Was I ever in for a surprise!
- How about the child (only Spanish) at home with a complex seizure disorder, cerebral palsy, intellectual delay, cortical visual impairment, and no speech?
- How about a child with normal receptive language (in Burmese) who appears to have selective mutism?
- How about the child with repeated surgeries and radiation for a brain tumor leaving him with severe language deficits among a multitude of other difficulties?
- How about the child with a fluency disorder known as cluttering---totally not mentioned in the NC speech pathology guidelines?
- How about the laryngectomy patient who subsequently had a stroke? (from my grad school days)
In our school system, I'm blessed to have both a strong Professional Learning Community (composed of all the speech pathologists in the district) to help with this process. When I have a particularly challenging case, I make phone calls, and drive to another school to discuss the particulars with my friends--other SLPs. I can also make a referral to our assistive technology team---a brilliant duo that often assist with some needy and confusing children.
The final decisions on therapy fall on me, however. I feel that my personal strength is that I often, very often, reflect on what I do and whether I have the data to continue with the current course. I hope that graduate schools now discuss problem-solving and self reflection, and teach their future SLPs to question their own therapy and past therapies in order to make the lives of their clients better.