What does a Speech Language Pathologist do?

A speech language pathologist, or SLP, is a specialist in communication disorders. Communication is an essential part of our daily lives and a disorder in the ability to communicate will impact the way one learns, develops relationships and functions as a member in society. A Speech language pathologist can evaluate and identify communication disorders and will develop a therapy plan to help improve communication abilities. Speech language pathologists can work with children and adults and are educated in the areas of: speech and language development; speech sound production; listening and processing information; word finding; memory; grammar; reading and writing; voice and speech quality; feeding and swallowing; fluency and stuttering; social and interaction skills; learning, developmental, acquired and physical disabilities.

What is the difference between speech and language?

“speech” refers to the ability to speak clearly and be understood by others. It is the ability to make individual speech sounds (“m” “g” “o”) and then combine them in different ways to form words (“go”) and phrases (“mom go”). It includes the development of muscles and complex motor movements required to produce and sequence each speech sound. Also known as articulation, phonology and intelligibility.

“language” is broken down into two categories:

1. “receptive language” refers to the ability to understand what has been said. Receptive language includes the ability to understand: vocabulary, grammar, directions, questions, abstract language and concepts and conversation. It also includes listening and cognitive skills such as: remembering, reasoning, predicting, problem solving and deciphering meaning from what is heard. Also known as comprehension and processing.
2. “expressive language” refers to the ability to use words and sentences to express oneself to others effectively. Expressive language includes the use of a diverse vocabulary and the ability to speak with grammar that is similar to those around us. It encompasses the abilities to use language to: respond, request, protest, initiate, direct, relate, interact and converse with others. Also known as expression and use.

Receptive language, expressive language and speech problems can exist separately or in any combination with one another

When should I be concerned with my child’s speech and language development?

Parents know their children best - if you are finding yourself concerned about your child’s speech and language development it is wise to seek a professional opinion. Contact your primary care physician and share your concerns regarding your child’s speech and language development. Your physician will be helpful in determining whether your child should be evaluated by a speech-language pathologist, audiologist or other developmental specialist.

“Early intervention” is a term that refers to identifying speech and language or other developmental problems early on in life (from birth) and starting therapy services right away. Early intervention is thought to be effective because a young child’s brain is able to adapt and learn more easily. Early intervention can be essential in promoting your child’s development of lifelong communication, physical and adaptive skills.

If your child has been diagnosed with a developmental delay or disability he or she can participate in early intervention services through your local school district and in medical and private settings.

Please refer to the chart, published by the American Speech-Language-Hearing Association, which details “typical” development of speech and language skills in children from birth to age 5 years: http://www.asha.org/public/speech/development/child_hear_talk.htm

Will my child ever speak “normally”?

It is extremely difficult to predict whether a young child will master the complex motor skills required to achieve intelligible speech. A correlation exists between the severity of a child’s disability and his/her difficulty in achieving intelligible speech. One method of predicting if a child’s speech production will continue to improve and become more intelligible is to look at their ease in acquiring speech sounds that are introduced in therapy.

It is important to keep in mind that there is great variability in how quickly a child begins to use speech sounds targeted in therapy. Some speech sounds may be produced accurately without much instruction while others will take longer to master and use in spontaneous speech. Your child’s speech therapist should be able to provide you with more specific information regarding his/her potential to use speech “normally” as his/her therapy program progresses.

How long will speech and language therapy take?

Each speech therapy session will last approximately one hour. It is common for speech therapy sessions to consist of a “50 minute hour”. Fifty minutes are spent in direct treatment with the individual and the additional 10 minutes are utilized to consult with parents/caregivers, write notes, clean-up and prepare for another session. Most individuals attend speech therapy one time per week but your therapist may recommend multiple sessions per week.

The length of time it takes before an individual no longer requires speech therapy will vary tremendously depending on his/her diagnosis, age, and commitment to therapy. Implementation and follow through of a home program will significantly facilitate an individual’s progress and reduce his/her overall time in therapy. Your speech therapist should be better able to estimate the anticipated length of treatment as the therapy program progresses.

Will my insurance pay for speech and language therapy services?

Many insurance carriers cover speech-language evaluations and therapy services. Each policy is different however, even within the same insurance company. You will need to review your health coverage policy in order to determine eligibility for services. Your insurance care provider and your therapist should also be helpful in providing you with information on determining benefits for speech, language and augmentative communication services. Many speech therapists accept reimbursement from a variety of private insurance carriers and Medicaid plans. Ask your therapist about other payment methods if speech therapy services are not a covered benefit on your insurance policy.

What are Assistive Technology (AT) and Augmentative Alternative Communication(AAC)?

Assistive technology and augmentative and alternative communication are changing the world for children and adults who experience physical and speech and language impairments. They are also opening up a whole new way to help children who have learning disorders. Children who are challenged physically can be more successful at playing and manipulating their environment; communicating their needs and discoveries to others; making choices and directing siblings and friends; independently moving around their world; learning and being included in regular classrooms.

Simply stated, AT are tools that provide a way to perform daily functional tasks. Examples of AT include wheelchairs, adapted walkers, speech communication devices, communication boards, computers, software, computer adaptations such as a hands free mouse, switches that engage a young child in play and touch sensitive keyboards. AAC are tools that provide a different means of communicating than speech and can include gesture, pictures, communication boards and speech generating devices.

When is it appropriate to consider the use of AAC?

The choice to incorporate the use of an AAC system into a child’s communication repertoire is often made when a significant delay becomes evident in the development of his/her speech and language– often due to the child’s diagnosis with a specific disability, developmental delay or motor speech disorder or after traditional speech therapy with continued unintelligible speech and significant frustration in not being understood.

AAC is often considered for adults who have had a stroke or have been diagnosed with a progressive disease such as ALS or Parkinson’s and can no longer speak clearly enough to be understood.

It is not necessary for a person to be of a particular age, physical or cognitive ability to begin using an AAC system. There are AAC systems that can be designed for individuals of every ability.

Will the use of an AAC system prevent my child from speaking or delay his/her development of natural speech?

The belief is common that children will utilize natural speech to their fullest potential whenever possible because it is the easiest and fastest way to be understood and accepted by others. Therefore in the case of most children, whenever speech is possible and effective, it will be used, first and foremost. An AAC system will often serve as one tool in a child’s communication toolbox when a he/she has difficulty making him/herself understood through natural speech.

By incorporating the use of an AAC system a child has the ability to use vocabulary that he/she understands but can’t speak clearly. Delaying a child’s access to means of communicating his/her needs, ask questions, relate an exciting or scary experience only continues to delay the development of the important skills of using words in sentences, gaining vocabulary use and understanding and most importantly, his/her ability to become a reader.

AAC allows a child the ability to communicate more independently with more peers and partners than before. Children who utilize an AAC system as one tool for communicating will often experience decreased frustration, improved social and interaction skills and self-determination.

Typically children being introduced to an AAC system will also continue to work on traditional speech therapy techniques to improve their natural speech production. The use of an AAC system therefore can be a long or short term solution and will depend on the child’s progress in traditional speech therapy.

The use of speech-generating devices with children and adults experiencing speech production impairments have led to improved word production and speech clarity. It may be said that having a way to communicate reduces the fear or frustration of not having others understand you. Being successful in getting your point across is a monumental achievement, particularly for someone who continually experiences failure.

Additionally, many therapists who have included AAC strategies or tools have noted that the repetition of hearing a word spoken even though it is from a device manages to strengthen the connections in the brain that allows us to orally sequence very small movements of the tongue and lips.

Scientifically controlled studies have documented the use of speech-generating devices or augmentative communication strategies to improve speech production.

Also, several experienced speech-language pathologists specializing in AAC have documented case studies of successful speech development in children who receive AAC intervention. Notably, this is the case with several studies that looked at children who are diagnosed with Developmental Apraxia of Speech (DAS).

How do I choose the most appropriate AAC system?

The use of an AAC system is often intended to be one of many modes of communication used by any individual when expressing him/herself. Individuals may utilize several different AAC techniques depending on what is most efficient and effective in the situation. Not everyone uses the same tools to achieve the same goals. A comprehensive AAC evaluation will help determine which AAC strategies would be beneficial for each person and their unique communication style and ability. It is vitally important to get an evaluation by a speech-language pathologist who has experience in recommending AAC and AT and creating an appropriate intervention plan to use these tools.

A comprehensive AAC evaluation may take place over multiple sessions. It will examine an individual’s current and future communication skills and needs. The evaluation will consist of an assessment of the persons: speech, language, literacy, cognitive, sensory and motor skills and potential. It will also look at the person’s typical communication environments, activities and partners. Most AAC evaluations will involve collaboration between the family and the speech-language pathologist as well as with other professionals involved in the person’s care. Everyone’s input is a vital part of the evaluation process.

Based on the information gathered, recommendations will be made regarding which AAC strategies would assist the individual in communicating more effectively. Often AAC strategies are recommended as building blocks to other skills, strategies and equipment. An AAC system is something that should always continue to evolve and change in response to the individual’s ever evolving and changing communication skills and needs. Parents and caregivers should be trained in using and implementing AAC systems recommended.