SeeHearSpeak Podcast

00:12 Tiffany Hogan: Welcome to See Hear Speak Podcast Episode 17. In this Episode I talk with Lisa Archibald about her advocacy around Developmental Language Disorder, her research on working memory, and her collaboration with clinicians and educators.
This conversation is 1 in a 5 part series on Developmental Language Disorder (known as DLD) released this week in honor of DLD Awareness Day, which this year is on Friday Oct 18th.
Thank you for listening! And don’t forget to check out www.seehearspeakpodcast.com to sign up for email alerts for new episodes and content, read a transcript of this podcast, access articles and resources that we discussed, and find more information about our guests. Also don’t forget to subscribe to this podcast and leave a positive rating in apple podcast or wherever you are listening.
01:12 Tiffany Hogan: Well, welcome to See Hear Speak podcast. Lisa, I'll have you start by introducing yourself.

01:21 Lisa Archibald: Okay, my name is Lisa Archibald, and I'm an Associate Professor in the School of Communication Sciences and Disorders at the University of Western Ontario. I have a background as a speech and language pathologist, and that's where I teach now.

01:34 TH: Fantastic! So these podcasts, I have series of five that are being released and you're part of it. They’re for DLD Awareness Day. I know you've been very active in the RADLD international efforts, and I wanted you to tell me a bit about what led you to advocate for DLD.

01:54 LA: Yeah, so, I think, I've been aware of the lack of consistency around identifying kids with language disorder and what we call them. So it’s takes up a lot of the work that we do, and yet we still don't really have a suitable name for these kids or something that we agree on. So that was really motivating for me. The opportunity to work internationally seemed, and not only with researchers, but outside of the research community as well, that all seemed like a pretty great opportunity. And then it sort of has snowballed from there! [chuckle]

02:31 TH: Yes!

02:32 LA: So, I got more like... Yeah, okay I'll do that. And I'll do that. Yeah, okay I'll do that too. And then, here I am, doing a lot. But anyways, it began there.

02:38 TH: Wow. And so this new, I guess, I was a little surprised when I talked to Carla and Sean. I guess surprised, more just reflecting on the fact that we haven't really been active in DLD awareness that long. This was really only the second DLD awareness day, even though there was the rally in 2017. It really shocked me because, I, like you, think, "Wow, we're doing a lot right now and it's really snowballing.” It's a great feeling. And I was wondering, how did you get involved in RADLD?

03:12 LA: Yeah so I was part of the CATALISE Consortium group. And so when that was coming out we were beginning to think about how to unroll that. And so I was watching the rally group, and I was moving into the we speechies Twitter space, and that was connecting me sort of more personally with all of those folks. As the original founding rally group moved to the International Committee, that’s when I became involved more heavily.

03:47 TH: That's great. What are you excited about with DLD Awareness Day coming up October 18th?

03:53 LA: So I think, if I can take a little side answer to that.

03:58 TH: Yes.

03:58 LA: I think what excites me about all of this is the conversations that I'm having with clinicians. That is a big part of what I'm doing in Canada, in ways that I've never talked to clinicians before, and I think that's super exciting. October 18th is gonna be a great day. We're already seeing story submissions coming in with our new theme of DLD You & Me, and I think that's hugely powerful about bringing DLD awareness to all kinds of sectors. I think that's the most exciting piece.

04:37 TH: What have you heard from clinicians as you're providing professional development interacting with them and clinical partnerships across Canada? What are you finding?

04:45 LA: I think, because I'm involved in the international committee, I get more aware of what are the issues in the different countries that I'm connected through. I think it's interesting to reflect on that. I think folks are in different places professionally about their practice around labeling, and they have different needs in terms of labeling. So, in Canada our educational system service or SLP Service in educational SLP is not really tied to the label like developmental language disorder. There's a few labels that matter for funding, for a service. But a whole lot of them wouldn't have a direct connection to funding. As a result, the practice of labeling hasn't been a big part of what educational speech language pathologists feels is a part of their service. So now it's a whole lot of conversations about why it's important. There's nobody creating service for kids who don't exist, right?

06:01 LA: Maybe we don't have services for kids with DLD, but if we don't have kids with DLD, then nobody's saying, "Hey here's a great service. Could you find some kids for it." So we have to start identifying those kids, so that they can have their outcry about the fact that they need services. So that really has to come to begin with us. With parents, they need some understanding of the child's disorder. They need sound bites, essentially. They need to know not in six-page reports necessarily, although that can certainly give them lots of detail, but they also need the sound bite of, "This is what my kid has, and this is how I'm gonna understand it." I think we need to move practice towards the use of a good label, more consistently. Even if it's not directly tied to you must use this label in order to get service. So that's the conversations that I'm having with clinicians in Canada, is why and how we go about implementing this in practice.

07:08 TH: Right, and thinking about the importance of a label, and why it might be beneficial to parents and children to have a label so they can get information. Then they can share that with others and their family and their community. Also, so children can become empowered by their individual differences and they can advocate for themselves.

07:31 TH: It seems to me, as someone who practiced too, and was really kind of uncertain, as a practicing clinician, about labeling. I felt very nervous about it, I could really empathize with the idea of, "Do I really wanna give this label? It's very weighty," you think, "Oh, there's label stigma." But I have to say that my experience working in the community of children with dyslexia has changed my mind. I’ve seen such a benefit in that community, talking to parents and saying to them, "Your child looks to have dyslexia. This is the profile." and then they say, "Oh, I've heard of that," or... And then I can send them to all these resources, International Dyslexia Association, there's a community for them, and I've seen that become very powerful, and so it's made me change my view about labeling. To think about the benefits of DLD as well for the people who have DLD in their families, I think it's just so critical. I also see... I don't know if you see this too, but I just see when I work with these families, mainly through my research practice now. I see that there's just a lot of shame associated with having problems in language.

08:41 TH: It permeates all aspects of our life. So having this deep shame about, "What did I do to make my child," Some kind of feeling of blame, like, "Did I do something wrong with my child? Did I not talk to him enough? Did I not read to him enough?" Or even just thinking about fear of what's gonna happen long-term. I personally see that label as being so critical, and I'm so glad you're having those conversations, Lisa.

09:08 LA: Yeah. And I think that's really an important piece. What I think is exciting is, I tell people this all the time, for the first time in my career, parents can go and Google, "Developmental Language Disorder," and find good information. Now is the time to be telling them, and now is a new time to be telling them, and that's very exciting. They have then the right to know that this would be the thing that they could go and learn about and advocate for. So I think that's important, to provide them with that information. If we have a medical problem, the first thing we do is go and search online on it. They need something to put in the Google search engine, and they should have that, and it should be clear. When they come home from a long meeting with us about assessment results, they should be able to tell their relatives, in one sentence, "This is what the person said." Because they won't be able to remember all the rest that you've told them. So I think sharing that label is really important for their sakes. I get that especially when it's a professional change, then it's challenging for the professional to know exactly what to do.

10:32 LA: I get a lot of questions, because people want the equation that their child will do this, this, and this. And that will equal giving the DLD label. It's important conversations, and I think we should have them. Unfortunately, I don't think the answer's gonna be quite as simple as that. But I think the more that we have those kinds of conversations, the more our practice will begin to align, and that's a really great thing.

11:01 TH: Yeah, I agree. There's not really an equation, because it's so heterogeneous and population. But I always think it's that old saying of like, "If it walks like a duck, talks like a duck, you know it is.” Because you see a constellation of features that say, "Yeah, looks like this child has language disorder." I know one of the biggest criteria is having language skills below what would be expected for their age. But as we know, based on psychometrics of different assessments, that cut-point can differ across assessments and across ages. That’s tricky. But it does seem like when I talk to clinicians, they do have a really strong understanding of, "This child seems to be presenting with Developmental Language Disorder," not just from the standardized test scores. They can tell with how they are producing and understanding language, and the amount of repetitions that it takes for them to learn language structures or vocabulary. It does seem like there's a fairly clear profile that comes forward, and the functional outcomes associated with DLD, even though there's more work to be done in that area.

12:13 LA: Yeah, I agree. I think clinicians, there'll be ones that seem, I think, clear cut. They’ll say, "This is a profile of DLD, this kid has DLD.” Then there might be others that it takes time to do assessment over some time, or consider what else is going on. And I think clinicians should feel comfortable with that because that's all a part of practice. They shouldn't feel under the gun to provide or make a diagnostic decision that they're not comfortable making. If they need to collect more information, that's all fine. But I think the mindset of moving towards providing a label as being an important part of assessment will help them to begin practice in this area. I think that's really important. I wanted to go back to your comments about the parents; I think the the challenge of sharing this information is important to consider. You have a podcast on crucial conversations, which I felt was really relevant to this idea. But I do think that as challenging as that first kind of conversation is, it's the kind of information that can move parents towards focusing on health and advocacy. Right, it’s almost like they need an answer to their question first, "What is it about my kid?”

13:42 LA: Until they get that answer, it's harder for them to move towards things that can really help. So if we can get them that answer first, we can begin that shift towards help and advocacy and support and that sort of thing. So I think it's another important thing, an answer to the question we need to satisfy. It will and up enabling parents to move past that question.

14:04 TH: Yeah, I think that makes a lot of sense. Then I love how this year, the RADLD campaign is really about bringing forward the stories of the individuals. Because to me, that's also so critical, when you have a parent and you say your child has DLD. You send them for information, but they're also looking for that personal connection. Is there another parent that has a child with DLD? What's it look like over time? Finding a parent who has a child with DLD who's in college or who is in high school. What does it look like across time? All these stories I think are so, so critical. Or meeting an adult who has DLD, and having them share their experience is really powerful.

14:43 LA: Oh, I think it's hugely valuable seeing all those services connecting with someone who has something that's kind of like what you have. It's going to be really important, and it's going to inform all of us, because we have fewer services and research into these older kids and adults. So we all need to see what this looks like in all sorts of different presentations. So it's a very exciting time! A while ago, I was at a meeting where we spent the first half of it talking about we need parents to be advocating for services. Then the second part saying, "Well we're not sure about using this label." How can parents be advocates, if they don't have anything to advocate for? So if we want them to be better advocates, then we need to be saying "Your kid has DLD, you have DLD.” Then we can have more synergy happen. There's groups will come together, and support each other and begin to be active. But that can't begin until people know what they have. So that's an important part of our practice, is answering those questions.

16:02 TH: I was thinking, too, about the debate between what to call DLD. It's been called so many different things. Dorothy discussed her paper that she wrote where she uncovered all of the different terms that had been used and how tricky that is for advocating, but I also think it's important for everyone to keep in mind. I remind myself of this, that it's pretty normal within lots of different disorders that are out there that there's this debate. Again, I'll use Dyslexia as an example because I'm most familiar with it. There's a book called 'The Dyslexia Debate' within the international Dyslexia Association a journal called 'Perspectives'. There was a whole issue on "Should we called this Dyslexia still? What should it be called? Should we call it a reading disorder?" So I do think that labels and picking the most descriptive and accurate label is something that is a struggle across many, many, many differences that we see in people. So that's, I think is a natural evolution.

17:04 LA: Mm-hmm. I absolutely agree with that. My observation is that the folks who are asking, ”Which label should we have?" They tend to be the sort of in-group right there. The crowd that are providing research, or maybe service in this area. But when we say, "Okay, we're gonna go ahead with this label." Now, we’re focusing on engaging people beyond the people who need to hear about it. That's something I can really put my energy into because I'm not sure we'll ever come to a final label agreement. We could keep arguing which label for forever. We often say, "Okay well, let's call it something arbitrary.” I'd be fine with that, but then it doesn't seem like people are really fine with any label we pick. I think that's what's impressive about the RADLD campaign though, is that we built enough of a consensus. We have enough resources to now be able to focus outwards. I think that's energy I'm really happy to spend. I think that we can really have an impact there.

18:17 LA: It might not be the perfect label. It might not take away the need to attach any other labels as you've described in some of your DLD and me articles about the other labels, that these kids might have. But what’s important is it can be a powerful label for us to talk about the picture of the language disorder.

18:42 TH: And it does create these awareness type of days. So they have the label everyone's rallying around it. Before I forget, because I'm afraid I will, I want to talk about something quite exciting happening October 18th in your neck of the woods to bring attention to DLD. So, what is that?

19:07 LA: Well, we are having a number of light up events! I should say that this wasn't my brainchild, I only am sharing in the glory because of the success we've had in Canada. So the idea that Sean had, he’s on the International DLD committee with me, was that we could have these monuments light up and sort of raise awareness, which is pretty cool, right? So I said, "Well maybe in Canada we could try these couple. It was much earlier on in the process, he had a little bit of time and he really was instrumental in completing those applications. We got word that we'll have Niagra falls lit up for 15 minutes on October 18, at 10:00 PM, so that's very exciting! My hotel room is already booked in the falls which is about a couple of hours away from where I live. So that's a very exciting one. When I posted that out on Twitter and the Facebook group it just went crazy because everywhere in the world, people know about Niagara Falls. So that's really, really exciting for us in Canada. We've also have the CN Tower, which is another huge structure here. That will be lit up on the 19th, and we’ve also had success in Edmonton and a tower in Montreal as well. So that's all very exciting.

20:43 LA: Until Sean got it going, I don't think I would have really seen this is what we should do. But there is a real gathering around that, and I'm glad that we did it. We had to do it well in advance, all of those applications, and we were saying at that time, "Well, we don't want the focus to be on the light up events," but we now have a lot of those in place. I know some we still have our fingers crossed for. But now, we can really bring our focus onto the You and Me stories, which will really be a lovely addition. I think really help the folks who are submitting the stories to see the world around them, also being aware. It's very exciting.

21:23 TH: It really is exciting. I was thrilled when I got an email on Monday from Carla that listed just some of the monuments that are being lit up. I'm gonna just quickly read some of those for the listeners. So Victoria Bridge in Brisbane, Australia will be lit up. Purple and yellow are the colors of DLD Awareness. Some are being lit up purple and yellow, some just purple. The Sir Leo Hielscher Bridge in Brisbane, Australia is lit up purple. The Bolt Bridge in Melbourne, Australia, purple and yellow. The Rochdale Town Hall in the UK, purple. The Whitman Life Tower in Omaha, Nebraska in the US, purple and yellow. Niagara Falls, as you just mentioned, in the US and Canada... Hang on there, shared monument, purple and yellow. The Zakim Bridge here in Boston, very excited. That's going to also be lit up purple and yellow. The Bob Kerrey Pedestrian Bridge in Omaha, Nebraska, purple and yellow. The CN Tower as you mentioned. The Optus Stadium in Perth, Australia. Matagarup Bridge in Perth, Australia as well.

22:38 TH: I think it's really exciting to have these monuments lit up. And I assume there'll be so many pictures online showing these places, and possibly people gathering around them. We have a gathering of the lab and some visitors that are in town for our Zakim Bridge and we're very excited to get that out. We’ve been thinking a lot about the different activities we're gonna do. That's really cool, Lisa.

23:08 LA: It's really cool. And if there are any others, you can just email the RADLD email and we'll add those to our list. Yes.

23:15 TH: Yes. Remind me too, we've talked about... and I'll link it to the podcast website… But where are the videos that are occurring? People are submitting videos from their selves or parents having DLD, and their personal experiences. Where are those videos located?

23:29 LA: Yeah, they're going to be linked on to the RADLD website. There's written stories and videos. They'll be linked there.

23:40 TH: That's great. So I'll make sure I have that in the See Hear Speak podcast website, so it'll be quick to get there. I was telling Carla and Sean, when I spoke to them. We had a discussion like this about advocacy, and I said to them, and I'll say the same too. "Boy, it seems like you're doing so much. This must be our full-time job, right?" No! It’s just a little sliver of what you do full-time. You mentioned you study DLD, and work with clinicians, and teach courses. But I was wondering if you could tell us about your day job. What are some of those findings that you've been particularly struck by or have thought have, were particularly relevant to clinical practice?

24:26 LA: Okay, yeah. Thank you. What drove me to become a researcher was my own clinical practice. I was working with kids, maybe with DLD at the time, and I was looking at their response to intervention. I was bringing my linguistic approach, which was really where my training was grounded. These kids need past tenses, they need these grammatical structure sort of thing. And for some kids, they really got it. They'd give me the thumbs up, they’d follow the pattern. Other kids felt to me like they parachuted in every day, and there wasn't really a connection between what I did one day and what I did the next.

25:15 LA: So I felt it wasn't so much it with linguistic structures with them. It was more their ability to learn and remember what was going on. That got me interested in whether or not there was more of a working memory problem for those kids, versus a more core linguistic problem. That's what took me to do my PhD and find that answer. It turns out, that's more of a career [chuckle] question than a PhD question. But, that's been a focus of my research. Can we look at cognitive and linguistic measures of these kids who are struggling with learning language? And then, could that help us understand individual kids' profiles, and maybe perhaps the interventions that we would do with those kids?

26:04 TH: What did you find about working memory in children with DLD?

26:09 LA: Yeah. So we have found groups that demonstrate there's some separation of kids who look like they have more working memory issues than kids who look like they have more linguistic issues. I think there's been a couple of other related research initiatives that have sort of gone along with this separation idea. We've seen this couple of follow-up papers that are at least consistent with that. Maybe not using the same kinds of labels that I was using, but are consistent with that idea. So I think, it's a help at least in understanding the profiles that these kids have. I say to people all the time, there are lots of reasons that there are language differences with kids in schools. And they might all come to you, so we need to have a holistic perspective. We have to look at what might be going on with that kid, and what might be limiting their language abilities and their language performance, perhaps. So we can consider a wider perspective of factors that might be influencing that.

27:21 TH: I've been on a team called Profiles of Working Memory and Word Learning for Educational Research Power, and our work was really inspired by the work you've done over the years. One thing that struck us in that team, which involved Shelley Gray and Mary Alton, Nelson Cowan, is that when we give a wide range of working memory measures in multiple domains… Things like executive function, phonological loop, visual spatial sketchpad. We found when we did a latent profile analysis, it really shows the heterogeneity of children with DLD. We also looked at children with dyslexia, and we know there's a high overlap of those children. And it really struck me of this very ability but it also it made me think back to my clinical experience as well. I would notice the children that had more difficulty in the treatment sessions, like how you said, they parachute in.

28:18 TH: I used to think it's like every session was new. Every session felt new. It was like, "We're starting something. Do you remember what we did last time?" And there was really no memory of what was done. So, you're starting fresh every time, and that heterogeneity that we talk about clinically with children with DLD. I think that understanding more about their working memory profiles is so powerful to think about that heterogeneity. What do you think are some of the ways that we could use that information? If you know about the child's working memory, on top of knowing more about their linguistic skills, how could that inform treatment?

28:55 LA: Yeah so that is a pretty tough question. When we think about the findings with regards to working memory interventions that are coming out now. Does it suggest that is really a near transfer sort of skill, right? I think that reinforces the need for us to make sure that we're providing intervention on what skills kids need at the time. But I think within that, we can be teaching strategies and skills that support the working memory functioning within those skills that they are needing at the time. I think we can sort of combine those things. That sort of strategy use goes along with the self-advocating piece. You mentioned earlier where people can know what their best way of learning, and the strategies that they need. I think in that way, it can support our services and interventions.

29:55 TH: I've been a little worried about throwing the baby out with the bath water when it comes to their working memory findings. So those findings being that if you try to improve a person's working memory, you don't see that improvement spreading and generalizing to other areas that are maybe more functional. If you teach children to have better skills, on let's say an executive function task, it doesn't mean that they're gonna apply that "improvement" in the phonological skill to learning new words. But I do think that when I say throwing the baby out with the bath water, it seems like still having that knowledge when you're giving maybe more "traditional" language treatment that you could still use that knowledge. Like you said, use it to your advantage as a clinician to tweak the sessions a bit, knowing that maybe this child really has such an impaired phonological memory that is so difficult to remember sounds and sound sequences. And so, that would be taken into account whenever you're working with that child. Because every child is so individual.

31:01 LA: It's true. And I think there's lots of questions we could still be asking about working memory intervention. Some of the things that I worry about are most of the intervention has not focused on kids with identified working memory deficits. So, if kids have adequate working memory, and you improve their working memory, that's not maybe working memory resources that they need for learning. They're already learning well, anyway. I'm not sure that that necessarily is the answer to the question. The other problem is that if you have poor working memory. That means that for a long time, you've been learning using other mechanisms. Now, if I improve your working memory, that doesn't mean you're going to change your habitual way of learning. You'll go back. You'll keep on learning in the way you've become accustomed to learning.

31:54 LA: So if I've improved your working memory, then I need to take another step. I now need to help you begin to use those resources to learn, and change your habits. I think that's another piece that we're not really following up on in terms of our working memory intervention. So I agree. I think it's something we need to keep thinking about. I think we can do that within the context of the kinds of functional task and skills that kids need to be learning. They really then have a win-win situation, where they're learning what they need to learn but maybe in a more efficient way as well. And I think then, if we could create some space in considering working memory interventions, not slam door quite so hard. I find that, right now, [chuckle] the door is slammed so hard that you can barely mention the word, right. But that doesn't then allow for future research opportunities if that door is slammed that hard.

32:55 TH: I agree, Lisa. We're struggling with that as a team. Sometimes these ideas get perpetuated, not only just in the public awareness, but really strongly in the research awareness too. Because funding is so tight and difficult to get, if you're a reviewer and you see something. If you say, "Oh, I think that's already answered," that’s a slammed door, and it does make it more difficult. But I'm excited that you are still working on this. I think your points are well taken, and we continue to push this as well on our team to think more about the complexities of working memory and how that impacts language learning. I have to say, when I talk to clinicians, they are always saying "Yes, yes, yes, yes, I see this too, I see this too." That's really reinforcing for me to hear, that clinicians find this to be important, even though there are some findings that are kind of restricting our funding at this point.

32:42 LA: Yeah, absolutely.

33:53 TH: I've also really intrigued, Lisa, by some of your findings. Children can have working memory deficits, but don't look to be impaired in language or academic outcomes. Can you talk a little bit about that finding? I'm just curious.

34:08 LA: Yeah, I think that is interesting. Measuring working memory is a thing, and so we need to keep working and not waiting for your group's assessment.

[chuckle]

34:18 TH: We're working on it, we're working on it. We're very close to having our assessment available, yeah.

34:24 LA: I do think that it could be a severity issue. So, language is a very redundant kind of learning process. There are lots of different ways that you learn language information. You can see it, you can hear it, you can have gestures around it. It gets repeated in different ways. So it allows opportunities for different mechanisms, different pathways into learning. Some of Dorothy's original ideas was that it's when more than one of these kinds of pathways are impaired, there's sort of multiple inputs. That's when we get this really long persistent problem with language.

34:59 LA: And so, if you have a kind of mild working memory problem, perhaps that doesn't impair your language learning all that much. You have other opportunities for language learning. With those other options, you can kind of get around that working memory problem, you look okay. But if you have quite severely impaired working memory, well, that maybe then begins to have an impact. In those kids, we're probably gonna see some language involvement as well. And our data supports that, to a certain extent. It does allow for also being variable, and not falling really in line with everything. But overall, there seems to be this trend that it's the more severe working memory impairments, where we're seeing impacted language.

35:51 LA: There is this the problem with the limits of our language testing as well. Are the language tests that we're giving, not taxing weak working memory? Well then, those kids are probably going to perform okay. They’re going to look okay on language tests even if they have weak working memory. Whereas, if we give a language test that places higher demands on working memory, then we might see it differently. I think that those might be the some of the reasons that we're seeing those kinds of kids who have poor working memory but may not be seeing that in their language testing.

36:27 TH: That's really interesting. I'm making a connection right now with some findings from that power study. We took children who had dyslexia, with word reading difficulties, and they showed phonological memory deficits. We also ensured, though, that they had good language score. So, on a CELF, they were above, I think, 88 was our cut point. But most of them were around 100 on a CELF core language assessment. And on expressive vocabulary, they were in a nice range of what you would think would be typical. But then we asked them to learn new words, which is a learning task. This part gets to your point. What is really the language measure measuring? Because it's not really measuring learning.

37:12 TH: So we did this word learning task, and we revealed that these children did have deficits in word learning. We think they were more related to their phonological memory, and we showed that some of our analyses. But it's interesting to see that gap between initial, very early word learning, that is less accurate than they're typically developing peers. But it’s also so different than what you might expect from their language skills, which are typical. But if you think about what's involved in my first exposures to a word versus, "Okay, now I know the word". And like you said, these children could be using a lot of compensation mechanisms to learn the word well enough to do quite well on a language assessment. But there's that big gap between initial learning and language. I think that's really hitting home for me as you’re talking. Some of our findings relate to your interpretation of working memory deficits.

38:11 LA: Yeah, that's interesting. Once we get a network, a semantic network that's rich, then that network scaffolds our learning of new words. It becomes the active pathway for how we build new vocabulary, and working memory demands are lower. As opposed to brand new words, where we have a high need for working memory. We see this in our own learning. For example, if we have a really foreign word that's really unusual to our language, we can see that the phonological memory demands of that are really high.

38:54 LA: But all kinds of other things that we're doing, and saying, and remembering, are really well associated with the demands on our working memory being considerably lower. So, if we ask kids to use language skills that they're pretty good with, then they'll have all kinds of other opportunities to support the processing of those signals. It will also support their production of those signals. Whereas, unfamiliar things, now that becomes a real working memory demand.

39:29 TH: Yeah, that makes a lot of sense. We found too, that children in our study were actually improving in their spoken production if we wrote the word down and showed them. These kids could improve even though they had difficulty with word learning, through the phonological aspects of hearing it. So just seeing it paired with something written, it's like a very permanent type of way to scaffold something transient like speech. Then that transferred. So that makes a lot of sense for what you're saying of using multiple modalities and multiple pathways.

40:03 LA: Right. You can say that. That's multi-modality at its best, right? Is that you see it, you say it, you get some semantic contextualizations. I'm often struck by it's not in the semantic piece that we remember. The next day I can remember something about the word, but I still haven't got the phonological for it. Then a couple days after when I've reviewed it more and more, I've now got some of the phonemes. Maybe the beginning and ending, but the full phonological representation is still not laid down in my long-term memory. It takes more and more practice until I finally get to the point of having the full phonological representation in a way that I can accurately recall on a consistent basis.

40:42 LA: So you can almost watch these new words come into your lexicon, and see how that's mapping out with the systems and their power for retaining information. I often say, if you imagined your semantic network, if it's very rich, like a net, and you toss something in, it's gonna get caught there. But if your semantic network is very sparse so and you toss it in, it's gonna fall right through. So if it's well-connected, and when we have rich semantic networks we have that opportunity, then those things are gonna stick versus ones that are more sparsely connected. That's gonna take many more representations to get stabilized connections in that representation.

41:20 TH: Oh that makes a lot of sense. That's very cool. Well I'm looking at the time. I know we're starting to move to the end of our talk, and I want to ask you two final questions I ask every guest. The first one is, what are you working on now that you're most excited about?

41:37 LA: So here at Western ,we’re working on a practice-based research initiative which is very exciting. It goes along with this idea of implementation science. So we're looking at how adjoining with clinicians to help them address questions that they wanna ask about their practice. What I was finding is, for me to go into schools with my ideas and wanting to do a research project there it was always a whole lot of work. People were loosely connected to it. Then I talk about that, and have clinicians come up and say, "Well I'm doing this." They tell me some amazing project that they had going on in their school boards with a control group and an external group. Everybody was invested in it, and it was all very exciting. I said, "Okay, well, can I just join you?"

42:22 TH: Yes, absolutely.

42:24 LA: Those questions are the same kinds of questions that I have. So that's been really exciting to begin working directly with clinicians and their questions, and joining with their service provision. To address those questions and come up with answers to those questions has been a very exciting new program. We have this model that through practice-based research, we can look at creating practice or changing practice or capturing present practice. That’s how we answer those initial clinical questions. We've had some powerful results from that. So we've helped a group see that one part of their tool was really capturing change that they were looking at, and one another part of their tool wasn't. In that meeting we revised that tool, and they implemented it within two weeks.

43:18 TH: Oh wow.

43:09 LA: That was really why I'm doing this, sort of answer that question. So that's a new exciting piece that I'm working on.

43:30 TH: That's so exciting Lisa. I'm going to watch those results closely because I also have such a passion for implementation science. We had a podcast about it with one of my current postdoctoral fellows and a past student. And I really am excited too, to see what's happening across the world with implementation science and building these really close connections with clinicians. We’re starting to make it not this one-way street that seems like, unfortunately, has been for some time like research feeding practice. But we need to flip it and think about practice feeding research much more closely. That's really cool and exciting. I'm looking forward to reading about that as well. So my next question!

[overlapping conversation]

44:09 TH: Oh go ahead.

44:11 LA: I was gonna say that I find the projects that the questions are asking but they're grounded in an evidence base. So it's not like they're coming up with things that are out there. But they're interested in narrative retells and its power for talking about kindergarten, or phonological awareness. Those are questions that I think we can continue to ask in advance. So I think there's a meeting space there with those clinicians.

44:38 TH: I agree clinicians are just everything to me. I think what they do is so powerful. And as one I know but I was only a clinician for a couple of years. I think what clinicians are asked to pull off these days in terms of knowing the evidence and thinking about documentation, it's so much! These clinicians are just making such a huge difference. I love working with them. It's so inspirational and so enriching on so many levels. So that's really fantastic. My last question for you is, what is your favorite book from childhood or now?

45:15 LA: Can I only the answer with one?

45:15 TH: Yes, absolutely.

[laughter]

45:18 LA: So, I wasn't a big book worm when I was young, but I did love books that had a rhythm to them, like a verse kind of book. There was a book called The Big Tidy-Up that had a poetic rhyme and beautiful big pictures. There were lots of things happening so you could be looking for things, and I really enjoyed that. I have an old torn up copy that I was able to replace when my kids were younger, and read it to them. Then another poetry book that I share with my kids is Something Big Has Been Here.

45:57 TH: Oh, that's awesome.

45:58 LA: When I got to start reading, I remember one was called The Heidi to Read Aloud. You can still find its old versions on Amazon. It was written I think before I was fully fluent with reading. So because it was written in a to read aloud format, I had the skills to be able to read it. It was highly visual. I can still imagine them melting the cheese, and then Claire's rocking chair going over going over the cliff and then sliding in the hills. And so, that visualization was really great. My daughter used to do a dramatic re-enaction of it and because that was one of her big skills was drama. She assigned my husband to be the wheelchair.

46:48 TH: That's fantastic.

46:48 LA: That's the only part she could find for him was he could be the wheelchair. And just a little bit older there was a book called The Wicked Wicked Ladies in the Haunted House, and that was a lovely one, for, again, the visualization. But at the time, when I felt I could manage a book that had full on chapters and smaller writing and I felt more confident about my reading. I got that through the school book club, which made me feel more of a book worm than I felt.

47:20 TH: You were so empowered, right?

47:22 LA: Yeah, exactly.

47:23 TH: Now, were you born and raised in Canada?

47:26 LA: Yes!

47:26 TH: Okay. Are those Canadian authors then of these books?

47:30 LA: I'm not actually sure.

47:31 TH: Okay, I'll look it up and put it on the website. I always try to put everyone's favorite books and try to find them. So I think that would be fun. The listeners could check those out, too. Especially with the verse. Are you a music person?

47:45 LA: No, not particularly. Not particularly artistic in a talent at all!

47:50 TH: I'm with you. My hobby is podcasting. So you could say I don't have any other hobbies. Clearly, I also resonate with that. But I do love to read, and one of my favorite parts of the podcast is hearing about all these different childhood books. What I typically do is buy them if I can for my own children because it's just such another way to incorporate a lot of different literature. So thank you for those recommendations, and they sound really, really fun. Well thank you so much for chatting today. I'm excited to release this during DLD Awareness Week and thank you so much for chatting with me.

48:28 LA: Thanks for having me, Tiffany. It's been great to talk to you.

48:33 Tiffany Hogan: Check out www.seehearspeakpodcast.com for helpful resources associated with this podcast including, for example, the podcast transcript, research articles, & speakers bios. You can also sign up for email alerts on the website or subscribe to the podcast on apple podcasts or any other listening platform, so you will be the first to hear about new episodes.

Thank you for listening and good luck to you, making the world a better place by helping one child at a time.