Too Much of a Good Thing: Technology, Apps, and Auditory Verbal Therapy

I love technology.  I love the ability it gives me to communicate with people around the world about the miracle of cochlear implants and listening and spoken language.  I love that, though Facebook, Twitter, and teletherapy services I am able to reach out to people with hearing loss, parents, and professionals to share information, advice, ideas, and support.  When used correctly, technology can be an amazing tool!

So, what’s the downside?

 As much as I love technology, I am dismayed by the growth in popularity of technological applications for speech-language pathology, more specifically, the proliferation of “apps.”  Not a day goes by that I’m not met with a request from a parent for recommendations for computer software, electronic toys, or apps to increase their child’s listening and speaking skills.  But parents are not the only ones to blame.  Perhaps more disappointingly, I see the same blind embrace of any and all technology in my fellow Speech-Language Pathologists.  In one SLP listserv to which I belong, approximately 90% of the posts are about smartphones, tablets, and various applications for those platforms to be used in therapy.  Ninety percent — and that’s a conservative estimate — of these professionals’ discussion is about technological games.  Not research, not evidence-based practice, not case studies.  Apps.  Gizmos.  Ways short circuit the process of human interaction that is integral to communication.

I am opposed to this trend for several reasons:

• We’re not teaching children to talk to a computer.  We’re teaching them to talk to people.  Practice for the outcome you want.

• There is no research behind the vast majority of these apps.  Just because it looks good does not mean that there are peer reviewed studies supporting its efficacy.  “Angry Birds” is a fun game, too, and it has just as much research supporting it as the majority of these apps.

• There is a large possibility for “wrong practice” with these apps.  Without an adult listener monitoring the child’s productions, he or she could play away all day long hearing or pronouncing something incorrectly without any evaluative feedback.

• The American Academy of Pediatrics recommends NO television (and, by extension, electronic media) for children under two, and limited exposure thereafter.  This position statement comes with a slew of peer reviewed journals supporting their rationale.

• While some parents may use these apps as part of a comprehensive therapy program, many parents (and therapists) use them to the exclusion of tried and true therapy methods.  Promoting these research-less apps encourages these people to be negligent in their practice, and normalizes “plug in therapy” as an appropriate intervention.

• One of the principles of AVT is that therapy is diagnostic.  That means, in the session, the therapist is constantly recalibrating the activities based on the child’s responses, and teaching the parent to do the same — to scale up or scale down the level of difficulty, to acoustically highlight this or de-emphasize that, all based on what the child is doing and saying in real time.  Apps cannot do that — again, there’s the possibility for lots of wrong practice.

• One of my best tools in therapy is my ear (okay, actually, I stole that from the venerable Jean Moog, who always says that the teacher’s best tool is her own ears to listen to what the child has to say).  When a child gets something wrong, I ask, “What did you hear?” to gain info about why they made the mistake they did.  Though error analysis, I gain a better picture of the mistake.  An electronic device knows only “right” and “wrong.”  So, if the child’s first guess is wrong, he can keep tapping buttons until he finally gets it right.  It’s just chance.  Do we know why he made the mistake in the first place?  No.  So how can we ever get at the problem that led the mistake to occur?

• On a professional level, I feel that the proliferation of the use of apps in therapy encourages shoddy practice.  As a parent, or school administrator, or insurance company, I would be hesitant to foot the bill for app-based therapy that I could be providing, with the help of a smartphone, without the “supervision” of an SLP.  Again, I have seen no peer-reviewed research that apps+SLP is any different that the child playing at the apps alone.  In that case, for what reason is the professional being compensated?  I my opinion, that professional is not doing his/her job.