Tough Talks An SLP shares why it’s important to get comfortable with breaking unpleasant news—and provides tips for tackling those conversations. Make It Work
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Make It Work  |   April 01, 2018
Tough Talks
Author Notes
  • Adrienne De Froy, MS, CCC-SLP, is a clinician in Carrollton-Farmers Branch Independent School District in Carrollton, Texas. adrienne@defroy.net
    Adrienne De Froy, MS, CCC-SLP, is a clinician in Carrollton-Farmers Branch Independent School District in Carrollton, Texas. adrienne@defroy.net×
Article Information
Normal Language Processing / Make It Work
Make It Work   |   April 01, 2018
Tough Talks
The ASHA Leader, April 2018, Vol. 23, 36-37. doi:10.1044/leader.MIW.23042018.36
The ASHA Leader, April 2018, Vol. 23, 36-37. doi:10.1044/leader.MIW.23042018.36
I make parents cry. A lot. They might yell or ignore me or deny what I’m saying. But mostly they cry.
I work for a school district, conducting autism spectrum disorder (ASD) assessments as part of a multidisciplinary team, so I am often the first person to tell a parent that we believe their child has ASD. Bringing up the subject to parents for the first time and recommending eligibility for services based on the diagnosis are easily the hardest parts of my job. They are also some of the most important.
These early conversations with parents shape their understanding of ASD and their feelings about special education. They open the doors to services and help build honest, trusting relationships. From those difficult conversations come the most rewarding of outcomes. None of us wants to be the bearer of bad news, but this is a critical element of our job, one that has serious ramifications for our students. But I know from peers in the field that broaching tough topics is a hurdle some avoid jumping.
Being the first
Many of us have experienced something like this: A parent brings their child to you with concerns about a language delay, but as you interact with them you suspect something more significant is at play—maybe it’s ASD, a syndrome or an intellectual disability. You know you aren’t qualified to diagnose it, but your experience tells you it’s there, and you think a referral for additional assessment would be appropriate. You are also fairly certain that no one has ever raised concerns to this parent before.
Here are comments I often hear from peers who avoid this situation, and why we have a responsibility to carry out these discussions:
“The thought of raising these concerns to the parent terrifies me (what if they get mad?), so I’m not going to say anything.” The child is more important than your feelings. Don’t let the child miss out on months or years of early intervention because you feel uncomfortable voicing your concerns.
“If the pediatrician (or other professional) hasn’t said anything, I must be wrong.” Don’t underestimate your training and experience. Pediatricians are not trained in communication disorders like you are, and have not had the same depth of interactions with this child.
“It’s so obvious, someone else is bound to say something soon.”You are that someone.

It was a tough lesson for this people-pleaser to learn: If a parent didn’t like me, I thought I had failed. But I realized our job is not to make people like us.

Breaking tough news
None of us became audiologists or speech-language pathologists because we enjoy delivering bad news, and most of us never received training on how to do it. Here are some tips for sharing tough news with parents.
Be clear. Use simple language and avoid technical jargon. Try not to overwhelm them by providing too much information at once.
Be honest. Sugarcoating the truth only confuses parents. It’s all right to allow parents hope, but don’t provide false hope to make the moment easier. Remember, this is about the child and the family, not your feelings.
Be respectful. Parents are going through a mourning process when you deliver tough news. Sometimes this process involves undermining your degree, experience or assessment process. Even in these tense moments, it’s important to keep your composure and remain professional. Listen without interrupting, judging or allowing your own emotions to interfere.
Be consistent. I have had many parents try to convince me I’m wrong, sometimes reinforcing their arguments with tears or yelling. Don’t backpedal because the parent is upset. They will have more confidence in you in the long run.
Be up front about what you don’t know. Avoid absolute language like “never,” “always” and “definitely” to talk about a prognosis. We don’t know if a nonverbal child will ever speak, or if a 3-year-old will be able to hold down a job one day.
Cultural competence
Learning about the cultures of the families you are working with is critical. How are gender roles defined, and how will that affect your interactions with the family? Are extended family members an important part of the nuclear family? How are school staff viewed (as experts who don’t need parental involvement, as working for the families and doing what they say, or as team members)? Is education something that ends when the bell rings, or is the family open to doing homework and generalization activities?
It’s equally important to analyze your own cultural beliefs and monitor yourself for judgments and biases against others. This lesson was difficult for me when I worked with my first family from a society with a gender-based hierarchy. I often caught myself making judgments about their decisions, such as the mother not being allowed to attend meetings without a male family member present. It is easy to believe that our own belief systems are correct, but this judgmental attitude interferes with our ability to establish effective relationships with families.

Sometimes, despite my best efforts, parents are angry with me. And that’s OK.

If at first you don’t succeed …
Sometimes I have to tell parents the same thing repeatedly. Sometimes parents deny a behavior the child is doing at that exact moment. Some parents are convinced I’m wrong because they read something on the internet.
What do you do when a parent seems not to listen? You keep giving the information. Try to reword things, or provide information in a different way (for example, I give parents written information restating what I’ve just told them about autism). But you don’t stop trying. You can only state what you know in a respectful, nonjudgmental way. Our job is to provide the most accurate information we can; ultimately, we must allow parents to make their own decisions.
Sometimes, despite my best efforts, parents are angry with me. And that’s OK. This was a tough lesson for this people-pleaser to learn: If a parent didn’t like me, I thought I had failed. But I realized our job is not to make people like us. Of course it is better when we have established rapport and have a mutually respectful relationship with parents—that should always be our goal—but sometimes our role might be to plant a seed of understanding that will sprout later.
Delivering tough news never gets easy—but it does get easier.
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April 2018
Volume 23, Issue 4