Scholarship

REFLECTIONS ON MY SCHOLARSHIP

This may come as a surprise to some but, despite having had continuous academic appointments since Jan 1999, I only heard about the Boyer scholarship categories in the last year or two. Indeed it was only in preparing this portfolio that I took the time to actually read Boyer’s 1990 paper Scholarship Reconsidered. Having done so I now realize that the nature of my own scholarship has been shifting in ways that are similar to what Boyer describes has been happening in all of academia.

I was trained to engage in the scholarship of Discovery and (because speech-language pathology by nature draws from many disciplines) the scholarship of Integration. Until recently I had fended off calls for me to work on the scholarship of Application however, because I was convinced that we needed to understand more of the basic science of speech and language development and disorders first. I now realize we will never know it all. Recalling my own days as a clinician the big concerns relate to specific assessment and treatment approaches. Without access to more well constructed, applied research most clinicians will do one of two things: (1) stick doggedly to doing the same thing year after year, or (2) latch on to the latest trends which (because they are often being presented by those without much research training) may lack meaningful evidence or even a solid theoretical foundation. Please note that I don’t intend to give up on research for basic discovery; I have simply decided to broaden the scope of what I will do. To date I have not done much (nor do I plan to do) that would fall into the scholarship of Teaching.

I would describe my general approach to research as being opportunistic. I don’t necessarily see this as a bad thing. I have been able to take advantage of opportunities that present themselves. I have done so for very practical reasons. Research into human behavior requires access to human participants. Early in my doctoral program I noticed widespread frustration among my fellow students and my professors with finding sufficient participants to answer the research questions that were being asked. There are many questions to be answered, and I’ve tended to let the available data drive many of the questions I’ve tried to answer. My doctoral dissertation was based on an existing data set which my mentor had created. My publications #18 and #19 were both based on other data sets I borrowed from the same source. My publications #11 and #25 were both based on data sets I borrowed from another researcher (Dr. S. Lee). Dr. Lee has since expressed interest in continued collaboration. When I arrived at the University of Tennessee one potential pool of participants was immediately obvious to me. These are children with severe and profound hearing impairments who have been fitted with cochlear implants who were being seen at Child Hearing Services, a clinical services program run by the department. My most recent entry into the scholarship of application (publication #27) arose, because I learned of this study while I was a journal associate editor. The study appeared to have been well designed but the manuscript was poorly written and rejected. After leaving the journal the author (S. Sacks) approached me about collaborating to get it published elsewhere. While working on that I also worked with him on a replication of the study which we presented in 2013 (conference presentation #44). We are working on designing another study now.

Being opportunistic doesn’t mean that my research hasn’t had any focus. Without question the central theme of my work is Speech Sound Disorders in Children. This is most evident by the fact that in the spring of 2006 I was, much to my surprise and delight, invited to be co-author on the 6^th edition of a classic textbook in my area. One of the current authors had just retired and the other was planning to soon( he did so in 2012). They and the publisher approached me, because they wanted the book to continue and thought adding a younger author would ensure that. The plan makes sense – the surprise was that they felt I was up to the challenge. If their choice of me as co-author is any indication of how well I’m doing, I guess I must be doing OK. The 7th edition of the book came out in fall 2012. We are just starting work on the 8th edition which is scheduled for release in mid 2016.

Speech sound disorders is itself a broad area; such problems occur in up to 10% of preschool children and make up as much as 60% of the caseloads of speech-language pathologists working in the schools. I have managed to generate research output that relates to several aspects of this sub-discipline in speech-language pathology. I outline those areas here:

Normal Development of Speech

This area of my research falls squarely into the scholarship of discovery. When one speaks of a disorder there is an implication of an ordered (or normal) reference point. Although there is much we know about speech sound development there remains much we don’t know. In several cases I’ve needed to develop normal reference data (which didn’t yet exist) to try to understand some aspect of disordered speech. My publication #7 was used to help generate the data for #13. #11 was used for #10, and #18 was used for #19. And #26 was carried out to potentially look at vowel space area in children with cochlear implants (I have data that I intend to use for that). See also technical reports #2-#4.

I have an ongoing study with two colleagues at the University of Wisconsin-Stevens Point that involves collecting data using a set of relatively new “whole word” measures. These have been suggested as possibly being a better way to describe both normal and disordered development. Once the data on the normal children are completed the goal is to use those as reference data to evaluate speech in both children with speech sound disorders and children with cochlear implants.

Understanding the Nature of Speech Sound Disorders

This area of my research falls into both the scholarship of discovery and the scholarship of integration. As part of my work on my doctoral mentor’s grant and with my dissertation I’ve completed several publications (#8-#10, #12-#15) that have attempted to add to our understanding of children with speech sound disorders. This broad population has long been treated as a single entity and their response to treatment has been mixed. This has led many to suggest that there may be subgroups. Each of these studies involved helping to sort out the nature of those subgroups.

Several of my publications (#2-#5, #16, #19) have focused on assessment issues related to this population. A number of my conference presentations have also done so. This arises directly from both a need for more understanding in this area and my personal affinity for clinical assessment.

I plan to continue this work. A recent student thesis that I directed at ISU (also conference presentation #43) involved looking at the impact of pacifiers of speech sound development and disorders. I have plans to extent this study to gather a larger sample and have begun discussing with several colleagues at other institutions around the country.

Children with Cochlear Implants

Here again this aspect of my research falls into both the scholarship of discovery and the scholarship of integration. I have devoted considerable time to trying to understand how speech and language emerges in this population. Historically this population would have received conventional hearing aids and may or may not have learned sign language along with speech. Their spoken language outcomes as well as their educational and occupational experiences have been disappointing at best. Most would have speech that would be less than 25% understandable to the average person, they often read at no better than a third grade level, and often ended up in low wage jobs. The question for many has been: would the cochlear lead to better outcomes? After conducting numerous studies (publications #17, #20-#25) the obvious conclusion I have come to is yes. Their speech is now often fully understandable and their educational outcomes now often match their normal-hearing peers. While there is much yet to be learned, my personal interest has waned to the point that (short of completing the write-up of some ongoing studies) I have decided to move on to other things.

Treating Speech Sound Disorders in Older Children

Here is where my research agenda has gone into a new direction namely the scholarship of application. In this case I am beginning to try to apply my understanding of both normal development and speech disorders to looking at treatment.

The two publications from my dissertation (#12 and #14) led me to an interest in long-term outcomes in these children. About 85% of this population end up with fully normal speech following treatment. But the rest (which represent about 1-2% of adults) have mild speech distortions. Although these errors do not limit communication there can be negative social impressions which may lead to life limitations. My dissertation was an attempt to see if it is possible to predict which children will not “normalize”. Thus far I have been unable to isolate anything that is predictive.

This failure to find predictive factors led to my current interest in treatment approaches with a particular interest in those older children who fail to completely resolve their difficulties. Current conventional approaches often fail for these children. It is not uncommon for clinicians to discharge them from their caseloads because of lack of progress. Many alternative treatments have been proposed for such cases but all have limited evidence to support them. Publication #27 is the first of what I hope will be many that tries to address that. I hope to work on this from several angles. In addition to continued work with S. Sacks on his SATPAC approach I have been speaking with the developers of Speech Buddies and have met with a local clinician who works extensively with a device known as a Smart Palate. I have also been discussing the possible use of spectrograms with a colleague here at Pacific. These three latter approaches all involve changing the feedback that children have available to them to allow them to change what they are doing.

Down Syndrome

This last area is essentially a minor sidelight, and I have no plans to pursue it further. I mention it here only because it appears on my CV. It represents both the scholarship of discovery and integration. My very first publication (#1) was a review paper on Language Development in Down Syndrome. The reader will note from the front page of the article that this was a “Special Student Paper”. As an undergraduate I wrote a paper for a class and my professor (Dr. Frank B. Wilson) encouraged me to enter it into a student paper competition which I won. Part of the prize was having it published in the then very new Canadian Journal of Rehabilitation. As I’m guessing most academics will admit I found that seeing my name in print for the first time was a very motivating experience. It spurred me on to submit my next four articles which were all based on work done before I started my doctoral training.

The choice of the topic for that first paper was simply one of convenience – I had read an article that suggested that the topic needed exploring. I was led to the topic of the second paper (publication #6) the same way. It was a case study. And this was again an example of my being an opportunist. It turned out that my doctoral mentor had a small database that allowed me to address the same question with a slightly larger sample.

Grant Funding

I do understand that in many cases it costs money to do research especially if one wants to do it on a large scale and/or quickly. As such I have attempted to secure funding support (see pp. 5-6 of my CV) for various projects. However except for some small internal grants I have been largely unsuccessful. In spite this I have managed to be what I believe is a productive scholar without it. I have not completely given up on grants. The pacifier study I mentioned previously may require writing a grant proposal, and my current collaborator (S. Sacks) on treatment studies and I have been discussing possible grant sources for expanding studies of his approach.

Documentation: My Evidence

Below are links to individual items related to the scholarship sections of my CV (pp. 2-10). Flipsen-CV-PacU-tenure Click on each item to view.

Peer-reviewed Publications

PRP1-Flipsen(1987) PRP2-Flipsen(1992) PRP3-Flipsen(1993) PRP4-Flipsen(1995) PRP5-Flipsen(1998) PRP6-Flipsen(1999) PRP7-Flipsenetal(1999) PRP8-Shribergetal(2000b) PRP9-Shribergetal(2000a) PRP10-Shribergetal(2001) PRP11-Flipsenetal(2001) PRP12-Flipsen(2002) PRP13-Karlssonetal(2002) PRP14-Flipsen(2003) PRP15-Shribergetal(2003) PRP16-Flipsenetal(2005) PRP17-Flipsen&Colvard(2006) PRP18-Flipsen(2006b) PRP19-Flipsen(2006a) PRP20-Lenden&Flipsen(2007) PRP21-Flipsen&Parker(2008) PRP22-Flipsen(2008b) PRP23-Flipsen(2008a) PRP24-Khwaileh &Flipsen (2010) PRP25-Flipsen(2011) PRP26-Flipsen&Lee(2012) PRP27-Sacksetal(2013)