The authors evaluated the ability of typically developing preschool children to acquire the phonemic awareness skill of first sound fluency (FSF) when trained through an explicit modeling treatment paradigm. Three preschool children participated in a single-case A-B-A research design in which the independent variable was shared book reading between professional and child with embedded modeling of first sounds in words and the dependent variable was the participants' ability to produce first sounds in words in response to the professional's auditory probes. A baseline phase included sessions without intervention. An intervention phase followed with sessions of explicit modeling of first sounds with hierarchal cueing and a follow-up phase. All three participants demonstrated immediate behavior change in an accelerating trend direction for FSF performance which was achieved after five sessions. However, the children's accuracy in producing first sounds in words was not maintained at levels expected for any of the participants. Suggestions are provided for how this strategy can be used and adapted by clinicians and educators to prepare preschool children for phonologically based emergent literacy skills needed to succeed in kindergarten.

Racially and ethnically minoritized (minoritized) autistic individuals face intersectional disparities in service access in the transition to adulthood. Our understanding of disparities is limited by systematic exclusion from research and inadequate approaches to characterizing services. To address these gaps and effect advocacy, this study (1) examined services received, unmet service needs, and barriers in minoritized autistic adolescents and adults and (2) determined if language, NVIQ, and autism traits predict services when deployed as binary or continuous variables. Academic and community partners tailored community-based participatory research (CBPR) to a local context. Participants ( = 73, ages 13-30) completed a behavioral assessment protocol. Participants and caregivers provided information on services received, unmet service needs, and barriers to services. Data were analyzed using descriptive and regression. Participants received multiple services yet had multiple unmet service needs and barriers. Effects of services differed by approach. Language impairment, but not language scores, predicted receiving more services. High levels of autism traits and autism trait scores predicted more unmet service needs. While the number of services and unmet service needs was similar to prior work, differences in individual service variables and effects support attention to heterogeneity. Findings support intersectional approaches to CBPR and autism research.

This research was designed to deepen the understanding of contributing factors to disparities in speech-language pathology (SLP) service delivery to children of diverse backgrounds with language and communication delays, as well as to initiate community connections. We sought to understand the perspectives and experiences of those who provide or oversee SLP services to children with communication disorders in early intervention settings in Washington State. Individual semistructured interviews were completed with six SLPs and three administrators across five organizations. The interviews were designed to understand both individual- and systems-level contributing factors to service delivery challenges. Interviews were analyzed using an iterative coding process with multiple rounds of coding and multiple coders. In addition to synthesizing participants' understandings of, and preparation for, culturally responsive practice, three overarching themes are presented: (1) assets of early intervention as a service delivery model, (2) the distance between families and the practitioners and systems that serve them, and (3) compromised access and quality of services due to a predominantly monolingual-English system. Findings inform the next steps for building community partnerships with early intervention organizations. The long-term goal of this work is to collaboratively develop a participatory research program on equitable service delivery that addresses children's, families', and SLPs' needs.

Millions of individuals who have limited or no functional speech use augmentative and alternative communication (AAC) technology to participate in daily life and exercise the human right to communication. While advances in AAC technology lag significantly behind those in other technology sectors, mainstream technology innovations such as artificial intelligence (AI) present potential for the future of AAC. However, a new future of AAC will only be as effective as it is responsive to the needs and dreams of the people who rely upon it every day. AAC innovation must reflect an iterative, collaborative process with AAC users. To do this, we worked collaboratively with AAC users to complete participatory qualitative research about AAC innovation through AI. We interviewed 13 AAC users regarding (1) their current AAC engagement; (2) the barriers they experience in using AAC; (3) their dreams regarding future AAC development; and (4) reflections on potential AAC innovations. To analyze these data, a rapid research evaluation and appraisal was used. Within this article, the themes that emerged during interviews and their implications for future AAC development will be discussed. Strengths, barriers, and considerations for participatory design will also be described.

This clinical tutorial draws on a case study to demonstrate how researchers can design studies that access the voices of even the youngest children. The case study explored young children's perceptions of reading at a time when government policy directs that reading should be taught through a systematic synthetic phonics "first and fast" approach and assessed using the phonics screening check. This collective case study, set within a single primary school, used a range of tools designed within a listening framework, to explore the views of seven 5- to 6-year-old children. By reflecting carefully on the methodology used in this study, this article demonstrates how children can be skilled and insightful participants in research provided they are given activities that allow them to engage, respond, and communicate in ways appropriate for their age. This tutorial has implications for all those interested in conducting participatory research with young children.

Audrey Holland's core beliefs of respect for people and the quality of their lives informed her life's work. This examination of the ways she managed the academic, research, and clinical parts of her illustrious career shows how Audrey leaves a rich legacy and serves as a model for navigating an impactful career path and enhancing clinical interactions. First, she mentored more than 30 doctoral students who then mentored further generations of students, ran clinics, or shaped policy. She also regularly taught classes, supervised student clinicians, and traveled the world doing lectures and workshops. Second, her scholarship spanned more than 50 years and a range of subjects, such as assessment and treatment, self-determination and self-advocacy, pragmatics, counseling, coaching, and communication strategies. Third, her collaborations with many colleagues within the field and in related fields extended her impact even further. Finally, a close analysis of her clinical communication style shows how Audrey's simple, nonverbal behaviors (e.g., eye contact, body position) brought out the best in the people with whom she worked. On all these levels-mentorship, scholarship, collaboration, and communication style-Audrey's legacy leaves a vast array of powerful lessons that can be studied, emulated, and appreciated for years to come.

Audrey Holland (1982) compared test scores to observers' ratings of conversational communicative success in people with aphasia (PWA). This springboarded a body of evidence employing observers to rate discourse. We review the utility of those ratings for assessing PWA's communication success. A traditional literature review identified 16 articles involving naive or trained raters assessing PWAs' communicative success across discourse genres. Another 10 articles reported ratings over time. Collectively, these studies evaluated 349 PWAs. Four studies utilized observers to rate the success of PWA's conversations. Eight studies that reported observers' ratings on other discourse genres found that multimodal communication and facilitative contexts improved success, and ratings of informativeness and comfort related to objective discourse analysis measures. Nine of 10 studies examining treatment effects found that communicative success ratings captured improvements. Observers' ratings provide social validity by reliably assessing the discourse-level communicative success of PWA. Ratings correlated with standardized diagnostic and objective discourse metrics but provided a window into factors that affect communicative success, including the degree to which communication is interactive, multimodal, and contextual. Integrating observers' ratings of discourse success at pretreatment may help identify supports or barriers to successful communication, facilitate individualization of treatments, and offer social validity of change.

Aphasia negatively impacts mental health, disrupting social connections and meaningful life activities. Gratitude interventions for healthy adults positively impact well-being, physical health, and mental health. A systematic review of gratitude interventions for people living with chronic health conditions was conducted to identify current practices and existing gaps and to map the literature for incorporating gratitude interventions into aphasia rehabilitation. A scoping review of the literature published prior to March 2023 was conducted using CINAHL, Google Scholar, PubMed, and ERIC to identify gratitude interventions for adults with chronic health conditions. The search identified 414 studies. Five met the inclusion criteria. Interventions targeting chronic health conditions included alcohol use disorder, chronic heart failure, cancer, and asthma. No empirical studies were identified that used gratitude interventions with people who have aphasia or have had a stroke. Four studies used journaling as the intervention and one used gratitude letters. All interventions used written or verbal expressions of gratitude. Gratitude interventions have been used in limited ways with chronic health conditions. As gratitude interventions are language-based and rely on writing, people with aphasia may need modifications to support accessibility to these interventions which can positively impact mental health and well-being.

Professor Audrey Holland is best known for her extraordinary contributions to the field of aphasia rehabilitation; however, for those working in the field of cognitive-communication disorders (CCDs) following traumatic brain injury (TBI), Audrey made seminal contributions to the conceptualization of language disturbances following TBI, setting the scene for a new era of investigation and discovery. This article describes Audrey's contributions which redefined communication disorders following TBI as being different from aphasia, leading to discourse and everyday communication being the gold standard for CCD assessment. Incorporating Professor Holland's influences, this article describes the advances made during the past two decades including the theoretical development of frameworks to inform clinical assessment; expert consensus guidelines that support the assessment of the individual in activities relating to their family life, their friends, their work, and their relationships; the policy from an International Classification of Functioning, Disability and Health (ICF) perspective; advances in technology including the use of automated discourse measures; TBIBank; and main concept analysis. Professor Holland's profound impacts include the recognition that communication skills play a central role in maximizing all aspects of one's life.

Dr. Audrey Holland was a friend to people with aphasia and related disorders, care partners, community advocates, students, clinicians, educators, researchers, and more. Her profound impact extended across these diverse communities within aphasiology and speech-language pathology. Through her words and deeds, Audrey established a rich legacy that continues to guide and inspire countless individuals. A careful examination of her contributions reveals a roadmap for those seeking to embark on a similar journey of compassion and influence. To pay tribute to our mentor and friend, we conducted a thematic analysis of her solo works to identify enduring themes, laugh-out-loud anecdotes, and poignant insights to share with her friends, colleagues, mentees, and even strangers who, after reading this article, will be touched and changed by her wisdom.

This article acknowledges Audrey Holland's influence on aphasiology as it specifically relates to the emergence of a strengths-based perspective on the everyday communication of people with aphasia. We explore a historical perspective, as well as current ways in which everyday communicative events are approached in both clinical and research practice. The term "functional communication" is synonymous with Audrey's work, with linguistically-based discourse analysis and therapy both viewed as natural companions and extensions of the concept within aphasiology. Audrey's focus on the interactional side of communication and psychosocial impacts of aphasia, as well as her expertise in analysis and measurement, contributed to the coalescing of impairment-based and social communication approaches, encompassing a true sense of humanity and connectedness. Her application of these in international contexts was also noteworthy. In this article, we hope to capture principles of aphasia management that underpin current clinical practice, and also move beyond the traditional clinic context to consider aphasia groups that have had such a key role in promoting successful social communication by and with people with aphasia. We suggest future directions to further promote the principles advocated by Audrey Holland in assisting people with aphasia to move forward with confidence with their conversation partners, friends, and communities.

For half a century, Dr. Audrey Holland investigated, developed, and implemented ways to extend the assessment of adult language and cognitive-communication disorders beyond traditional impairment-based approaches. This article summarizes Dr. Holland's many groundbreaking contributions to assessment practices by describing and exemplifying major conceptual and measurement innovations that have emerged from her research of both formal and informal assessment techniques. Dr. Holland's assessment contributions encompass the development of many widely used measures of functional communication, discourse, and cognitive-communication abilities. She also contributed to the development of assessment principles that have become part of best-practice standards of care. Some of her most significant contributions include: Drawing attention to assessment within authentic functional contexts; highlighting connections between language, communication, related cognitive abilities, and broader aspects of health including quality of life; raising psychometric standards; and emphasizing the value of implementing multiple person-centered measurement techniques spanning formal and informal as well as quantitative and qualitative approaches. Dr. Holland's career-long commitment and contributions to developing more meaningful and authentic assessment practices have transformed our field and substantively elevated the quality of care and services that we are able to provide to all persons who are impacted by language and cognitive-communication disorders.

Throughout her career, Audrey Holland advocated for persons with aphasia, urging clinicians and others to view each person in the context of their needs and desires in navigating daily life. In this article, we acknowledge her ideas about functional treatment, and consider their influence on contemporary, activity-focused aphasia treatment. Three criteria define activity-focused treatment: (1) activity-specific goals, (2) personally relevant targets, and (3) near-real-life practice settings. Elements of treatment design, activities, and outcome measurement described here exemplify Audrey's beliefs in person-centered clinical aphasiology. Operationalizing treatment elements and designing a context as close to real life as possible are clinical actions that support these beliefs. Activity-focused treatment and other life participation approaches have often been relegated to the s of treatment; following Audrey's example, we advocate with activity-focused treatment based on a client's communication needs and desires. Activity-focused treatment benefits persons with aphasia, their families, clinicians, and other stakeholders by presenting outcomes that reflect communication change in a real-life context and that are individually relevant. Such outcomes foster an individual's inclusion in their communication environments, respect the WHO platform of functional treatment, and prepare a clinician to present outcome data relevant to that individual.

Audrey Holland was a leading innovator and speech-language pathologist (SLP) in adult neurological communication disabilities for over five decades. She was a pioneer in the involvement of SLPs with people with dementia, inspiring both knowledge development and clinical practice regarding language, functional communication, and quality of life in persons living with dementia. Dr. Holland was also an extraordinary mentor who has impacted many generations of researchers and clinicians. Here, four researchers in the area of dementia and communication discuss the lessons they learned from Dr. Holland that fundamentally shaped their careers and the field of dementia and speech-language pathology. Lessons learned include the following: (1) do not be afraid to stand out when you have a novel idea that will help people; (2) look for strengths to support functional communication; (3) use communication strategies to support identity, quality of life, and self-determination in adults with acquired communication disabilities, including those with dementia; (4) shift from pathologizing to coaching; and (5) challenge the status quo. This article concludes by discussing Dr. Holland's lasting legacy.

Individuals with Parkinson's disease (PD) exhibit a variety of impairments in nonmotor symptoms including emotional processing and cognitive control that have implications for speech production. The present study sought to investigate whether impairments in cognitive processing in individuals with PD impact emotional sentence production as indicated by changes in speech rate. Thirty-six individuals (20 individuals with PD, 16 healthy controls) completed subtests 8A and 8B of the Florida Emotional Expressive Battery (FEEB) to elicit speech samples in five different emotional tones (happy, sad, angry, fear, and neutral). Sentences contained either semantically emotional or neutral information, resulting in conditions of congruency (same semantics-tone) and incongruency (different semantics-tone). Speech rate was impacted by the emotional tone of all participants. Individuals with PD demonstrated faster speech rates under conditions of conflicting semantic information than healthy older adults. Changes in speech rate under emotional conditions were not influenced by global measures of cognition or depression. The results of this study indicate that individuals with PD struggle to manage irrelevant information present during emotional speech production. Speech rate is a simple, easy-to-measure metric that may reflect cognitive processing impairments in PD.

Interprofessional practice (IPP) is thought to increase coordination of care and provide numerous benefits for clients and practitioners. While the importance of interprofessional education and practice has been emphasized in the literature and by numerous organizations including the World Health Organization, understanding what is working for practitioners is still elusive. Using the World Health Organization's framework regarding IPP and the Interprofessional Education Collaborative (IPEC) guidelines and competencies, this research attempted to identify what is working for practitioners when it comes to IPP and where opportunities for growth are still evident. The Collaborative Practice Assessment Tool was distributed to practitioners across disciplines, with a focus on speech-language pathologists and behavior analysts, and both qualitative and quantitative measures were analyzed to determine what reported IPP strategies are in use. Results indicated that practitioners are more similar than they are different when it comes to what is working with regard to the IPEC competencies (i.e., values/ethics for interprofessional practice, roles/responsibilities, interprofessional communication, and teams and teamwork) and where change is needed. Discussion and suggestions relevant to clinical practice were identified and a call for development of IPP training across and within disciplines based on IPEC competencies is recommended.

Researchers implemented a short-term cascading coaching model focusing on naturalistic developmental behavioral intervention with three participant triads. Triads consisted of a graduate student clinician, a minimally verbal child with autism spectrum disorder, and the child's parent. Coaching and intervention occurred during an interprofessional summer clinic that included graduate student clinicians from special education and speech and hearing sciences departments. The efficacy of short-term instruction, researcher coaching for student clinicians, and student clinician coaching of parents was evaluated using a multiple baseline across participants' design. The dependent variables were student clinician's and parent's use of elicitation techniques (creating communication temptations, waiting, and prompting) and response techniques (naturally reinforcing children's communication and providing spoken language models). Following coaching, parents and student clinicians from all triads increased their use of elicitation and response techniques, with very large effect sizes across all variables. Visual analysis findings suggest individualized differences and variability across triads. Implications for graduate education and parent coaching programs are discussed.

Speech-language pathologists and board-certified behavior analysts both provide important support services to children who are candidates for augmentative and alternative communication. Current assessment practices neglect critical socioecological factors that are necessary to inform communication-based interventions. By leveraging the unique knowledge, research, and expertise of both disciplines, an interprofessional approach to assessment may help realize individualized or precision interventions and personalized supports that address the unique communication needs of each person. The purpose of this article is to introduce a process-based approach to assessment called the "Applied Model of Interprofessional Collaboration-Assessment (AMIC-A)." The AMIC-A will be defined and detailed including the rationale for development, a description of the approach, and recommendations for implementation. A case study example is provided to illustrate implementation of the AMIC-A.