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WHAT ARE THE FOUNDATIONS OF COMMUNICATION DISORDERS?

History

• School-based speech and language services began nearly 100 years ago in 1910. (p. 216-17)
• In the 1950s, "speech correctionists" worked with primarily elementary school children in articulation, fluency, and voice. (p. 217)
• In the 1970s, "speech therapists" learned to identify and treat language impairments. (p. 217)
• In 1979, ASHA added language to its name becoming the American Speech-Language-Hearing Association. (p. 217)
• Today, the speech-language pathologist typically works as an educational team member and collaborator to provide services and support in the general education environment for students with communication disorders. (p. 217)
• Both assessment and intervention have become more contextually based and educationally relevant. (p. 217)

Definition

• Communication encompasses both speech and language. (p. 217)
• Speech includes the articulation of sound, the quality of voice, and the fluency of language. (p. 217)
• Language is made up of five components: phonology, morphology, syntax, semantics, and pragmatics. (p. 217-20)
• The definition of speech and language impairments provided by IDEA 04 is, "a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, which adversely affects a child's educational performance." (p. 220-21)
• The more frequently used ASHA definition is much more specific in defining speech and language disorders. ASHA defines a speech disorder as an impairment of the articulation of speech sound, fluency, and/or voice. ASHA defines a language disorder as the impairment or deviant development of comprehension and/or use of a spoken, written, and/or other symbol systems. The disorder may involve the form, content, and/or function of language in communication in any combination. (p. 221)

Prevalence

• IDEA reports that approximately 2.3% of students aged 6-17 received services for speech and language impairments with two thirds of those being male. (p. 221)
• The actual number of students receiving speech and language services is much larger than 2.3% as only those students with primary communication disorders are included. About half of children with another primary disability also have speech-language disabilities. (p. 221)
• If both primary disabilities and secondary disabilities are considered, the largest number of children receiving services in special education are those with communication disorders. About 22% of all children who received services for disabilities under IDEA Part B in 2002 received services for speech or language disorders. (p. 221-22)

WHAT ARE THE CAUSES AND CHARACTERISTICS OF COMMUNICATION DISORDERS?

Causes

• Causes of communication disorders vary and are unknown at the present time in the largest number of cases. (p. 222)
• Some speech and language disorders are congenital, others may be acquired. (p. 222)
• Some speech and language disorders are organic. Organic causes may be related to heredity, factors during pregnancy, birth trauma, accidents, or diseases. (p. 222)
• Other speech and language disorders are functional. These disorders are presumed to be the result of learning, psychological, or environmental factors. (p. 222)

Characteristics

• Language impairment characteristics may include problems in one or more of the components of language and are thus quite varied. (p. 224)
• Regional, social, and/or cultural/ethnic variations in language are not communication disorders. (p. 225)
• Secondary language characteristics will be related to the characteristics of the primary disability. (p. 226-27)
• Speech characteristics may include atypical production of voice quality, pitch, and/or loudness, atypical production of sounds, and atypical flow of verbal expression characterized by impaired rate and rhythm (e.g., stuttering). (p. 227-28)

HOW ARE STUDENTS WITH COMMUNICATION DISORDERS IDENTIFIED?

• Identification should involve information from several people and several types of procedures in several settings. (p. 228)
• Standardized, norm-referenced tests; informal measures; and the perceptions and concerns of those who are significant in the child's life may be included in the evaluation of whether a language disorder exists. A family history will be an essential initiation into the evaluation process. (p. 228-30)
• The evaluation of a language disorder will include tests of expressive and receptive language skills (using standardized tests as well as an analysis of spontaneous speech). (p. 228-30)
• Procedures used in the identification of a speech disorder may include an articulation test, a measure of auditory discrimination ability, an evaluation of fluency, an evaluation of voice, a hearing test, a case history, an examination of samples of the child's work, and checklists or scales completed by parents and/or those who work with the child in the educational setting. (p. 230)
• Alternative techniques proposed for assessing culturally and linguistically diverse students for whom English is a second language include norming a test for the specific population being tested, using dynamic assessment techniques to determine a child's response to intervention, using other nonstandardized measures such as parent interviews or checklists, and modifying standardized tests. (p. 230-31)
• In assessing language proficiency, it is important to determine both basic interpersonal communication skills (BICS) and cognitive academic language proficiency (CALP) in both the first language and the second language. (p. 323)

WHAT AND HOW DO I TEACH STUDENTS WITH COMMUNICATION DISORDERS?

Instructional Content

• A child's language abilities may affect social outcomes such as peer relations, family relations, and later employment. (p. 232)
• A communication disorder will likely interfere with reading and language arts skills. (p. 233-34)
• A language disorder may also result in poor problem solving abilities and poor information storage and retrieval. (p. 233)
• Social behavior, educational achievement, and occupational success will likely need to be addressed in programming. (p. 233-34)

Instructional Procedures

• Intervention in a natural environment, such as the classroom, provides many opportunities to practice language in its natural form. (p. 235)
• Effective teaching strategies that may be applied to oral language development include direct instruction, cognitive and metacognitive strategies, and the use of graphic organizers. (p. 235)
• Techniques which can be used to stimulate both speech and language development include modeling, expansion, self-talk, parallel talk, and cloze procedures. (p. 236)
• Games and activities may be developed to focus on particular forms, structures, or vocabulary. (p. 236)
• Therapy for voice disorders involves teaching a vocal behavior that is not currently present, substituting a new appropriate vocal behavior for an inappropriate one, or strengthening weak or inconsistent vocal behaviors. The special and/or general education teacher can be of great assistance to the SLP in the management of the voice problem. (p. 236-37)
• The goal in articulation therapy is for a child to produce correct speech sounds in all speaking situations. Collaboration between the SLP who is administering the therapy and other professionals and family members in the student's environment will be necessary for generalization. (p. 237)
• Stuttering therapies include stuttering modification, fluency shaping, or a combination of elements of both. For the young child, therapy may be indirect, and the teacher and parent will play a significant role in modeling speech. (p. 237-38)
• Several specific suggestions for teachers in promoting fluency at all ages are focused on putting all members of the classroom, particularly the student who stutters, at ease. (p. 237-38)

WHAT ARE OTHER INSTRUCTIONAL CONSIDERATIONS FOR TEACHING STUDENTS WITH COMMUNICATION DISORDERS?

Instructional Environment

• The physical environment determines the degree to which a student's communication ability is taxed. Adapting the environment or providing strategies that are relevant in a particular environment may facilitate communication. (p. 238-39)
• There are many service delivery options for students with communication disorders. Instructional grouping will be influenced by the delivery system. (p. 241-43)
• Peer support interventions and cooperative learning groups can also promote communication. (p. 242-43)

Instructional Technology

• Augmentative communication includes methods and devices that supplement existing verbal communication skills. (p. 243)
• Alternative communication refers to techniques that substitute for spoken communication. (p. 243)
• AAC systems may be unaided or aided. Unaided AAC systems require no external devices. Aided systems use equipment or devices to provide the user with a means of communication. (p. 243-44)
• A variety of instrumentation has been used to treat disorders of fluency. (p. 244-45)
• It is the responsibility of the teacher to assess the effectiveness of any communication devices. (p. 245-46)

WHAT ARE SOME SPECIAL CONSIDERATIONS FOR THE GENERAL EDUCATOR?

• The majority of students with communication disorders will be taught in general education classrooms. (p. 246)
• Examining students' communication needs, designing objectives, and implementing an intervention plan are joint responsibilities of the teacher(s) and the SLP with the involvement of other specialists, administrators, support staff, and parents as appropriate. (p. 246-47)
• Naturalistic settings provide the best settings for intervention for the student with a communication disorder. (p. 246)
• Teachers need to be positive and supportive. (p. 246)