SeeHearSpeak Podcast

00:11 Tiffany Hogan: Welcome to See Hear Speak Podcast Episode 22. This is a special episode in which guest host Kelly Farquharson asks me questions to celebrate the 1-year anniversary of the podcast. I now have even more empathy of my wonderfully brave guests because being in the hot seat as a guest is a lot more nerve wracking then asking the questions. You may recognize Kelly’s name because she has been a guest on a few SeeHearSpeak episodes so check those out to hear more about her amazing work! And as always, 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. Speaking of those resources, I’m still working on getting many of them posted to the website, so thank you for your kind patience and stay tuned! And don’t forget, if you enjoy this podcast, please subscribe and leave a positive rating in apple podcast or wherever you are listening.

01:20 Kelly Farquharson: Welcome to a special episode of SeeHearSpeak Podcast. My name is Kelly Farquharson and I am your guest host this week. I'm really excited to be turning the tables on to our favorite podcast host, Dr. Tiffany Hogan. So welcome Tiffany.

01:36 Dr. Tiffany Hogan: Thank you.

01:38 KF: I'm gonna have you start this podcast episode by introducing yourself the way that you typically have your listeners introduce themselves. So, tell us a little bit about yourself.

01:46 TH: Okay, well, I'm Tiffany Hogan, and I'm definitely getting the feeling of how my guests might feel 'cause I'm quite nervous having the tables turned. My name is Tiffany Hogan, as I said. I am a professor at MGH Institute of Health Professions and I'm the director of the speech and language literacy lab here. And I study the relationship between oral and written language with a focus on those who struggle in those areas, so children who have speech sound disorders, dyslexia or developmental language disorder.

02:18 KF: Fantastic. And so this is a special episode. As your listeners may be aware, you have recently celebrated the one year anniversary of SeeHearSpeak Podcast and so this particular episode is to highlight some of the research that you've done. But we've also collected and solicited some questions from current and former students and postdocs as well as listeners who have signed up to receive the email alerts for your podcast. And so, I'm gonna start by... You've introduced yourself and I think most people who listen have heard you talk a little bit about your research and a little bit about maybe why you started the podcast and what has led to your interest in having these conversations about the developing child. But I'm hoping that you can really spend some time and I know this is awkward for you, but actually really spend some time talking about your research. So you are a full professor, you've had your PhD for about 14 years. You've been doing this research and training students and reaching out to communities for quite some time now, first in Arizona, then in Nebraska, now in Boston, Massachusetts. And your career is just one that we all aspire to be. So I'm hoping that you can spend some time talking a little bit about your research, so maybe where your initial interest started and then maybe where you think now your current focus is.

03:44 TH: Oh, thank you. This is a really cool opportunity to talk about that, so thank you. So when I... I was a practicing clinician for three years or so, before I started the PhD. And one thing that struck me as a practicing clinician is that we often... In the programs for getting your degree in speech language pathology, you take courses that really silo areas that children might have difficulties, so you take the course in speech sound disorder. You take a course in language disorders. If you're lucky, you took a course in literacy assessment and intervention, which I didn't have a course like that, but many places do now. And I think these courses and silos teach you and give you an opportunity to get a breadth and depth of these disorders. But when I became a practicing clinician what struck me the most is that these disorders often co-occur in children.

04:40 TH: So you have one child sitting in front of you who has all of these issues, and then you also have the developmental nature of it, so you have a child who you see in preschool and maybe you work on speech sound and some language and then they seem to be doing better and then you get a call back that they're struggling with literacy. So having that developmental picture as a clinician and then also seeing the child as a whole and thinking about what they bring to the table and their abilities and what the environment does and all of those interactions, got me interested to do some more research and learn more because I was just hitting a wall trying to answer some of the clinical questions I had. So then I started my PhD with Hugh Catts who happened to be down the road. I was in Kansas City and he was already, he was at the University of Kansas. And I started very interested in these phonological deficits that we see in children with dyslexia.

05:28 TH: So I was intrigued by the fact that you could have children with speech sound disorder, which presumably have this difficulty producing individual speech sounds and patterns of speech sounds, because they have a phonological deficit and then you have children with dyslexia who have this phonological deficit, that go on to have word reading problems. But children with dyslexia didn't always have speech sound disorders. And children with speech sound disorders didn't always have dyslexia. So, I wanted to think more deeply about the underlying mechanisms associated with phonological deficits and that's what I did for my dissertation work, and also, my initial R03 NIH grant. I looked at this idea of lexical restructuring.

06:06 TH: So, vocabulary words, as they enter the lexicon force you to an unconscious level, more deeply specify your phonological representation. So that brought in this idea of vocabulary simulation, how do you learn words and how that word learning and vocabulary simulation and knowledge could impact phonological deficits. And then in that work, I also thought more deeply about speech-sound-disorders and working with children who have speech sound disorders, and how their speech perception might give us insight into their future treatment response and also their literacy impairments. And that's where I had the great opportunity to work with you on speech sound disorder and also work with Katy Cabbage. Then you two are still just pushing that agenda, which is awesome.

06:54 TH: And then I also very early on in my discussions with Hugh, my mentor, we talked a lot about protective mechanism. So, why some children have risk for dyslexia, and go on to not have dyslexia and some go on to have severe dyslexia. So, and it wasn't always predicted by their phonological deficit as you thought it might be. So, there are many children. I was part of this longitudinal study where we found that there are many children who had phonological deficits but didn't go on to have dyslexia. So that's the flip side of this, is the protective mechanisms that might be involved in resilience, risk and resilience and those kinds of things.

07:34 TH: And mechanism is something that really drives a lot of the work I do, so trying to dig deeper and understand individual differences in the heterogeneity of the kids I saw clinically. And one of those mechanisms is working memory. So I've also studied working memory differences in children with dyslexia, developmental language disorder, and both of those co-occurring deficits, and that's work with Shelley Gray and Mary Alt, and we've created a working memory battery that's child-friendly, and we've had some really interesting results looking at how children with dyslexia have quite different working memory profiles.

08:10 KF: I know we had predicted that all the children we saw with dyslexia would have at least a quarter would have semi-phonology and we don't find that. They have widely different profiles of working memory, which I think explains a lot of the heterogeneity we see clinically, but it also pushes the work forward to try to think about, should we be thinking more about working memory profiles as opposed to just the impairment of dyslexia? Having dyslexia, that's a word-reading deficit, what can we get beyond that diagnosis by looking at working memory, and how could that inform our clinical practice in improving our interventions for children, especially those who are treatment resistors? And I've also looked at another work looking at language intervention and thinking about the processes, again, that predict development over time. Development's also been another theme in my work.

09:00 TH: I've had the good fortune of working on several longitudinal studies, which, by the way, are really hard to do, as Kelly will attest to, as she was a doctoral student when I was running one of them. But they take a lot of effort to keep the kids in the study and to make some tough decisions about how to get them seen, but getting that data is just so critical for us to help to understand how changes occur over time. And in particular, prediction, I think that's really important. So in the Language and Reading Research Consortium study called LARC, we looked at children as they progressed from pre-K to grade three and tested them every year, and then Shelley Gray, Kate Cain, and Mindy Bridges are following those kids now, they're in eighth grade. I know that because my own child was pre-K when we started that study, and now he's in eighth grade, so I always know how old those kids are in the LARC study.

09:51 KF: Yeah, yes, hard to believe it.

09:53 TH: Yeah, right? And so we've had a lot of really interesting results from that study looking at the language basis of reading comprehension over time, and one of the key findings actually harkens back to some of the work I did with Hugh on a different longitudinal study where we find that early-on word reading really predicts a child's ability to comprehend what they read, probably because the text is pretty easy, and if they can actually decode the words, they can understand it. And then later on, it's really more about language comprehension differences that predict reading comprehension abilities, and we've hypothesized it's not only because the text becomes harder, but you also can get to a certain point of word reading ability that is at a threshold, so you can read enough of the words to comprehend.

10:43 TH: So, it's less about the word reading differences and more about the language comprehension differences, and this has a lot of clinical implications for thinking about who will have problems in the future and focusing on both word-reading and language comprehension. And then recently I've been working on a new project looking at orthography and word learning and how to predict children with developmental language disorder who will go on to have dyslexia and who won't, but I'll talk about that later in the podcast, 'cause I know you're gonna ask me. I'm gonna reserve that for your question you're gonna ask me about my exciting new project, 'cause that's one of them. So, again, thank you for the opportunity to talk about this a bit and think about the work and where it's gone from the beginning of my career 'til now.

11:28 KF: Well, that's fascinating, and I'm sure that your listeners are gonna be really excited to hear a little bit more of those details about the projects that you've been involved in. And I'll just take the opportunity to make sure that your listeners also know that that body of work is published across, is it 80 different publications now, peer-reviewed publications? This work is funded by millions and millions of dollars from a variety of funders, so NIH, the National Institutes of Health, IES, the Institute of Education Sciences, and so this is work that is clinically relevant, that is rigorous from a research and methodological standpoint, but is also really impressive the way that you have disseminated this work through so many publications, so many collaborations, and really is exciting to see that a practicing speech-language pathologist who has a burning desire to answer questions in a deeper way and a different way can really go on to have the kind of career that you've had so far.

12:27 TH: Well, now you're making me blush, so I don't know.

12:31 KF: Also, then, along those lines, as I mentioned, you've gotten a lot of great questions here from a lot of my friends too, our academic family, so previous students and postdocs, and a lot of the questions did follow similar themes. And so instead of going through each one at a time, we have collapsed them across some of the more common questions that people had. And so thinking about those publications and all of the accomplishments that you have had so far in your career, one of the questions is, what is one of the top three things you're most proud of having been a part of professionally?

13:13 TH: Well, this was a really hard question. And so instead of saying one, I'm just gonna say the top three so I have just a little bit of leeway. One of the things I'm most proud of happened last year when I was asked to lead the first-ever ASHA Journal special issue Focus on Dyslexia. It was such an honor to do this, even though we've had a position statement from ASHA for many, many years now, almost two decades, showing that we have a strong role as speech pathologists in literacy. Being the first one to lead a special issue on dyslexia, a population of children and adults that I adore, was just such an honor, and so I loved doing that. So that's one of the first ones. And the second one I thought about really is just my students. It has been such an honor, and I'm just so proud of each and every one of them, and I've just enjoyed working with them, training them, but they train me as well.

14:16 TH: It's really bi-directional and to see how you and these students have excelled in the academy and found your individual path has been just a real gift and how you've held on to your individual passions and take in what you learned about being a scientist and a clinician and moving forward. And for the ASHA fellow recently, I know Kelly you were a big part of this, is that you got all of them together and that's something I'm not very good at. You asked about how many papers, I'm not really good at keeping track of some of those products, although I do have the CV and I try to keep it up to date, but I have never really stopped to count the students and postdocs I had worked with and it was 16 and I was shocked. So just to see them together and to think about where you've been, has just been such a blessing.

15:09 TH: And then the last thing I'll mention is this podcast. I really took a chance on it, it was very terrifying and I had to, I guess, walk the walk and I've always preached that you need to do uncomfortable things and this was super uncomfortable, so I took that chance and it's turned out to be really amazing, and I've loved it. So those are the three things I thought about, although I've just, in thinking about them, there's many more I could have mentioned.

15:41 KF: Oh, indeed. I'm sure there's tons you could have mentioned but I'm really excited that you were able to think about those things and it has been really special to see this podcast develop and to listen to all the episodes and to hear you talk to some people that I've maybe had the chance to know personally, but also a lot of people I got to meet through your connections with them, and so that's been a really, it's been a really fun way to get to know people, and I'm sure you've experienced the same thing. So, I'm excited that you asked me to guest host this week as well. I think, in addition, you mentioned the special issue on dyslexia and so, you do typically also link resources to your listeners, and so that will be something that will be linked for this episode, for any listeners who maybe haven't had the chance to look through that yet, we'll make sure that that's something they have access to. Okay, so, in moving forward, I love this question, I think this is one that you'll really have a fun time with and I think your listeners will enjoy. So if you had an audience of every speech language pathologist in the world, what would you want them to understand about reading and language?

16:53 TH: Okay, so for this one, I'm gonna answer two parts. So first, I'm gonna focus on more of a content that I would love everyone to understand, and then I'm gonna focus on the concept. So the content is that I would love for everyone to understand that there's these two big primary components involved in reading comprehension. There's a lot more than that, but there's this model that has the most support for models of reading called the simple view of reading, and it shows that children have to use their ability to read words and turn those written words into something spoken, and when I say spoken, it's either out loud or in their head and then they have to comprehend or understand that spoken language, whether it's read out loud or in their head. So these are the two primary components. And there's been such great progress in thinking about the word reading component, so with movements like Decoding Dyslexia, a focus on really strong classroom-based word reading instruction, that's been fantastic and I'd love to see that movement towards improving word reading instruction, I would love to see that same type of movement for language comprehension.

18:02 TH: So focus on it early and screening for children who have language comprehension problems and word reading problems. So those who have word reading problems, if they have extreme difficulties then they are gonna have dyslexia, so that would be a diagnosis. And if you have difficulties in language comprehension, that's really a characteristic of a child with developmental language disorder. This overlaps about 50%, so it's 50% of the children on average across studies, who have dyslexia, also have DLD or developmental language disorder and the vice-versa, 50% of DLD, children with DLD have dyslexia, so it does co-occur, but it also means it's not a full overlap. So there are some children who will only have problems in the language comprehension piece, they can read words and vice-versa, those who have problems with word reading, but can comprehend if the text is read out loud to them. So that's something that I wish that everyone could know because then it would create procedures and policies and practices in which both of those are screened early, both are addressed early and across the continuum.

19:07 TH: And then I think our job is to try to think more deeply about how do we simulate each of those in the best way, how do we individualize our treatment for each of these areas, how do we determine how much time to spend on each of them for all children, and for children who are struggling? So those are some of the really outstanding questions we need to address. The other is a concept as I mentioned. So that was more of the content, the concept, I wish everyone understood more and I didn't really understand it as a clinician myself, until I became a researcher, is this idea of the normal distribution, that everything is really on a continuum. So when we talk about a diagnosis of something, it's really where we've decided that's the low end of a normal distribution. So when I'm doing these longitudinal large-scale studies, people will say, "How many children in your sample have dyslexia for instance?" And that is a question that varies depending on where I decide to mark, "Okay, this is the place in which if you score below a certain point, you have dyslexia."

20:13 TH: So a good example is, if you're giving the test of word reading efficiency, it's a common test administered, it's a timed word reading and non-word reading test, and if someone says to me, "How many children in your sample have dyslexia?" If I decide, 'cause it's a normal distribution, it's just a distribution of scores. If I decide, well, the 10th percentile, that means that the children in the sample who had the 10th percentile or below have dyslexia. There is a child, several, that have 11th percentile, 12th percentile, 13, 14, 15 'cause it's on that continuum. So if I say 10th percentile, if it's normally distributed and we have a large enough population of children, it's about 10%. If I decide, well, 16th percentiles where I'm cutting, where I'm cutting the distribution, that means they're gonna be 16% of the children who have dyslexia. So this question of prevalence is a tricky one, because it really has to do with arbitrary cut points and the same for language. So, I think understanding this...

21:12 TH: This concept that there's a normal distribution of skills along a continuum, on all types of skills also helps me to think more about individual differences. So, I've been starting to use this visual of a mixer, like a mixing board, when... I think they still have them, but I think from my childhood where you would turn up the bass and the treble and all these different things. And so if you think about a mixing board with levers that go up and down, you could think about those as individual abilities of a person, a child, and you can think about their individual differences in word reading, language comprehension, executive functioning, ATHD characteristics, lots of things, speech sound production, and you could think about where they are on that scale and where they are on all those levers is gonna create basically a fingerprint of their cognitive linguistic profile and that's going to make that child unique.

22:12 TH: So, even if I say, two children have dyslexia, it's really their severity of dyslexia and their profiles in other areas that determine how you might best treat them and determine their individual profile. So, been thinking a lot about those individual differences and this idea of the normal curve. And that really has helped me to think about how science and practice interface, when I think about this normal distribution.

22:40 KF: Wow, that's fascinating, and I'm certain that all of your listeners are just gonna be excited to hear about that because I think it really is important that we're thinking about the science behind our decisions but then also this idea of individual differences is so important, and as you know a lot of my recent work has been trying to understand this idea of eligibility criteria, particularly in schools. And so, everything that you're saying is just really resonating with a lot of things that I have been thinking about, too, because I think we do ultimately need to have a way for clinicians to carry the science forward, and that's kind of where we tend to get tripped up as a field, because there isn't a great communication between all the information that you're talking about, with this overlap and prevalence and cut points.

23:22 KF: And I love the idea, your mixer board example and the idea of it being a fingerprint, I think is just so profound, because I think that really helps us understand how unique each of these kids are. It's really easy... It's really... I think in some ways we think of it as convenient to wanna try and put labels but arbitrary cut points as a hard and fast rule, and to put kids in boxes so that we can better understand them, but that's really ultimately not exactly how it works. And so I think this is a nice way of thinking about it and hopefully our science will continue to evolve so we can support kids and clinicians alike.

23:58 TH: I think this will really make... I think this concept will become more prevalent and understood as we move forward with risk models. So now, having... I think it's 42 states last time I checked, have laws for dyslexia. Some of them, most of them include screening for dyslexia, but screening is just a risk percentage, right? So it's just the percentage of risk that you have. So if you score low on a battery of assessments that determine risk for dyslexia, you should get basically a percentage like you're 80% chance of having dyslexia, 70%, 50%. But that's still gonna require practitioners, clinicians, educators, administrators, to decide at what percent risk do I intervene and how do I make those decisions. It's still gonna be a continuous distribution that we have to consider. It's not, yes risk, no risk. It's really on a continuum. And I think understanding that is going to help us make better decisions about assessment intervention.

25:00 KF: Absolutely, and I think one thing that you've done really well as a researcher among other things, is establish some of those relationships in your community. And I know how difficult that can be, to create those relationships to recruit students and children or adults or participants for your studies and to really come and get your voice out there. So I can envision that being maybe one of the obstacles you've faced in your research career but my next question really does have to do with the obstacles in general. So being a scientist is difficult. Being in the academy is difficult. Being a clinician is difficult, but I'm gonna ask you to reflect on maybe the biggest obstacle that you've experienced in your research career so far and how did you overcome that?

25:45 TH: So the biggest obstacle is, myself ultimately because it's that I wanna do too much. I'm very impatient and I wanna make progress now. I want the answer to research questions, I wanna believe the work I'm doing will help a child somewhere someday. I'd like it to happen now. So, I'm very impatient. The way I've really got around this as a scientist, is to realize that it just takes time, it takes time, and I would say we're moving mountains, it just takes time. But I felt this way as a clinician, too. I wanted to see the progress right away, but I realized with experience that with time you do see that progress. And so as a scientist, one way I've tried to get around this impatience is to work on really good teams, delegate, trust your collaborators, trust the process. I don't micromanage.

26:32 TH: When I work on a great team, you've multiplied the times, the things that you're doing and the impact you have because a team, it's really the whole is greater than some of the parts. So you can make a bigger impact, move the science forward as a team. And I love that process. And selfishly I just really like working with other scientists too, and clinicians and school administrators. So that team process is quite fantastic. I'm just really constantly asking myself if I'm the only one that can do a task I'm doing. If the answer's yes, I forge on and go for it, but if the answer is no, someone else could be doing this, then I give someone else the opportunity to do it and I ask for help. So I think that that's... What I've tried to understand is that time is the biggest obstacle but with patience and continued effort I've seen the work pay off, it just takes time.

27:25 KF: Yeah, so you're basically saying, "I come by it naturally."

27:27 TH: Yes, that's right.

27:29 KF: I feel that impatience myself quite a bit. Especially I think it's one of those things too, where the more you know, the more you know that you don't know.

27:36 TH: Yes, oh my gosh.

27:38 KF: That makes sense? And so you just... Once you start to learn more about all of these cognitive processes and then the extent to which they can be implemented in different clinical settings and different questions that you get from your listeners, your students and clinicians in the field I think open up the flood gates in ways of like, "Oh we can maybe work on that." or, "Let's see if we can put a study together, and examine that. And not just... " it creates a lot of irons in the fire, but you seem to manage it very well.

28:02 TH: Yeah, it's tricky. [laughter]

28:04 KF: Right. Easy for me to say. So then, if that's the case, so you do this very well, and you're an excellent researcher, but if you could do something else with your career, what would you want to be if you weren't a researcher?

28:18 TH: I would be a pre-school teacher. I love that age, and I just would love the opportunity to really get in there, and teach the early reading skills, and the comprehension skills seamlessly together. And those kids just say the cutest things. So my middle child is in pre-kindergarten and every time I go into his room, I just feel like, "Oh, I'm home." I just... I love that group. I think that what teachers do, managing a whole entire classroom, trying to personalize instruction, trying to manage so many things, I'm just in awe. As a clinician, I would manage some small groups, but I didn't manage a classroom, but I've had the opportunity, as a researcher, to work with so many teachers and even be a part of a large team that developed a classroom intervention. And I just still think that what teachers do on a daily basis in the classroom is just so amazing. And I think that would be really stimulating and just super fun. I would love it.

29:10 KF: Absolutely. And I think that would talk about opening up more cans of worms with respect to questions and new directions for your research. I think every time I hear kids say something that's really cute, or funny, or interesting, it does make me think, "Oh, I wonder, where did they learn the vocabulary word? Or why are they saying it that particular way?" So I think that really does fuel that... Your passion there in both directions. And so, to that end, do you ever miss clinical practice? You've talked a lot about being a clinician. Do you miss it?

29:40 TH: Well, I say that I don't miss clinical practice because I... It was too much to manage for me when I started as a... In a doctoral program. I did some private practice, but I really just want to throw my full self into the doctoral study, so I let go of those private clients. And I've really been working wholly in research for so long now and I think I just get... I think because my work involves clinical problems, I feel that I'm not super far away from clinical practice, in the sense that I get to talk to clinicians, I get to go into schools, and I feel like I have a sense of what's happening. But something interesting happened earlier this year, where I went into a school and I was... One of our assessors, I think wasn't well, or there was just a scheduling issue, and she was like, "Hey, Dr. Hogan, can you do this?" "Yes, I would love to." And I had been wanting to administer this dynamic decoding screener by Doug Petersen and Trina Spencer for a long time 'cause I've read about the research, and one of their articles was in the special issue so I said, "Yeah, I want to do this." So I went in for two whole days and I tested kindergarteners, mostly five-year-old’s, and it took about 10 minutes per kid, and oh my goodness, it was so fun, it was like riding a bicycle. I just remembered all my old stupid jokes and they laughed, and it was pure joy.

31:00 TH: And so, at the end of it, I told my project manager, I'm not going back to the lab, I'm just gonna hang out here, this is where I'm missing so much. So, I think I might miss it more than I admit, but it's more of a time management issue. I just... I can't do it all. And so, I get to talk to clinicians, and get do these partnerships with schools, clinicians, and think about implementation science, so how what I'm doing fits into clinical practice and how it happens in the moment as I'm doing the studies. Most of the studies involved going into schools and working in that situation and thinking with teachers, administrators, educators SLPs, special educators, like how is this working now, how's it not, where are the barriers, facilitators. So really lucky to get to do that type of work. I love that type of work 'cause it keeps that integration of research and clinical practice for me.

31:52 KF: That's great. And I think it's also really interesting to hear the extent to which you're... Kind of this evolution of your access to working directly with kids and how that's changed over time, and how it's important to view the work that you do from whatever that position is. So if you're teaching clinicians, then you're reaching a broader group of children who may have some of these speech and language disorders. If you're disseminating research, then, hopefully, you're reaching clinicians nationwide or maybe even worldwide, and then influencing the children on their case load. So I think it's a really important viewpoint to maintain for researchers.

32:30 TH: I think that's great, Kelly. I will say that my priority is always the children. That's my first priority. So every decision I make, what I do as a researcher, as an instructor, I'm constantly thinking about the children, how this would, hopefully, impact them in a positive way. I was recently invited to present to a large group of teachers through the reading league, so I'm very excited.

32:52 KF: Oh. That's great yeah.

32:52 TH: I haven't even told you about that Kelly. I'm super excited about it. And they have such an impact. And I thought that when I was asked to do this, my first thought was, 'cause they said a lot of their presentations are seen by thousands of teachers, and I thought every teacher this year alone, will see 20 kids, so that's 20 kids affected by every teacher. I started to do the math and then I thought about the long-term effect and it just gave me great joy to think about how this could impact children, even though I don't get to see it every day, these kinds of opportunities are very helpful to think about the impact, and I'm very grateful.

33:29 KF: Wow, that really is just... I imagine it's humbling to just imagine the amount of teachers who may take that information and move it forward.

33:37 KF: And I take it so seriously because when I'm putting together slides, every word, I try to think very deeply about how this would be interpreted, how this really impacts what they're doing. Am I being clear? And then, I just talk to teachers and say, "Hey, how does this look?" And try to do a test audience too, because they're the best ones to tell me whether it makes sense to them or not. And it's really bi-directional. And that's the tricky part about presentations, they're not really bi-directional, you're just talking. So, I try to create some of that bi-directionality ahead of time so that I can get a sense of what that might be like for them hearing what I'm discussing, and how it matters to what they're doing every day.

34:17 KF: Yeah. So with those kinds of ideas in mind, and I think you've talked a little bit about working with doctoral students and postdocs, and I think another big part of your career, and your legacy, certainly, has been your mentorship, and the extent to which you engage, and preparing the next generation of researchers, myself included, thankfully. And so for people who are maybe considering getting a PhD or for current PhD students who are trying to think about how they might juggle that connection between the clinical world and the research world, do you have advice for that population of people?

34:55 TH: Yes, I think it's just different, across the different phases of your career, right? So in the beginning, I think about the career, it's just really about proving to yourself that you can do the work. Other people can see it in you. Most people, I would venture all people have champions they can turn to, mentors, people that say, "Hey you're doing a good job." and supporting them but you almost have to believe their vision before you see it yourself. So, it's really proving to yourself that you can get the work done, get it funded, write up the research paper and that you're trying to balance in that moment. How do you be yourself what you bring to the table, but how do you fit this kind of mold of what you think you should be doing, and I think this applies across not just being an academic, but even as a clinician like how do you bring yourself to that role and looking for models. I spend a lot of time looking for models and I think ultimately, that was a waste of my time, because I think you have to decide what works for you, and how you can best be yourself in the role and how you bring yourself to it, to the role.

35:56 TH: I think a lot about this example in psycho-linguistic work where they had children draw birds and children tend to draw a bird that doesn't exist, it has a lot of characteristics of all birds. It looks closely, it's probably the closest align to a Robin, what a Robin would look like, but that bird just doesn't exist. I think that's the case with trying to model yourself at each stage to someone that you admire, for instance, is that you're modeling yourself to something that just doesn't exist because that view, that model is just an amalgamation of all these different characteristics. So you have to find out what bird you are essentially and I think that's what you're doing, especially in the beginning of the career and I think that there's an old school view that you should establish yourself and you should do all the research and then you should try to disseminate to a broader audience. I really think that's outdated and I think that we have to find ways to reward and acknowledge dissemination to broader audiences. Early on in the career I think that reward has to come from your yearly evaluation. I think it has to come from your peers. I think it has to come from funding agencies that will acknowledge the broader impact in what you're doing.

37:12 TH: And I think it's also gonna require some training. I know I didn't. I wasn't trained how to disseminate to a broader audience, and that's not the same skill set that it takes to write a research paper to other scientists and write grants and so I think that it unfortunately does add another level of training for students that are already having to learn so much, but I also think it goes back to bringing yourself to the tasks. So not doing it, okay, I have to translate to a broader audience so I have to do a podcast 'cause that's what Tiffany did. And I think you have to find out what you like to do, what's good for you, and then how do you translate that to a broader audience and taking advantage of some of the connections you have for instance, locally, nationally, whatever connections and your skill set, what you feel comfortable with and everyone can work to translate and make an impact and be an advocate depending on their situation, what they bring to the table.

38:08 TH: For me, podcasting made a lot of sense because I like to talk, and I really like to listen to what other people are doing and ask them questions about the research. So, it was almost like, "Oh, this is what I do every day". So, it made a lot of sense, but if I didn't like those things and it wouldn't be a good match. And so, I think everyone can find what they can best do to learn to translate the research practice in their own way, at their own stage.

38:36 KF: Wow! That's fascinating, and I absolutely love that bird example because I think it's so true and I think it's also really helpful for those of us at a variety of stages, so I think you've got some people listening who maybe have thought about getting a PhD but have thought, oh, I don't know if that's something I could do. And I've been there. You've been there, and now you're a full professor, and obviously, well-established. And so I think it's nice to see that trajectory and to think about how it might, it can and should be different for each individual person and I love the idea of how to consider bringing yourself to the role, and I just think that's a really great way to think about that. And so again, your contributions to the field, this is coming from one of your listener questions, your contributions to the field have really been multi-faceted, and so I've mentioned your research program, your teaching, your advocacy, your mentorship, we've just talked a little bit about dissemination and how to best do that, and really there's just so many things that we could really be thinking about the ways that in which you've contributed to the field.

39:41 KF: But, and how you manage all of these things, like how do you decide, I know you've already kind of said that you're impatient with moving some projects forward and seeing the results, but how do you decide what to prioritize? And when you have such limited time, just as an average human would, how do you decide what to prioritize and how to invest your time in certain areas?

40:04 TH: I think this is such a tough question and I really thought a lot about it. I'd like to say I go with my gut but I think that's a bit of a cop out and it's just more complicated than that, and I think it really involves more balancing your own curiosity with where you see the field moving. So I think at any given time you could make so many different choices, but I try to think about all the choices I want to make in my research career, and then I think about what's happening in the context and what might make the biggest impact at that time. So, I think that one example for instance is I've been interested in screening for a very long time, but I do think that right now, with the movement towards these, with these dyslexia laws and it's really a great time right now to work on screening. So even though there's other things I could work on, that's something I wanna put my time and effort into because I think also the context and the environment supports it too. I think also, I think it's just acknowledging that you can't really multi-task.

41:04 TH: So the idea of multi-tasking is not valid, it's really just shifting attention and how quickly you can do that and also how focused you can be on the one task. And so, I try to just every day create priorities and instead of thinking about this has been a long transition in my process of thinking about this but instead of thinking about checking things off the list, I try to just think about timing, so I have my list of priorities, and then I just think I'm gonna do my very best job to be as focused as I can on what I'm doing at the moment, and I'm gonna work this number of hours and then once I'm done with the number of hours I'm not gonna chastise myself for not getting things done as I wanted, but I'm gonna reward myself to say, "You worked hard, you did the best you could" and then I put the glass down. So I know I've talked, Kelly, about this before, of like I love this analogy, and I love all analogies and metaphors, but I think that... And I like to speak in them.

401:58 TH: But if you have a glass, I think about this a lot, if you have a glass and you pick it up and you hold it for 30 minutes, it becomes very, very, very, very, very heavy and your arm hurts, but if you put it down for even just 10 seconds, pick it back up again, it's very light. And I think that's a lot of how our cognitive load is, if we just push through and work, work, work, work, work, we never set the glass down and we never have that refresher time. And so I just try to put the time in, take the time off when I need it, listen to my gut, if I'm feeling burned out, which definitely happens, then I have to stop for a bit and take some time and... But at the same time, there's some moments where I'm feeling so energetic and I just wanna work more and I do that too, so I try to have a little bit of flexibility there, but I'm also not always on time with everything. It's not uncommon for me to be a week or two late on things and I think I'm getting better at communicating that and thinking about how long it takes to do things. That's also a really hard task for me and I think for a lot of people, is how long is it gonna take to write a 10-page paper? I don't know, it's hard.

43:00 TH: So I think it's trying to figure that out and multitask and again it goes back to asking for help too, because I think that if you are doing things other people could do, that's not really the best use of your time, and giving other people opportunities is helpful. And then just setting realistic goals and being kind to yourself. I'm getting better over time with that, but it is a learned skill. It's not something automatic and patience, right? It's a virtue, so... [chuckle]

43:27 KF: Yes, yes, absolutely. And I've used the cup metaphor myself, obviously learned from you, and it is so important that we give our self some of that grace and really some space to have conversations about what is my priority, what does work for me? But what I love the most about what you said is really just this idea of being kind to yourself and rewarding yourself for the work that you have put in. And I'm a big to-do list checker offer, so, and it is hard to let go of that, when that's something that you're used to. And it is motivating for me to cross things off of a list, but it is also helpful to know that the work that I've done in the course of a day is contributing towards the greater good and is also moving something on the list forward, even if it's not something that you can fully check off. So, I think that kindness to ourselves is really, is completely underrated and very necessary.

44:17 TH: I also think that one of the worst things we do to ourselves, and it's just pure human nature is comparison, comparing ourselves to other people is the worst. And I love this quote, "Comparison is the thief of joy", 'cause it absolutely is. How many times have you done something great and then I don't know why, it's human nature to be like, "Oh, but I guess it wasn't as good as this person" or you... You just start automatically comparing, I don't know what that is but it happens and I just think it goes back to the model we're looking for and we're trying to think of anchors to know if we're doing well, we're constantly like, "Are we doing well enough, are we doing well enough, are we doing enough?" So we look to other people as a comparison to try to validate that and it's just really the worst thing you can do because no one is you and I do love this cartoon that shows two flowers, and it says something like, "Oh, I love your blooms. I wish, I bloomed." And it was like, "Well, we're different flowers silly. Basically you are gonna bloom at a different time. Everyone's doing their own path."

45:13 TH: So I think we have to also, I have to do this a lot too, you just have to practice that cognitive, just constant cognitive practice and mindfulness, of like don't compare, do the best you can, when someone else succeeds celebrate their successes, don't compare and automatically feel somehow bad about their successes, that's the opposite. Get joy from their successes, and then surround yourself with people who also have joy in your successes, 'cause if you're around people that are constantly comparing, that's not great either because then they're not celebrating you. So, I think it's choosing the right flock to hang with and also really working on yourself to just not compare yourself, I think that's really detrimental.

45:57 KF: Yeah, absolutely, and our shared friend, Julie Walter, she and I, one of the trainings we've been through has talked about surrounding yourself with nutritious people.

46:06 TH: Oh, I love that.

46:07 KF: And I learned about that in the ASHA Leadership Development Program, which is where I met Julie, and then subsequently met you and that sticks with me all the time. And it doesn't necessarily mean that you can just say, "Well, I'm not gonna be around that person because they're not nutritious", but it is something that you can just tell yourself, "I feel better, and I feel different when I make sure that I do spend time with nutritious people", and it's also been a mission of mine to make sure that I offer that space for people too, that I try to be a nutritious person. But as any of your listeners can see, this is, this is where I've gotten it from, is from you because you model this. And I remember as a doctoral student 10 years ago now, you talking about there's plenty of room at the table for everybody. And I was very interested in speech and sound disorders kind of out of the gate and worried about well, what if somebody has my idea before I do, and your response was always kind of like, "They might and that's okay, but it doesn't mean it's gonna be the same way you'd answer it and that there's different... There's room for everybody in this, in this sandbox of research."

47:10 TH: Yeah, that's right.

47:12 KF: And so, the last question before we move on to wrapping up is just kind of reflecting on what a momentous year this has been for you, professionally. So, you mentioned briefly receiving ASHA fellow this year and so one of the things I'm gonna ask you to link in the listener resources is what it actually means to be ASHA fellow. So, a link to the requirements of what it took to receive the nomination and to put the application packet together and to actually receive that award because it is a huge milestone, professionally. And so, that paired with this one-year anniversary now of the podcast, are there any specific moments from those particular milestones, or the culmination of what they mean for you, that you'd like to reflect on?

48:01 TH: This is a tricky question for me, because I do definitely think it's those little moments every day that you have, and just grabbing those little moments that really make up the big moments. And it was such an honor to get the ASHA Fellow. I definitely never started the career thinking, I'm gonna get an ASHA Fellow. I just started the career thinking, I just wanna do the best work I can to help kids and keep a job. That's really important as well.

[laughter]

48:28 TH: So, I can keep doing what I'm doing. And I definitely have this view of, keeping your eye on the ball. I used to play softball, and now my kids play baseball. And one of the things that I always think about is that, when you're teaching a child to hit the ball, they always look at the outfield. Like," I wanna hit a home run." And they look at the outfield. But actually, that's the big mistake. You have to look at the ball. And if you look at the ball, and keep your eye on the ball, you will hit the home run. And so to me, the ball is the children, and these little small moments that you have along the way. So I think that cumulation resulted in this ASHA Fellow which is a huge honor to me, but it's been through keeping my eye on the ball I think that it's happened, and I'm very grateful. But some of the moments... I will answer the questions.

[laughter]

49:20 TH: So some of the moments that I think about is, when I've gotten notice of a research grant. That has been really big moments, and they don't happen very often, so difficult to get research grants. And especially ones that focus in clinical practice, they're really tricky. And these have been huge, because every time I get a research grant, I just automatically think, "Cool, I get to actually do the work." And I can fund students, and I get to work with interesting people to solve these cool problems. So those are big moments for me. Other big moments that stand out are graduations, I'm a sucker for the graduations. And just seeing my students earn their PhD, and become doctor so and so, it fills me with absolute joy. But again, it's those little moments of just, when I talk to a parent, and provide them information that, gives them really for more information for their child.

50:10 TH: Or when I see a light bulb moment in my students eyes when I'm discussing a concept. Or they have a big idea, and it's like, "Yeah, that's awesome." Those are really cool and important to me. And another big moment truly, has been the success of this podcast. It has been the greatest surprise of my career, and I just love it so much. And I've been so grateful to the guests I've had. They donate their time and effort. And they talk with me, and they're honest, and I get to learn something right along with the listeners. And just the feedback I've gotten through the listeners has been so amazing, and just so humbling. And it's very cool, and the fact that it's worldwide has been just amazing. And so that's been a great moment too and a real honor.

51:00 KF: It has been incredible to watch the growth of the podcast, to just one short year. I'm very excited to see where it's gonna go next. And I'm sure that there are many more of these wonderful moments on their way, because you've got a new group of PhD students and postdocs. And for many more years to come, I know that you'll continue to contribute to our field in big ways. So for the sake of time, I'm gonna wrap up by asking you the two questions that you always end your episodes by asking your guests. And so the first one is, if you could tell us a little bit about what you're excited about right now, that you're currently working on? So I know you've got a lot of irons in the fire, but what's the most exciting thing for you right now?

51:45 TH: This is a tough one too, 'cause like you said, I do have a lot of things moving forward. But one of the things I'm most excited about, is this large National Institute of health grant that is funded to myself, collaborator Julie Walter, you mentioned of the University of Montana, and also collaborator Jessie Ricketts who's in London at Royal Holloway. And the cool part about this grant is that we get to answer some very interesting research questions. Many of these questions have plagued me for a long time, and I just have not had... It wasn't the right time. I haven't had the energy, and the time to make it a priority, and now it's come about. And Kelly, it's cool, right? Because you were... I say this research grant, which involves orthographic processing, so learning of letters and letter patterns. And this has been one that I've always tried to keep kindling. It's like a fire in the background, I'm trying to kindle along the way, as I'm doing other things. And you as a doctoral student saw some of that kindling that occurred.

52:44 KF: Yes.

52:44 TH: And were a big part of it, before it was funded. 'Cause there was a lot of barriers that had to be addressed before the grant could even go in. One of them being, how do we even determine based on a child database of what children are looking at in books? How do we determine the probability of letters co-occurring? And that took a lot of work to even get a database in process. So it took nearly 15 years really to get this work together. And Julie and I were doctoral students, when we first talked about this grant. And we weren't... We didn't get the grant 'til we were full professors. So just again, that patience and time. But in this grant it's particularly special to me, because we're working with a full school district. So we have a school district here we're working with. And to work at the district level with all of the teachers, and the administration, and that whole system has been amazing.

53:35 TH: And Julie's doing the same at the University of Montana with a full school system, so we feel very integrated, and we have such a committed team. And in this grant, we are going in training teachers, kindergarten teachers in particular to screen for dyslexia, and language impairment. And we're using some of the measures we've created that are group screeners. So, we test kids in a full classroom, so it takes about 20 minutes to test all of the children. And we wanted it to be efficient, 'cause we have so much to do. There's so much testing, and we wanna be as efficient as possible. So, we're testing all of these children, we just finished testing 3,000 kindergarteners for language comprehension ability to determine risks for Developmental Language Disorder. And now we're doing the follow-up testing to determine, how sensitive and specific the screener was. And then we're also getting ready to do some more screening for dyslexia in the spring, so coming up here in a couple of months with those districts.

54:30 TH: And then we're choosing kids that have Developmental Language Disorder to ask them to be in the experimental part of the study, where we created a computer-based word learning task. And then we are asking them to learn novel words that we present either only through auditory, so there's nothing written, or we present with the written form. And we're looking at, what's called orthographic facilitation, or the ability to recall the spoken form of the word more readily when it's been paired with the written form during learning. So asking, "What is this called?" And there's nothing written, and if you see it during the learning process, if you see the written form, you see how it's written out, then you're more likely to remember it. And our hypothesis is that children with Developmental Language Disorder who go on to have dyslexia are gonna show these initial deficits in orthographic learning, or remembering letters, and letter-sound sequences, compared to those with Developmental Language Disorder, who don't go on to dyslexia.

55:29 TH: And that's also been something that I've been fascinated with for a very long time, and that is that only about 50% of children with Developmental Language Disorder in kindergarten go on to have word reading problems. But initially they all have these phonological deficits, so for this group of children with Developmental Language Disorder, phonological impairments is not a good predictor of dyslexia, 'cause they all have these phonological impairments. And I have a new article coming out, I just did the page proofs last week and Journals Speech-Language-Hearing Research, JSHR that talks about this. It's determining risks for dyslexia, and children with DLD. And we confirm that the phonological skills are not the best predictor for this population of children. So our hypothesis is, it's more about letter-name knowledge, letter-sound knowledge, and orthographic learning.

56:16 TH: So it's been an exciting project. We're only in year two, so we'll see how it goes. And I'm excited to share those results, and to continue to really work towards this implementation science. Working with full school districts to think about their barriers, and facilitators as we move forward in how it can impact our practice right now.

56:36 KF: That's so exciting. And I think it's also really inspiring for someone at my stage in my career, pre-tenure faculty member, to just be thinking about how long it really takes to do some of these projects and some of this work. And I think the important part is that you never gave up on the idea of this orthographic processing study. And really looking at this from the level of a school district is just so fascinating. So I'm really glad that you get to do this work and importantly, that you're really able to model this perseverance for those of us who are just really kind of watching your career and admiring you from a far, or close up as the case.

[laughter]

57:21 KF: And so then, the second question I'll ask before we end for today is, what's your favorite children's book?

57:27 TH: So I said this in episode one. And I tried to think if there was a different answer, but it's the same one. I loved Nancy Drew books. I just loved them, I devoured all of them. And I used to just wanna solve a mystery. I know now as an adult that I was very lucky to have a uneventful childhood. It was a great childhood, nothing really happened, but at the time I thought was really boring.

[laughter]

57:50 TH: And so I always wished for a mystery, and I always wanted to solve a mystery. And I think that's the cool part about being a scientist, actually. I do feel like I am an investigator. I'm the Nancy Drew for literacy, and reading, and those things. Because I do think that I still haven't lost that desire to solve a mystery, and to think about all the clues, and how they come together. And so Nancy Drew, it's always gonna be Nancy Drew for me.

58:17 KF: I love that, and I love the connection that you just made to... It really is solving a puzzle, or solving a mystery, all the work that you've been doing. And so I look forward to hearing all the answers as you continue to publish all your work. And I've been really thankful for you to give me this opportunity to guest host today. And I've loved listening to all the episodes of SeeHearSpeak Podcast, I know your listeners have too. And so thank you for the work that you've been doing. I know one of your tag lines has been, Helping children... Changing the world one child at a time. And I hope that you've been able to reflect in the past year on how many children you've changed directly, and indirectly. Your work is just so inspiring, and so helpful. And thank you for creating this podcast as a platform to highlight that.

59:01 TH: Well, thank you so much. And I just wanna take the time at this one year anniversary to thank my listeners. My listeners inspire me, they really do. They're the ones with boots on the ground. And they really are changing the world one child at a time. So thank you, Kelly, for doing this.

59:20 KF: Thank you Tiffany. And thank you, listeners for having me.

59:28 TH: 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.