are not my strong suit and I think that’s kind of what made the decision for me. I’m more of a creative, artsy person so I felt like I was able to express that a little bit more in speech and language pathology. BUT, that’s not to say that you have to be a number person to go into audiology because I really enjoyed my audiology courses and I definitely saw where you could potentially have a creative outlet in that field as well. I think it’s just something you have to decide after taking the prerequisite courses.”

LS: “That’s very good advice. I get lots of DMs about this actually on Instagram, which is so fun, I love connecting with you guys. And one of the things I add to all of the students that ask me, I offer to people that they should do some shadowing and connect with some audiologists in the community and speech pathologists in the community and say, ‘Can I just hang around for a couple of days?’ In the summer, on break, on Friday or whatever day you have off, to just go and be active in the investigation of knowledge, and see which one is for me. And of course you’re not going to get all the data you need from just a couple hours of shadowing but that was very meaningful for me, because not only did I spend many hours in an audiology clinic when I was an undergrad, I think probably over the whole semester, I did every Friday. So it must have been 15 sessions or something like that, a bunch of times that I went. I got to see what they do, what the diagnostics are like, I got to be familiar with the different testing and say, ‘Hey this is fun.’ I liked the way that one minute they are playing with the kid, trying to get the kid to throw blocks into the bucket for their hearing assessment and the next minute they are teaching someone how to use a hearing aid and explaining all of the different things.

I was like, ‘I like this.’ There’s different variety throughout the day so not only did I get that experience, I also made these incredible connections with all these professionals. You know, every time you come in, you are respectful and helpful and you make an impression on people and that’s going to come around to you when it’s time to ask for recommendation letters or placements. So it’s never a bad thing to put yourself out there, even if you are not up to those stages just to make those connections and to get a sense of what goes on. So the downside to that is of course, like what we are saying, you can’t know if you are just being biased, like if you are going to shadow a school SLP, maybe you didn’t even know swallowing was in the whole story. You still have to be knowledgeable and aware and that’s where the courses come in and ask everyone you know, that’s another piece of advice, ask everyone you know and DM random people on Instagram. (laughing) Get a lot of advice!”

ML: “Yes, absolutely. Don’t be afraid to reach out. I reached out to so many people on my journey to becoming a speech and language pathologist especially because I decided as an undergrad that I wanted to become a speech and language pathologist but we did not have a speech and language pathology program. So I felt like I was kind of navigating blindly in my junior and senior year of college, when I was applying to graduate school and I was trying to decide where I wanted to go. I had no idea that all of this was available to me and so I reached out to speech pathologists in the schools, in private practices and I asked if I can please just shadow you and talk to you about what you do. Everyone was so helpful and so willing to talk to me. So that’s the number one thing, just reaching out to people and letting them know that you’re interested. We are all happy to help!”

LS: “Especially if you are deciding for not only SLP or AUD, but SLP at all or any other profession, that’s just good career advice in general. And also that you don’t have to know for sure. I know many people who started a graduate program and after one semester or one year, decided it was just not for them and that’s okay.”

ML: “Yeah, absolutely.”

LS: “So another thing I wanted to ask you about was some of the common misconceptions is that there is about SLPs besides for you only deal with lisps and stutters, but is there anything else that really bugs you when you hear about it? You say, no listen to me…Let’s hear if you have one of those.” (laughing)

ML: “Sure. I think on the medical side, we are often known as the “diet police” and all we do is change people’s diet, and make them NPO, which in hospital language means nothing by mouth, so we’ve kind of gotten a bad rap in the hospital that we just take away people’s food and put them on puree diets and that’s absolutely not what we want to do or what we do at all. We do so much more. So what we try to do is we try to get our patients on the least restrictive diet and so oftentimes that means using compensatory strategies, it might mean making diet modifications. But our diet modifications are typically the last thing that we want to do. So if we can do exercises or compensatory strategies, if we can do education, by all means we want to do that. And like I tell my patients, none of this is permanent. This is only temporary for now. So even if we do have to make a patient NPO or change their diet, our goal is always for it to only be temporary. So it really bugs me when people say, ‘here comes the diet police. Or speech is going to make them NPO or going to take their food away.’ That is not what we want to do. We are all about finding solutions and improving quality of life and we are all about just making eating and drinking as comfortable as we can and reducing the clinical risks and improving the patient’s health as much as possible. So yes, that is one thing that really bugs me. Thank you for letting me share that.” (laughing)

LS: “So to understand, you’re saying, maybe someone is eating like mixed fruit, what are those called, those little fruit cups and it’s a danger that they might choke or that they might gag because their swallowing muscles are not strong enough. So you come in and say “eat purees” and everyone is like, come on, let them have the fruit cup. And you’re like “I don’t want them to choke.”

ML: “Right and that’s a perfect example. And I think a lot of people say that we come in and give them a puree diet, ABSOLUTELY NOT! What I would do is talk to the patient and talk to the family and I would talk to the caregivers and I would ask them, what is it that you want out of life. Is it that you are 85 years old and all you want is a fruit cup, so let’s figure out a way to get you your fruit cup. Let’s do some instrumental assessments, let’s get some imaging of your swallow and let’s see what could be the safest way for you to eat this fruit cup. If this is something that you really want, let’s try to make it happen. Let’s not take things away. I think that’s a misconception, that we’re often taking things away and when in actuality, we are trying to work with the patient and improve their quality of life. Absolutely, we don’t want you choking on a fruit cup, that’s not going to improve your quality of life. So if it means taking away the fruit cup temporarily so that you aren’t choking on it, while your muscles are still a little bit weak, then let’s lay off the fruit cup for a little bit and we can focus on some other things and we’ll have you be able to swallow and hopefully be able to come back to the fruit cup.”

LS: “And in the meantime you’re strengthening and doing exercises to get them to the place where they could return to the fruit cup.” (both laughing)

ML: “Yes, return to the fruit cup.”

LS: “That’s just what occurred to me about hospital food. I’m sorry!” (both laughing)

ML: “Yes, fruit cups are very tricky!”

LS: “Gotchya. Who thinks about speech pathologist and then thinks about swallowing? I’m so glad you’re here. What other kinds of areas of SLP are overlooked or aren’t given enough attention?”

ML: “So aside from swallowing, I think that cognition is a big one. That we don’t talk about enough. Most people think that we are just doing speech and language, and to be honest when I graduated from graduate school, I was kind of taken aback by how much cognition we do because I feel when I was in graduate school I was prepared for so much speech and language and the reality is that we don’t see a ton of speech and language, we see a lot of cognition. So again that cognition is your attention, your orientation, your reasoning, problem solving, organization, thought formulation. We are looking at how those things intersect with speech and language. And they intersect quite a bit and overlap quite a bit. So that’s a lot of what we do, is cognition as well. I think that often gets overlooked in our field. Another thing that gets overlooked is some of the less common specialties of speech pathology. So for example, accent modification, that is something that we do in our field. We work with voice specialists, we work with singers, people that have voice disorders, we work in conjunction with ENT (ear, nose and throat) physicians. A lot of these things are overlooked. Even speech pathologists who work closely with audiologists, the oral rehab portion of our field, I think that often gets overlooked and how closely we do work with audiology. So I think people think you are either in the hospital or you are in the schools but there is so much more that we do.”

LS: “I’m glad you mentioned oral rehab. Would you mind giving us a definition and overview of what that is for our listeners? Because most of the people that are listening will have some experience with children with hearing loss or just a connection to this specific field.”

ML: “Yes. So I have to be honest, I don’t know a whole lot about oral rehab because that’s not what I do on a daily basis, but I do know that when children have hearing loss, oftentimes it can result in delayed speech and language. So once the hearing loss is address, oftentimes the speech pathologist will work with these children, and adults as well, to work on their speech and language. A big thing that I know is that people who are getting cochlear implants, oftentimes, we will work with them on their speech and language. For adults who are trying to rehabilitate their speech and language after a hearing loss, we will work with them. And I have seen some adults who have gotten hearing loss later on in life and have gotten cochlear implants and I have worked with them on their speech and language, which is very interesting. I haven’t done it often but it’s very interesting. And also our children who are getting cochlear implants or hearing aids, and we’re working with them on their speech and language after they have gotten an intervention from an audiologist.”

LS: “And that connection is very important that interdisciplinary model working together and it’s one of my favorite parts working as an educational audiologist. I was an educational audiologist in a school and there was one of me, and about 12 speech pathologists. Because the nitty gritty, the day to day work, of doing the practicing and discrimination. So all the actual tasks and drills that the children needed to do, practicing and getting it right day to day, I was there to make sure all their equipment was functioning and to be part of a team. But I had so much respect for the patience, the creativity that the speech pathologists had to bring for that day to day. And that’s where they were being called the speech teacher. I get there’s mixed reviews on the speech teacher. On one hand, you actually are a specialist, you have a masters degree in this field, a lot of training, so not to bring down teachers either, but you would like to be known as a speech language pathologist. On the other hand some people are just more chilled and get that it’s just the school culture and environment.”

ML: “Of course, yeah.”

LS: “What do they call you at the hospital?”

ML: “They call us speech therapists at the hospital. So our name tags say SLP (speech language pathologists) but oftentimes, we’re just called speech therapists which is kind of a hot topic now because we are not technically just therapists, we are pathologists, we are doing the diagnosing as well. So we are doing the evaluation and the diagnosing which is different from your occupational therapist or your speech therapist. So we are actually in a very unique field where we are not just treating, we are also diagnosing. For example, we are diagnosing different types of aphasias, we are diagnosing different types of dysphagias, or swallowing disorders. We use the instrumental assessments such as the modified barium swallow study or the “FEES”, the Fiber-optic Endoscopic Evaluation of Swallowing. We are using those, we are making diagnoses from our evaluations which is unique to this field. No other therapy, at least rehab therapy field is doing this. So that’s why it’s kind of a big deal. Are we speech therapists or are we really speech language pathologists?”

LS: “So when you are speaking, you are referring to the therapist word, and I think from our conversation you would even have an issue with only speech language, maybe it’s speech language cognition pathologists…”

ML: “Right. Or speech language swallowing pathologists. That’s also a hot topic.”

LS: “Right so at a certain point we are onto semantics already but I definitely feel it.

One of the big controversial issues among audiologists and speech language pathologists is this key about oral rehab, that oral rehab can be billed by an SLP. If an SLP provides a service, it’s billable, but if an audiologist provides a service, it isn’t. So it needs to come out of pocket, I mean most audiologists are not providing oral rehab and if they are, they are charging for it. And that just seems like one of those things that just doesn’t really make sense because we are trained in it and it’s our specialty and it’s in our field but we can’t bill for it. So at least in the United States that is a big issue. And why we have to have such close relationships (with SLPs).”

ML: “Absolutely.”

LS: “MariLouise, would you tell us a little bit about the breakdown in terms of special populations that SLPs work with? We spoke about children with hearing loss, patients that have neurological events, what kind of other groups are there?”

ML: “So that’s what I love about my job, we deal with all types of people. So as far as special populations are concerned, we are working with people who have hearing loss, hearing deficits, we are working with people who are non-English speaking or second language learners. We are working with people who have intellectual disabilities, we are working with people of all different socio-economic statuses, all different education levels. You name it, a hospital doesn’t discriminate. And that’s what I love, you will see everyone in a hospital. You will see the CEO of a building or an organization, you’ll see your teacher or the butcher, every occupation, every socio-economic status. Everyone is in the hospital so we see all different types of populations. In regards to diagnoses, like you said, we see our neuro patients so that would be any types of strokes, brain tumors, aneurysms, seizures. We see our trauma patients, which are traumatic brain injuries, falls, car accidents, gun shot wounds, we see head and neck cancer patients, so that is throat cancer, tongue cancer, laryngeal cancer, all of those patients will fall into that category. We’re also seeing a lot of heart and vascular patients. So when you think about our anatomy, and the nerves that run through our body and around our hearts, a lot of our patients who are getting open heart surgeries, these sternomities, they are having swallowing issues afterwards. Our patients who are just general medicine, sometimes you see patients who come in and are just a little bit confused, a little bit tired, things are off metabolically, and we are seeing swallowing issues with them. Even if it’s just temporary and it’s affecting their stay in the hospital, these swallowing issues are putting their health at risk. You name it, we are all over the hospital, we are seeing all types of people, all populations.”

LS: “That’s so fascinating what these professions do. When you come in and say I want to be in a helping profession and you look at all the choices you have, lots of us, OTs (occupational therapists), PTs (physical therapists), we are all kind of on the same team, getting people either to catch up developmentally or help them function in whatever stage they are in life, from newborn babies, kids at school, adults, elderly, it’s one of those fun things. And then whatever profession you pick, you can then go into different age groups, different population fields.”

ML: “Right, it’s a big choice to make.”

LS: “It’s really nice that you can also make a pivot at any point in time.”

ML: “Absolutely.”

LS: “If something isn’t working for you, then you can move on to another clinic or placement.”

ML: “Yes, absolutely.”

LS: “It’s so interesting. I have one question, something that’s occurring to me. When you talk about orientation, you mean knowing what day of the week it is, where you are, who you are, those kinds of things…?”

ML: “Yes. Those are basic orientation questions. Often times we will ask even more in depth orientation questions so basically it may be about holidays, or birthdays. Often times we’ll incorporate long term memory. I love to do that, reminiscing with my patients. “Tell me about what you do on Christmas, when is Christmas. It’s on Dec. 25, tell me about what you do with your family on Christmas. What kind of foods do you eat?” It gets the patient reminiscing so not only are we working on orientation but we are also working on long term memory and the two kind of go hand in hand. Again, remember we are talking about how these cognitive deficits intersect with our language deficits and our speech deficits. Sometimes it’s a great task just to get some language going and using those language skills as well. For our more higher level patients, we might use orientation as far as using a map, or finding their way around a building. I’ve had patients who come and see me, and every week they get lost and they forget where they parked their car and we have to get security to help them find their car. That’s a cognition deficit, orientation deficit, memory deficit and these are the same people who will roam around for hours without asking for help so now we are talking about a problem-solving deficit. So we are able to work with these patients on those higher level orientation tasks as well.”

LS: “That’s what I mean. Who would think that those are issues that fall under your scope? You would have to know about what a speech therapist does. Do you intersection with psychology team as well?”

ML: “Absolutely. And if you are lucky you’ll get a great psychologist or a neuro psychologist in your building. When I worked in in-patient rehab, we had a wonderful neuro-psychologist who would help us. She would assess our patients and we would often co-operate on what would be the best treatment or the best resources to send our patients home. I think neuro psychologists and psychologists are great especially for children who are trying to go back to school maybe after a car accident or something like that and have a brain injury. Working with a neuro psychologist is very helpful and being that liaison with a guidance counselor or something like that to get them the accommodations they need when they get back to school. So yes we work very closely with psychologists. And from a medical side, it’s often a neuro psychologist.”

LS: “I think it’s very fair to say that I’m very impressed (hahaha)”

ML: “Thank you!”

LS: “And I feel, as much as I’m familiar with the field, there is still so much that you are teaching me right now that I’m so happy to be learning.”

ML: “Great!”

LS: “My question now is this: After all of the special things, let’s go back and tell us what is the bread and butter of what the typical speech therapist at school, speech language pathologist or speech teacher (whatever you want to be called, haha), at a school, what are they working on? What should a parent be looking for in their overall typically developing child but then they have some questions? Let’s go back to the middle of the bell curve for a minute and hear a little bit about that.”

ML: “For school-aged children?”

LS: “I guess I”m thinking like some of the common questions I get, “My child is 17 months old and they are not speaking yet. Or my child is 2 and a half and they only say a few words.” At what point to people get anxious enough for evaluations, or is this something you prefer not to speak on, if this is not something you are comfortable with.”

ML: “I don’t know a whole lot about children and what is typically developing for children, but I will say, my advice would be, any parent that has concern about how their child is developing or if they are developing typically, I would absolutely recommend going to see a child speech and language pathologist, whether it would be testing through the school or outside of school. There are lots of private practices that do evaluations, a lot of universities do them as well. Some hospitals do some out patient evaluations. I would recommend you see someone if you have any questions about whether or not your child is typically developing, because the last thing you want to do is wait and prolong that process and prolong those answers. You are wasting valuable time because kids grow so fast and they learn so quickly. It’s important to address any of those concerns as early as possible. So while I can’t say what is typically developing or when a parent should reach out to a speech pathologist or get an evaluation, I would say if you have any concerns to do it immediately, and as quickly as possible. Because time is language. Time is speech. We don’t want to waste any time.”

LS: “100%. I echo that also in audiology because if your kid says “What, what, what?” for one weekend, that’s enough for me. Please come in! Don’t come in and say that you realized this let’s say six months ago, or three years ago (laughing). Where have you been? Please come in. And then you get the parents that are like, ‘It happened this morning…’ (both laughing) So yeah, come somewhere in between.”

ML: “I just encourage parents to trust their gut, I mean, I know that we are seen as the professionals. But really it’s the parents that are the professionals. They know their children better than anyone else. Better than we will ever know them. So if you have a hunch that something is wrong or you are seeing your children in comparison to other children their age and their peers, and you have a concern, it doesn’t hurt to talk to someone or at least to inquire about it. Because you know your children better than anyone. So trust your gut if you feel like something is not right, then reach out to a speech language pathologist or an audiologist as soon as possible.”

LS: “Thank you so much. You are saying everything I have been saying. It’s almost like you listen to the show (both laughing). Yes, I am a big fan of parents.”

ML: “Yes, they are great.”

LS: “Yes, we are the ones. I happen to be a parent too so I’m just going to give myself a pat on the back. What parents do is morning to night, 24/7 with the kid, and sometimes you need that professional, but don’t forget your role. And parents being their child’s biggest advocate. That’s the message from me.”

ML: “Yes, absolutely.”

LS: “I’m so glad I got to talk to you today!”

ML: “Yes, me too.”

LS: “If anyone wants to learn more about you or anything like that, do you have links or anything that you want to share?”

ML: “That’s a great question. I’m actually in the process of starting a blog of my own, and it is metheSLP. So I’ll be starting that soon. Hopefully I’ll be able to launch it for “Better Speech and Hearing Month” which is this month, May, so I’m hoping to launch it by the end of the month. So if anyone is interested, by all means, please check out my blog, it’s metheslp.com and basically, what I’ll be doing is I’ll be just be providing insight on what it means to be a speech pathologist and helping those especially minorities kind of find their path and find their place in this field and really just highlighting the diversity in our field and all that we do. I’m hoping to launch that by the end of the month so if anyone is interested in learning more about me and my path as a speech and language pathologist and hoping to get in the field of speech and language pathology, by all means, check out my blog metheslp.com.”

LS: “That is such a wonderful endeavor. I wish you the best with that. And diversity is so important in every field because diversity is what our population is made of. So it has to be represented and it has to match with our professionals and I think that’s so important.”

ML: “Yes, yes. I’m hoping to highlight that in my blog and for those who feel like they are having difficulty finding their path and finding a spot in this field, it’s available. You just have to make it for yourself. So if anyone is interested in insight, you’ll be able to find that on my blog.”

LS: “Thank you so much MariLouise Nichols.”

ML: “No problem, thank you.”

Thank you again to MariLouise Nichols. There will be links in the show notes and in the post that goes together with this at allaboutaudiology.com where you can find MariLouise and her work. I appreciate her coming on the show and I’m looking forward to hearing what you guys thought about our conversation.

Thanks so much for being a listener! I’m Dr. Lilach Saperstein and this is the All About Audiology podcast.

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