Speech-language pathologists are professional who specialize in the study, evaluation and treatment of individuals with communication and swallowing difficulties. Like audiologists, speech-language pathologists practice in medical, clinical, private practice, rehabilitation, home health, geriatric (such as long-term care), early childhood and school settings.
What is Communication?
Communication is the means by which people share thoughts, ideas, and emotions. It includes both verbal and nonverbal characteristics. Speech-language and hearing are typically considered the most important elements of communication. Good communication skills are important for a child to explore and make sense of his or her environment and to be successful in the school environment. They are equally important for adults to fully build and maintain social and work relationships.
What are Communication Impairments?
Communication challenges are called communication impairments or disorders. They are among the most common disabilities in the United States. The term communication disorder refers to impairment of the ability to receive, understand, process, and send verbal, nonverbal, visual and/or graphic (written) messages.
Language is the socially shared code or system for communicating concepts which is governed by formal and informal rules and is understood by users of the language. It includes the understanding of verbal, gestural, nonverbal (such as body language), or written messages or receptive language and the use of verbal or nonverbal messages or expressive language.
Language is generally broken down into three broad systems. A language impairment can exist when any of these systems of language (or combinations of systems) are not effective for an individual to meet his or her needs as expected based on age, culture, or experience. The three broad language systems, include:
- Semantics is sometimes thought of as vocabulary, but is much more than simply understanding or using individual words. It includes word meanings and combinations of word meaning and their relationships.
- Syntax is sometimes thought of as grammar. It is governed by rules which specify word order, sentence organization and relationships between words. A related aspect of syntax is morphology which includes the rules governing how words and word combinations are changed to change meaning. One example is adding an ‘s’ sound to the end of words to indicate more than one (plural).
- Pragmatics is the social use of language to communicate. We use pragmatics to comment, disagree, negotiate, ask questions and socialize. It also includes social language skills such as eye contact, topic maintenance, turn-taking, interrupting, etc.
Sound System (Speech) Impairments
Speech is the motor act of using the respiratory and oral mechanism (lungs, larynx, lips, palate, teeth, tongue, jaw, etc.) to shape sounds in order to make word combinations that have meaning for a community or society. Our ability to understand speech can be affected by articulation errors, phonological patterns or a combination of both.
- Articulation is the movement of the lips, palate, teeth, tongue, jaw, etc. to shape air and vibrations to make sounds or words. It begins to develop at birth and is shaped throughout a child’s early years. We recognize it as talking. Children and adults may have articulation disorders, which are sometimes called a speech impairments or Sound System Disorders. An impairment might be identified if sounds are produced in error. Sounds may be added, omitted, distorted or substituted for other sounds. Sound System Disorders may exist in otherwise typically developing individuals or may co-occur with or result from other impairments such as cerebral palsy, traumatic brain injury, stroke, etc.
- Phonological patterns are used by children when speech sounds are difficult for them to pronounce. Some patterns are typical, meaning they occur in most children who are learning to speak. In typically developing speech, the phonological patterns follow a predictable sequence in which they are inhibited or no longer heard. For example, a phonological pattern called fronting velars occurs when a child replaces back sounds (sounds made in the back of the mouth) with front sounds (sounds made in the front of the mouth). This occurs in typically developing speech, until about age three or four, and can be heard when a child replaces ‘k’ sounds with ‘t,’ so the word “cat” sounds like “tat.” Some patterns, are not considered typical since they do not occur in most children learning to speak. A phonological disorder may be present if a child uses atypical patterns or does not outgrow the use of typical patterns by a certain developmental age.
Fluency is the fluent flow of speech. Disruptions in the flow of speech are called disfluency, stuttering or cluttering. Disfluencies are often categorized as repetitions, prolongations or blocks in speech. They are sometimes accompanied by physical tension or struggle as well as emotional reactions such as fear or anxiety. There are many different patterns of stuttering just as there are different degrees, ranging from mild to severe. Although the exact cause of stuttering is not known, it is known that it is not caused by emotional problems It is not the fault of the person who stutters or of others around them. There is no simple cure for stuttering but individuals who stutter can learn to speak more easily and communicate more effectively.
Voice is the sound made by air passing from the lungs through the larynx, or voice box. The larynx contains the vocal cords which vibrate to produce sound. Problems with voice quality occur when there is a change from what we perceive as typical. This could be when a person’s voice sounds hoarse, nasal, raspy, breathy, etc. Voice changes also can include pitch or loudness which is inappropriate for age or gender. Although there are normal temporary changes in voice due to infection or cold, medication, or other medical reasons, a voice disorder may be present when the voice does not return to what is typical for the individual. A common cause of vocal problems is vocal misuse, which may be caused by frequent shouting, throat clearing or using inappropriate pitch. Speech-language pathologists work with individuals with atypical voice problems but it is usually recommended that a physician be consulted to rule out any medical causes prior to evaluation by the speech-language pathologist.
Signs You or Your Child may have a Communication Impairment
You may suspect a communication impairment if you or someone you know has difficulty understanding or using spoken or written language. Any disorder in ability to receive, process, and send verbal, nonverbal and written messages could be a communication impairment. In children, communication impairments may affect ability to meet grade level expectations and to adjust socially. In adults communication impairments can affect job performance, ability to get or keep a job, social interactions and quality of life.
If you think your child may have communication difficulty, look for some of the following signs with both familiar and unfamiliar people:
- needs someone to interpret what is said to others
- says sounds or sound combinations differently from other children his or her age
- has difficulty socializing with peers because of different communication skills
- has difficulty expressing ideas or needs
- may not be able to tell you why he or she is upset about something
- does not understand what others say or does not respond to information or follow directions
- performs in some or all academic areas below grade level peers at schools
- demonstrate difficulty with reading and/or writing
- shows signs of being self-conscious about his or her ability to talk or interact and may not talk as much as peers
What Do I Do if I Suspect a Communication Impairment?
If you think you or someone you care about has a communication impairment, communication specialists (audiologist and speech-language pathologists (SLPs)) can be found in a variety of settings. Both audiologists and SLPs work in medical settings, hospitals, clinics or doctor’s offices. Often your medical doctor can refer you. Some audiologists and SLPs work in private practice. Some public schools have educational audiologists, but these are generally found in larger school districts. Rehabilitation facilities and long-term care facilities such as nursing homes often provide services of audiologists and SLP.
All public schools in Missouri are required to provide services for children ages 3 through 21 who are eligible for specialized services or therapy because of communication impairments as defined by state guidelines. These services may be provided by a SLP or by a speech-language pathology assistant under the supervision of a qualified SLP. Some private schools also provide the services of SLPs. SLPs also provide services to children ages birth to 3 years through the Missouri First Steps Program https://www.mofirststeps.com/. If you suspect a communication impairment, your local public school can give you information as to where you may access services.
Head Start programs generally have access to the services of communication specialists and also cooperate with public schools in making referrals for children they have concerns about. Many early child care providers such as day cares and preschools also make referrals to school-based SLPs.