Formerly referred to as speech therapy, the techniques, strategies, and interventions designed to improve or correct communication disorders are known as speech-language pathology. Both speech disorders, which involve difficulty in producing the sounds of language, and language disorders, which involve difficulty in understanding language or using words in spoken communication, are treated by speech-language pathologists.
In 1993 there were nearly 70,000 speech-language pathologists in the United States certified by the American Speech-Language-Hearing Association (ASHA). Speech disorders treated by speech-language pathologists include voice disorders (abnormalities in pitch, volume, vocal quality, or resonance or duration of sounds), articulation disorders (problems producing speech sounds), and fluency disorders (impairment in the normal rate or rhythm of speech, such as stuttering ). Language disorders in children involve the comprehension or use of spoken or written language. They may represent an isolated problem, or they may be associated with mental retardation , autism hearing impairment, or acquired aphasia . Speech-language pathologists participate in the screening, assessment, and treatment of patients.
Children with isolated speech disorders are often helped by articulation therapy, in which they practice repeating specific sounds, words, phrases, and sentences. For stuttering and other fluency disorders, a popular treatment method is fluency training, which develops coordination between speech and breathing, slows down the rate of speech, and develops the ability to prolong syllables. A child may practice saying a single word fluently and then gradually add more words, slowly increasing the amount and difficulty of speech that can be mastered without stuttering. The speaking situations can gradually be made more challenging as well, starting with speaking alone to the pathologist and ending with speaking to a group of people. Delayed auditory feedback (DAF), in which stutterers hear an echo of their own speech sounds, has also been effective in treating stuttering. When a speech problem is caused by serious or multiple disabilities, a neurodevelopmental approach, which inhibits certain reflexes to promote normal movement, is often preferred. Other techniques used in speech therapy include the motor-kinesthetic approach and biofeedback, which helps children know whether the sounds they are producing are faulty or correct. For children with severe communication disorders, speech pathologists can assist with alternate means of communication, such as manual signing and computer-synthesized speech.
The majority of speech-language pathologists work in educational institutions, many of them in public elementary schools. They are also found at both residential health care facilities and over 300 outpatient clinics that specialize in communication disorders and are often affiliated with hospitals and universities. Professional training programs in speech-language pathology are offered at both the undergraduate and graduate levels. Undergraduate training may include classes in biology, anatomy, psychology, linguistics, education, and special education . Most clinicians hold a master's degree in communications sciences and disorders from a program accredited by the ASHA.
Diagnosis and treatment
Pediatrician and author T. Berry Brazelton has recommended early evaluation for speech or communication disorders in young children who show any of the following signs:
1) no intelligible speech by two years of age
2) nasal or high-pitched speech sounds
3) utterances without facial expression
4) lack of responsiveness when spoken to or looked at
5) continual repetition of adult speech without variation or modification.
Children may receive speech therapy either through their public school or privately. Speech impairment qualifies as a disability under PL 94-142, the federal law mandating education for the disabled. Most communities have school speech pathologists. There is no cost to the family whose child receives therapy in public school. It is convenient; children often have the opportunity to work in groups, and the speech pathologist has easy access to child's classroom teacher. At a speech and hearing clinic, on the other hand, earlier intervention is possible, and parents can often work more closely with the speech pathologist than they could under a school program.
Parents seeking speech therapy for their children are advised to look for a clinician with certification by the American Speech-Language-Hearing Association who is favorably recommended by current or former clients, has good rapport with children, and is willing to speak openly and clearly with parents about the child's condition and progress and the treatment methods employed. Active involvement by parents is an essential component of an effective speech pathology program. Many programs require parents to attend special educational sessions with the clinician, and they may be encouraged to attend the child's therapy sessions as well. They may also be instructed or advised on specific activities they can pursue at home as a supplement to the sessions with the clinician.
For Your Information
* Flower, R. M. Delivery of Speech-Language Pathology and Audiology Services. Baltimore, MD: Williams and Wilkins, 1986.
* Hicks, Patricia Larkins. Opportunities in Speech-Language Pathology Careers. Lincolnwood, IL: VGM Career Horizons, 1996.
* Lass, N. J., L. V. McReynolds, and J. L. Northern. Handbook on Speech-Language Pathology and Audiology. Philadelphia: B. C. Decker, 1988.