American Journal of Speech-Language Pathology

Purpose Dynamic Temporal and Tactile Cueing (DTTC) is an evidence-based treatment for children with childhood apraxia of speech. In clinical practice, speech-language pathologists (SLPs) frequently use an eclectic approach incorporating aspects of DTTC, for reasons that are not well understood. This research note describes a qualitative investigation of the experiences of SLPs and caregivers who participated in protocolized research DTTC for a 24-session treatment efficacy study. Specifically, we sought to understand the perspectives of these SLPs and caregivers regarding (a) DTTC treatment, as provided during the study, and (b) participating in a treatment research study. Method Four SLPs and three caregivers participated in semistructured interviews, via Zoom, 4 weeks after the treatment study. Questions explored perceptions of research DTTC treatment and experiences of participating in a research study. Data were analyzed with inductive thematic analysis using an iterative and reflective process. Results One overarching main theme was identified: “Research and clinical practice: Different priorities and processes,” with five subthemes. The subthemes were (a) research DTTC is more challenging, (b) research DTTC is surprisingly effective, (c) clinical practice is preferable to research, (d) research participation leads to new learning, and (e) power differential exists between researchers and clinicians. Conclusions Aspects of the research DTTC were uncomfortable for SLPs and families, despite its efficacy and what they learned from participating. SLPs perceived a schism between researchers and clinicians. More needs to be done to decrease the perceived gap between researchers and clinicians to facilitate implementation of evidence-based practice in nonresearch contexts. Supplemental Material https://doi.org/10.23641/asha.28299764

Purpose This study examined the quantity and complexity of speech-language pathologists' (SLPs') talk during therapy with school-aged children and explored the extent to which SLP- and session-level characteristics contribute to the variability in SLP talk quantity, grammatical complexity, and lexical complexity during therapy. Method We used secondary data collected from 209 business-as-usual therapy session recordings collected in the fall of the school year involving 75 SLPs and 281 kindergarten, first-, and/or second-grade students. Students were receiving services for language disorder and had therapy goals targeting various domains of language. SLP talk was coded to capture various aspects of quantity and complexity. Results SLPs with more years of experience tended to produce a lower quantity of talk, whereas higher levels of time pressure were associated with increased quantity of talk as well as grammatical and lexical complexity. In addition, session length, mean age of children, and children's phonological awareness scores were significantly associated with SLP talk quantity, grammatical complexity, and lexical complexity. Conclusions This study adds to the evidence for the variability of SLP talk. SLP talk quantity and complexity are related to SLPs' years of experience and time pressure. Session-level predictors suggest grouping strategies for therapy sessions.

Purpose Ankyloglossia (tongue tie) is common, and its clinical relevance is hotly debated among multidisciplinary health care providers including pediatricians, lactation consultants, otolaryngologists, and speech-language pathologists. The literature focuses on breastfeeding symptoms; less evidence exists to clarify the spectrum of possible symptoms after infancy. We conducted a scoping review of potentially related symptoms in pediatric patients who presented for clinical evaluation of untreated ankyloglossia, with the aim of mapping symptoms that providers may want to evaluate and identifying targets for further research. Kummer (2025) has alleged “erroneous statements without evidence” about “the effect of ankyloglossia on speech,” “inaccurate citations,” and “errors of omission” in our scoping review (pp. 1, 2). This letter provides a rebuttal of her statements. Results Based on results from 20 primary studies, our review drew a provisional conclusion that ankyloglossia may be associated with speech difficulty in a subset of patients; we did not assert any causal relationship. Kummer took issue with a citation in one sentence of our review; we note that some of her concerns were inaccurate, though we appreciate her clinical expertise on speech sound production. The omissions she perceived were in fact present in our original review article. Conclusions Kummer's letter does not warrant an erratum to our scoping review. However, her letter prompts us to urge the multidisciplinary community of providers involved in studying and caring for patients with ankyloglossia to engage in a collaborative and open-minded discussion. We must reduce professional antagonism around this controversy and work together on patient-centered research to support children whose experiences may not fit the typical clinical picture.

Purpose This study was motivated by goal samples from practicing speech-language pathologists (SLPs) that were submitted to a website our group maintains about treatment planning for aphasia. Upon analyzing the goals, we found that less than 3% involved any form of communication partner training (CPT). Considering this finding, we sought to understand how and to what extent aphasia clinicians in the United States use CPT with significant others. Method We constructed a survey that included a mixture of multiple-choice and open response questions around goal setting and CPT for significant others. The survey was posted to the same website where we had originally collected the goal samples. Responses were summarized with descriptive statistics and thematic analysis. Results One hundred fifty-six SLPs and 138 graduate students completed the survey. Almost all SLPs (97%) reported engaging in CPT with family members, and approximately half indicated they also wrote goals about this service at least occasionally. However, most explained that CPT was typically handled without goal setting. Graduate students reported limited experience with CPT. Thematic analysis of the open responses yielded five themes and 24 codes that collectively display a multidimensional implementation problem. Discussion SLPs recognize the importance of CPT and employ a range of training techniques with significant others. Nevertheless, they face barriers that lead to ambivalence about writing goals for this service. On the rationale that explicit goals ensure accountability and transparency, we address some of the barriers by providing practical resources as steps toward solution-focused collaboration.

Purpose There is a great deal of misinformation among professionals about the effect (or lack thereof) of ankyloglossia on speech. Consequently, many children undergo unnecessary frenotomy procedures that do not improve their speech and may cause unnecessary complications. This letter points out several erroneous statements in Cordray et al. (2023) about the effect of ankyloglossia on speech. In addition, it identifies articles that were incorrectly cited to support these statements. This letter also reveals significant errors of omission, including the results of the systematic review from the Agency for Healthcare Research and Quality, which found that there is insufficient evidence to conclude that ankyloglossia affects speech. Another omission was the consensus statement from the American Academy of Otolaryngology–Head and Neck Surgery Consensus Report, which states that ankyloglossia does not typically affect speech. Finally, this letter details the reasons why ankyloglossia is highly unlikely to affect speech. Conclusion Contrary to statements made in Cordray et al. (2023), there is no evidence that ankyloglossia affects speech production, and therefore, it is highly unlikely to be the cause of a speech sound disorder. This is because even with severe restriction of tongue tip movement, a compensation (or alternative method of production) can be used to produce lingual phonemes with the same acoustic output.

Purpose The aim of this study was to investigate whether successful surgical management of velopharyngeal insufficiency (VPI) aids in the remediation of compensatory misarticulation errors (CMAs) among children with VPI and CMAs. Method Fourteen participants with VPI and use of CMAs from a larger study were included in this retrospective cohort study. The mean age at the time of preoperative evaluation was 8.9 years (SD = 1.1). Perceptual ratings of hypernasality, phonetic transcription, and anatomic measurements from magnetic resonance imaging were performed by raters blinded to the participants' medical and surgical history. The mean percentage of CMAs produced on the American English Sentence Sample was calculated. The Wilcoxon signed-ranks test was used to compare the change in CMA use pre- and postoperatively. During the study period, 71% (n = 10) of participants received speech therapy. Results Nine participants had resolved hypernasality after surgery, and five had persistent hypernasality. Among those with resolved hypernasality, the mean percentage of CMAs significantly decreased from 14.6% preoperatively to 1.1% postoperatively (p = .028). For participants with persistent hypernasality, the mean percentage of CMAs decreased from 27.6% to 22%; this change was not significant (p = .586). Conclusions Correction of VPI may aid in the remediation of CMAs as participants have more normal anatomy to achieve velopharyngeal closure. These findings suggest correction of VPI may reduce the amount of speech therapy needed to treat CMAs.

Purpose Rating the quality of conversations can assess communication skills in both people with acquired brain injury and their communication partners. This study explored the clinical feasibility and reliability of two conversation rating scales: the Adapted Measure of Participation in Conversation (MPC) and the Adapted Measure of Support in Conversation (MSC). Method Raters were final-year speech and language therapy students (n = 14) and qualified clinicians (n = 2). Raters attended training on the Adapted MPC and MSC, watched 5 or 10 min of videotaped conversations (n = 23), and then scored them on the MPC and MSC scales. Data were collected over four phases, which varied according to the length of the training, sample length, number of samples rated, and level of clinical expertise. Feasibility data (time taken to score conversations and ease of use) were collected. Interrater reliability was assessed using intraclass correlations (ICCs: absolute agreement, single measures). Results Raters took 30–45 min to score a 10-min sample, and they took 20–30 min to score a 5-min sample. Ease of use was rated highly across all phases. Overall reliability for rating 5 min of conversation (ICC = .52–.73) was better than for 10 min of conversation (ICC = .33–.68). Reliability for the MPC was moderate for both students (ICC = .69) and clinicians (ICC = .55), and for the MSC, it was moderate for both students (ICC = .73) and clinicians (ICC = .58). Reliability was better for students compared with clinicians. Conclusions Rating a 5-min conversation in under 30 min was feasible, with more reliable results for 5-min compared with 10-min conversations. Implications for assessing conversation in the future are discussed.

Purpose Cerebral palsy (CP) is the most prevalent motor disability affecting children. Many children with CP have significant speech difficulties and require augmentative and alternative communication (AAC) to participate in communication. Despite demonstrable benefits, the use of AAC systems among children with CP remains constrained, although research in Canada is lacking. Method Data were collected as part of an exploratory survey of Canadian caregivers and clinicians (N = 60) who shared their perspectives on children's need for, access to, and use of AAC systems. Quantitative data were summarized using descriptive statistics. Qualitative data were analyzed using inductive content analysis. Results Caregivers and clinicians reported high rates of need for AAC systems (> 75%) among children with CP. Both groups reported that access was roughly equivalent to need, although caregiver reports were lower. Despite high rates of need and access, only 38% of children used AAC systems. Children who used AAC primarily used high-tech systems, mostly to make choices, rather than engaging in meaningful reciprocal interactions and conversations. Conclusions Canadian children with CP who required AAC systems generally received them. However, AAC systems were not used to their full potential, suggesting limited participation in social and learning situations. Like reports on other pediatric populations, barriers to obtaining AAC systems related to service, family, and child-specific factors. Although our sample captured the complexity present in the CP population, sample sizes were small and unlikely to be representative of the population of Canada, indicating the need for further research on a national scale. Supplemental Material https://doi.org/10.23641/asha.28229720

Purpose The purpose of the current study was to gain insight on augmentative and alternative communication (AAC) interface designs for children with cortical visual impairment (CVI). Children with CVI frequently require AAC and specific interface supports, and customization may be necessary to support access and use of speech-generating devices. Method A focus group methodology was selected to gain feedback from vision professionals on helpful AAC features for children with CVI. Participants included eight teachers of the visually impaired and one optometrist. Two virtual 1-hr focus group sessions were conducted and recorded for thematic analysis. Results Three primary themes and eight subthemes emerged from the transcripts of the focus groups. Themes included characteristics of the AAC interfaces such as background, high contrast, and symbolic representation; characteristics of children with CVI (preferred colors, visual field preference); and the development of AAC interfaces over time. Conclusions Vision professionals have identified characteristics of AAC interfaces that should be considered when working with children with CVI. Future collaboration with such professionals is needed to further inform the design of current and future AAC technologies to allow speech-language pathologists to meet the unique needs of this population. Supplemental Material https://doi.org/10.23641/asha.28279184

Purpose Vocabulary access is important for individuals who use augmentative and alternative communication (AAC), especially for children in the early stages of language learning. This study sought to understand how accurate speech-language pathologists (SLPs), teachers, and parents are in predicting the vocabulary needed by early symbolic communicators who use AAC in three contexts. Method Ten groups, each with a child who used AAC as their primary mode of communication and who was classified as an early symbolic communicator and their parent, teacher, and SLP, participated. The parents, teachers, and SLPs predicted a vocabulary list of words children who use AAC needed to participate in a dinner, a math lesson, and a speech session using the blank page method and categorical inventories technique. Children were then recorded in 15-min videos participating in the three contexts. Words were recorded and compared to the words predicted. Results There was large variability in the accuracy of percentage of words the children used that were predicted by the adults out of all the words the children used. The adults were significantly more accurate predicting the vocabulary for the math lesson than the dinner. Conclusions Parents, teachers, and SLPs predicted much of the vocabulary of early symbolic communicators who use AAC. Implications for early vocabulary selection and alternatives to predicting vocabulary are discussed.

Purpose The purpose of this study was to determine the sensitivity and specificity of the Yale Swallow Protocol (YSP) in detecting aspiration in recently extubated patients. Method One hundred fifty-four participants referred for swallowing evaluation underwent the YSP and fiberoptic endoscopic evaluation of swallowing (FEES) in random order within 48 hr of extubation. The YSP included orientation questions, an oral motor exam, and a 3-oz water swallow test. Failure was defined as interrupted drinking or immediate cough after drinking. FEES exams were rated using the Penetration Aspiration Scale. Fisher's exact test and t test were used to test for association between failure on the YSP and participant factors (sex, age, reason for admission/intubation, duration of intubation, number of intubations, and time post-extubation of exam), aspiration on FEES and participant factors, and a false negative on the YSP and participant factors. Results Fifty-seven percent (88 of 154) failed the YSP. Fifty percent (77 of 154) of participants aspirated on at least one trial during the FEES. Sensitivity of the YSP was 75%, and specificity was 61%. Participants who failed the YSP were older (M = 61 years; p = .0030). More women failed the YSP than men (p = .0007). No patient factors were associated with aspiration on FEES. Participants admitted for respiratory etiologies (pneumonia, chronic obstructive pulmonary disease exacerbation) were most likely to have a false negative on the YSP (p = .02). False negatives were also more likely in participants with a size ≥ 8 of endotracheal tube (p = .03). Conclusions The YSP has suboptimal sensitivity and specificity for detecting aspiration in recently extubated patients. More data are needed on predictors of false negatives in order to improve sensitivity and specificity in this critically ill patient population.

Purpose There is a scarcity of language assessment tools properly adapted for use with minimally speaking autistic children. As these children often use nonspoken methods of communication (i.e., augmentative and alternative communication [AAC]), modification of traditional assessment tools is needed to capture the full range of their communicative repertoires. We modified the MacArthur–Bates Communicative Development Inventories (CDI) to explore how vocabulary size and composition are impacted by considering nonspoken, as well as spoken, expressive vocabulary (AAC-modified CDI: Words and Gestures). Method Our initial sample consisted of 16 minimally speaking autistic children, 3–9 years old, whose caregivers completed our modified CDI after taking part in an AAC intervention. Our final sample included 15 participants, after removing an outlier. Results Accounting for both spoken and nonspoken communication significantly increased participants' reported expressive vocabulary by an average of 14 words (z = −2.61, p = .009, r = .75). Verbs made up a sizable portion (13.3%) of vocabulary when accounting for all modalities, while nouns made up the majority (51.5%). Conclusions We demonstrated the value of including both spoken and nonspoken modalities of communication when assessing the expressive vocabulary of minimally speaking autistic children. Prior work has shown that minimally speaking autistic children's spoken vocabulary was prominent in verbs (i.e., contained proportionally more verbs than that of vocabulary-matched typically developing children). In our sample, which used a broader definition of minimally speaking, we found that the proportions of verbs and nouns were consistent with what has been reported for typically developing children with similar-sized productive vocabularies.

Introduction Though the research on the quality of life of people who stutter is extensive, there is minimal research on cluttering's life impact. Anecdotal reports from people who clutter¹ and their significant others have described some elements of cluttering's impact and advocated for these components to be addressed in treatment. Three formal studies have used semistructured interviews to document cluttering's impact. These non–peer-reviewed studies make important contributions; however, more research is needed to add to this existing information. The current study adds perspectives of adults who clutter related to cluttering's impact upon the specific contexts of work, school, and social situations. Method In this phenomenological study, 10 adults who clutter participated in a semistructured interview. Through grand tour, mini tour, and example questions, participants were asked to provide their perspective on the life impact of cluttering. Each interview was orthographically transcribed, and transcripts were coded for themes. Triangulation and member checking were conducted to establish reliability and validity of themes. Results Results revealed the following themes: Social impact of cluttering leads to avoidance, misunderstanding, and feelings of isolation; cluttering impacts natural tendencies; educational impact of cluttering results in misunderstanding and struggle; occupational impact of cluttering leads to role entrapment and difficulty maintaining employment. Conclusions This study adds perspectives of adults who clutter regarding specific aspects of quality of life such as social isolation, frequent misunderstandings, and negative educational and occupational impact. As more voices are heard within the cluttering community, more support is presented for the importance of understanding the negative life impact cluttering can have. Further understanding of these perspectives adds to the information needed to inform holistic cluttering assessment and treatment.

Purpose The aim of this study was to describe the development of and pilot feasibility outcomes for a strategy-based, brief, intensive cognitive rehabilitation intervention delivered to U.S. service members and veterans with mild traumatic brain injury in a recently completed 3-year pragmatic clinical trial: Symptom-Targeted Approach to Rehabilitation for Concussion (STAR-C). Method To develop STAR-C, we used the Rehabilitation Treatment Specification System to identify core elements and principles from a previous randomized clinical trial of cognitive rehabilitation, and incorporated principles of neuroplasticity (e.g., high-dose spaced practice of personally meaningful tasks), best clinical practices (e.g., client-centered goal setting), health psychology (e.g., a focus on self-efficacy and motivation), and community-based participation research (e.g., the protocol was co-designed by clinicians and researchers). Treatment was based on a resource-allocation theory of everyday cognitive challenges, which predicted that automatic strategy use would reduce cognitive demands of everyday activities and therefore reduce cognitive symptoms. Treatment was delivered by speech-language pathologists (SLPs) and occupational therapists (OTs), using a protocol that included a problem-focused intake questionnaire, manualized treatment, and clinician resources. Therapy was delivered individually in six to 10 virtual or in-person sessions over 3–4 weeks. Therapy focused on desired changes in function, scaled using Goal Attainment Scaling. Results Trained SLPs and OTs delivered STAR-C to 53 U.S. service members and veterans, with treatment fidelity > 95%. Participants and clinicians rated STAR-C as acceptable, feasible, and appropriate, and most participants attained and maintained targets. Conclusion STAR-C appears to be a feasible method for improving everyday cognitive performance and efficacy should be tested in a controlled study. Supplemental Material https://doi.org/10.23641/asha.28222613

Purpose Swallowing difficulties have a substantial impact on the burden experienced by care partners of individuals with neurodegenerative disease. Given this, there is a clear need to easily identify and quantify the unique aspects of swallowing-related burden. The purpose of this study was to establish the validity and reliability of the Caregiver Analysis of Reported Experiences with Swallowing Disorders (CARES) screening tool in care partners of individuals with neurodegenerative disease. Method Survey data were collected from an international sample of 212 individuals caring for family members with amyotrophic lateral sclerosis (n = 49), dementia (n = 110), or Parkinson's disease (n = 53). Respondents completed the CARES, Eating Assessment Tool-10, International Dysphagia Diet Standardisation Initiative–Functional Diet Scale, and Zarit Burden Interview. Reliability and validity of the CARES were evaluated via internal consistency alpha coefficients, Spearman's rho correlations, and logistic regression analyses with receiver operating characteristic (ROC) curves. Results CARES scores demonstrated excellent internal consistency (α = .90–.95) and high test–retest reliability (r = .86–.91). The CARES was found to be valid, as increased swallowing-related burden was associated with increased severity of swallowing difficulties (r = .79 to .84), diet restrictiveness (r = −.50 to −.54), and general caregiver burden (r = .36 to .40). The CARES had excellent discrimination between care partners with and without self-reported swallowing-related burden, with a score of ≥ 4 suggesting a heightened risk of experiencing this burden. Conclusions Results establish the CARES as a valid and reliable screening tool that can detect burden related to swallowing difficulties among care partners of individuals living with neurodegenerative disease (score ≥ 4). Clinical implementation of the CARES requires the concerted efforts of the larger multidisciplinary team who can collaboratively identify the presence of burden and target the multifaceted sources of burden that a care partner may be experiencing.

Purpose Management of discourse is acknowledged as a critical component of speech-language pathology practice with cognitive communication after traumatic brain injury (TBI). This scoping review aimed to collate the visual materials that are being used in empirical research for spoken narrative elicitation post-TBI, in both assessment and treatment contexts. We aimed to examine the format, structure, and sources for visuals used. Discourse analyses were also investigated. Method The research was conducted and reported as per the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews between September 26, 2023, and March 1, 2024. Four electronic databases were searched for peer-reviewed original research studies reporting spoken narrative tasks using visual elicitation stimuli after TBI. Secondary searches of backward and forward citations were also undertaken. Results Of the 1,461 studies found in the search, 60 studies were eligible for data extraction. Eleven visual stimuli were used in 51 of the studies to elicit narratives. The visual stimulus reported in the highest number of studies was The Flowerpot Incident, a six-picture black-and-white picture sequence. Overall, the most frequently used format was a wordless storybook, analyzed most frequently at the macrostructural level. Conclusions Research studies are using picture sequences or wordless storybooks to elicit discourse samples after TBI. This contrasts with a recent survey of clinical practice with discourse post-TBI, where The Cookie Theft picture was most reported in use (Steel et al., 2024). We discuss the relevance of findings in relation to recent INCOG 2.0 guidelines (Togher et al., 2023) and speech-language pathology practice, and make recommendations for clinical and research future directions. Supplemental Material https://doi.org/10.23641/asha.28098113

Purpose Research has shown that prolonged endotracheal intubation can increase risk of aspiration following extubation. This study examined the relationship between swallowing and intubation among patients with COVID-19. We investigated the association between the duration of intubation and time until an oral diet was safely initiated and the correlation between the length of intubation and reduced sensation with aspiration as seen on flexible endoscopic evaluation of swallowing (FEES)/videofluoroscopic swallowing study (VFSS). Method This study is a retrospective analysis of all intubated patients admitted with the primary diagnosis of COVID-19 between April 2020 and March 2021 who received an inpatient speech-language pathology consultation. We utilized univariate linear regressions to investigate the dose–response relationship between duration of intubation and time until cleared for oral diet post-extubation. Dysphagia outcomes were analyzed, including results from 39 instrumental evaluations (VFSS and FEES). Results During this 1-year period, 94 extubated patients were examined by a speech-language pathologist (SLP). We observed a near-exponential increase in the days until cleared for oral diet from 3% versus 69% when intubated for 10–16 days versus 17–34 days, respectively. Second, 39 patients received a VFSS/FEES evaluation. Of those who aspirated on an instrumental swallow study, there was a 78% rate of silent aspiration. Conclusions Prolonged intubation has a near exponential dose–response on the time until a patient becomes cleared for an oral diet after extubation. Prolonged intubation also increases the rate of aspiration observed on VFSS/FEES evaluations. Thus, SLP evaluation of oropharyngeal swallow physiology is important to minimize complications and improve patient outcomes. Supplemental Material https://doi.org/10.23641/asha.28165631

Purpose Traumatic brain injury (TBI) is a life-altering event that can abruptly and drastically derail an individual's expected life trajectory. While some adults who have sustained a TBI go on to make a full recovery, many live with persisting disability many years postinjury. Helping patients adjust to and flourish with disability that may persist should be as much a part of rehabilitative practice as addressing impairment, activity, and participation-level changes after TBI. Living with a sense of purpose in daily life has been shown to provide numerous health and psychological benefits in the general population, especially in the face of major life transitions. In this article, we argue that rehabilitative professionals across disciplines can fruitfully leverage the construct of purpose in life to lend structure, meaning, and intrinsic motivation to TBI rehabilitation and to the recrafting of lives in the aftermath of unexpected change. Method We provide a narrative review of the literature relevant to recovery and long-term well-being after TBI and of the role of purpose in daily life in promoting well-being in the general population. We then outline avenues for, and potential benefits of, incorporating a focus on purpose in life into TBI rehabilitation and discuss future directions in purpose-in-life rehabilitation research. Conclusion We propose that an overarching rehabilitative focus on purpose in daily life could improve well-being after TBI by grounding therapeutic services in a construct that meaningfully connects traditional rehabilitation targets to patients' broader lives, while concurrently addressing injury-related purpose disruption, in order to promote flourishing after brain injury irrespective of a person's degree of functional recovery.

Purpose Despite recent advances, gender inequality remains a major concern within the workforce. One manifestation of gender inequality in academia is the undercitation of women-authored compared to men-authored papers that is thought to reflect implicit biases and has important implications for the academic advancement for research-intensive female faculty. These studies largely stem from male-dominant professions. Thus, in this study, we investigated gendered citation practices within communication sciences and disorders (CSD), a female-dominant discipline. We also examined the impacts of the COVID-19 pandemic as an exogenous driver of short-term change in publication and citation practices in CSD. Method Using methods from Dworkin et al. (2020), we characterized expected versus actual man first/man last–authored (MM), man first/woman last–authored (MW), woman first/man last–authored (WM), and woman first/woman last–authored (WW) articles published within a 24-year time span in the four American Speech-Language-Hearing Association journals. We compared gendered publication and citation practices in the 10 years before (2010–2019) to during (August 2020–November 2022) the COVID-19 pandemic. Results Across journals, we found WW publications increased while MM publications decreased from 1998 to 2022. We found a pattern of overcitation of WW papers and undercitation of MM papers, which was driven primarily by the citation practices of WM and WW teams. These citation trends were found for the years before and during the pandemic and remained when controlling for relevant paper characteristics and author and paper network variables. Conclusions Consistent with our predictions, we found gender-based citation imbalances that aligned with the gender distributions of CSD, like other fields. The findings align with the notion of homophily (i.e., like attracts like). We review the findings within the context of citation research from other fields as well as discuss the larger implications of these patterns for professional practices in CSD.

Introduction Evidence-based practices (EBPs) use evidence (external and internal), clinician expertise, and client/caregiver perspectives to deliver effective, individualized care. Each component of EBP is highly relevant and most effective when implemented together. Families with cultural or linguistic backgrounds different from the mainstream experience inequitable treatment across all disciplines. As the United States' population becomes increasingly diverse, it is paramount for speech-language pathologists (SLPs) to obtain education and support to provide evidence-based, culturally responsive care. Method This study conducted a scoping review to determine what is known regarding SLPs' perspectives and experiences working with families or children with different cultural or linguistic backgrounds. Articles were included if they (a) contained empirical novel data, were available in English, were peer-reviewed, and were published; (b) included experiences of SLPs who self-reported that they work with children and/or families with cultural and/or linguistic backgrounds different from themselves or the regional mainstream; and (c) reported effects of cultural or linguistic difference on SLP service provision. Results Results indicated that SLPs encounter many barriers but often exhibit culturally responsive clinical decision making through the consideration of evidence (external and internal) and their clinical expertise and opinion. Multiple strategies for increasing culturally responsive care and areas that would benefit from further research and systemic change were identified. Discussion Barriers and solutions to culturally responsive care represented two areas of needed change: personal and within system. Though not all change may occur immediately, the present study offers suggested solutions for SLPs to implement in their clinical practice for increased culturally responsive care. Supplemental Material https://doi.org/10.23641/asha.28119836

Purpose The aim of this study was to gauge the impacts of cognitive empathy training experiential learning on traumatic brain injury (TBI) knowledge, awareness, confidence, and empathy in a pilot study of speech-language pathology graduate students. Method A descriptive quasi-experimental convergent parallel mixed methods design intervention pilot study (QUAL + QUANT) was conducted with a diverse convenience sample of 19 first- and second-year speech-language pathology graduate students who engaged in a half-day TBI point-of-view simulation. The simulation was co-constructed through a participatory design with those living with TBI based on Kolb's experiential learning model and followed the recommendations for point-of-view simulation ethics. After setting goals, participants engaged in four station activities completing cognitive communication activities of daily living, while experiencing manipulations to their sensory systems. Activities included reading while wearing goggles with blurred or double vision, listening with tinnitus and auditory processing disorder, and taking notes during a manipulated college lecture. Participants also interacted with an individual living with TBI and responded to targeted prompts throughout the day. Quantitative outcomes were measured using published TBI knowledge and empathy scales and analyzed with descriptive, parametric and nonparametric statistics, while qualitative data were analyzed through thematic analysis. Data were then triangulated through mixed methods. Mixed methods design quality was ensured by following the Mixed Methods Appraisal Tool (Hong et al., 2018). Results After experiential learning, significant increases in speech-language pathologist (SLP) TBI knowledge, empathy, and awareness of TBI symptom and symptom impacts were found. Many, but not all, participants also reported changes in clinical confidence. Conclusions Cognitive empathy training using experiential learning appears to be a viable method to increase SLP knowledge, empathy, and symptom awareness for TBI clinical care. Future research should replicate the study with different types and locations of speech-language pathology graduate programs to consider TBI empathy training as a standard training method to improve both individual and provider outcomes. Plain Language Summary Individuals and families living with traumatic brain injury (TBI) say their providers lack necessary knowledge; do not seem to understand what living with TBI is like; and can be dismissive, uncaring, and lacking empathy. Health care providers do not automatically imagine the world from the patient's perspectives, to “walk in another's shoes”; it takes intentional effort and training. This project attempted to train those specific empathy skills for speech-language pathology graduate students through experiential learning. Experiential learning is a process where people engage in meaningful activities and spend lots of time reflecting on their experiences. Working with people living with TBI, we built a half-day workshop where 19 graduate students completed normal daily activities (such as texting, reading) through different stations that provided insights into what it may be like to have a TBI, such as wearing goggles to induce blurred or double vision, having ringing in their ears (tinnitus), and watching an overwhelming manipulated college video lecture. Afterward, participants listened to a person living with TBI and asked questions. This was important because engaging in activities without interacting with someone living with TBI misses a key idea about listening to and learning from individuals and families. We measured TBI knowledge, empathy, and confidence by looking at surveys pre- and posttraining and reading students' written reflections. Participants reported significant changes in how they think about brain injury and how they will provide clinical care for people living with TBI in the future. Supplemental Material https://doi.org/10.23641/asha.28098254

Purpose The purpose of this scoping review was to understand what is known about the friendships of individuals who use augmentative and alternative communication (AAC) devices. Because communication is important to friendship, severe communication impairment may impact the establishment or maintenance of friendships in unique and important ways. Method Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews and Covidence software using an established set of operationally defined inclusion criteria supported the identification of the 46 papers included in this review. Included papers presented original data on the friendships of individuals with disabilities (acquired and developmental) who could benefit from AAC across the lifespan. Data were extracted to identify features of the body of literature and to identify themes that could inform future research and clinical practice. Results Themes identified from the included studies related to how friendship is defined, supports for friendship formation and maintenance, help and care in friendships, positive outcomes, barriers, the impact of AAC, and recommendations for moving clinical practice and research forward. Conclusions Friendships are chosen relationships that stem from congruences in perspectives between two individuals. People who use AAC, like the broader population, are likely to seek out and maintain friendships with people who are similar to them: people who share personality traits, past experiences (including experiencing disability), interests, and activities. Creative solutions are needed to increase the independence of disabled children and adults to meet and engage with new people with a variety of lived experiences. Supplemental Material https://doi.org/10.23641/asha.28119857

Purpose Effective self-management is key for older adults with and without traumatic brain injury (TBI) to maintain their health, safety, and independence. Self-regulation is one method of promoting self-management. However, it is essential to examine effective methods of self-regulation interventions to maximize the use of such health promotion. Method Forty-one older adults (19 with TBI; 22 without TBI) participated in an in-person or telepractice health education intervention for fall prevention with 15 speech-language pathology student clinicians. The intervention was a self-regulation strategy, mental contrasting with implementation intentions (MCII), for promoting fall prevention. This mixed methods study explored treatment adherence and evaluated implementation outcomes through acceptability, appropriateness, feasibility, modifications to treatment, and therapist adherence and client participation. Results All participants demonstrated some behavior change. Participants without TBI evaluated the MCII protocol as more acceptable, F(1, 39) = 5.88, p = .018; appropriate, F(1, 39) = 5.34, p = .023; and feasible, F(1, 39) = 9.56, p = .003, than participants with TBI, although all ratings were perceived as neutral or positive. From clinician data, protocol adherence, F(1, 39) = 1.57, p = .22, and client participation, F(1, 39) = 0.10, p = .92, were similar across injury groups, but participants with TBI required more fidelity-consistent modifications to treatment, F(1, 39) = 6.88, p = .012. There were no differences between settings except that those in telepractice had more client participation, F(1, 39) = 21.02, p < .001. Clinicians felt MCII was equally appropriate for both groups in all settings, acceptability: F(1, 48) = 0.082, p = .78; appropriateness: F(1, 48) = 0.554, p = .46; feasibility: F(1, 48) = 0.197, p = .66. Conclusion MCII may be a feasible tool to provide health education as it offers enough structure and individualization to be considered appropriate and relevant for older adults, and for novice clinicians to administer and modify as needed based on client needs. Supplemental Material https://doi.org/10.23641/asha.28074443

Purpose The purpose of this pilot investigation was to identify formative feedback to guide the development of a North American version of the TBIconneCT program. A secondary purpose was to examine the feasibility of delivering the intervention by graduate students. Method Two cohorts of individuals with chronic brain injuries and their communication partners were recruited for a 10-week, modified TBIconneCT program delivered by graduate student clinicians via telehealth. Eight dyads were recruited for the first cohort, but only four dyads completed the investigation. Ten dyads participated in the second cohort, but only seven dyads completed the investigation. Along with pre and post self-reported measures of communication and participation, participants completed an interview about their experiences. Interviews were transcribed and qualitatively coded using reflexive thematic analysis. Results Participants from both cohorts improved in all pre- and postmeasures of communication and participation; however, gains were modest across the cohorts. Qualitative analyses were conducted separately by cohort, as results from the first cohort informed modifications that were implemented in the second cohort, primarily to address Australian English dialects. Across both contexts, overarching constructs included “participant perspectives regarding outcomes,” “assessments of the effectiveness of specific portions of the program,” and “suggestions for improvement.” Conclusions The modified TBIconneCT program (North American pilot version) produced modest gains in measures of social communication, participation, and quality of life. Qualitative analyses provided insights into the strengths and weaknesses of the modified program, along with suggestions for refinement of the pilot version.

Purpose Joint attention predicts later language in Down syndrome (DS) and autism. The co-occurrence of autism in children with DS is 6%–19%, which is higher than in the general population. However, little is known about how co-occurring autism in DS impacts the development of joint attention. This study compared mother–child and father–child interactions in families of children with DS. Our purpose was to investigate differences in caregiver joint-attention bids and whether caregiver and child joint attention were associated with autistic traits and receptive language in children with DS. Method Fifteen children with DS (Mage = 39.67 months) and their biological caregivers participated in the current study. We collected mother–child and father–child interactions in participant's homes. Using Wilcoxon signed-ranks tests, we examined if there were differences in mothers' and fathers' joint attention bids and if children responded differently to their bids. We used Spearman correlations to examine the associations between child autistic traits, receptive language, and caregiver and child joint attention. Results We found that mothers initiated more joint-attention bids than fathers but did not find differences in child responsiveness or initiations based on communication partner. Mothers used more bids when children had more autistic traits. Child autistic traits were negatively correlated with child responsiveness to father joint-attention bids. Children with more autistic traits produced fewer joint-attention bids with both caregivers. Conclusions Findings suggest mothers and fathers may use differing approaches to support their child's language development. Regardless of communication partner, children with more autistic traits engaged in fewer instances of joint attention.