Life as an SLP: My Thoughts on "Speechless"

It's been a few weeks since "Speechless" premiered on ABC. In case you've missed the media blitz, it chronicles the journey of a family with a 16-year-old son with cerebral palsy who uses a low-tech AAC device to communicate. The premise is based upon a switch to their son's 6th public high school so that he might finally be in a "regular high school." Because, despite typical cognition, cerebral palsy has kept their son trapped in "special education schools." This new public school, strangely, has never had a single student with disabilities (and thus does not have an SLP... or any other special education staff for that matter).

Ahh, television realism at its finest, am I right?

When I heard about the premise of this show, I said to myself, "I work at a public high school with a teenage student with cerebral palsy who uses an AAC device! I am actually qualified to comment on the quality of this programming!"

I've been following this show since I heard it was in development and I've waited until now to post a review and share my thoughts because I wanted to give the show a few weeks to develop before I passed any serious judgement. ...Perhaps it was just the pilot that was a disaster, right?

Well, it's been a few weeks. And while the show is garnering well-deserved praise for highlighting a family dealing with the realities and challenges that cerebral palsy and AAC bring, I can't help but be frustrated by the portrayal of the special education process.

So What's Bad About The Show?

1) Special education is entirely erased from the show

We live in a world of FAPE (Free and Appropriate Public Education), LRE (Least Restrictive Environment), and so many other acronyms that exist to ensure our students are receiving an education in the setting that will provide them with the most appropriate learning environment. However, for those who do not work in special education, there is still a prevailing attitude that comprehensive high school sites do not provide special education services and the students are shipped off to some different "special education school."

This was the case in the past, and still may be in extreme cases that require Nonpublic Schools or parents who can afford fancy private schools that specialize in services. But for most families with students with special needs... they end up at a comprehensive high school site. And pretty much every public high school today has special education professionals working there (because at the very least there are RSP teachers and I think you would be hard-pressed to find a public high school without at least a Mild/Mod SDC program).

A show like "Speechless" comes along and reinforces the idea that a high school with a planetarium has managed to exclude every student with an IEP from it's school.

Let that sink in for a second.

Yeah. I know it's TV, but this would be as if the hospital in House had literally no anesthesiologists and Doctor House himself put patients under before surgery. Not only is it not realistic, the absence is glaringly obvious to those in the field.

These are damaging stereotypes and missing roles that serve to undermine the extremely arduous efforts that public school special education professionals put in every day.

2) JJ's mother is frightening and encourages frivolous lawsuits.

As an SLP involved in a current legal battle involving a student with cerebral palsy and an AAC device, this show has caused me grief in each of the 4 episodes that have aired to date. Minnie Driver's character, JJ's ferocious helicopter mother, is scarily straight out of real life. We are supposed to chuckle at her over-the-top actions, like when she demands that a groundskeeper with no experience as a paraprofessional be hired as her son's aide.

Yes, we are supposed to think that she is a little crazy, but she is played as very sympathetic and her behavior is supposed to make the average viewer wonder "Gee, why is JJ only attending a "regular high school" just now?"

Which is a ridiculous question, because as we all know, sequestering JJ away in a "special ed school" was denying him FAPE and very illegal. A student with typical cognition would have been in a general education program from the start. But now the general public has the idea that we deny students with disabilities appropriate services.

Let's not even mention the fact that in one episode she literally says something to the effect of, "Don't make me call my lawyers," Uhhhhh... Your son has been denied an appropriate education for approximately 11 years and you're going to call a lawyer because you didn't get the aide you wanted? Where are your priorities, woman?!

The fact that she is played as sympathetic and that the staff cater to her every whim is scary. As special education professionals, we literally cannot bend to insane parental demands unless a student's educational well-being is at stake. Can we consider for a moment that perhaps she's moved her son to 6 different high schools because she is a crazy person expecting unrealistic outcomes? Since the writing team has clearly never heard of FAPE (or even an IEP, for that matter), we get this ridiculous notion that 6 public schools have all woefully failed to provide JJ with what he needs and therefore her behavior is completely justified and acceptable.

And thus we further the public's belief that schools fails children with special needs.

3) Where is his high-tech device?

OK, so according to the creators, they consulted with a woman with cerebral palsy who uses a low-tech system like JJ's. That's cool. From an interview with her, it appears she is older and may not have had access to a high-tech system when she was being served by the schools. The creators say the low-tech device plays better on TV and of course, it's the entire reason JJ requires and aide which is the premise of the show.

But guess what?

Any SLP with a specialty in AAC would take one look at the typically-developing cognitive skills and precise head control he demonstrates in the show and recommend a dynamic display that could be controlled with eye gaze or another means of access (I do not claim to be an expert in this area of the SLP field).

So why would a dynamic device be better?

Well, besides the obvious reasons of high-tech devices having internet access and the ability to use them to complete school work (and you know, access the internet, which he currently can't do), my main reason would be that with a high-tech device, JJ wouldn't need an aide to "speak for him." He would literally have his own voice that he alone controls. On a frequent basis in the show, we see JJ's family and aide censor his voice by choosing to only say what they deem acceptable even though JJ is communicating more. They are essentially denying him the agency that, as a person, he deserves. A dynamic-display device would allow JJ to speak his thoughts completely uncensored and grant him the basic human right of free communication that his family likes to so easily take away from him.

If his mother was truly the lawyered-up advocate she claims to be, why is she not fighting for her son to receive a high-tech device that could be his true voice? Could it be that she just wants to be his voice for him, maintain control over him forever, accept his thoughts only when they are convenient for her, and deny him autonomy (in a kind of sick and twisted way when you think about it)?

Naw, this is primetime television, so it's easier to pretend that such high-tech devices wouldn't be an awesome fit for students with profiles like JJ's.

So What's Good About The Show?

Of course, it's fabulous that students with disabilities are being highlighted on primetime television. JJ's character is amazing - in the 4th episode, his aide forgets his communication board and the sheer terror he experiences at being unable to communicate is so real and human. The daily challenges his family faces at altering their life to accommodate JJ are true and would motivate anyone to imagine how their life would be different if it included a family member with disabilities.

"Speechless" also features an actor who has cerebral palsy in real life, a nice move considering characters with disabilities are sometimes played by actors without those disabilities.

But sadly, in my opinion, JJ's realism and humanity is the show's only saving grace. The downside is that, in order to create a situation where JJ's struggle is most impactful, special education professionals and the work they would do to support JJ are erased from the narrative. The 6 previous schools that JJ's mom "fought with" must look inept and under-prepared to serve JJ in order to make the premise for this show function. And the idea that schools are somehow cheating their students with special needs is how I end up with legal battles over non-issues. I am a huge advocate for students like JJ and of course some schools/educators/programs are failing. No one can deny this, problems exist everywhere. But this show doesn't even have a slight grip on the reality of special education in the public schools, and that's dangerous.

Keep trying, ABC. Maybe for your second season you can actually have someone involved in special education consult with you to highlight the many, many places you got it wrong.
- Jillian, the No-Frills SLP

The Moderate/Severe Population: Structuring Therapy Sessions

Over the years, I've realized that when working with students in my Mod/Severe classes, my sessions are most successful when they include several parts that we can "check-off" on an agenda, visual schedule, etc. This is most necessary for my students with behaviors who have limited attention and need to constantly be looking towards the next activity. For example, here's a re-usable visual schedule I use with a student who has particular difficulty attending to tasks for more than a minute or two.

Thus, the clinical question I realized I needed to answer was this: what activities can I do with my Mod/Severe students to break-up an otherwise long, single activity?

What Do My Mod/Severe Sessions Look Like?

My Rules ~ 1 - 2 minutes
As I mentioned in my very first post about working with this population, I always start out by quickly going over the "rules" to get everyone in the mindset of participating and focusing on their good speech strategies. You can find my rule sheet here, although I have recently been contemplating updating it to include an AAC rule since I have several new AAC users this year.

Warm-Up ~ 3 - 7 minutes
I like to do some sort of quick activity to get my students talking and ready to engage in the main activity for the day.
- For my lowest-functioning class, I use the free "Touch and Say" app and open different pages for different students: the "silly" page for students working on imitation, "feel" page to quickly target some emotions, or "color" to work on some basic functions. It may look juvenile with the little mouse-looking creature, but on the actual pages there is no mouse, just a solid color with a "Nick Jr."-esque face. It ends up being much more neutral than some of my students other preferred interests (e.g. Thomas the Train, Dora, etc.).

- For my higher functioning classes, I created the "Conversation Balls." Essentially, it's two dollar store balls (one big, one small) that I hot-glued a long string between to connect. The game is played by selecting a student who gets the big ball and a target prompt (e.g. "What did you do over the weekend?" or "What's your favorite food?"). The student then throws the small ball to a peer and asks them them target question. The string connects the two balls, serving as a good reminder for students to use eye contact and face their conversational partner. After the student with the big ball makes a comment, the student who had the small ball selects someone else to be their partner and then they receive the big ball. I prompt as needed for the students to make comments, ask/answer questions, etc as the balls get passed around the room between all the students.

**For some groups, the conversation ball can be so time consuming that it can take up an entire session; it really depends on how well your students can ask and answer questions**

- If an exciting topic has recently happened, such as Christmas or summer vacation, I may just ask the students to go around and each share one thing that's on their minds. They get to practice their language skills (because most of their day is spent in total silence!) and I get to learn more about their lives! It's a win-win.

Main Activity ~ 15 min - 25 min
You can check out some of my "main activities" that I have posted about in the past here and here. You can also check out my blog post here where I describe some of my favorite "off-the-shelf" materials, some of which I have used with my higher-functioning Mod/Severe students as "main activities." There's many other activities that will one day make it into a blog post, such as using themed surveys to ask and answer questions, re-telling short animated clips, using News 2 You, and modifying traditional games like bingo and go fish to target functional communication and intelligibility. Stay tuned for more ideas for working with this population in the future!

Wrap-Up/Reward/Transition ~ 1 - 5 minutes
With my higher-functioning classes, we always do a quick wrap-up to discuss what we were targeting that day - such as new vocabulary, explanation skills, good speech skills, social skills, etc. This is an important part of any session, but I actually forgot to implement a wrap-up with my Mod/Severe students until this year... whoops! They need the reminder of what they were working on as well!

You may also have some students/classes that need to be working for a reward. I typically implement a short, funny video as the reward since it can target an entire class and be over within 60 seconds or less. Popular google searches for appropriate and enjoyable videos include "dog dancing," "funny cats," and other animal-related videos. I also try to schedule my sessions at the end of a class period so that when my session ends, the students are ready to transition to their next classroom or activity. I feel like this gets some teacher buy-in as well, because the students are completely finished with an activity and are generally willing to transition with little difficulty.

I think the key take-away in planning sessions for the Mod/Severe population is to always try to plan for any crazy thing that may happen and to then have some sort of back-up in mind! Behavior issues? Have that visual schedule, Class Dojo, or reward system ready to go. Session not going well? I keep the students' favorite Matt and Molly stories in my Mod/Severe therapy bag just to whip out in case things go south.

What are your favorite ideas to keep your Mod/Severe sessions running smoothly? How do you handle behavior issues or keep your students focused on your activity? Please share your ideas in the comment section!!

As always, it doesn't have to be fancy, just keep it fun and functional!

• Jillian, the No-Frills SLP