EPISODE 229

[INTRODUCTION]

[0:00:00] MD: The next on the list in our gratitude journal entry, this moment of gratitude goes to 
a review written by New York Peds SLP, so NY Peds SLP. This individual shared that this is their 
new go-to. ÒSo happy I found this podcast. There is such a wide variety of information and 
guests for the research-hungry pediatric SLP. Michelle and Erin are so joyful. You can tell how 
much they care about our field. I can't wait to see what else they have in store.Ó Thank you. 
Thank you for getting it. We all want to do better, but we don't have access to research as 
quickly as some of our colleagues, because enjoying a research article oftentimes requires us to 
pay for access, right? That's not in all of our budgets, but we still want to do the best that we 
can, and that's all-todayÕs guest. 

Today's guest is none other than Dr. Michelle Therrien from FSU. She is a researcher on 
building friendships for children and adults with disabilities that are AAC users. You all, this is 
like the missing link. It's the best of floor time meets AAC with a little bit of psychology and hope 
tossed in. It's how do we help our students and our patients build a meaningful play connection 
and they use AAC?

NYPs SLP, thank you for sharing our passion and research and joining us as we try to be that 
bridge in the research to practice and make research accessible for everybody. Also, on that 
note, you all go check out her lab on Facebook page. It's called AAC Connect Lab. Happy 
gratitude.

[0:02:12] MD: Hi, folks. Welcome to First Bite: Fed, Fun and Functional. A speech therapy 
podcast sponsored by SpeechTherapyPD.com. I am your host on this nerd venture, Michelle 
Dawson, MS, CCC-SLP, CLC, the All-Things PFDs SLP. I am a colleague in the trenches of 
home health, early intervention right there with you. I run my own private practice, Heartwood 
Speech Therapy here in Columbia, South Carolina. I guest lecture nationwide on best practices 
for early intervention for the medically complex graduates. First BiteÕs mission is short and 
sweet, to bring the light, hope, knowledge and joy to the pediatric clinician, parent, or advocate.

[0:02:32] EF: By way of a nerdy conversation, so there's plenty of laughter, too.

[0:02:36] MD: In this podcast, we cover everything from AAC to breastfeeding.

[0:02:41] EF: Ethics on how to run a private practice.

[0:02:44] MD: Pediatric dysphagia to clinical supervision.

[0:02:47] EF: All other topics in the world of pediatric speech pathology. Our goal is to bring 
evidence-based practice straight to you by interviewing subject matter experts.

[0:02:56] MD: To break down the communication barriers, so that we can access the knowledge 
of their fields.

[0:03:02] EF: Or, as a close friend says, ÒTo build the bridge.Ó

[0:03:05] MD: By bringing other professionals and experts in our field together, we hope to 
spark advocacy, joy and passion for continuing to grow and advance care for our little ones.

[0:03:16] EF: Every fourth episode, I join them. I'm Erin Forward, MSP, CCC-SLP, the Yankee 
by way of Rochester New York transplant who actually inspired this journey. I bring a different 
perspective, that of a new-ish clinician with experience in early intervention, pediatric acute care 
and non-profit pediatric outpatient settings.

[0:03:37] MD: Sit back, relax and watch out for all hearth growth and enjoy this geeky gig 
brought to you by SpeechTherapyPD.com.
com.

[INTERVIEW]

[0:04:19] MD: Okay, everybody. Today's guest, I am kind of geeking out on because I was 
incredibly socially awkward around the first time that we met. I couldn't believe she was sitting 
caddy corner, and I was like, ÒMichelle, play it cool. Michelle, play it cool.Ó Also, we're talking 
about social skills and relationships today, so of course, I geeked out with her. 

I have none other than Dr. Michelle Therrien, and I'm hoping to God I said your last name right? 
You all, she is the researcher with AAC Connect Lab. She's an assistant professor in the School 
of Communication Sciences and Disorders at Florida State University, and her lab focuses on 
building connections and making relationships like, building friendships, but from the 
perspective of individuals across the life continuum that have disabilities and use AAC. 

I mean, Erin's first or second love in the world of Speech Pathology is making connections. But 
how we do that for the little ones, and the big ones but we talk about the little ones here, that 
have an AAC device, and she was right there. We met at Ð I didnÕt even say where we met. I get 
so excited. We met at the ASHA Planning Committee, because she is one of the topic chairs for 
ASHA 2023 in Boston. Dr. Michelle, thank you for coming on. 

[0:05:41] MT: Thank you so much for having me. 

[0:05:43] MD: Yes. I hope I wasn't as awkward as I think that I was. Yay, social anxiety. 

[0:05:49] MT: ItÕs fine. IÕm right there with you.

[0:05:52] MD: Okay. I mean, we all have our little niche areas within the world of Speech-
Language Pathology. Can you talk about your journey as a Speech Pathologist and how you 
found this area as a researcher? Then how you became the topic chair, because you're the 
topic chair of autism, right? No, it's AAC. 

[0:06:15] MT: Yes, AAC. 

[0:06:17] MD: Yes. It was one of the A's. There were a lot of tables and name tags at the 
convention planning. Take us to the beginning. What made you want to do all of this? 

[0:06:25] MT: This is actually a hard question, because I'm not actually an SLP. That was not 
how I was trained. I went to college for the first time, and my major was English literature. I 
always said that my ideal job would be getting paid to read. Unfortunately, that's not actually a 
job. I had to figure out what I wanted to do with it. I was a teacher for a little while, middle school 
English. 

[0:06:55] MD: Oh, my God. 

[0:06:57] MT: I decided that was not what I wanted to do. I did love the children. However, I just, 
yeah, it was not for me. 

[0:07:03] MD: Okay, on that note, Mrs. Peterson, my seventh grade English teacher from Gayle 
Middle School, if you're listening. I am sorry, because seventh grade and 13-year-olds are hard. 
Mrs. Peterson deserves an award. Also, she was going through menopause, and I remember 
her having hot flashes and dripping sweat back in the day with like and just standing in front of 
seventh period, 13-year-olds like, they did not pay that woman enough. Also, wait, I do want to 
know, whoÕs your favorite author? 

[0:07:34] MT: I hate favorite questions, because I have such a hard time with them. I don't 
know. I used to say John Steinbeck, but I haven't read Steinbeck in a really, really long time. I 
pretty much like, I don't know. I read very broadly. I just like good stories. I don't even have 
particular genres that I go for. It's like Ð 

[0:07:58] MD: I'm on an Agatha Christie kick with Hercule Poirot. 

[0:08:02] MT: I think, yeah. 

[0:08:04] MD: Yeah. I'm like, the quirky little man with the mustache that always solves Ð it's like 
the OG murder mysteries from back in the day. Yes. Okay, continue. You decided that maybe 
teaching 13-year-old prepubescent children was not the right route. 

[0:08:18] MT: Not the right route, correct. I am married to a pediatric physical therapist. We, In 
our spare time when we weren't working, volunteered with an organization in St. Louis, Missouri 
called the Disabled Athletes Sports Association. Shout out to Kelly Behlmann, who founded that 
organization. My first experience with AAC ever, was one of the athletes used AAC. I was just 
what like, ÒWhat is this? This is so cool.Ó My first reaction, right, is, ÒThis is so cool.Ó Then as the 
years have passed, I've been like, ÒOh, but it's also so limiting. I want to figure this out.Ó Like 
both things are true. I floundered for a little while like, ÒHow am I going to do this? I'm not an 
SLP. I didn't study that. I don't know where to go from here.Ó I ended up getting a master's 
degree in computational linguistics. 

[0:09:14] MT: What? What is that? 

[0:09:16] MD: It's like the intersection of computer science and linguistics. It's a lot about how 
computers can understand human language and translate. It's like the translation between 
computer language and human language. People who have that degree work on things like 
speech recognition or AI things related to speech. It was fascinating. I did take some of the 
classes that SLPs take like phonetics and I learned about sound waves and all this stuff, but I 
never took it from the clinical angle. It was more this teaching computers how to do that angle. 

I thought that I would then work on design of systems. That turned out to not be where my heart 
lay, either. I was not happy only working with computers. I wanted to be with people. Again, a 
crisis of like, ÒWhat am I going to do with my life?Ó Then in the middle of the crisis, I took a job 
as a therapy aide at a pediatric clinic. I did some cutting out of things like sensory letters and 
laminating things for people, but in the process of doing that, I spent a lot of time with SLPs, 
OTs, PTs, psychologists like, the whole gamut of pediatric therapeutic services. 

I learned a lot from just observing. An amazing amount I feel like, like around people who do 
that can just teach you so much. As I was in that job, I recognized that there were many kids, it 
was a center that was particularly for kids with autism diagnoses. We had some other kids 
there, but generally that was the majority. I noticed a need for something besides just working 
on speech, which is what I mostly saw happening. Couldn't they have some other option to get 
what they want to say out? Keep working on speech, of course, but like, what about now? What 
about now when speech is so hard? Can we give them an option? I wrote a proposal to start an 
assistive technology program there. 

[0:11:37] MD: You just casually wrote a proposal. Oh, my God. I love you. That is like, I mean, 
in one breath, complain about a situation, recognize there is an issue in the next breath. Let's 
save the world. I love that. Okay, continue. Casually wrote a proposal. This was like?

[0:11:55] MT: I don't know what year. A little bit before 2010. It was when iPads were new and 
no one really knew that they could be a therapeutic tool. We called our assistive technology 
program, I Learn. We just like, brought in the iPads and brought in iPod touches, which I don't 
get anymore. Yeah, we just started doing it. I did a lot of self-study into research so that I was 
doing things that were soundly, grounded in science in some way. 

I don't remember how long I did that, but I remember getting to a point where I was like, ÒOkay, I 
don't know what to do anymore.Ó Like, the answers to my questions, I cannot find by searching 
the research. Again, on a little bit of a limb like the proposal writing, I applied to a doctoral 
program. 

[0:12:54] MD: Your husband must be of the same genre of mine. 

[0:12:59] MT: I had no sense of what it meant to get a PhD, really. It was more like I had 
questions and these people seemed like they probably could help me figure these questions 
out. Also, I don't know if I really want to do this, but if I get in, I'll deal with it then. I'll answer the 
question of if I really want this then. 

[0:13:23] MD: Where did you go for your PhD? 

[0:13:26] MT: I was lucky to get my PhD at Penn State on the AAC Leadership Project, which 
was a grant funded by the US Department of Ed. That project has been going, I don't know how 
long. I'm the worst person for remembering all these details, but it has been going since before I 
was there and it is still going today. You get to work with Janice Light and David McNaughton 
and Krista Wilkinson and Kathy Drager; people who have been studying this for a long time and 
who are really experts in the field. It was quite an experience. so that brought me here, I guess. 
I don't know if I answered your question, but I gave you a long answer. 

[0:14:14] MD: Everybody's walk is unique and it helps us know, like, I love learning about a 
speaker at the start of a course, right? What were their personal intimate experiences that made 
them fill this void that we didn't even know existed, but all of a sudden, you're like, ÒWow, that is 
a problem.Ó Right? ÒWow, we need to do better.Ó Then you just do. Write a grant, write a Ð I 
mean like, we just fix it. Yes. Okay. You went to FSU. Now did you go straight from Penn State 
to FSU? 

[0:14:47] MT: I did. I went straight from Penn State to FSU. I think now that I'm like, thinking 
back on our conversation, a part of your question was about how I started doing the friendship 
and the social interaction part. I think that's actually a good thing to talk about, because I'm 
working with doctoral students right now who are similar to me where theyÕre like, ÒI just think 
AAC is awesome.Ó Okay, but like, okay, we need to find a space for you. Like, what's your space 
within that? Because AAC seems like a small space and it's okay to just think, ÒI'm going to 
research AAC,Ó but there are really so many smaller spaces where you can really dig in and 
become an expert in a particular area. 

[0:15:30] MD: Caregiver coaching for routines based early intervention. Can I put that request 
out? Like, I need that. I need that, because you know what? Right now, I think I might literally be 
the only SLP in the Midlands of Columbia. You all, if you're listening and I'm wrong, shoot me a 
message and tell me. I'm the only one that's doing AAC and EI. I go to present and people look 
at me like I'm crazy. They're like, ÒAn 18-month-old can't do this.Ó I'm like, ÒDo you want to see 
the videos where they're telling me what I need to be doing?Ó 

I have this precious child that told me this week, and I was trying to understand from her thought 
process, she has a very robust vocabulary. She's level three lamp at 18 months and navigating 
this sucker like it's nothing. She goes over, tells me, ÒPlay.Ó Tells me, ÒChick.Ó Starts flapping and 
starts looking around. I'm like, ÒBaby girl, what do you want to play? Come on, mama, tell me. 
What do you want to play?Ó She's like flapping and goes back and play chick and then comes 
back to me with a worm. I'm like, ÒOkay.Ó It's a plastic worm, sorry. I should clarify. Oh, my God, 
the look on her face. It's a plastic worm. 

Mom. I'm sorry. Santa for Christmas got her this new game to help with her fine motor because 
we have some brachial plexus stuff going on from complications with delivery. You all, brachial 
plexus injury is an injury in the innervation of the shoulder and it's compromised her right 
shoulder down to Ð it almost looks like Torticollis, but it actually impedes how she holds that 
entire, essentially quadrant of her body. We've been working on like, range of motion, crossing 
midline like technically PT is, but like, we're interspersing the strategies. But like, she wanted to 
play the baby chick game where she feeds the worm and she wanted me to imitate her. Then 
she went to colors and she told me how to play. It was just like Ð I need more of that. Yes, 
please. Okay, continue. I'm sorry. I got excited. This was great communication. 

[0:17:29] MT: That's exciting to me, as well. This is what I have just been telling my doctoral 
students that what I was encouraged to do was to make a list of all the questions I had. Just 
like, make a list. I still have that list. I called it the, what I wonder list. Then we worked through 
prioritizing that and thinking about what really mattered. That's what led me down like prioritizing 
communication as a tool to build relationships with people. 

[0:17:55] MD: Do you do anything with the DIR Floortime there? Because I know they're in 
Florida. Stanley Greenspan's outfit. No?

[0:18:02] MT: No, I donÕt.

[0:18:03] MD: That would be a really good idea for one of your students and collaborate there. 
Okay. One day I want to go back and get a PhD. We'll just add that to the to-do list. In the 
meantime, we have to pay for archery lessons. Like, the 10-year-old. That's where our budget is 
for the Ð 

[0:18:21] MT: They got horseback riding, so similar. It's so Ð

[0:18:24] MD: Oh, itÕs so expensive to have extracurriculars. That's a budget, a line item in the 
pack Dawson of family line items. Okay. Then let's go. Let's hit the road. Okay. We've got a lot of 
ground to cover, but can we start with, you have this amazing research lab and it's called AAC 
Connect Lab. Why did you call it that? I love the history of why people call their labs these 
things. 

[0:18:47] MT: I chose that because I feel like one of my main aims is to support connection 
building, generally. Obviously, we just talked about friendship and social interaction and that's 
the primary connection I focus on. I don't think that happens in a vacuum. I think about the 
connections between SLPs and researchers. That's like another connection. That's really 
important in order to get our research into the hands of people who can use it and make a 
difference, right? The connection between teachers and parents, right, or SLPs and parents, 
right? Like all of these connections are going to impact the quality of life of the individual who 
uses AAC. That's why I named the lab, so that it would be encompassing of all of those different 
ways of building connections. 

[0:19:45] MD: I know everybody's lab is different. Is your lab doing intervention in therapy or are 
they generating research? What does it look like inside the lab? 

[0:19:55] MT: It's just a research lab. Not doing therapy, although our department, our School of 
Communication Science and Disorders at FSU is in the process of renovating a space, which 
we have not come up with a name for quite yet, but we're working on it, that simulates a really 
awesome preschool space. It is not a preschool, but it will have a big like, motor component, a 
sensory component, literacy component, like all of these really great things. Then we're hoping 
to work with the clinical educators in our department and the students in our department to bring 
programming to that space. I think that is going to be a really cool opportunity for us. 

[0:20:46] MD: When I was a clinic coordinator at Francis Marion University, our department 
chair, Dr. Frances Byrne, her focus area is actually early intervention, but not just within the 
wheelhouse of birth to three, but up to five. We had two preschool rooms embedded within our 
clinic and they were set up just like that. We had, I mean, down to like the flow of the room like 
you had your little kidney table or whatever it's called for tabletop activities, which we did great, 
that was great for the PFD component, like how we engage in pediatric feeding disorders within 
an early childhood sped classroom. 

It was so foundational for those children that in their transition process from IFSP to IEP and like 
accessing language, and like coaching parents through those, the routines of a classroom and 
making it language rich. It was phenomenal. Although my favorite part, honestly, was the little 
tricycles that we had and we would ride the tricycles through the labs. I mean, you all got on the 
tricycles and were like, getting it. We were communicating on our devices like, ÒWatch me. I'm 
going to beat you.Ó 

[0:22:01] MT: ThatÕs awesome.

[0:22:02] MD: My recommendation to FSU is buy tricycles Ð 

[0:22:11] MT: Brain break activity for everyone. 

[0:22:14] MD: Yeah. It really was. I was. We learn through play. That's how you make a deep 
connection. Love this. Okay. When we're going through here, how is this so vital for individuals 
with disability across the lifespan, that connection? What does that deep connection open for 
them as a human? 

[0:22:37] MT: Yeah. I mean, I think that's a hard question to answer, but it would be a hard 
question to answer for anyone, right? I mean, when I'm writing up the studies that I do related to 
friendship and social interaction, I always struggle because I have this idea of what an 
introduction should be, right? You start with X and then you move on to this and then it's Ð 
anyway. I always struggle, because the first thing I want to do is a section on why friendship is 
important. I always type and erase, and type and erase, and type and erase, because why is 
friendship important to all of us? Like it's a really hard argument. 

We all agree, right? I don't think anyone would disagree that friendship is an important part of 
our lives. Yet, being able to articulate why is like, I don't know why. It just is, right? We can say 
what the research says about that, but I don't feel like that captures really why it's important, 
right? Certainly, there's research out of psychology that says things like itÕs protective, right? 
Like you have better health outcomes. You have better mental health outcomes. Research out 
of education says that if you have good social relationships, your academics improve, right? 

These things are shown through the research and yet, I don't know. To me, it's not important to 
work on friendships so that academic skills improve. Although, I like to use that point to sell it to 
teachers and administrators, that friendship is something they should care about. But to me, 
friendship is enough of an end. Like it doesn't have to contribute to something else too. It's hard 
to argue why, but I just feel why. 

[0:24:23] MD: It's giving it the heart. There is nothing worse than being lonely. When you're 
lonely, everybody sit there for a second, when you're lonely, think about the time that you're 
lonely. You're vulnerable. You're at risk. You're insecure. It opens the gates for isolation and 
depression. All of us at one point in time in our lives have felt those feelings and our feelings are 
valid, right? Friendship offers the opportunity to spread joy and love and light. 

[0:24:57] MT: Right. So much of the research shows that people with disabilities in general have 
access to those experiences, I don't want to say in the same way as everyone else, because I 
don't think everyone else does it in the same way, first of all. And second of all, I don't think that 
like our goal is always to make it so that everybody experiences things in the same way. That's 
not really the goal. But if, like you said, people are telling you, ÒI feel lonely. I wish I had friends.Ó 
Then we have to listen, right? 

I think because communication plays such a large role in both developing and maintaining 
friendship, that people who use AAC are at somewhat of a disadvantage even if they're really 
good AAC communicators. Like even if we're talking about, ÒI can compose full sentences. I can 
meet most of my communication needs using AAC.Ó Even then, there are barriers to friendship 
that exist for them that don't exist for me, because I can use speech.

[0:26:10] MD: One thousand percent, yes. We have a trail that we hike as a family and it's a 
phenomenal trail. It's over in Casey. You all, if you ever come to Columbia or the Midlands part 
of South Carolina, it's the Casey Trail and the 12,000-year-old park. They found a Woolly 
Mammoth there, hence the 12,000-year-old park. Out of context that doesn't make sense. But 
the trail is designed for ADL accessibility. It's very flat. It's very wide. We passed an eye gaze 
user on the trail. 

My sons were like, ÒWow.Ó Like they're whispering. They're like, ÒMom, is that like the ones that 
you use?Ó He was an adult and wrapped and warm, because it was brisk outside. I was like, 
ÒYes, but mommy does things with little itty-bitty versions.Ó As a mom, there's that barrier of, ÒI 
want them to ask questions and do it in an uplifting positive way, but I don't want them to cause 
offense or hurt someone's feelings,Ó right? All the mommies in the room know exactly what I'm 
talking about, right? My husband has an older special needs brother. Our world is a little more 
open. 

[0:27:28] MT: Disability aware.

[0:27:30] MD: Yes. We have more disability awareness. We talked about it and they waved high 
and said hi. Then we went on about our business and we were in the process of shooting 
pterodactyls, so like we had grand Ð obviously, we had to go back to decimation of pterodactyls 
to protect Casey and the Woolly Mammoths. I digress. That's when I think of the barriers, 
especially for pediatrics, is there's a fear there, because it's different. How do we overcome that 
fear? You gave a beautiful answer. Also, I can see your heart in this like, oh, my God. Just so 
much love. Why is it important that SLPs think about friendships for their clients across ages 
and disabilities? I think of it as the next step like, how do we integrate this into our IEPs like, our 
IFS piece? 

[0:28:18] MT: I just wrote a paper on this. It is in Perspectives. So, check that out. 

[0:28:24] MD: What's the title of the paper? 

[0:28:26] MT: Oh, gosh. You are asking hard questions. I will have to look, but I can try to look 
fast while I'm talking. Let's see if I can multitask. I don't know if I can. 

[0:28:37] MD: That's totally fine. We can edit out the time it takes to look, but like, you all, this 
woman has published like a lot. That's why I was sitting there like, ÒOh, my God. It's that woman 
who I love, but I can't say her last name.Ó 

[0:28:51] MT: Well, good. It's a very Americanized version of a French name. As long as you 
don't think you know French, then you probably are going to say it right. 

[0:29:01] MD: We were talking this morning about Dawson. Goose said, ÒSometimes I think we 
should have gone with Lawson, but Bear would never have been able to say the L.Ó I'm like, ÒDo 
not pick on your brother.Ó He wanted the double L, because his first name is Ryland. I'm like, 
ÒOkay, I get that. That's fine.Ó 

[0:29:20] MT: Okay. The paper is called AAC and Friendships: Considerations for SLPs. It was 
in Perspectives. Yeah. I worked on that with some collaborators. If you search my name, you 
should be able to find it. We talked about the goal of SLPs developing a friendship mindset. It's 
hard to always have a research based specific intervention that you're going to do for everything 
that you want, right, for everything that you want to do as an SLP. Research is just not fast 
enough to keep up with that. We encourage this friendship mindset where if you're writing goals 
for an IEP, for example, that you think about, if friendship is my ultimate goal, I'm not going to 
write in the IEP like, ÒWe'll make one friend.Ó That is not super valuable, right?

[0:30:20] MD: Also, that's really sad. 

[0:30:25] MT: Yes. We donÕt want one friend. I'm not going to write that necessarily, because 
maybe, I don't have the support from the administration to target friendship if I write the word 
friendship. Or old SLPs who work with adults will say things like, ÒWell, insurance is not going to 
fund a friendship goal.Ó But if you think about the factors that contribute to making friends, then 
you can start to see, ÒOh, I could write a goal for that.Ó Right? Social communication is totally 
within our scope of practice, right? 

I could write a goal for social communication and not just social skills that we work on in this like 
isolation way, but like a goal that actually gets this child that I'm working with engaging with a 
peer in a natural way, in ways that kids interact with each other. If I can keep that in mind, then I 
can write a communication goal that has friendship in mind, right? I'm keeping this friendship 
mindset even while I'm writing a goal that focuses more on expressive language or receptive 
language or whatever. 

[0:31:38] MD: I'm trying to think of how to word that goal and what that would look like and 
that's tough. If you have suggestions here, I'm all open for suggestions. 

[0:31:50] MT: I do. In that paper, we created a table that goes by age. We have a preschool 
section in the table, an elementary section in the table, secondary, and adults. A sample goal 
that demonstrates a friendship mindset, although they're not written in good IEP language so of 
course, like we would have to take them and make them more specific and measurable and all 
of those good things. We were not trying to do that. We were giving a broad goal. 

Then some sample treatment activities, what kind of materials you might use, and then what 
aspect of friendship development that sample goal would address, right? For example, the 
preschool sample goal was: student will increase communicative participation within interactions 
with peers. Of course, you could write that in lots of different ways. The sample treatment 
activities and materials came directly from another one of my studies where, I will say, the 
outcomes of my study were not friendship, right? Because friendship is squishy. 

[0:32:58] MD: I just saw a card from Hallmark that says, Òwe've aged like good wine, but where 
did the box of chocolate go?Ó It was two 80-year-old biddies in a bikini and they had gotten 
squishy together.

[0:33:10] MT: Perfect. 

[0:33:13] MD: Sorry, that was a very Ð yes, Hallmark, man, they get me with their cards and 
their movies. Okay, continue. IÕm so sorry.

[0:33:21] MT: What I mean by that is that friendship is hard to measure and our attempts to do 
it, I think, miss the mark, right? If we just say, ÒWell, how many friends do you have? Let's just 
count them.Ó That's the way we measure friendship. Well, I mean, I think we could all say that 
discounts how important my one friend is. Like, that is not right. Okay, so then we try to Ð

[0:33:43] MD: That quality. I want quality. 

[0:33:46] MT: Yes. Yeah. Quality is not necessarily observable, although again, people have 
tried to do this. I just think we aren't there yet. I would like to work on that. Future research. IÕve 
got plenty of things in mind. In the studies that I did, I was measuring things like the number of 
symbolic communicative turns within the interaction, right? How many times did they 
communicate to each other, the two kids? 

Again, this is not friendship, but it is something that you won't have friendship without it, right? If 
you never communicate with a peer, it's going to be hard to make friends. It's that friendship 
mindset thing, right? If the goal is increasing communicative participation, this is the activity that 
we did. In my study, it was just looking at storybooks together, which is something that kids do in 
preschool classrooms. I was trying to make a natural context. 

Also, storybooks are really nice, because they give you a shared vocabulary. I would love to do 
more work outside of the storybook area with play and all other things, but storybook is very 
nice, because it is a structured activity where that vocabulary is going to be similar. We can find 
characters and topics that both kids are interested in like trucks or Dora the Explorer or 
whatever characters they're interested in. For me, the most important thing about the 
intervention study that I'm talking about that I have done is that the two children, one child who 
uses AAC and one child who doesn't, although I would argue that you could do it with two kids 
who use AAC, there's no reason that a child's friends have to be kids without disabilities. 

[0:35:40] MD: Beautiful world. IÕm good. Yes. 

[0:35:43] MT: But one important thing about that study is that the two children are taught 
communication skills together. It's not the child with a disability who has to fix their 
communication as much as it is that the two children have to learn how to communicate 
together. The peers, like you were saying with your kids walking on the path, they have to know 
things so that they can interact appropriately with someone. It's similar for these kids in 
preschool classrooms, right? If they've never interacted with a child with a disability before, then 
they are going to need to learn some communication and interaction skills in order to make that 
interaction successful. 

We work with both kids. We teach them that, it's kind of the way a conversation works around a 
book, is that you take turns. One person shows their friends something in the book and tells 
them something about it, and then that person needs to chill and wait and let the other person 
show something in the book. Those are the only skills we teach. It is preschool so we have to 
keep it pretty like preschool level, right? We're not teaching anything super complicated. It's 
show, tell, and wait. Those are like the key words. 

[0:37:09] MD: I don't know when that's ever fully learned, though, because I know some second 
graders that the weight piece, oof.  

[0:37:17] MT: For sure, and especially with the AAC that we're using as a part of the study. 
We're using an iPad, which is cool, and everyone wants to touch it. So what we've done is take 
the storybook and take pictures of the entire thing and turn it into basically a communication 
storybook. It is using visual scene display technology. They're not using traditional grid-based 
AAC within this interaction, but it's basically like an eBook that has communication built in. 

It doesn't read the book, because when three-year-olds sit together with each other looking at a 
book, they don't read it. They look at the pictures and they talk about it and they laugh about it, 
but they don't actually read it. Yeah. Exactly. It's pre-literacy. They're turning the pages. They're 
talking about what they see. That's what it's meant to do. They can touch different spots on the 
screen, and it might say Ð if the book is a little blue truck, it might say, ÒLook at the blue truck.Ó 
Or, ÒWhat's he doing?Ó Or any kind of normal communication thing that you might say when 
you're looking at a book. We try to make them really engaging and exciting for them to do 
together. That is one example going through the goal, the materials, and what you're working on 
in that. 

[0:38:42] MD: This is amazing. Okay. I'm just trying to troubleshoot how to replicate that in my 
head. Sorry, folks. I'm just thinking about how can we replicate that more and create peer 
interactions for the prior to three? Because once they turn three, normally our little ones that are 
AAC users or hearing stuff like, they get referred to early childhood special education 
classrooms, right? Like, we have that natural progression to there, but it's capturing them before 
that. 

Folks, if you have Ð do you want to hear a dream? I have a dream. Okay. This is very exciting. It 
makes me sit up. I want to create an interactive AAC circle time at a public library for toddlers, 
for the little ones, right? Like that to me would be a phenomenal activity. We have circle time. I 
cherished those memories as a mom of taking my kids to circle time. I mean, yes, was it difficult 
to schedule in my work life? Yes, but life is more than work. 

I have a dear friend who, we became friends because I treated her daughter. She didn't get to 
do those activities because of the fragility of her daughter. Now she has a typically developing 
second child and they've been able to do that. She's like, ÒI didn't know what I was missing. I 
want to create that.Ó If you're listening and you have the collaboration and opportunity to partner 
with your local library, and you're also an AAC fan like us, maybe let's spit ball this, write a grant, 
write a proposal and make it happen. Okay. 

[0:40:44] MT: Yeah. 

[0:40:44] MD: We speak it into the universe here. We can manifest. That's the word Erin uses. 
We're manifesting. Okay. 

[0:40:50] MT: I think that leads into something else that I'm working on. I'm going to keep going 
with the school stuff because I think a lot of kids make friends at school. It is like the primary 
place where they spend a lot of time with other kids. However, it is not the only place. I think 
what you just said for that younger set, right? Like the library, that's a community place where 
kids might interact with other kids. If it becomes a regular thing, then they might develop a 
friendship. 

I have sat and thought about that; where do kids play? Where do they play and interact with 
other friends? Another branch of my research tree, to use the analogy, is related to playgrounds 
and how kids who use AAC experience playgrounds. That's in its infancy. I don't have any 
answers. I actually get a lot of emails from SLPs when they hear that I do that, like, ÒWhat 
should I do? This is happening.Ó Or like, ÒMy school is doing this. Is that good?Ó I'm like, ÒWe 
don't know yet.Ó Research is so slow and we want it to be faster. 

I think playgrounds are a good space. In general, all community spaces are things I want to look 
at. Like a children's museum. How could we make a children's museum a place that supports 
communication and engagement for kids who use AAC? I think there's a lot of opportunities out 
there. 

[0:42:18] MD: There is, I'm trying to pull it up, something called The Good News by a guy 
named Tank. They had on here about a Ð oh, my gosh. I'm trying to find it. I told you all, I don't 
actually follow that many SLPs on my personal feed. I follow a lot of happy good news things on 
my personal feed in social media and circumference animals. There's a fabulous Instagram 
page called Round Boys. It's spherical animals that move and fall into fabulous things. One of 
them was a group of children that created a fundraiser to completely demolish their current 
playground to make an accessible playground for all. The children that were fundraising were 
like, ÒTwo of our friends couldn't play with us on the playground. That's not fair to them.Ó 

They did it for two peers that were in a wheelchair. One of them was an AAC user. I feel like as 
a society, we need to make a shift that all playgrounds should be accessible. Just period from 
the get go. I mean, long gone are the days of the hot metallic slides that we all probably 
sustained second degree burns on in the summertime, but like, yes. Okay, so when that 
research comes out Ð then I wonder how is language going to look different in an accessible 
playground versus an inaccessible playground? 

[0:43:39] MT: Absolutely. What does accessible mean when you're talking about language, 
right? I think, mostly we think about physical disabilities, so building things like ramps and 
different stations that are at different heights or whatever, like making things physically 
accessible, but that's not the only thing that should be a part of that accessibility definition. I've 
seen at least people who have looked into this for kids with autism. Our playgrounds need to 
have both spaces where someone can remove themselves from all the sensory stimuli or places 
where there is more sensory stimuli, like things they can touch or water features are sensory, 
right, is another area of accessibility to think about. 

I think communication is something that we don't really think about when we think about 
playgrounds, because my hypothesis would be that even if a playground is fully physically 
accessible to someone who uses AAC, that there would still be barriers to communication on 
that playground. If they can't communicate, then it's hard to engage other people in that play. 
They might be able to go down the slide, but they're doing it by themselves. 

[0:45:02] MD: Last summer, was it last summer? It might have been a year and a half ago. I 
had a young lady on who partnered with a local charity and they created AAC boards for her 
community playgrounds and like, that's phenomenal. There are preexisting AAC boards that you 
can order. I know, Talk To Me Technologies has vinyl ones. I don't know if they're latex free or 
not, especially within the paint. That can be a barrier for some children, because I've worked 
with plenty of kids that have latex allergies. They can't have certain types of foods, because they 
actually fall within the same family. 

They have pre existing boards that you can adhere to the chain link fence. We did that at a clinic 
that I worked at. We got those boards and put them in every single therapy room in the entire 
building. They had an outdoor playground, like an outdoor backyard, that was built, just like you 
described, for seekers and avoiders. We had an autistic volunteer, she's an adult, that actually 
studied visual arts. She hand-painted one. 

Working with her, collaborating with her on that thought process, changed my selection of 
vocabulary when we collaborated, because she could bring a neuro-diverse lens to the table to 
say, ÒWell, I would prefer this vocabulary because I feel da-da-da-da.Ó I'm like, ÒOkay. Yes.Ó 
Because we have to listen to their voices. Yes, continue. That's amazing. 

[0:46:34] MT: I feel like I see lots of those playground boards. I think it's an awesome first step. I 
also don't think it's really the solution. I mean, like I said, I think it's a start. We don't know what 
else to do, right, at this point, because people haven't studied this. I'm hopeful that we can find 
some things that are more in the moment where you don't have to leave the activity that you're 
doing to go to a board and talk, but we're not there yet. We're not there quite yet. 

[0:47:02] MD: What if there were placards spaced throughout, like miniature versions that were 
just like places where you naturally see a kid huddle? Like the top of the slide, or adjacent to the 
swings, or we have this one thing that makes me nauseous to this day, where you spin the 
wheel and it makes everybody spin. But I mean like, where a kid's hand would naturally go on a 
playground feels like to me - you're a genius. I love that idea. 

[0:47:30] MT: Yes. I really think that that's important. Then thinking about what words do kids 
actually use in all of these spaces?

[0:47:40] MD: ÒGet out of my way.Ó

[0:47:41] MT: That's another space for research, right? Like I want to know what kids are really 
saying in different places on the playground. Where do they actually play with other kids and 
where do they play by themselves? All of those things I think are ripe for research. Just haven't 
quite done it yet. 

[0:48:02] MD: Okay. If I can help in any way, shape or form, or if you want to get my kids to 
carry a microphone around when they're on a playground, let me know. This is awesome.

[0:48:12] MT: That is a plan, someday. 

[0:48:16] MD: Oh, my God. I'm slightly terrified as to what my Theodore would say with a 
microphone. 

[0:48:22] MT: You need lots of kids, so that we get averages instead of specific compilations. 
Yeah. 

[0:48:33] MD: Oh, my gosh. Okay. All right, so then how? What, as an SLP right now in the 
community, can I do to support friendship building, like creating the framework or the possibility 
for my AAC users? I know you're talking about the research being in its infancy, but what do I 
do? 

[0:48:56] MT: Yeah. I mean, I think keeping a depth Ð sorry. Now I'm mincing words. I think 
understanding what friendship really is and actually keeping that in your mind when you're trying 
to do peer stuff, if peer stuff is the thing you do, is really important. What I mean by that is not 
everybody has the exact same definition of what a friendship is, but if we look at the research on 
the whole, we see people, including people who use AAC, defining friendship in some similar 
ways. No one would define a single friendship that way, but if we think about generally the 
concept of friendship, we talk about, ÒWell, we both like each other.Ó That reciprocal liking is like 
technical terms, right? We both like each other. We would choose to hang out.

[0:50:02] MD: We have a shared interest that Ð 

[0:50:05] MT: Right. We have a shared interest. We have an equal status at some level. I feel 
like that's one of the hardest ones when we're talking about therapy, because I think that's the 
one that people forget. There are peer tutoring interventions where I teach a peer to help a child 
with a disability, which is great, right? We want people to have empathy and to provide support 
and help. 

Also, if that's your role, then you're probably not friends. You're something, right? But it's more 
like, you're a caregiver on some level, you're providing a service. It becomes less equal or less 
Ð I hate saying equal because I don't think that everyone has to contribute the same thing into a 
relationship for it to be friendship. I also don't want to say that helping is not a part of friendship, 
because it is, right? Like we all would say that our friends help us. 

I think, if the help is one way, then that sets up a certain dynamic. Something that is tricky is 
thinking about, whatÕs an authentic role that the child who uses AAC can have in whatever I'm 
setting up, right? I don't want to fake that they have some skill that they can bring, but 
legitimately, what can be their job in whatever activity I'm setting up so that they have a valued 
role in the relationship and are not just the person that is being helped? Yeah, that feels pretty 
important to me. 

When I look at the body of literature around how we're using peers, it is overwhelmingly as mini 
teachers or mini SLPs rather than as friends or peers or classmates. The hard part about that is 
that all of those studies show that they're effective, right? But then we have to think about what 
they're effective for. What's the outcome that we're measuring? Is that an outcome that leads to 
friendship or is it not? I don't think there's anything wrong with it if your outcome that you're 
choosing to work on is not friendship, right? Like not everyone has to do what I do. 

But if you're doing that, thinking that you are helping kids become friends, I think you're wrong. I 
think you're mistaken there; you're not actually helping kids become friends. You might be 
raising their awareness about how to support people with disabilities, right? You might be 
supporting communication and language development for that child with a disability, but I don't 
think you're supporting friendship, unless you're considering those things. 

[0:53:43] MD: Yeah. This triggers a thought. This is spot on. Sorry, there's four different 
thoughts going through my head. Okay, so we had Morgan Oates on in January about 
neurodiversity. She's getting her PhD at the Ohio State University with Alison Bean, right? She 
was talking about how when a neurodiverse peer talks to another neurodiverse peer, they have 
matched, what was it? It's not minimal pairs. God bless America. That's a phonological process. 
Give me two seconds. It is double empathy. That's the thought process, double empathy.

She talked about how one way they communicate with each other is information dumping. I was 
like, ÒOh, my God. That is my Goose.Ó My 10-year-old information dumps all historical facts, but 
that's how he creates friendships. Bless his little heart, he has found two buddies in class that 
also information dump historical facts. They just thrive in this little trio. Their friendship is based 
upon information dumping of facts. So I'm wondering, and this gets back to additional branches 
of like research, if that's how a neurodiverse child builds friendship is by info dumping at each 
other over a shared topic, but they thrive in this process, are we then looking at their unique 
fringe vocabulary to make sure that they have access to the French and Indian War? Which I 
didn't know was as pivotal a moment in American history as it apparently was.

Or as my Goose Bear or Boobare Dawson like origami and how you have to fold and create 
crisp lines. Then there's different types of paper. Then the papers influence the outcome of, is it 
to sit and be pretty, or is it functional origami, because you can make origami for a purpose 
aside from looking at? It's just very like Ð theyÕre our children. I love them. 

One day they're going to listen to these and be like, ÒMom, why did you talk about that?Ó I may 
or may not also information dump, but this is what I'm thinking, are we sitting back and looking 
at their unique vocab as it relates to how they could build friendships? That's cool. 

[0:56:40] MT: Right. I think about how systems could support that. It's tricky, right? Because the 
more vocabulary you have, the deeper the level, the more organization is needed, the more 
navigation is needed. It does become tricky, especially with the systems that we have. I keep 
going back to two things. One, the importance of literacy, right? In the space of like, if I really 
want to say anything that I can possibly think of in my head, being able to spell is going to make 
a world of difference. That's one. I do not do literacy work, but I have many lovely colleagues 
who do. Then Ð 

[0:57:29] MD: Kelly Farquharson. 

[0:57:32] MT: Then the other thing is visual scene displays and video visual scene displays, 
which I also have colleagues who are really working on that in the space of social conversations 
because they allow for more use of digital pictures. 

[0:57:52] MD: Wait. What are the words that you're talking about? 

[0:57:55] MT: A visual scene display. It is just a digital picture with communication hotspots. A 
video visual scene display is literally a video that pauses sometimes and you can touch different 
spaces to say different things. The two combined, I think, expand what we traditionally think of 
as AAC, and I think that's good. I don't think AAC needs to be one thing, and there are so many 
possibilities out there. I'm digressing a little bit, but in a conversation with a person with aphasia 
that I met at a speaking thing. His AAC system was the photos app on his phone, the calculator 
on his phone, right? He was able to communicate with me things that he couldn't say with 
spoken words, because of those two apps, and that's AAC. 

I like to expand what we think of as AAC, but visual scene displays as one component of how 
we communicate can be so powerful in social interactions because we are used to sharing 
pictures with friends and videos with friends. I think we do as a society now. I think probably 
always, but now it's so easy to take videos, right? We don't have those huge home video 
cameras. We can do everything with a teeny little phone, and really all of these AAC systems, 
dedicated or not, can take pictures. 

Being able to take a picture of something cool that you did over the weekend, right, and build in 
communicative hotspots that tell the story of what is there and what you learned, what was fun, 
in full phrases. It doesn't have to be, but like, then you don't have to generate all of those words. 
You don't have to find all of them in this thousands, and thousands of words system. Of course, 
it takes someone programming that. There is a downside, but I think there are some really good 
benefits to being able to do that and share yourself through pictures in that way. 

[1:00:25] MD: Okay. I felt a person in the universe question, but I don't have time to program 
and I can't build to program. Aha, but you actually can pull up the ASHA Superbill for Speech-
Language Pathologist and you will find CPT codes for reimbursement for spending an hour with 
the patient's device and actually programming it. 

So, if you're under a productivity parameter, which let's be fair, most private practice SLPs have 
to meet productivity, there is a measurable tool that you can then build for to program that child's 
device and get reimbursed for your time to show your supervisors that not only is this necessary 
for the outcomes of this patient, for this child to be able to communicate and engage, but you're 
also still meeting your productivity chart. That's a real barrier in the world for practitioners that 
sucks, but it can be overcome if you just know the right tools. ASHA Superbill is right on ASHA, 
just type in a Google, it's a PDF, they're done. 

[1:01:39] MT: Perfect. Good. These are the things that, as I'm not practicing SLP, I'm not an 
expert. 

[1:01:46] MD: Oh, I got you. I got you. This is great. Okay. One, I have a request. Can you 
please introduce me to the people that are doing the research on visual scene displays and all 
of these, like that put the movies in, because I want to know more about that? 

[1:02:00] MT: Yeah, absolutely. 

[1:02:01] MD: Okay. Then we're over on time and I have to be respectful of your time, so can 
we come back and do this again in the fall or like winter? 

[1:02:11] MT: Absolutely. 

[1:02:12] MD: This is great. Okay. Then I always Ð can you share your information where 
people can find you? 

[1:02:21] MT: Sure. I'm not super active, but the AAC Connect Lab does have a Facebook 
page. If you just search on Facebook, AAC Connect Lab, you will find that. Then I do have a 
Twitter, although Twitter is so weird these days, but it is @dr_mctherr, T-H-E-R-R, which is the 
beginning of my last name. That's an option. You can always search my name and email me at 
work. I get lots of emails from SLPs, something that many people don't know is that authors can 
share their work, their published work. If you're having trouble accessing it because you don't 
have a subscription or that your place of work doesn't have one, feel free to email and we can 
share that. 

[1:03:19] MD: Awesome. Okay. Then my last question. If anybody has a little extra love money,  
that's what my grandma calls it at the end of the month, I say calls it as if she's still living, but I 
know she's right there. Where would you recommend, they could donate to or is there an 
organization that you'd like to support? You mentioned the Disabled Athletes of St. Louis, but 
like, what can they do? 

[1:03:45] MT: Yeah. Well, we are going to actually have a, FSU puts on a Great Give campaign. 
It is not open yet. It's like a one day or two-day thing, so I can send it to you, although, actually 
that might happen before these airs, so we might Ð

[1:04:02] MD: But they can at least be ready for it next year. What is it called? 

[1:04:06] MT: Yeah. This year we are proposing a small fundraiser to support the development 
of that space that is for, not a preschool, but like preschool type programming and for the 
development of the outside space related to that. That's something that we are doing. That's the 
FSU's Great Give. Then you just have to search Communication Science and Disorders. But 
like you said, Disabled Athletes Sports Association in St. Louis is a great organization. They are 
not specific to AAC and friendship, but they do really great work and they got me going in this 
field. That would be a good option, too. 

[1:04:47] MD: Awesome. Michelle, thank you. Thank you so much for coming on. This was 
awesome. 

[1:04:52] MT: It was fun.

[1:04:53] MD: Folks, if you're listening, you can find us at First Bite Podcast on Instagram. That 
is automatically attached to the First Bite Podcast Facebook page, so whatever, normally 
whatever, unless I screw up the hyperlink, whatever I post on Instagram shows up on the 
Facebook page. If it doesn't, you can guarantee that I posted it and I screwed it up somehow. 
Check us out there. I'm always so grateful when you get on the First Bite Apple page and give 
us a review after you listen to an episode. We love your kind words. Thank you for being with us 
on our nerdy SLP adventures and journey to expedite research to practice.

[END OF INTERVIEW]

[1:05:40] ANNOUNCER: Feeding matters, guides system-wide changes by uniting caregivers, 
professionals and community partners under the Pediatric Feeding Disorder Alliance. What is 
this Alliance? The Alliance is an open access collaborative community, focused on achieving 
strategic goals within three focus areas, education, advocacy and research.

Who is the Alliance? It's you. The Alliance is open to any person passionate about improving 
care for children with a pediatric feeding disorder. To date, 187 professionals, caregivers and 
partners have joined the alliance. You can join today by visiting the Feeding Matters website at 
www.feedingmatters.org. Click on the PFD Alliance tab and sign up today. Change is possible 
when we work together.

[1:06:32] MD: That's a wrap folks. Once again, thank you for listening to First Bite: Fed, Fun 
and Functional. I'm your humble, but yet, sassy host, Michelle Dawson, the All-Things PFDs 
SLP.

This podcast is part of a course offered for continuing education through 
SpeechTherapyPD.com. Please check out the website if you'd like to learn more about CEU 
opportunities for this episode, as well as the ones that are archived. As always, remember, feed 
your mind, feed your soul, be kind and feed those babies.

[DISCLOSURE]

[1:07:18] MD: Hey, so it's Michelle Dawson here. I need to lay out my disclosure statements. If 
you ever wondered how bad my ADD, ADHD and lack of sleep, Monday through Monday, 
actually as well, here you go. These are my non-financial disclosure statements.

I volunteer with Feeding Matters. I'm a former Treasurer with the Council of State Association 
Presidents and a past president with the South Carolina Speech-Language-Hearing 
Association. I am a current member of both ASHA and SCSHA. For this year for 2021, I 
volunteered for the Pediatric Feeding Disorder Planning Committee for the ASHA 2021 
Convention.

My financial disclosures. All right, so I receive compensation for First Bite presentations, as well 
as Talking Teletherapy and Understanding Dysphagia from SpeechTherapyPD.com. I also 
receive royalties from SpeechTherapyPD.com for ongoing webinars that I have on their website, 
as well as compensation from PESI for a lecture course and webinar that I have on their 
website, as well. I am coordinator for clinical education and clinical assistant professor for the 
Masters of Speech-Language Pathology Program at Francis Marion University in Florence, 
South Carolina, for which I receive an annual salary.

I also received royalties from the sale of my book, Chasing the Swallow: Truth, Science and 
Hope for Pediatric Feeding and Swallowing Disorders that I self-published and is available on 
Amazon. I do receive royalties from the accompanying 13 and a half hours CEU for the book 
from SpeechTherapyPD.com.

Yeah. I stay pretty busy. Those are my financial and non-financial disclosures. If you ever have 
any questions, please feel free to reach out. All right. Thanks, you all. Bye. 

[1:09:27] ANNOUNCER: The views and opinions expressed in today's podcast do not reflect 
the organizations associated with the speakers and are their views and opinions solely. 

[END]