Firrst Bite Ep 279
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Michelle Dawson: [00:00:00] Hi folks, and welcome to First Byte, fed, fun, and functional, a speech therapy podcast sponsored by Speech Therapy. I am your host on this NerdVenture, Michelle Dawson, MSCCC SLP CLC, The All Things Peds 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 Cullatown, South Carolina.

And a guest lecturer nationwide on best practices for early intervention for the Medically Complex Project. First Bite's mission is short and sweet, to bring light, hope, knowledge, and joy to the pediatric clinician, parent, or [00:01:00] advocate by way of a nerdy conversation. So there's plenty of laughter, too. In this podcast, we cover everything from AAC to breastfeeding, ethics on how to run a private practice.

Pediatric dysphagia to clinical supervision and 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. To break down the communication barriers so that we can access the knowledge of their fields.

Or, as a close friend says, to build the bridge. 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. Every fourth episode, I join in. I'm Erin Forworth, MSP, CCC SLP. The Yankee Byway of Rochester, New York transplant, who actually inspired this journey.

I bring a different perspective, that of a new ish clinician, with [00:02:00] experience in early intervention, pediatric acute care, and non profit pediatric outpatient settings. So sit back, relax, and watch out for all our stories. Hey,

this is Michelle Dawson and I need to update my disclosure statements. So my non financial disclosures, I actively volunteer with feeding matters. National Foundation of Swallowing Disorders, NFOSD, Dysphagia Outreach Project, DOP. I am a former treasurer with the Council of State Association Presidents, CSAP.

A past president of the South Carolina Speech Language and Hearing Association, SCESHA. A current board of trustees member with the Communication Disorders Foundation of Virginia. And I am a current member of ASHA, ASHA SIG 13, SCISHA, [00:03:00] the Speech Language Hearing Association of Virginia, SHAHB, a member of the National Black Speech Language Hearing Association in Basel, and Dysphagia Research Society, DRSA.

My financial disclosures include receiving compensation for First Byte podcast from speechtherapypd. com as well as from additional webinars and for webinars associated with understanding dysphagia, which is also a podcast with speechtherapypd. com. And I currently receive a stipend. Salary from the University of South Carolina in my work as adjunct professor and student services coordinator.

And I received royalties from the sale of my book, chasing the swallow truth, science and hope for pediatric feeding and swallowing disorders, as well as compensation for the CEUs associated with it from speechtherapypd. [00:04:00] com. So, those are my current disclosure statements. Hi, this is Erin Forward and these are my disclosure statements.

I receive a salary from Cincinnati Children's Hospital Medical Center. I receive royalties from Speech Therapy PD for my work with First By Podcast and other presentations. I also receive payment for sales from the First By Boutique. Which I have with Michelle Dawson for non financial disclosures. I am a member of ASHA and a member of Special Interest Group 13.

I also am a volunteer for Feeding Matters. I am a contributor for the book Chasing the Sol of Michelle Dawson, which I received no financial gain. I also am a member of the South Carolina Coalition Committee with ICDL DIF for a time. 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.

All right, everybody. Y'all, we are in for a treat. Today's guest, I [00:05:00] actually met last year in my first week out at James Madison University. We have none other than Mr. Nate Ellis, MS, CCC-SLP. He's a school based speech language pathologist here in the Commonwealth of Virginia, and this man ties of his time and does it in a three piece suit with a vest and tie, because I have seen him pull that off and it looks fabulous mate, but he has also served on the conference planning committee for the Speech Language Hearing Association of Virginia.

He has been part of the continuing education administration team for SHAH, the Speech Hearing Association of Virginia and His professional passions are in an area that absolutely boggles, if not scrambles my mind. He talks all things, phonological processes speech, sound disorders, and, and, and he thrives [00:06:00] also the way he explains it.

Makes it not sound so completely frickin overwhelming for people like me that struggle with that area. But my favorite fun fact is he has a cat named Zargo. So, Nate, thank you, thank you, thank you for coming on. 

Nate Ellis: Absolutely, thank you for having me. 

Michelle Dawson: Yes. Okay. So, Git, please give us the backstory. How did you find out about the world of speech therapy and then want to become a speech pathologist?

Nate Ellis: I have to give all of that thanks to my mother. 

Michelle Dawson: Awesome. As a boy mom, I love that. Okay. 

Nate Ellis: I had started off wanting to do musical theater. Okay. I have been doing that a lot in high school. I had private voice lessons and all of those things and was really wanting to, to be on stage and, and acting and singing, not so much dancing.

But I [00:07:00] really kind of got in, I went to JMU for undergraduate. I was kind of chasing my best friend who had gone to JMU. And I had started off doing, That, as a major, didn't like it. 

Michelle Dawson: Really? 

Nate Ellis: No. And then I switched and switched again, and switched again, so I'd gone through four different majors. I was ending up in Anthropology, because it was the closest thing at JMU that I could get to Linguistics.

Michelle Dawson: Okay. Okay. 

Nate Ellis: And then, I remember one day, my mother called me and said, Nathaniel, stop switching majors. I've looked on the website and there is a speech pathology department and in my time as a nurse and working in the hospital I worked with speech pathologists. I think this is for you. And here I am. 

Michelle Dawson: Wait, are you [00:08:00] a double duke then?

Nate Ellis: No, I got my masters at Radford. 

Michelle Dawson: Awesome. Wait, what's Radford's mascot? Oh, 

Nate Ellis: I'm really bad at that kind of stuff. 

Michelle Dawson: Oh, that's my, I don't do sports, but I love the mascots. They make me chuckle. It's like when we moved to South Carolina and everybody was wearing an I'm a cock shirt. And I was like, is this allowed?

I don't think this is allowed, but their mascot is a game cock. So obviously they had to shorten it to I'm a cock. I love my U. S. Sea people, just so you know, but 

Nate Ellis: let me see here now. I have to look it up. 

Michelle Dawson: Okay. So inquiring minds want to know what were your four jumps? You went from musical theater to 

Nate Ellis: Highlanders. I should have known that the Radford Highlanders. Wow. Yeah. Okay. It was like musical theater then, which is like musicals. And then there's music theater, which [00:09:00] is doing more opera type of things. Both of those. And then I think Maybe it was only into then after that I got into anthropology. So maybe it was really the fourth change was getting into communication sciences and disorders.

Michelle Dawson: That's awesome. 

Nate Ellis: Just because I had always been interested ever since I was like five or six years old in languages. I was pretty interested. Kind of was, I was like J. R. Tolkien in, I was making up my own languages as a kid grammars, writing systems and everything. Just one of those little secret hobbies I've had for many, many, many years.

Michelle Dawson: I love that. We my boys went to a Mandarin immersion school, so they learned Mandarin and tones. And we, they were in that school for. Four years prior to us moving to Virginia. And they miss it. I, they do, they miss it. But now they're learning Spanish and they have picked it up so quickly because since they [00:10:00] were teeny tiny humans, they were, you know, learning two languages.

But I love watching Goose's little engineering brain analyze It's the tones of, of Spanish. And mommy can say it's necessary to use the bathroom and where is the bathroom? And that's it. So I'm still learning, but they're, they're now teaching me. So, yes, but this is lovely. Okay. So then you go to Gradford, you become a speech pathologist.

How in the world did you then trickle down the path of phonological processes and speech sounds? And. Okay. Was that the outgrowth of Tolkien? 

Nate Ellis: Before I'd ever actually gotten into the CSD major at JMU, I had gone to the library and checked out the clinical phonetics textbook and then got into the major and went, Oh, that's our textbook. I already read it. 

Michelle Dawson: Huh. For funsies. 

Nate Ellis: For fun. Yes. Because I just [00:11:00] got very. I don't really know what it is. I'm very interested in the sounds of languages. And obviously I think that goes very well into why I like speech sound disorders, because I kind of think of every kid I treat as their own little world.

And I just I'm also a musician. I play the piano. So I, sound is very important to me. I can't, I'm slightly colorblind. So definitely art and visual things are not my thing. But sounds I love just sound. I think it's a very human thing. thing we're very attuned as humans to being, to picking up on sound.

And you can take that example of Mandarin, like we, we as English speakers, We don't hear those tones. No, I don't. And even other types of synodic languages, ones that are related to Mandarin Chinese have even more tones than that. Like Cantonese, I believe has six tones. So you have to get, and, and [00:12:00] our brains just don't hear that because we use tone in, in English and other types of Indo European languages in a very different way than what you would use in, in, in like more East Asian types of languages. So. 

Michelle Dawson: So my next question for you is when are you coming back for a PhD? 

Nate Ellis: I would like to be able to work at the same time. Ah. Yeah.

Michelle Dawson: Ah, I have an idea, friend. We will talk about that one later. 

Nate Ellis: The suspense. 

Michelle Dawson: Yes, the suspense. Well, well, folks, I got to tell y'all. Last summer I had the pleasure of watching Nate work his magic and it truly is magic. James Madison University, of which I am a very proud alum from the online program back in the day when it was just, called the Distance Learning for Virginia Educators, the DELV program. 

Nate Ellis: DELV program, yeah.

Michelle Dawson: I did DELV because I started out as a quote unquote [00:13:00] speech teacher in the public schools too many eons ago before we had the SLPA, but it was, I went through something my third My first residential clinical practicum was something called Scottish Rite. Now, if your university that you go to is affiliated with Scottish Rite, I can you'll know all about Scottish Rite camp, but if you don't, Scottish Rite is a do good association that's across the continental United States. States. It's akin to Lion's Club. Like, Lion's Club helps funds hearing aids and glasses for children and adults that can't afford out of pocket expense.

Scottish Rite funds speech therapy for individuals that are at risk, can't afford it, or just in need. And James Madison has hosted a Scottish Rite camp, I think, almost all 40 years that this program has been around. Yeah, it's been a while. Yeah. [00:14:00] So it is an opportunity for university clinics to Be an equal partner with the community, open the doors and offer free speech therapy.

And it was so good for my soul to come back many, many, many, many years later and see that this thing is still in action. But that's where I met Nate. So partnered with the James Madison University Young Children's Program program. Dr. Sheree Harbick and Miss Sarah Teeter were the Scottish Rite camp leads and they were like, wait until you see Nate.

And I did. Watching him soup students, watching him mentor students in how to take their coursework understanding from Dr. Emily Zane, who's fricking brilliant, and then apply it into a school age, [00:15:00] classroom for summer camp throughout the summer. It was amazing. And then he started talking about like triangles and sounds and, and all of these things.

And I was like, I don't understand because he's like, it's like listening to a guru. And I am like, I don't, Nate, I don't even know how to read the phonetic alphabet or phonemic alphabet because I don't do that type of speech therapy. 

Nate Ellis: And I would, I would flip that around and say, Nate. That you are an expert in, I, I wouldn't even know where to begin, except that food goes here.

Michelle Dawson: He just pointed to his mouth. Yes. Yes. But like, that's what, yo, this is what makes our world go round as professionals. It's because you don't have to know it all and good Lord Almighty, you're never going to know it all. So give yourself grace. That's why you found a friend. That's why you have a colleague.

So I asked Nate to come on and talk about [00:16:00] the craft that it is that he does. And it's that's the episode today. We are integrating phonetics and phonology. New ways to learn. To understand speech sound disorders from a colleague who, yes, he's subject matter expert, but he's also right there in the trenches serving, because you're in Stanton City Public Schools, right?

Nate Ellis: I sure am. Yes, I am. 

Michelle Dawson: Awesome. I know where that is because we go downtown a lot. Yay! Okay. So, let's take it from the top. Can you describe for me some background as to why phonetics and phonology seem so starkly separated. Also, that's like the world's best question. And y'all, I didn't think that one up.

That is all Nate. 

Nate Ellis: So a lot of what we use to as the foundation for our treatment of speech sound disorders in kids, specifically developmental speech sound disorders. So if you hear me [00:17:00] saying that throughout us talking really is the the way I describe what we term as phonological disorders. Come, a lot of the foundations for that comes from linguistics.

Mm hmm. So, people studying all kinds of languages in, in a theoretical framework. And over the past, I'd say 60 ish years, there has been a separation of phonology, which we can think of as being very cognitive and competence based versus phonetics, which is all production. And we can, we can really see that a lot in the way that we diagnose or the way that we separate speech sound disorders into different areas.

Diagnostic categories like we have phonological impairments. We have apraxia of speech [00:18:00] dysarthria. We have residual airs and they all fit into different diagnostic categories based on the describing the symptoms that we see with them. And a lot of times what you'll find is if there is some kind of phonetic or motor or real motor speech impairment, we classify that in the apraxia, dysarthria.

Residual errors, or R, L, or S errors, and pretty much everything else is phonology, a phonological impairment, where we assume that a child has lost contrastivity, the ability to use contrastive units, different sounds, a P versus a B, pit versus bit and that type of framework has really stuck. In the way that [00:19:00] we do a lot of work, the way we approach analyzing heirs, treating heirs with kids.

And it's been that way for a while and I think a lot of it has just stuck. Even in the face of research that is saying, hey, let's take a different look at that. Perhaps the two are not so starkly different. Or should be so separated. Maybe there's a lot more that's intertwined between the two than we think.

Michelle Dawson: Okay. So now I want to know that I want to know the reason to translate that. 

Nate Ellis: So that would be. We put a lot of emphasis on, on sticking with very formal type of almost mathematical formalisms in trying to explain how [00:20:00] language works in that lots of abstract units that are stuck up here that are translated into the way we form words.

Form our sounds. Okay. Versus, so I think of that as a top down type of approach. Okay. Versus a more phonetic type of approach, which is really. Bottom up. And I'm actually at the moment I'm, I'm looking at the PowerPoint presentation I gave at the conference last year last week because it has every, everything that I, I'm pretty much loved it.

Michelle Dawson: Yeah. Folks loved it. 

Nate Ellis: And, and so there's this idea that we're born with a lot of knowledge already that gets trickled down into the way we speak. But I'm kind of on, I'm way on the other side of that, in that this, what we use when we're making sounds, the articulators, the [00:21:00] vocal track, that system is what gets worked to form those categories of sound that we, we would term a phoneme.

Michelle Dawson: But that would make sense, that makes sense culturally. 

Nate Ellis: I agree, 100%.

Michelle Dawson: Yes, because we each, humans are designed through, that pulls in your anthropology piece, by the way. I like how this trickles over from an anthropological perspective. We have evolved as humans to Sustain life in the environment with which we were born and adapt to that environment.

This is why, this is why we're all different colors, shapes, and sizes. That's what makes us a beautiful rainbow. And that's why we all speak so differently. Yes. Because of where we're from, what influenced us. Yes. [00:22:00] Oh, I love that approach. Oh, that. Yes, that makes sense. I'm with you. 

Nate Ellis: I, I, I like to see the light bulbs go off when you Yes!

Because a lot of what we get taught is, when, when we're taught phonetics, I'm gonna quote unquote that, what we get a lot of Is phonology. So when it comes to, let's say you're treating a kid, Oh, well, how do you make that sound? I don't know. How do you make an R? My son was an R kid. I didn't think we would ever figure that out. It's hard. 

Michelle Dawson: It's so, well, you know, there's no input when you make an R it's in the middle of your mouth. Like, how do you, I don't know how to describe that where your tongue is placed because it doesn't really touch anything. It's just there. Like, rrrr. Yeah. 

Nate Ellis: It, it, R is the hardest sound of, of all that, that we produce in English. It's also a very rare sound cross linguistically is because with [00:23:00] most sounds that we make, there's one constriction somewhere in the vocal tract. An R, we have three constrictions. You have one at the lips because we do have some lip rounding on it. You have one somewhere in the palatal region, and that can.

The tongue shape for that can be. Many different ways. That's another reason it's difficult. And then there's also a pharyngeal constriction, which we don't is so hard to get. Because you can't see it, you can't feel it. I often will have kids lay down on their back and let gravity do the work to create that constriction.

Because it's so hard to Oh, and you need to pull your tongue root back towards your pharynx. Okay. 

Michelle Dawson: Every five year old knows what that is. 

Nate Ellis: Exactly. But, but that's why that sounded so hard is because it has this extra bit of constriction on it that you don't get with some other sounds.

Michelle Dawson: Okay. I'm just, I'm just thinking your R is the way when I have a patient that's got [00:24:00] some nasopharyngeal regurgitation of food and we're working on like, velopharyngeal closure, not necessarily due to like VPI, but Most of the kids that I have for feeding, if they have nasal regurgitation of food, they have flaccid dysarthria as an underlying etiology.

Normally like an infarct, a stroke maybe low tone due to a genetic condition, whatnot. But I'll try to teach them How that closure should feel by laying on the ground and doing really hard, really loud. That sound. I don't, I don't know if I hard see a K sound that I call it. We're going to talk about kitty cats and then yeah.

Yeah. But that, that stop is a stop plosive. Am I right? Stop. 

Nate Ellis: Oh, see, I use the word plosive. 

Michelle Dawson: Plosive. Okay.

Nate Ellis: Now that's phonetics world. Okay. You'll, you'll most [00:25:00] often hear Stop. Yeah. I prefer the term plo there. I, I prefer very specific terms when it comes to sounds. 'cause I think of it in, in this way.

'cause to me, you can also have nasal stops, which are your Mm mm mm. Yeah. Which, which some people could, you could make an argument, well, that's not a stop, that's a nasal well. We can get into that, but I prefer plosive because it creates a closure and then what is characteristic of those sounds is the explosion of air that comes from the burst and releasing that sound.

So I prefer the term plosive. But that's a whole nother story in our talk we could get into. 

Michelle Dawson: This is, this is why we have to talk about a PhD, sir. Okay. But what are some of these reoccurring themes that have emerged within the research literature that like questions the separation that makes perfect sense from [00:26:00] like a anthropological human side?

Nate Ellis: The very first thing that I came across that really started me talking about Because I had these ideas that there's something, something's not making sense for me. All of the kids I treat, I could say, okay, that's a phonological disorder. But I can, I can understand why they're doing what they're doing from a motor basis, from a developmental basis, versus using these abstract type of categories to describe what they're doing.

Because, ultimately, I am more concerned about why they do what they do. Explaining what they do versus just describing what I see. Okay. So one thing that really got to me and started to kind of reaffirm that I'm, I'm on the right [00:27:00] track here are called undifferentiated lingual gestures. That's a mouthful.

Michelle Dawson: What does that mean? 

Nate Ellis: So an undifferentiated lingual gesture is it's an abnormal type of articulation. And it occurs obviously with lingual consonants, where there is tongue palate contact across multiple places of articulation. So if we're going to think, I always like to use my hand as, as my tongue, because it's a really good diagram because the front part of your tongue is very flexible.

The tip and the blade is a very flexible and the back part of your tongue, the dorsum is not, it kind of moves. Okay. Up and down, up and down. So it's a good my, I like using my, my hand. So what you're going to get is instead of these really differentiated movements of the tongue to make a dental sound or an alveolar [00:28:00] sound, it's just up and down.

The tongue muscles haven't been able to differentiate themselves between the different muscles of the tongue, as well as differentiating between the muscles so let me, let me rephrase that. And that the, the, the, in the four intrinsic muscles of the tongue haven't been able to differentiate as well as the four extrinsic muscles haven't been able to differentiate and be able to move separately, which is what we would expect in typical motor development for speech and feeding and swallowing as well.

And, and so the tongue and the jaw just move differently. And down, up and down, up and down. And so there's this contact across the whole palate versus this nice differentiated contact and to our ears, our English biased [00:29:00] ears, we might hear that. As sounding like a T versus a K. Okay. And we go, Oh, that's VLR fronting.

Okay. Is it? So what, what has been done to figure this out was back in 1990. So it's been a while. 

Michelle Dawson: Wait, don't imply I'm old because I was born in 83, but continue.

Nate Ellis: I was born in 87, so we're We're pretty close. Is using electropalatography. 

Michelle Dawson: What is that? 

Nate Ellis: So electropalatography is a type of instrumental method in clinical phonetics where you create It's a You put sensors across the tongue.

Okay. I'm sorry, I mean, sorry. 

Michelle Dawson: Is that the thing that looks like a it looks like a snowflake, but it goes in the mouth, like the sensors, it kind of looks like 

Nate Ellis: it goes, it goes atop the palette [00:30:00] and then each one has to be specifically made. It's like a dental implant has to be specifically made for each person that's going to be using it.

Okay. And then what it does is it is able to record using electrodes where the tongue touches. On the palette. Oh, that's cool. And what this researcher, Fiona Gibbon, who's been the one who discovered this back in 1990, found was that what we think is viewer fronting. isn't really happening. The kids still make two distinct articulations for a T versus a K, but our ears can't hear it because our ears are biased to filtering everything. If we're English speakers, our ears are, are biased to filtering everything through the sounds of English. So a kid may go, kuh, and then they may go, kuh. Those are two separate sounds. But the second one to our ears sounds like a [00:31:00] T. Duh. Yeah. Duh. But a T for me is T. Yes. And so what we, what we would think is, Oh, they've lost contrastivity. And so we'll treat that as, as a wheeler fronting air, trying to teach the kids the difference between the two different sounds when in the end, they haven't lost contrastivity. They just haven't gotten enough motor development. to differentiate lingual movements to make those two sounds more distinct.

Michelle Dawson: Okay, so I have four thoughts. One, is the scientist that determined this, are they a speech pathologist or are they a linguist? Speech pathologist. Amazing. Two, my next thought is, I would love a study on the frequency with which [00:32:00] SLPs that are treating this get their hearing screened. The same way that I want to study on the frequency with which pediatricians are having hearing screens to rule out a potential heart murmur and underlying cardiac etiology and or how old their stethoscopes are because I have a gut instinct that neither one of those are really happening given all the PDAs that have been found in some of my cardiac or subsequent cardiac kits that were originally feeding kits, but I digress.

And then the third question is. Has did that research finding the implication for driving the change in our understanding of acquisition of norms, like typical acquisition of those sound productions is profound, but then I immediately go over to, but that's a fine motor.

And that [00:33:00] explains in my mind why so many of our children with Down syndrome get misdiagnosed with apraxia of speech when it's just they're not there yet in their developmental patterns. Oh! The clinical implication of that is profound, Nate! 

Nate Ellis: And I had never heard of this until I found it myself. 

Michelle Dawson: How did, okay, what rabbit hole did you go on to find this? 

Nate Ellis: I honestly don't. All of the textbooks that I use, that I have bought myself, because, textbooks. 

Michelle Dawson: Y'all, he has, also they're color coordinated, and it's really pretty. I appreciate that. 

Nate Ellis: I, all of the textbooks that I use for my own reading on phonetics come from outside of the U. S. So I, I get a lot from [00:34:00] England, Ireland, Canada, and Australia. Yeah. Beautiful. And sometimes I feel like they're a little more on top of, of. Integrating this type of research into clinical practice on 

Michelle Dawson: Australia's cutting edge on utilization of tell us the health for pediatric feeding and swallowing assessment treatment.

I mean, it's profound. So we, we have to think globally when it comes to extrapolating data and putting it into practice. So yes, totally agree. 

Nate Ellis: That's why I'm really interested also in like implementation science and taking things directly from research and putting them into practice. Yes. But this, this idea of.

these contrasts that we think are gone but are still there. They're called covert contrasts. So the little quote I have here is, children who appear even to a trained listener, me, or any, I would assume any other speech language pathologist, to a trained listener to neutralize [00:35:00] phonological contrasts in reality produce consistent, articulatory differences between target phonological categories.

Those, these are difficult to detect by the human ear.

Michelle Dawson: We're not equipped to do the thing we're supposed to be doing. 

Nate Ellis: Now, I think you can be definitely equipped to do it, but to do so requires a lot of ear training. Okay. And the way I think about that is when I was in, in doing musical theater and things like that, I did a lot of piano accompaniment for music students And they take semester after semester after semester of ear training.

Michelle Dawson: Yes, they do. 

Nate Ellis: So that you can go, Oh, I know what that note is. I know what that chord is just by hearing it. And we don't do that. In our, at least in my experience, I don't know across the country, the country is a very big place. [00:36:00] The type of training that we, we give to undergraduate and graduate students on being able to hear things differently and not parsing everything through the lens of English. Because if you think a kid's making an error that they're really not, and you spend all that time doing therapy on something that's not there. I mean, that's weeks and weeks and weeks of your time wasted. That could be frustrating the, the, the kid, because you're trying to work on something that's not an issue.

Michelle Dawson: And wait, and then add in the other layer of, Dialectal variations and do we fully recognize and understand the nuances in a, in a different dialect or a E L versus E EL one or L one [00:37:00] versus L two language one versus language two and the natural beautiful variations in that. Oh my goodness. Okay. So then wait, how do you do the ear training?

Like, is there something for us as speech pathologists to, how do we go about learning that? 

Nate Ellis: I've, a lot of the ear training that I have done has just been taking the time with my kids to listen to them and, and transcribe and re transcribe. It's just kind of whenever I can have that practice with them, you know, we've, we've gotten some of our therapy done.

Let me hear you talk. Yeah, and but but I'm also a little you know, I'm a musician I've also loved languages for many many years. So I've been kind of inundated with it a long time Yeah, but I [00:38:00] would highly suggest visiting things like the International Phonetic Association's website and clicking on their resources and and doing train and Doing finding sound files to hear a sound versus what the symbol looks like.

Michelle Dawson: What, what is, what is this place called? 

Nate Ellis: The International Phonetic Association. I didn't know that was a thing. They are the organization that maintains the International Phonetic Alphabet to ensure consistency in its use. Another great resource is Wikipedia. Their phonetics articles are great. are very good. And they like every sound you can click on, it gives a huge description of it phonetically and it has sound files so you can hear what it sounds like. So those are, those are great places to start. It just takes time that and which is, you know, one thing that a lot of people do not have.[00:39:00] 

But it, it does take time to, to train your ears, but I have found that doing so has been very beneficial to being able to differentiate what my kids do in different contexts, different contexts. Syllable shapes, different vowel context, different places within words where I can hear the subtle differences that they're making, which informs me whether that's an error we need to work on.

Is it because of the context? And that way I know maybe that's not something I need to approach or, Oh, it's really close. So I don't really need to work on that sound or that pattern that they're making. Let's say

Michelle Dawson: y'all, this website is. You aren't kidding the amount of resources that are available on here.

Nate Ellis: There's a lot. I mean There's a lot of stuff. [00:40:00] 

Michelle Dawson: Yes. You guys, I highly, highly recommend it. Also students, if you are studying and in class, they have a, you can join it and there's study guides on this website. I am a member of the IPA. Yes. They do not have an Instagram account. You need to tell them to Get with the times here, sir. We, we, 

Nate Ellis: they're, they're a very formal organization. 

Michelle Dawson: They have a Facebook and a Twitter. That's not a Twitter. What, what is it? X? Yes. Yes. Okay. I digress. Change topics. 

Nate Ellis: So, so those undifferentiated lingual gestures to get back, get the train back on track is kind of the first thing that I came across and went, thirst. Okay, I think I'm on the right track with the way I'm thinking about things because I always think of things very differently. I'm not very mainstream, but that gave me that little bit of, [00:41:00] of confidence boost of, okay, I think I'm thinking correctly here, something I'm on the right track. One of the other things that is more recent in the literature is called tongue shape complexity. And I actually got an article, one of the ones I use specifically I came out during Scottish Rite last summer and I immediately printed it out and I sat there with my four graduate students going, Oh my god, you have to read this. Because it goes over this idea of tongue shape complexity, which is being measured using ultrasound imaging, another very up and coming type of instrument.

Michelle Dawson: Wait, what is this article? 

Nate Ellis: It is called let me find my, my references page. It is called Tongue shaped complexity in children with and without speech sound [00:42:00] disorders. Nice. And it's from the Journal of Speech Language and Hearing Research, so if you're an ASHA member, you can get it. Who was the first author? Dokovova. D O K O V O V A. And what this is showing are talking about is that we can measure curvature. So this is a more, we have to get a little bit into math. Okay. So curvature is you, is exactly what you think. It's a measure of how much something deviates from a straight line. Mm hmm. And the tongue. is a muscular hydrostat. It's a great phrase. So it can deform and move in all kinds of ways, and you can get all kinds of different curvature values across the tongue.

And the more complex the sound becomes, it has more [00:43:00] curvature. It has more points along it that have different values for, for its curvature. And without going too deep into what that is, because we, we, we would need a little bit of calculus, but we're not going to go that far. 

Michelle Dawson: I don't like budgets. Mr. Dawson handled that and then color codes it to keep me interested. So, you know, Awesome. 

Nate Ellis: So for example, a sound like K. Doesn't have much, it's got a little bit of curvature to it, but compared to the curvature, the tongue needs to form to produce an R. It is, there's more complexity needed in the, the differentiation of all of the tongue muscles to create the shape necessary to produce an accurate R.

Are. And in a quote from that article specifically says [00:44:00] that there is evidence to suggest that the presence of, oh, actually, nope, hold on. It's this other one here. That. Another article reported that typically developing children aged four to six had more inflection points. So there was more points for curvature to occur on the tongue than for an R than their same age peers with a speech sound disorder.

Michelle Dawson: Okay. Say that again so my brain can fully wrap around it. 

Nate Ellis: Aren't able to make the tongue move as well and, and create different points along it 'cause they just haven't gotten enough motor control over the different muscles in the tongue. to create the [00:45:00] complex shapes necessary for things like an R. Specifically, that's what they were reporting on here. But from my practice, I can absolutely think of some other sounds such as an S, which requires a nice, very thin medial groove down the center of the tongue that funnels the sound towards the cutting edge of the teeth, which is what gives it that high frequency noise, ssss. And that takes a nice curve looking in a coronal plane versus a sagittal plane. And. And that's really hard too. I have a lot of kids that can give me something like an S, but I hear it and go, I can tell you're just having trouble getting that real narrow groove down the center. You're having trouble with a more complex tongue shape.

And so instead of getting a S, I get something more, some more like a S, which doesn't, it kind of sounds like an S. [00:46:00] H, but I, I, my ears know that that's not an S H. I know what they're trying to do. And that's another one of these little bits where I go, there's something subtle there that's speech motor, but I've been taught that this is a phonological problem.

I can't follow along in, in that line of thinking. And get to the same, get to that conclusion. I just go, Oh, you're having trouble grooving your tongue. So we need to work on that. That was it being some kind of phonological impairment. 

Michelle Dawson: Bear, bear struggled with all this. My youngest who's nine now, we did therapy from the time he was two and a half until bless. I think he finally graduated speech around six. Chronic ear infections, labor stopped a billion times. That'll do it. Remy, all of the above [00:47:00] adenoids tonsils also had an inguinal hernia in his right testicle, but less is a little hard. He's really been through the ringer, but he'd had it wasn't a lateral list, but it was a lot like to me, it sounded like a lateral list.

He said shit for shit, so he would say mama come shit with me, and it sounded like he was cussing, but like he wasn't Until he hit about four and a half and he realized what he was saying or what it sounded like he was saying and then He thought it was real funny, but he he is my child. Oh, yeah, but it was It just sounded different. And Angela tried to, she explained it, but like, like I am one of those. I have to hear it presented a couple different times and then a couple different ways, but this I'm y'all can't see it, but I'm gesturing to the different planes with which he described. I'm holding my hands. Y'all can't see that, but trust me, there's a lot of hand gestures going on, but like, that was my booboo Lou.

And yeah. [00:48:00] Okay. All right. So. I have so many follow up questions, but we have to get to like the next formal question to like keep our train running. But articulatory phonology, so this is, I feel like this is the application of the bear question or story. 

Nate Ellis: So articulatory phonology is a is a phonological framework that was designed. to explain typical phonology in adult speakers, just like any other phonological theory that has come from linguistics. Okay. However, it is, and it's been doing this since 1986. So that's when this idea first came out. Now what sets articulatory phonology apart from other, mainstream phonology theories is that it [00:49:00] focuses on phonetics and articulation first and from the, the phonetic level, the phonology develops versus The opposite way, which is the phonology is there first and then from that, the phonetic, the production arises. And for me, this makes complete sense. And so it, for, for those who will be listening, the, the idea of distinctive features where sounds have a set. Of binary features. A sound can be a stop or not a stop. It can be nasal, not nasal. It couldn't be a sibilant, not a sibilant.

So you have a, it's an on off switch and a sound may have all of these different features where one is on and one is off. And the, the, the. Combination of all those features [00:50:00] together is what makes a sound its own unit. Articulatory phonology thinks of this in a very different way. In that, phonology is a set of relations among physical events.

Physical events that are occurring with your articulators. Things going on in your vocal tract. And From that, we get the idea of what's called an articulatory gesture. And if you have really delved deep into the cycles approach, there is some of articulatory phonology, they called it gestural phonology, it's another name for it as well, that was used in coming up with that approach.

So I can get on board with, with the cycles approach. That's typically what I use for all my kids. And So we're not thinking of things as these binary units anymore. I've never been able to think of things in a, it's a black or white. It's on or [00:51:00] off. I can't, everything is a, is a middle gray ground.

Michelle Dawson: Yes. But then all of the things overlap on each other and like, yes. Okay. I agree.

Nate Ellis: And so what we get with this articulatory gesture is, is that's our fundamental unit. So we're no longer thinking of a. Like the phoneme. We're thinking of this gesture. And a gesture is just, where are we having different constrictions occur within the vocal tract? Because ultimately that's what speech is. It's a series of constrictions made by the articulators in the vocal track that we then interpret as having meaning. And so there are all these different parameters that a gesture can have. Where is a constriction happening? How much of a constriction is having, you can have a closed constriction, and we think that as a stop, or if the tongue is just slightly open.

From, [00:52:00] from that stop, that closed position, oh, we have a fricative now. You open a little bit more and you get an approximant. So, and that's the, the term I use, what others would be more familiar with hearing glide or semi vowel. I, I prefer the term approximant.

Michelle Dawson: , but what is a glide or a semi vowel or an approximate? 

Nate Ellis: A glide or a semi vowel is what we would think of as a W, a Y. Oh, okay. The phonetic, the, the, the phonetics term for it would be an approximate because the articulators approximate each other and they're in between a fricative and a vowel.

Okay. Okay. So we can include some more sounds and approximates, like you can do your W's, your Y sounds, your L's, your R's. And then as you open the vocal tract even more, you're starting to get high vowels, your E's and OO's. And then you open more and more and more, and you get your A's and your AH's.[00:53:00] 

And we're going to describe different sounds based upon where that constriction is happening and how much of a constriction is happening versus talking about place and manner, which we can still think of in that same way. The, where the constriction happens is your place of articulation. How much of a constriction is happening is your manner of articulation.

And there, that way we're relating the articulation. to an actual physical event versus an abstract set of features to describe the sound, which to me makes a whole lot more sense. It does. And the other great thing about articulatory phonology that other mainstream kinds of frameworks aren't able to do is it's able to describe how things occur in time.

So when you transcribe, let's say you're [00:54:00] just transcribing a phoneme, like the word cat, you get that k, a, and t, none of that describes how those sounds occur with each other in time. Okay. They're individual, segmented, discrete units. It's as if you're saying a kuh, and then you're instantly into an aah, and then you're instantly into a tuh.

Michelle Dawson: Is that co articulation, like one sound influencing another? 

Nate Ellis: Into another. So that's what articulatory phonology is really able to do, is it has the explanatory power, not just descriptive power, the explanatory power to show how sounds co articulate with each other and why they do that. So cool. Okay. And so what we can say is it shows how gestures are able to overlap with each other in time, which is what happens.

Yes. That's why certain things sound the way they do and why we don't just [00:55:00] articulate one phoneme and then it goes into the next and then it goes into the next. 

Michelle Dawson: This is why I have a hard time. I have a hard time with multi syllabic words trying to say eosinophilic esophagitis. I had to practice that because of the, the way the S's rolled into the other ones. It was very difficult. 

Nate Ellis: It's a lot of lingual, it's a lot of lingual consonants right up front. Yes. It's, it's very hard to, to articulate. Mm hmm. Mm hmm. 

Michelle Dawson: Sorry. I got excited. I understood that. You're so good at this, Nate. 

Nate Ellis: And so even though this way of describing phonology has been around for a long time, is only recently that I find one article that I used as the basis for this major presentation I did.

It's, I've only been able to find one where it's incorporating this [00:56:00] idea of articulatory phonology to explain, not just describe, explain, Speech sound disorders. And I have read it in some other books where it said that, you know, this, this is a completely different way of, of understanding speech sound disorders, but it really gives you a lot of power that other approaches don't, don't give you because most approaches will just give you a way to describe what you see versus an explanation of what you see.

Of what is occurring. And for me, the why is the most important because the why is what directly translates into what you do in analyzing and treating sound errors.

Michelle Dawson: My brain is going 400 different directions. 

Nate Ellis: I love it. [00:57:00] And that's what I always say. What I have what I have to present on that I'm, I'm really enjoying it. presenting on is a lot. I've spent a long time researching this, researching it and putting it all together. But as long as somebody comes away with a, with a seed in their brain, if I'm going to think about something differently next time, I am as happy as can be.

Michelle Dawson: Okay. So for those that are listening, that are school based therapists or private practice therapists, what can they start doing clinically or thinking clinically as their next step? 

Nate Ellis: And, and that's a harder piece because a lot of what we use to help determine like eligibility for kids in schools is based on the more mainstream types of, of approaches to phonology, process [00:58:00] errors and things like that.

So obviously that's not going to change anytime soon. That's a whole nother world of advocacy and trying to get People who don't really know, have a clue what you do, to understand what you do, so that they can change things to make it easier. The policy makers that are not actually speech pathologists.

Correct. Got it. Duly noted. So, a lot of what I am talking about, does kind of run into or run counter to what we typically use in like a school based practice. However, the way I think about it is I use, this is the stuff I use behind the scenes, is you don't have to explain everything that you do. As much as I would love to, I would have 55 page reports.

So [00:59:00] for me, this is the stuff I use when I'm analyzing my kid's speech during an evaluation or when I start getting into treatment. Like I use these ideas to help filter through the types of targets I want to use in therapy. And so it's more so the, the nitty gritty behind the scenes. stuff that you will use on a day to day basis versus having to kind of use it as a means to explain eligibility, let's say. Because I still have to go through the same type of processes and things like that to, to find a kid eligible. I'm using these principles to inform How I think about why my kids are doing what they do. And from that I can take that to drive your data, to inform, to drive, drive your plan, to [01:00:00] drive how I plan and what I wanna work on with them.

As well as using it as a means to determine what kinds of words are gonna be the best to help my kids be successful. 'cause I do like to spend the time to kind of curate the right types of words. To make my kids successful because I find that a lot of target words aren't designed to Really get the sound out in a in a way that's going to make the kids successful, you know, it might It might give a real pretty picture on your card.

But if I've got a kid who has an L problem, I'm not going to want to use like Lama. Lama would be okay. Okay. But more like a loop. Okay. The word loop, because if they're turning an L into a W, let's say. Which we can explain, but I want to use those principles to know [01:01:00] that I'm not going to want to use like a rounded vowel because that co articulation there, it's going to be too difficult for them.

And it's going to really push them into wanting to articulate something in a different way versus a word like leaf. Where that spreading is really forcing their articulators into a certain position, that's going to be more successful for them to get the sound out. 

Michelle Dawson: Can I, if you, I don't know if you have done this yet, but the next thought from your work to me would be creating a, a spreadsheet or a flow sheet of If this, then do this too soon.

I'm saying, cause that's how, that's what helps me when I'm talking PFD to the students. If you see this, then refer here or request a referral to this specialist for this. Have you done this yet? 

Nate Ellis: No, it's still kind of a, a work in progress because I've, I've [01:02:00] never seen any of this information in action.

I feel, except in my brain, I feel like I'm in a little bit of a bubble in that I don't, I feel like this is, this is, I don't want to say old material. It's just not been, into the mainstream to a point where it can be applied. So, while I have the information, and I am trying my best to apply some of its principles in my everyday practice, just based upon what I know, it's not, it's not mainstream enough. to be, it's just not disseminated enough and people don't know about it. 

Michelle Dawson: This is the ketogenic diet. Back in 1994, there was a bunch of researchers up in New [01:03:00] York City that were doing studies on the ketogenic diet for seizure management and pediatrics, and it yielded better results for stopping or halting certain pediatric seizure disorders than any of the contemporary pharmaceutical approaches. Approaches. However, the research didn't really come to light or go anywhere for like 10, 15 years. And now all of a sudden we've got like more volumous a research being done on it, but it had to go, I mean, you could do this folks. I'm like Nate's like, like nerdy hype SLP friend over here, because like, this is, I've seen the way he explains to the students and it and it clicks. Yeah. So then, dude, let's make it. Make it, friend. 

Nate Ellis: I always say that I am much more interested in what a kid does [01:04:00] than what my interpretation of their air is. I'm very chi I'm very, very child centered. Yes. I could, I really could care less about adults. But, if. If we as adults are allowing our ears to hear kids kind of incorrectly, then, and we have this, this idea, this model that allows us to, to really delve a little deeper into what they're doing.

I don't know why we're not wanting to jump on top of it. I do think that some of the difficulties come from the fact that this does require a lot. more in depth knowledge of phonetics and speech science, which, and anatomy and physiology, which we, you take at the very beginning of your undergraduate coursework, and then you never think about it ever again.[01:05:00] 

Michelle Dawson: Until you go to take a board exam and you restudy everything. 

Nate Ellis: And, or you're in the middle of practice going, I remember learning something about this. But I can't remember any of it. 

Michelle Dawson: Let me dust out the cobwebs here, friend. 

Nate Ellis: But I have found that those areas are things that have informed my practice more so than anything else I have learned.

Michelle Dawson: Okay. So then what I need to do on my end is introduce you to my sweet friend Yoomi with Speech Therapy PD because this needs to go into some webinars. And I pluralized that on purpose. And then I need to have a sidebar conversation with you about pursuing PhDs because this has to happen and then you need to craft it and build it because Well, we're speaking it into the universe here.

Yes. While I sit here and [01:06:00] stem on my focus, I, I got little, those little touchy pads that have the bumps in them. Do you know what I'm talking about? A poppet. No. Well, it's like that, but it's I don't know. They're, they look like scotch tape, but they're raised and bumpy. They're delightful. So folks, if you too get excited in STEM, these are delightful.

And I have them stuck on my desks. I'll have to take a picture and send you a picture of it, but yes. Nate, this is lovely. We could go on and on, but I would really like to have a part two on like, interventions and approaches that way. 

Nate Ellis: And, and that's, that's tough because. There's nothing out there unless I just can't find it because it's behind you know, the, the wonderful 

Michelle Dawson: paywalls paywalls.

Nate Ellis: But, as I have been told, you could just email people, and they would be happy to send you the copy of their research. 

Michelle Dawson: First authors on articles have the ability to disseminate the journals. 

Nate Ellis: And I'm just too nervous [01:07:00] to go, Hi, can I have a copy of your article? 

Michelle Dawson: Dude! Folks love that! Because it means that somebody is equally passionate and Dr. Memory goes, who I think is like a fairy godmother and she's only like a year older than me. I might actually be a year older than her, but like, do you hear me interjecting with butt likes? That's how like nervous and excited I get just thinking about her. She shared in an episode we just recorded on prom, like, look, when we're first authors or when we're authors on the articles, if, if somebody reaches out to us, we're going to share it because that means somebody is Passionate. Yeah. And that was incredibly, I don't know. It was a profound heartwarming moment for me. But all right. If folks are listening and they have one extra mad money or a little bit of love money lying around and they want to donate somewhere in your honor, [01:08:00] where would you like them to send it?

Nate Ellis: I would probably recommend donating to the Communication Disorders Foundation of Virginia. We, I'm not a member of it, but I just know that they are do fantastic work specifically with every year. Promoting student research. And if there's anything that I think any organization can do, or, or any practicing professional can do is, is to promote and support students in research, their own research in learning those skills, because they are not just vital to doing research, if that's what you want to do in actual practice.

All of those ideas transfer over to practice. I have a hypothesis and now I have to test it. So I'm going to do an evaluation and then analyzing it. What are my results and my [01:09:00] conclusions? It's all the same process. So if we can. If you've got a little extra and you want to give that, donate that, the Communication Science, the Communication Disorders Foundation of Virginia is where I would absolutely say to donate.

Michelle Dawson: Y'all, I did not pay him to say that, but I do have to give the disclosure that I'm a board of trustees member on that. Foundation, but we do and we throw one heck of a party. So y'all come to SHAV next year. It's back in Richmond and I think a different hotel. We're downtown Richmond next year, but yes, but y'all come on.

Because on Fridays we had. We have our poster presentations that the students disseminate the research he was talking about, and I think this year we had 20, 30 presentations. 

Nate Ellis: There were 32 submissions and 31 of them were there. Yes, that's profound. Which is a lot more than we've had before. Yes, which we squeezed [01:10:00] into a little hall.

I guess I guess I should also put out the disclosure that I'm also a reviewer for those submissions. So I read through all of the student poster submissions and it is I like to see. students having that passion, because I did not have that when I was in graduate school. Me either. I could have cared less.

Michelle Dawson: Nope, me too. I was trying to survive life at that stage of the game, but 

Nate Ellis: Correct. Yes. And, and so to see students having that passion at that age, Age, even though that doesn't seem like it's very young, is wonderful. And if we can support that, I absolutely think as professionals, we should. 

Michelle Dawson: Yes. Okay. Now the second question that I have to close this out on is, if somebody wants to learn more from you, Are you comfortable with giving out either an Instagram handle or a email address that they could reach you at?

Nate Ellis: I'll give an email because I [01:11:00] don't, I, what's social media? You're so funny. That's me. That's me. That is definitely me. Yeah. It's ellisphonetics@gmail.com it's very easy to remember. E L L I S P H O N E T I C S. 

Michelle Dawson: I'm glad you spelled it. I wouldn't have gotten that far. But yes. Ellisphonetics. Ah. Well, just email me and he does respond.

He's way faster than I am. So folks, if you are listening and you haven't found us on the social media First Bite is on social media. So check us out on First Bite podcast on Instagram, on Facebook. Erin and I both have LinkedIn accounts as well. You can reach out to us there, but Nate with a very full heart.

Thank you so much for coming on and being here.

Nate Ellis: You're welcome. 

Michelle Dawson: Thank you. .

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Michelle Dawson: Feeding Matters guides system wide changes by uniting caregivers, professionals, and community partners under the Pediatric Feeding Disorder Alliance.

So 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. So who is the Alliance? It's you. The Alliance is open to any person passionate about improving care for children [01:13:00] 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 PFD Alliance tab and sign up today. Change is possible when we work together. That's a wrap, folks. Once again, thank you for listening to First Byte, fed, fun, and functional.

I'm your humble but yet sassy host, Michelle Dawson, the all things PEDS 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.

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