Introduction

No kidding. Someone actually once asked me, "What's a person trained like you doing working in an area like this?" I even think that the person in question had inserted the word "nice" in front of "person." Please note that I have removed the word "nice" in the title above to decrease the likelihood of being drawn into a conversation about which communication disorder area has the "nicer" people providing service delivery or conducting research! Instead, my goal for this paper will be to try to explain its title and speculate about why someone would have asked me such an unusual question, rhetorical though it may have been.

To begin with, my colleagues know that it is not easy to describe my interests or expertise in a singular fashion. I added to my M.A. graduate training as a speech-language pathologist (hereafter SLP) and became a researcher with a specialty in child language disorders, their assessment and treatment when I earned my Ph.D. almost 25 years ago. Some people who know me are surprised to discover that before I began my doctoral program, I had had several years of clinical practice under my belt including experiences that had led me down the path of a general practitioner in an SLP sense. When I began my doctoral program, however, it was clear to me that child language was where I wanted to place my energies despite all my varied clinical experiences. I had served on a cleft palate team, facilitated weekly group therapy sessions for persons following laryngectomy surgery, and even saw many patients each week for voice therapy.

Given the breadth of my clinical history, I can say that my decision to pursue a specialty area in child language development and disorders in my doctoral program was made with a comprehensive knowledge of the roles and responsibilities of SLPs. At least, I had the knowledge of how an SLP's scope of practice was defined in 1979 and I made an educated choice. And at the time there was nothing that fascinated me more than how it came to pass that so many children learned their first language without a hitch, far more than the small percentage that had difficulties with this complex developmental achievement.

A Useful Analogy

For the sake of my ongoing explanation, I am going to refer to my "expertise" in child language as my "E1" much as with bilingual speakers we would refer to their primary or dominant language as their "L1." For the rest of the paper I will be referencing this analogy to adopting a second area of expertise (or "E2") just as many people the world over acquire a second (or third or fourthŠ) language or "L2". Unfortunately for most Americans in the mainstream, our tendency is to be monolingual English speakers and true to that tendency although I dabble with Spanish and to a lesser extent French (by-the-way, my Latin is not bad), I am far from a bilingual speaker. It is interesting that it was far easier for me to adopt an E2 than an L2!

Returning to my story, with my Ph. D. completed I set off to be an easily identifiable "child language person (E1)" and found myself predictably assigned to teaching courses in language development and disorders, and phonological disorders, as well as courses in general SLP diagnostic and intervention methods. And, I began to establish myself as someone who was a child language specialist.

Once I had moved from the University of Colorado to the University of Iowa, slowly but surely, I found my interests being pulled in unexpected directions. Pretty soon I was expanding into what was to become my E2 or my second area of expertise, fluency disorders. Initially this occurred through my research interests and later through additional clinical experiences.

At that time my combination of child language expertise and stuttering expertise, although not unheard of, was a rare commodity to be sure. In the United States when bilingualism does occur, I would be fairly safe making a large wager that it would be the English and Spanish languages we were talking about. To a lesser extent, would the languages in question be Finnish and Italian, not that there's anything wrong with that and is likely a handy combination when traveling.

I used to explain my budding interest in fluency disorders by saying that it allowed me to work with a University of Iowa colleague in a collaborative fashion to investigate the answers to clinically-based research questions we could both contribute to answering. And, that is partly true. For example, we were interested in knowing whether children who stutter (CWS) were actually more likely to stutter when they responded to questions. Historically, caregivers had been told to minimize the questions they ask their young CWS and we wanted to see whether there were data to support the necessity of this admonishment. In order to pose this research question in a reasonable way, we not only needed to know something about characteristics of CWS but also how to incorporate a conversation framework comprised of solicited conversation turns, like answers to questions. See Weiss & Zebrowski (1992) for the results of this particular study.

Besides the benefits of collaborative research, my transformation into a professional with a somewhat rare mix of expertise can also be attributed to the fact that working with persons who stutter clearly brought into focus that my essential goal as an SLP is always about improving my clients' ability to communicate. However one characterizes stuttering or deconstructs it or whatever you choose to call it, my role as an SLP is to teach clients how to improve upon their ability to communicate. I also credit my E1 with fostering my clarity of purpose. That is to say that I look at stuttering through communication-tinged glasses when I am working with persons who stutter. Simply stated, it is impossible for me to separate therapy from its context, that being conversation. I would argue that conversation is the most common context for communication, especially for young children who stutter. Whatever the targets might be for a client's therapy session, I cannot find a good reason to engage in any prolonged teaching in isolation. My goal is to make them immediately useful as part of the communication exchange found in a conversation.

Returning to my analogy of the successive learning of two languages in bilingual speakers, research has shown that the acquisition of competence in L1, a person's first or dominant language, fosters transference to L2, a second language being learned (Goldstein, 2000). So, children who first attain competence in their first language will have a much easier time in learning a second language. A very simple explanation is that the second language is built on the foundation provided by the first language. This is a rationale used to provide support for providing intervention in L1 for bilingual individuals with bona fide language disorders.

In a similar way my initial acquisition of expertise in child language, my E1, has undoubtedly colored the way I learned about and understand my approach to fluency disorders, my E2. For me, the purpose of therapy is the prevention or amelioration of problems with communication. To do this, I invariably evaluate my clients' conversation competencies and evaluate the degree to which stuttering is compromising their ability and/or willingness to successfully communicate in their activities of daily living. This information gives me insight in where to begin in terms of therapy context and where to look for clinically-significant change over time.

I am certainly not suggesting that professionals not trained in working with children with language disorders are not currently taking the same holistic, top-down, "big picture" perspective that I do. I just believe that for me it now comes as second nature because for most of my professional life I have been entrenched in viewing how children use the language they have in service to communication.

If I switch back over to bilingual lingo, I am expressing that I experience easy transference between my two "languages" and none of the interference that can sometimes occur when someone proficient in one language attempts to learn a second. That is, I am not putting my adjectives after the noun in L2 (English) because that's where they belong in L1 (Spanish). In SLP terms, I can easily transfer what I know about the importance of practice and modeling and generalization in child language disorders to work with clients who stutter.

Perhaps I should have been describing my analogy as being bi-dialectal, proficient in more than one dialect of the same language, rather than being bilingual. Why? Well, linguists agree that except in unusual cases, dialects of the same language (like African American English or Appalachian English when compared with Standard American English) are far more similar than they are dissimilar. In fact, Wolfram (1991) listed only eight syntactic/morphological differences that distinguish African American English from Standard American English. So to push my analogy even further, there certainly are some critical differences in service delivery to children with language disorders compared with those who stutter. I would argue, however, that general principles of intervention apply to both. There are many more aspects of therapy programming that are similar or the same than are different. The key is to know how to code switch, or seamlessly move back and forth between clients providing appropriate services depending on their individual needs.

Back to the Title

Let's return to the title of the paper. Was the author of this comment attempting to insinuate that I was somehow not qualified to work with persons who stutter? I hope not. Maybe the warning was that I should stick to what I know better and not get involved in what might be perceived as a stickier clinical situation? I hope that's not the right interpretation either. I very much enjoy providing clinical services to persons who stutter even though I may have come to that place a bit later than most. I think that my less-than-usual path, although more unusual in an academic setting (where specialization is becoming a luxury, by-the-way, reserved for only the largest training programs in the United States), is not all that uncommon for SLPs who work in other settings. Clinicians working in the schools or medical settings are likely to develop expertise according to the demographics of their typical caseload. As professionals, we are constantly adding to our knowledge base. In fact, our national organization now requires periodic proof of our continuing education efforts to maintain our certification. Regardless, I feel perfectly comfortable being a relative latecomer to this therapeutic endeavor.

You will notice that I have earned specialty recognition status in child language through the American Speech-Language-Hearing Association. I will probably never be able to earn the same distinction in stuttering because the requirement for demonstrating clinical expertise for specialty recognition requires far more hours of annual clinical work than I could ever cram into my professor's schedule. And, I don't think that's unfair. Specialty recognition is meant for clinical specialists. It is up to me, as it is to all professionals, to continue to accrue continuing education by attending workshops to learn new approaches and further hone my skills and I have willingly accepted that challenge.

We are living in exciting times when more emphasis is being placed on a reasonable fusion of evidence based practice, clinical expertise, and client/patient values in the provision of best service delivery practices. Hopefully, the way professionals categorize themselves and others in terms of their clinical training and expertise will share in this expanded point-of-view. What am I doing working with clients who stutter? I am providing them with the benefits of all of my experiences and all of my expertise.

Goldstein, B. (2000). Cultural and linguistic diversity: Resource guide for speech-language pathologists. San Diego: Singular Thomson Learning.

Weiss, A. & Zebrowski, P. (1992). Disfluencies in the conversations of young children who stutter: Some answers about questions. Journal of Speech and Hearing Research, 35, 1230-1238.

Wolfram, W. (1991). Dialects and American English. Englewood Cliffs, NJ: Prentice Hall.

You can post Questions/comments about the above paper to the author before October 22, 2007.