communication skills speech language pathologist

Speech-Language Pathologist (SLP) Career Guide

• Career guide intro
• How to become
• Specializations
• Career path

Similar job titles

• Trends and outlook
• Career tips
• Where the jobs are

What is a speech-language pathologist?

A speech-language pathologist, also known as an SLP or speech therapist, is a licensed healthcare professional who assesses, diagnoses, and treats communication and swallowing disorders. They work with individuals of all ages, from infants to older adults, who experience speech, language, voice, fluency, or swallowing difficulties. Individualized treatment plans are developed and implemented to help patients overcome challenges and improve their overall quality of life.

SLPs are trained in therapeutic techniques and strategies to address a wide range of communication and swallowing disorders. These may result from various causes, such as developmental delays, neurological disorders, brain injuries, hearing loss, or genetic conditions. They empower patients to communicate more effectively by providing targeted interventions and support, enhancing their social, academic, and professional success.

Many patients have difficulty with speech or language disorders because they prevent clear communication, so speech therapists must be compassionate. Understanding what patients are going through helps to connect with patients and succeed with treatment. 

SLPs must have a knack for scientific processes. Understanding biological and social sciences and anatomy will help with treating patients. Treatment is different for everyone, so pathologists must adapt when creating and adjusting plans for various situations or disorders. 

Duties and responsibilities

Speech-language pathologists assess, diagnose, and treat communication and swallowing disorders. They begin by conducting comprehensive evaluations, including observing patients, administering standardized tests, and analyzing speech and language samples. Based on the findings, an individualized treatment plan is developed and tailored to a patient’s needs and goals.

Various therapeutic techniques are used to address issues such as articulation, language comprehension, expressive language, voice disorders, fluency, and swallowing difficulties. SLPs educate and support patients’ families, caregivers, and educators, offering guidance or strategies to facilitate communication and promote progress outside therapy sessions. Detailed records track progress, and collaboration with other healthcare professionals is conducted as needed to ensure comprehensive care.

Work environment

Speech therapists work in various settings, including hospitals, rehabilitation centers, schools, private practice, and research facilities. They work with a diverse range of patients, from children with speech and language development issues to adults suffering from neurological disorders or injuries.

The role can be both physically and emotionally demanding, as it involves standing for long periods and dealing with the emotional challenges of patients struggling with communication disorders. However, it can also be highly rewarding, particularly when they see their patients make significant progress.

Typical work hours

The typical hours for an SLP can vary based on the type of work performed. Most full-time pathologists work 40 hours a week during traditional business hours. Those in schools may start as early as 7:00 am and work until 3:00 pm.

Private practitioners can set work hours or schedules to fit their lifestyles. Weekend or holiday office hours garner more revenue than regular business hours.  

How to become a speech-language pathologist

In this career guide section, we cover the steps you’ll need to take to achieve your goal of becoming an SLP:

Step 1:  Earn a bachelor’s degree in a relevant field

The first step is earning a bachelor’s degree in a field that prepares you for graduate school. Popular undergraduate majors include communication sciences and disorders, language development, education, linguistics, psychology, and English. The communication sciences and disorders major is typically the best since its requirements usually include all the prerequisites for graduate school. 

Here are the standard prerequisite courses needed for a master’s degree:

• Anatomy & Physiology of the Speech Mechanism focuses on the structures and functions of systems and processes involved in speech production. This usually covers the phonatory, articulatory, resonatory, and nervous systems and how they relate to sound waves. 
• Phonetics, or the science of speech sounds, covers how sounds are produced, perceived, and classified.
• Language Development discusses different developmental periods when children understand language and communicate with speech. 
• Communication Disorders is an introductory course into the different types of communication disorders. This involves an overview of speech, language, cognitive, swallowing, and feeding disorders that pathologists help diagnose and treat. 

Step 2: Obtain a master’s degree in speech-language pathology

Once you earn a bachelor’s degree, it is time to look at universities offering a master’s degree in speech-language pathology. Before admission into graduate school, ASHA requirements for undergraduate work must be completed. This involves:  

• Physical Sciences
• Behavioral/Social Sciences
• Biological Sciences
• Completing 25 clinical observation hours
• Neuroscience/Neuroanatomy
• Auditory Rehabilitation
• Speech Sound Disorders

Step 3: Complete the required number of supervised clinical hours

During a graduate program, you can complete 400 hours of supervised clinical experience as a “practicing” speech-language pathologist. Twenty-five hours must be in guided clinical observation, while 375 hours must be in direct patient contact. Guided clinical observation includes activities such as viewing educational videos, discussing therapy and evaluation procedures that have been observed, and documentation practices. Direct patient contact includes time with patients and dealing with particular speech and language disorders.  

Step 4: Find a specialty

There are many different work environments for SLPs. They can work in schools, hospitals, rehabilitation centers, or residential healthcare facilities. The American Speech-Language-Hearing Association recognizes various areas of specialization, including:

• Motor Speech Disorders
• Fluency Disorders
• Language Disorders
• Feeding & Swallowing Disorders
• Cognition-Communication Disorders
• Resonance Disorders

Speech therapists gain experience with disorders during supervised clinical hours in graduate school. It is essential to learn more about disorders before choosing a specialty. 

Step 5: Pass the Praxis exam

You must pass the Praxis examination to become licensed to work in your state as a practicing speech-language pathologist. The Praxis demonstrates competence, knowledge, and instructional skills for various situations. The exam allows 150 minutes to answer 132 questions, and the current passing score for ASHA certification is 162 based on a 100-200 scale. Some states may require lower or higher scores to become licensed. 

The Praxis examinations cover the following topics:

• Foundations and Professional Practice
• Screening, Assessment, Evaluation, and Diagnosis
• Planning, Implementation, and Evaluation of Treatment 

These topics will focus on the Big Nine areas: 

• Speech sound production
• Voice, resonance, motor speech
• Receptive and expressive language
• Social aspects of communication, including pragmatics
• Communication impairments related to cognition
• Treatment involving augmentative and alternative communication
• Hearing and aural rehabilitation
• Swallowing and feeding

Step 6: Complete a clinical fellowship

A nine-month clinical fellowship must be completed after passing the Praxis examination and becoming licensed. A minimum of 1,260 hours of clinical experience must be earned. At least 80% of those hours must be direct clinical contact regarding disorders, diagnoses, and treatment. The other 20% of hours can be met through various activities, including attending training sessions or giving presentations.

Examples of direct clinical contact include: 

• Screening, response to intervention, or observations of patient
• Assessment and diagnostic evaluations
• Writing reports or notes
• patient consultation or counseling
• Individualized Education Program meetings

Step 7: Get certified through the American Speech-Language-Hearing Association

Most states require certification through the American Speech-Language-Hearing Association (ASHA) to become licensed. Here are ASHA’s standards for becoming a nationally certified speech-language pathologist (CCC-SLP):  

• Earn a graduate degree from an accredited program
• Clock 1,600+ hours of supervised clinical experience during schooling and a clinical fellowship
• Pass the Praxis examination 
• Take 30 hours of continuing education credits every three years for license renewal

Step 8: Stay up-to-date with certification, licenses, and continuing education

Continuing education requirements may vary from state to state. Most SLPs must attend additional training or courses to keep their licenses active. The American Speech-Language-Hearing Association requires 30 hours of continuing education credits every three years. In addition, consider taking courses to develop relevant skills.

Here is a sample of some of the options available for continuing education:

• Hearing Loss in Children
• Introduction to Ear, Nose, and Throat Disorders Specialization
• Speech-Language Pathology 101
• Speech and Language Therapy for Children

How much do speech-language pathologists make?

A variety of factors can influence an SLP’s salary. Educational background plays a central role, as all professionals in this field require a master’s degree, and those with a doctoral degree may command higher salaries. Experience also heavily influences earning potential, with seasoned professionals making more than their less-experienced counterparts. Industry and area of specialty also impact salary; for instance, speech therapists in healthcare settings may earn more than those in educational services. Geographic location also plays a considerable role, with pathologists making more in urban areas or states with a higher cost of living.

Finally, the employer’s size, whether a school district, hospital, or private practice, can also affect compensation.

Highest paying industries

• Management of Companies – $100,050
• Home Healthcare – $95,460
• Residential Care Facilities – $94,680
• Health Practitioner Offices – $90,035
• General Medical and Surgical Hospitals – $89,650

Highest paying states

• New Jersey – $95,100
• California – $93,510
• New York – $91,740
• Colorado – $90,980
• Connecticut – $90,550

The average national salary for a Speech-Language Pathologist (SLP) is:

Browse SLP salary data by market

Specializations of speech-language pathologists

Speech-language pathology services fall into nine different categories. Although pathologists have experience with all nine, they may only specialize in one or two types. In this career guide section, we will explore the different specialties, shedding light on their unique responsibilities and areas of focus. 

Articulation

This area focuses on the pronunciation of speech. Pathologists teach people how to properly move their tongue, lips, teeth, and jaw to produce speech sounds. 

Fluency refers to the smoothness and effort that goes into speech production. The focus is treating disfluencies such as repetitions, prolongations, and blocks.

Voice & resonance

These types of disorders focus on the sound vibrations in the pharynx (throat), oral cavity (mouth), and nasal cavity (nose). 

These pathologists help individuals with comprehension or the use of language difficulties.

This area includes attention, concentration, orientation, and word retrieval. 

In collaboration with audiologists, patients are helped with hearing impairments to improve communication. 

These pathologists help diagnose and treat swallowing disorders by observing the patient eating and drinking and providing them with different exercises to strengthen swallowing muscles. 

Social communication

This category involves pragmatics, social interaction, social understanding, and language processing. These pathologists offer techniques and strategies to strengthen social skills and language competence.

Top skills for speech-language pathologists

SLPs draw on many skills to deliver optimal patient care. These skills comprise deep clinical knowledge and expertise in speech-language pathology, excellent communication skills, sharp observational skills, strong problem-solving capabilities, high levels of patience and compassion, and solid documentation and record-keeping abilities. Understanding a patient’s needs and tailoring treatment plans accordingly is an integral part of the role, as is maintaining ongoing professional development in an ever-evolving field.

Pathologists need extensive clinical knowledge and expertise to effectively diagnose, evaluate, and treat speech, language, communication, and swallowing disorders. This involves a comprehensive understanding of physiological and developmental aspects of speech and language mechanisms. It is important to stay updated with the latest research and treatment methodologies to provide the most effective care.

Strong communication skills are necessary to communicate complex concepts clearly and concisely to patients and their families. Pathologists must be able to actively listen to understand a patient’s needs, concerns, and goals. These communication abilities extend to interactions with other healthcare professionals, making it a critical skill for ensuring holistic care.

Assessing and treating speech and language disorders requires good observational skills. Pathologists must be able to closely observe a patient’s verbal and nonverbal cues to identify abnormalities, track progress, and adapt treatment strategies. Adeptness at noticing subtle changes or improvements significantly influences a patient’s therapy plan.

Speech therapists frequently encounter diverse and complex cases, making problem-solving skills essential. They need to use critical thinking to diagnose disorders, develop customized treatment plans, and modify treatment based on a patient’s progress or response to therapy.

Their work requires considerable patience and compassion. Speech and language therapy requires repetitive practice, so patience encourages patients to remain persistent. Compassion and empathy are the cornerstones of supportive, patient-centric care.

Maintaining accurate and up-to-date records is crucial in speech-language pathology. This includes documenting assessments, treatment plans, progress notes, and other relevant information. Good record-keeping ensures continuity of care, aids in tracking progress, and supports billing and reimbursement procedures. It also forms a vital part of compliance with healthcare’s legal, ethical, and professional standards.

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Speech-language pathologist career path

A career as an SLP typically begins with an entry-level position, often in a supportive role to more experienced clinicians. In this initial phase, recent graduates can apply theoretical knowledge gained during academic training to practical, real-world scenarios. Working with experienced speech therapists promotes learning from their expertise.

After gaining some years of experience and additional certification in a chosen area of focus, speech-language pathologists often progress to more senior positions. They handle more complex cases at this stage and begin specializing in pediatrics, geriatrics, or specific speech or language disorders. These specialized roles often require additional training and certification but offer the opportunity to become an expert in a particular area.

Experienced SLPs can take on supervisory roles, overseeing the work of less experienced clinicians. They may provide training and guidance, help develop therapy plans, and ensure quality standards are met.

The next potential step on the career ladder could be a management or directorial position. These roles often involve administrative tasks and managing a team or department. Sometimes, these positions may require a higher degree, such as a doctorate or a master’s in health administration.

Alternatively, some pathologists may decide to move into academia or research. In these roles, they can contribute to the development of the field by teaching future generations of speech therapists or conducting research to advance our understanding of speech and language disorders.

• Behavior Analyst
• Certified Nursing Assistant
• Occupational Therapist
• Physical Therapist
• Physical Therapy Assistant

Position trends and outlook for speech-language pathologists

The role of speech therapists is becoming increasingly recognized and valued in various settings such as schools, hospitals, private practice, and telehealth platforms. Increased autism diagnosis rates and a more comprehensive understanding of communication disorders have increased the demand.

Technological advancements have ushered in new forms of therapy, like computer-based articulation and voice therapy programs, providing innovative tools for intervention. Telepractice, the online delivery of speech-language pathology services, is another growing trend in the field, making services more accessible to those living in remote areas or with mobility issues.

Employment projections for SLPs

According to the latest data from the Bureau of Labor Statistics, employment for speech-language pathologists is projected to grow 21% through 2031, much faster than the average for all occupations. As the baby-boom population grows older, there may be an increase in conditions such as strokes and dementia, which can cause speech or language impairments.

Pathologists will be needed to treat more patients with these conditions. Additionally, medical advances are improving the survival rate of premature infants and victims of trauma and stroke who require assessment and possible treatment.

Speech-language pathologist career tips

Understand your patients’ perspectives.

Being an SLP involves more than understanding the technical aspects of speech and language disorders; it requires empathy and understanding patients’ experiences. Spend time understanding patients’ perspectives, feelings, and frustrations. This will help build rapport, earn trust, and better address specific needs.

Stay updated with research

Speech-language pathology is a dynamic field, with ongoing research continually unveiling new techniques and approaches for managing speech and language disorders. Stay updated with the latest research findings by subscribing to professional journals, attending webinars, and participating in workshops.

Collaborate with other professionals

Pathologists often work with other professionals, including psychologists, occupational therapists, and educators. Building solid relationships with these professionals can enhance your understanding of patient’s needs and help provide a more holistic care approach.

Build a professional network

Building a professional network can significantly benefit your practice as a speech therapist. It can lead to collaboration opportunities, job leads, learning, and more. Here are a few professional associations and networks worth exploring:

• American Speech-Language-Hearing Association (ASHA)
• The National Aphasia Association
• International Association of Logopedics and Phoniatrics
• Academy of Neurologic Communication Disorders and Sciences
• Special Interest Group for Speech-Language Pathologists (SIG-SLP)

Continuous learning

Given the dynamic nature of speech-language pathology, continuous learning is essential. Here are a few suggestions:

• Subscribe to professional journals and attend webinars and conferences to keep updated with the latest trends and techniques in speech-language pathology
• Additional certifications in specialized areas, such as dysphagia or language literacy, can enhance skills and make you a more versatile professional
• Understanding various populations’ cultural and linguistic nuances can help serve a more diverse range of patients

Embrace technology

The role of technology in speech-language pathology is growing, with numerous apps and software programs available to assist with therapy. Being comfortable with and integrating this technology into your practice can enhance services and make treatment more engaging and accessible for patients.

Work on your communication skills

While this may seem obvious for an SLP, it’s worth reinforcing. Excellent communication skills are vital in therapy sessions and when interacting with patients’ families, other healthcare professionals, and stakeholders. Clearly and empathetically convey information and be an excellent listener.

Practice self-care

Speech-language pathology can be a demanding job, both physically and emotionally. It’s important to prioritize self-care and maintain a healthy work-life balance. This can help prevent burnout and ensure you can provide patients with the best care.

Be patient and persistent

Progress in speech-language pathology can sometimes be slow, and treatment plans only sometimes yield immediate results. Patience and persistence are key. Celebrate small victories, maintain a positive attitude, and reassure patients they are progressing, even when progress seems slow.

Where the SLP jobs are

Top companies.

• Kindred Healthcare
• Genesis Rehab Services
• Reliant Rehabilitation
• Mayo Clinic

Top job sites

• SimplyHired

What educational background is necessary for a speech-language pathologist?

To become an SLP, you typically need a master’s degree in speech-language pathology. Before this, an undergraduate degree in communication sciences and disorders or a related field provides a good foundation. A master’s program usually involves both classroom study and clinical experience. After graduation, a period of supervised professional practice, often called a fellowship, is required before becoming fully licensed.

What are the essential skills a speech-language pathologist should possess?

An SLP should have excellent communication skills, as they need to effectively explain treatment plans to patients, their families, and other healthcare providers. They should also have strong problem-solving skills to diagnose speech and language issues and develop appropriate treatment strategies. Empathy, patience, and the ability to work well with people of different ages and backgrounds are important as well.

How important are licensing and certification for a speech-language pathologist?

Licensing is essential in this field. All states require SLPs to be licensed, though the specific requirements can vary. In many cases, this includes having a master’s degree in the field, completing a supervised clinical fellowship, and passing a national examination. Additionally, many employers prefer or require pathologists to have certification from the ASHA.

What does a typical workday look like for a speech-language pathologist?

The typical workday involves assessing, diagnosing, and treating speech, language, cognitive communication, and swallowing disorders in individuals. Pathologists may work with patients one-on-one or in group settings, develop individualized treatment plans, and keep detailed records of patients’ progress. Additionally, they may consult and collaborate with other professionals, like teachers, physicians, and psychologists, to better support patients.

What role does a speech-language pathologist play in a patient’s healthcare team?

As part of a multidisciplinary healthcare team, a pathologist is critical for diagnosing and treating communication and swallowing disorders. To create comprehensive patient care plans, they work closely with other healthcare providers, including doctors, psychologists, physical and occupational therapists, and social workers.

Can a speech-language pathologist specialize in specific areas?

Pathologists can specialize in various areas such as pediatrics, geriatrics, neurology, or specific types of disorders like dysphagia, voice disorders, or cognitive-communication disorders. Specialization involves gaining additional experience, training, or certification in the area of interest.

What settings do speech-language pathologists typically work in?

SLPs work in various settings depending on the population they serve. These include schools, hospitals, rehabilitation centers, residential healthcare facilities, private practices, and research institutions. Some provide home health services or virtual therapy sessions.

Is continuing education necessary for a speech-language pathologist?

Continuing education is vital for maintaining licensure and staying updated with the latest research and treatment techniques. This ongoing learning can be achieved through workshops, conferences, webinars, and formal continuing education courses.

How physically demanding is the job of a speech-language pathologist?

While the job is not typically physically strenuous, it can involve physical demands, such as standing for extended periods during therapy sessions and possibly assisting patients with physical disabilities. Additionally, pathologists may need to move equipment or materials used in therapy.

Do speech-language pathologists often work with other professionals?

Collaboration is a crucial part of the role. Pathologists often work with teams of professionals, including educators, occupational therapists, physical therapists, psychologists, social workers, and physicians, to provide comprehensive care for patients. Effective communication and teamwork skills are essential for therapy. 

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What Is a Speech Pathologist?

Also Known as a Speech-Language Pathologist (SLP) or Speech Therapist

• What They Do
• Conditions Treated

Training for Speech Pathologists

• When to See an SLP

A speech pathologist, also known as a speech therapist, is a healthcare professional who helps you improve your speech and communication if you have been ill, injured, or have a chronic disability. Speech pathologists may also be called speech-language pathologists (SLP).

Speech pathologists also work with people who have difficulty swallowing food or drink to help them stay safe while eating.

This article examines the important work that speech pathologists do as part of a rehabilitation team of professionals. You will learn what conditions they treat and when you should seek out the services of an SLP.

What a Speech Pathologist Does

A speech pathologist is a trained medical professional who works with patients who are injured or ill and are having difficulty speaking or swallowing. They work to prevent, assess, and treat these disorders in adults and children.

Speech pathologists help people communicate, and this may involve:

• Expressive communication : The ability to communicate verbally and nonverbally
• Receptive communication : The ability to understand verbal and nonverbal communications

Some speech therapists work closely with audiologists (healthcare professionals who treat hearing and balance problems) to ensure that you can hear and understand language correctly. Others work with otolaryngologists , also called ear, nose, and throat physicians (ENTs), to help patients swallow food and drink safely and to assist patients with oral motor function.

Common Specialty Areas

Some speech pathologists have a more generalized practice, while others have a more narrow focus on specific areas or problems such as:

• Social communication
• Voice and vocal hygiene
• Speech sound disorders

Some of the official certifications that a speech pathologist may receive include:

•  Intraoperative monitoring
•  Fluency disorders
•  Swallowing and feeding disorders
•  Child language disorders

Speech pathologists seeking specialty certification have to meet education, experience, and clinical practice requirements as established by independent specialty certification boards.

Where Speech Therapists Work

There are a variety of settings in which speech pathologists work. This may include:

• Schools: Speech therapists working in schools help children with speech disorders learn to overcome their communication challenges.
• Nursing homes: Speech therapists in nursing homes help patients with dementia or communication issues caused by other conditions like stroke learn communication strategies. They also work with staff on ways to help residents communicate more effectively.
• Hospitals: A speech pathologist working in a hospital may help diagnose and treat language communication problems and swallowing disorders in hospitalized patients. 
• Private practices: Speech pathologists may also work in private practices where they may specialize in one or more language problems or health conditions in specific populations.

Speech pathologists can also work as educators in colleges and universities, and they may be involved in research.

Conditions Speech Therapists Treat

Speech pathologists work with people of various ages and with a variety of conditions. They sometimes work with young children who are having problems speaking properly, or they may help older adults with cognitive communication (communication that is affected by memory, attention, organization, and problem-solving, which are examples of executive functioning ).

A stroke can cause damage to the part of the brain responsible for language and communication. Depending on the extent of the stroke, this loss of ability may be short-term or long-term. A speech pathologist can help someone who is recovering from a stroke regain their ability to speak and understand language.

What is aphasia?

Aphasia is a condition of the brain that affects how you communicate with others. It is caused by damage to the part of the brain responsible for language and can affect your ability to speak and understand what is being said.

Hearing Loss

A speech pathologist may work with other professionals such as audiologists and ENTs to help assess, manage, and treat someone with hearing loss. Some of the things a speech pathologist might do to help someone with hearing loss include evaluating the person's speech, helping them improve listening skills, and working with them to develop alternative communication strategies.

Vocal Damage

Vocal cords can become damaged in various ways including persistent coughing and voice overuse. A speech pathologist can teach you muscle strengthing and voice rehabilitation excercises and other strategies to help your vocal cords heal (such as cough modification). 

English Language Learners

If you are learning a new language and wish to alter your accent, you may benefit from the services of a speech-language pathologist, as well. They can help you form words and sounds correctly to alter your normal speech in learning a new language.

Traumatic Brain Injury

Traumatic brain injury after a blow to the head or an accident that affects the parts of the brain that control language can also lead to problems with communication. A speech therapist can help someone with this type of injury recover lost speech and language skills.

Swallowing Disorders

Dysphagia is the medical term for difficulty swallowing. It can be caused by several different medical conditions including muscular problems, a narrowed esophagus, damage caused by gastroesophageal reflux disease, or esophageal cancer. 

Untreated dysphagia can lead to problems eating and drinking including choking. A speech pathologist can help you develop strategies for safe chewing and swallowing, including exercises, correct body position, and food preparation recommendations. 

People with autism can have difficulty with both written and spoken communication as well as body-language forms of communication such as pointing and waving. Autism is also associated with difficulties relating to and socializing with other people. 

A speech pathologist can help people with autism understand communication norms and improve their written and spoken communication skills. They can also work with the families of people with autism on strategies that can help develop communication skills.

Alzheimer's Disease

People with dementia or Alzheimer's disease may develop communication problems as the disease progresses. A speech therapist can help the person develop memory skills and other strategies that will help them communicate.

Speech pathologists also work with the family and caregivers of people with dementia so they can help the person implement communication tools and strategies.   

Fluency Disorders

Fluency disorder describes speech patterns characterized by differences in rate and rhythm compared to how most people speak. 

Stuttering is the most common example of a fluency disorder. Another example is cluttering, which describes speech that is atypically fast and irregular.

Speech pathologists usually develop an individualized treatment plan for someone with a fluency disorder, which may include strategies such as:

• Minimizing negative reactions to the problem
• Increasing the person's acceptance of the problem
• Improving confidence
• Reducing avoidance behavior

Speech Sound Disorders

Speech sound disorders describe problems articulating words. People with speech sound disorders may be hard for others to understand. This can result in problems with social relationships, at work, or at school. 

Speech sound disorders are common in childhood and can be treated with the help of a speech pathologist. The pathologist will look at how the person moves their tongue, lips and jaw and help them learn the correct way to make sounds. 

People with speech sound disorders often have other problems with language; their speech therapist can also help them develop strategies to overcome these problems.

Gender-Affirming Voice Therapy

Voice therapy for transgender people can be an important part of gender-affirming healthcare. Learning to speak in ways that align with gender identity can improve a transgender person's quality of life as well as their social and psychological well-being.

A speech pathologist can help a transgender person learn to modify the pitch of their voice in ways that limit fatigue and damage to the vocal cords. They can also help the person learn nonverbal communication, articulation, and other strategies that can help their voice align with their gender identity.

To be a speech pathologist, a person must have a master's degree in communication disorders from a program accredited by the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA).

Many undergraduate and graduate programs in speech pathology require time spent observing a speech therapist at work prior to admission. This satisfies the requirement for entry into school and provides a good understanding of what a speech pathologist's job is like.

The first year of work as a speech therapist is called a clinical fellowship year. During this time, aspiring speech pathologists will work under the supervision of a licensed speech pathologist.

Additional steps to becoming a speech pathologist include:

• Obtaining a certificate of clinical competence in SLP (CCC-SLP)
• Passing a national Praxis examination for Speech-Language Pathology
• Applying for SLP licensure in the state in which you will be working

A speech pathologist's education does not end when they leave school and pass the national examination. They must also fulfill continuing education requirements from the American Speech-Language-Hearing Association (ASHA) to maintain their license.

When to See a Speech Pathologist

There are certain instances in which you may need to see a speech pathologist. For example, parents commonly notice small speech or language impairments in their children and seek out an SLP.

Adults may want to work with a speech pathologist to help with new or existing communication or language problems.

If you become hospitalized, you may have a speech pathologist come to your room and work with you at your bedside. They can help you with speech and language, swallowing and diet issues, and can work with other members of a rehab team to ensure that it is safe and appropriate for you to return home.

When to see a medical professional

Many speech and language disorders benefit from the help of a speech therapist, but some are more urgent than others. Any sudden onset of impaired speech should be considered an emergency, as the person may be experiencing a life-threatening problem such as a stroke.

Children should be closely monitored for speech and language development. If your child does not have the language skills expected for their age, it is a good idea to see a speech pathologist as soon as you can.

If you or a loved one is having trouble communicating or understanding language, then working with a speech pathologist may be a good idea.

SLPs treat children and adults with a variety of conditions, including Alzheimer's disease, stroke, neurological injuries, autism, and more. They are trained to assess your condition and offer strategies to improve your expressive and receptive communication and swallowing function.

Pascoe A, Breen LJ, Cocks N. What is needed to prepare speech pathologists to work in adult palliative care?: What is needed to prepare SPs to work in adult palliative care? .  International Journal of Language & Communication Disorders . 2018;53(3):542-549. doi:10.1111/1460-6984.12367

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American Speech-Language-Hearing Association. Clinical specialty certification .

Reilly S, Harper M, Goldfeld S. The demand for speech pathology services for children: Do we need more or just different? . J Paediatr Child Health . 2016;52(12):1057-1061. doi:10.1111/jpc.13318

National Aphasia Association. Stroke .

Johns Hopkins Medicine. Aphasia .

American Speech-Language-Hearing Association. Hearing loss in adults .

American Speech-Language-Hearing Association. Autism (autism spectrum disorder) .

Alzheimer's Association. Strategies to support changes in memory, language and behavior in the early stages of dementia .

American Speech-Language-Hearing Association. Fluency disorders .

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Salary.com. Speech Pathologist Salary in the United States .

By Brett Sears, PT Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.

What does a speech language pathologist do?

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What is a Speech Language Pathologist?

Speech language pathologists (SLPs) specialize in diagnosing, evaluating, and treating various communication and swallowing disorders that can affect individuals of all ages, from infants to the elderly. They work with patients who experience difficulties in speech articulation, language development, voice production, fluency (stuttering), and cognitive communication skills. They also assist individuals who have challenges with swallowing or feeding due to medical conditions or developmental issues.

Speech language pathologists collaborate closely with patients, their families, and other healthcare professionals to create tailored treatment plans that address specific communication or swallowing goals. Their expertise extends beyond assessment and therapy, encompassing research, education, and advocacy to promote effective communication and enhance the quality of life for individuals with communication disorders.

What does a Speech Language Pathologist do?

Speech language pathologists play an important role in the assessment, diagnosis, and treatment of communication and swallowing disorders. They employ a range of evidence-based techniques and technologies to help their clients improve their communication and swallowing abilities. By providing personalized therapy plans, counseling, and education, SLPs help individuals with communication and swallowing disorders achieve their fullest potential and enhance their quality of life.

Duties and Responsibilities Some of the key duties and responsibilities of a speech language pathologist include:

• Assessment and Evaluation: SLPs conduct thorough assessments to identify communication and swallowing disorders in patients. They use standardized tests, observations, interviews, and clinical observations to gather information about a patient's speech, language, voice, fluency, and swallowing abilities.
• Diagnosis: Based on assessment results, SLPs diagnose the specific communication or swallowing disorder affecting a patient. They analyze the collected data and provide a comprehensive understanding of the individual's challenges and needs.
• Treatment Planning: SLPs develop individualized treatment plans tailored to each patient's unique needs and goals. These plans may include strategies to improve speech articulation, language development, voice production, fluency, cognitive communication, or swallowing function.
• Therapeutic Interventions: SLPs administer therapeutic interventions to address communication and swallowing difficulties. They guide patients through exercises, activities, and techniques designed to improve their speech clarity, language comprehension, expression, voice quality, and fluency.
• Patient Education: SLPs educate patients and their families about the nature of the disorder, treatment options, and strategies for managing communication challenges in everyday life. They empower individuals to actively participate in their treatment journey.
• Collaboration: SLPs collaborate with other healthcare professionals, such as physicians, audiologists, educators, and occupational therapists, to provide comprehensive care to patients. They work as part of a multidisciplinary team to ensure a holistic approach to treatment.
• Progress Monitoring: SLPs regularly assess and document their patients' progress throughout the treatment process. They adjust treatment plans as needed based on ongoing evaluations and discussions with patients and their families.
• Adaptive Technology: In some cases, SLPs may recommend and assist patients in using adaptive communication devices or technologies to enhance their ability to communicate effectively.
• Swallowing Assessment and Treatment: SLPs evaluate and treat patients with swallowing difficulties (dysphagia). They may develop strategies to improve safe swallowing and prevent aspiration during eating and drinking.
• Research and Education: Some SLPs engage in research to contribute to the advancement of their field's knowledge and practices. They may also provide training and education to students, colleagues, and the community.
• Advocacy: SLPs advocate for individuals with communication disorders, raising awareness about the importance of effective communication and access to appropriate services.
• Documentation: SLPs maintain accurate records of assessments, treatment plans, progress notes, and outcomes to ensure effective communication with patients, families, and other healthcare professionals.

Types of Speech Language Pathologists Speech language pathologists can specialize in various areas within their field to address specific communication and swallowing challenges. Here are some types of specialized speech language pathologists:

• Pediatric Speech Language Pathologists: These professionals work primarily with children, addressing speech and language disorders that can arise from developmental delays, speech sound disorders, language impairments, and early communication difficulties. They may work in schools, early intervention programs, clinics, or private practice.
• Adult Speech Language Pathologists: Adult-focused speech language pathologists work with individuals who have communication and swallowing difficulties due to neurological conditions, strokes, traumatic brain injuries, or degenerative diseases like Parkinson's. They help adults regain or maintain their communication abilities and improve swallowing safety.
• Accent Modification Speech Language Pathologists: Accent modification specialists assist individuals who wish to modify their speech patterns to improve communication clarity and reduce accent-related misunderstandings, often in professional or academic settings.
• Voice Disorder Speech Language Pathologists: Speech language pathologists specializing in voice disorders work with individuals who have conditions affecting their vocal cords, pitch, volume, or quality of voice. They provide therapy to improve voice production and prevent vocal strain.
• Fluency Disorder Speech Language Pathologists: These professionals focus on treating individuals with fluency disorders, commonly known as stuttering. They use techniques to help individuals improve their speech fluency and manage their disfluencies.
• Augmentative and Alternative Communication (AAC) Speech Language Pathologists: AAC specialists work with individuals who have complex communication needs and may require alternative methods of communication, such as communication devices, symbols, or gestures.
• Swallowing and Dysphagia Speech Language Pathologists: These speech language pathologists specialize in evaluating and treating individuals with swallowing disorders (dysphagia) caused by various medical conditions. They help patients safely consume food and liquids.
• Traumatic Brain Injury (TBI) Speech Language Pathologists: Speech language pathologists with expertise in traumatic brain injuries provide therapy to individuals recovering from head injuries, helping them regain language, cognitive, and communication skills.
• Neonatal Speech Language Pathologists: Neonatal speech language pathologists work with infants in neonatal intensive care units (NICUs), addressing feeding and swallowing difficulties in premature or medically fragile newborns.
• Geriatric Speech Language Pathologists: Geriatric speech language pathologists specialize in addressing communication and swallowing issues in older adults, often dealing with age-related conditions such as dementia and age-related changes in speech and swallowing function.
• Educational Speech Language Pathologists: These professionals work in educational settings, such as schools, to provide speech and language therapy to students with communication disorders, supporting their academic success.

Are you suited to be a speech language pathologist?

Speech language pathologists have distinct personalities . They tend to be social individuals, which means they’re kind, generous, cooperative, patient, caring, helpful, empathetic, tactful, and friendly. They excel at socializing, helping others, and teaching. Some of them are also investigative, meaning they’re intellectual, introspective, and inquisitive.

Does this sound like you? Take our free career test to find out if speech language pathologist is one of your top career matches.

What is the workplace of a Speech Language Pathologist like?

Speech language pathologists work in a variety of settings, such as hospitals, schools, private clinics, rehabilitation centers, and nursing homes.

In a hospital setting, speech language pathologists may work in acute care or rehabilitation settings, providing assessment and treatment for patients with speech and language disorders resulting from medical conditions such as strokes, traumatic brain injuries, and cancer. They may also work with patients who have difficulty swallowing, which can be a common issue for individuals who have had strokes or are recovering from surgery.

In schools, speech language pathologists work with children who have communication disorders, such as stuttering, articulation problems, or language delays. They work with teachers, parents, and other professionals to develop and implement individualized education plans for students. They may also work with students who have hearing impairments, providing assistance with hearing aids and other assistive devices.

In private clinics, speech language pathologists may work with clients of all ages who have a variety of communication disorders. They may specialize in working with specific populations, such as children with autism or adults who have had strokes. In these settings, speech language pathologists work closely with clients and their families to develop treatment plans tailored to the client's specific needs and goals.

Rehabilitation centers and nursing homes may also employ speech language pathologists to work with patients who have suffered from strokes, traumatic brain injuries, or other medical conditions that affect speech and language. In these settings, speech language pathologists may work with patients to improve their ability to communicate effectively, both verbally and non-verbally.

Speech Language Pathologists are also known as: SLP Speech-Language Pathologist

Top 12 Speech Pathologist Skills to Put on Your Resume

Crafting an impactful resume as a speech pathologist requires the articulation of specific skills that showcase your expertise and dedication to helping individuals overcome communication barriers. Highlighting a well-rounded set of professional abilities can set you apart in the competitive healthcare job market, demonstrating your readiness to contribute effectively to a team and improve patient outcomes.

Speech Pathologist Skills

• Rehabilitation
• Articulation
• AAC (Augmentative and Alternative Communication)
• Language Development
• Voice Disorders
• CAS (Childhood Apraxia of Speech)
• SLP Software (e.g., SLP Toolkit)
• Teletherapy Platforms (e.g., Zoom, TheraPlatform)

1. Assessment

Assessment in the context of a Speech Pathologist involves the systematic evaluation of an individual's speech, language, communication, and swallowing abilities, using a combination of standardized tests, observations, and interviews to identify strengths, weaknesses, and any disorders. This process informs diagnosis, planning, and intervention strategies.

Why It's Important

Assessment is crucial for a Speech Pathologist as it helps to accurately identify and diagnose communication disorders, tailor intervention strategies to individual needs, and track progress over time, ensuring effective and personalized therapy for each client.

How to Improve Assessment Skills

Improving assessment in speech pathology involves refining techniques to ensure accurate, comprehensive evaluations of individuals' communication abilities. Here are concise strategies:

Stay Updated : Regularly update your knowledge with the latest assessment tools and evidence-based practices. American Speech-Language-Hearing Association (ASHA) offers resources and guidelines.

Incorporate Technology : Use digital assessment tools and apps for more interactive and engaging evaluations. SpeechPathology.com provides reviews and information on the latest technological tools.

Client-Centered Approach : Tailor assessments to the individual’s unique needs, considering their background, culture, and personal goals. ASHA's Practice Portal on Cultural Competence offers insights into culturally responsive assessments.

Interprofessional Collaboration : Work with other professionals (e.g., psychologists, occupational therapists) for a holistic understanding. Interprofessional Education Collaborative (IPEC) highlights the importance of interprofessional practice in healthcare.

Continuous Professional Development : Engage in workshops, courses, and seminars to hone your assessment skills. Continuing Education Board (CEB) of ASHA lists opportunities for ongoing learning.

Feedback and Reflection : Seek feedback from peers and mentors, and reflect on your assessment processes to identify areas for improvement.

By integrating these strategies, speech pathologists can enhance their assessment practices, leading to better outcomes for their clients.

How to Display Assessment Skills on Your Resume

2. Rehabilitation

Rehabilitation, in the context of a Speech Pathologist, refers to the process of assessment, treatment, and management aimed at restoring or improving communication, swallowing, and cognitive skills that have been impaired due to injury, illness, or developmental delays.

Rehabilitation is crucial for a Speech Pathologist because it aids in the recovery and improvement of communication and swallowing functions in individuals with speech, language, voice, or swallowing disorders, enhancing their quality of life and ability to participate in daily activities.

How to Improve Rehabilitation Skills

Improving rehabilitation, especially from a Speech Pathologist's perspective, involves a multifaceted approach focusing on evidence-based practices, personalized care, and interdisciplinary collaboration. Here are key strategies:

Stay Updated with Research : Continuously update your knowledge with the latest research in speech pathology to apply evidence-based practices. The American Speech-Language-Hearing Association (ASHA) provides resources and journals.

Personalized Care Plans : Develop individualized treatment plans based on thorough assessments and the client's specific needs, preferences, and goals. The National Institutes of Health (NIH) offers insights into personalized medicine.

Use of Technology : Integrate technology, like speech therapy apps and teletherapy, to enhance practice and accessibility. The International Journal of Telerehabilitation offers insights into current technological advances.

Interdisciplinary Collaboration : Work closely with other healthcare professionals to provide holistic care. Interprofessional Education Collaborative (IPEC) promotes teamwork across disciplines.

Continuing Education : Participate in workshops, seminars, and courses to enhance your skills and knowledge. ASHA Professional Development offers various opportunities for learning.

Client and Family Education : Empower clients and their families with knowledge and strategies to support rehabilitation. Patient Education and Counseling is a resource for strategies on effective communication.

Feedback and Adaptation : Regularly solicit feedback from clients and adapt strategies as necessary to ensure the effectiveness of interventions.

Implementing these strategies can significantly improve the outcomes of rehabilitation services provided by speech pathologists.

How to Display Rehabilitation Skills on Your Resume

3. Articulation

Articulation, in the context of speech pathology, refers to the physical process of producing clear and precise speech sounds using the coordinated movements of the lips, tongue, teeth, palate, and respiratory system. It involves the ability to form sounds into recognizable speech. Speech pathologists work to diagnose, assess, and treat articulation disorders, which are characterized by difficulties in producing specific speech sounds correctly.

Articulation is crucial for a Speech Pathologist because it impacts clarity of speech, affecting communication effectiveness, social interaction, and literacy skills development. Proper articulation ensures individuals can express themselves clearly and be understood by others, facilitating overall communication health and well-being.

How to Improve Articulation Skills

Improving articulation often involves exercises and techniques focused on clarity, precision, and the correct formation of sounds. Here are concise steps and resources for a Speech Pathologist:

Assessment : Evaluate the individual's speech to identify specific articulation errors. ASHA's guidelines can help in conducting a thorough assessment.

Target Sounds Selection : Choose specific sounds that the individual struggles with, starting with those that impact intelligibility the most.

Visual and Auditory Feedback : Use mirrors and record/playback devices to provide immediate feedback. Tools like SmartPalate offer visual feedback on tongue placement.

Articulation Exercises : Practice targeted sounds in isolation, then in words, sentences, and conversation. Incorporate exercises that strengthen the tongue and mouth muscles, such as those found on HomeSpeechHome.

Phonological Awareness Activities : Enhance awareness of sounds in words, which is crucial for articulation. Activities can be found on Reading Rockets.

Consistent Practice : Encourage daily practice outside of therapy sessions for faster improvement. Setting realistic goals and tracking progress can motivate continuous effort.

Generalization : Gradually move from structured exercises to more natural speech contexts to ensure the transfer of skills.

For professional development and additional resources, Speech Pathologists can refer to the American Speech-Language-Hearing Association (ASHA) , which offers a wealth of information on articulation disorders and therapy techniques.

How to Display Articulation Skills on Your Resume

Fluency, in the context of speech pathology, refers to the smooth, uninterrupted flow of speech. It is the ability to speak without involuntary disruptions or hesitations, such as stuttering or stammering.

Fluency is crucial for clear, efficient, and effective communication. It allows individuals to express thoughts seamlessly, fostering social interactions and academic or professional success. For a Speech Pathologist, enhancing fluency is essential for helping clients overcome communication disorders, ensuring they can participate fully in their communities and achieve their personal goals.

How to Improve Fluency Skills

To improve fluency, follow these concise strategies, keeping in mind the perspective of a Speech Pathologist:

Practice Slow Speech : Encourage the use of a slower, more deliberate speech pattern to reduce the speed of speaking, which can help with the clarity and fluency of speech. ASHA provides resources on managing fluency disorders.

Use Breathing Techniques : Implement controlled breathing exercises to manage the rhythm of speech. This can aid in reducing instances of stuttering or speech blocks. Stuttering Foundation offers tips and techniques for better speech management.

Develop a Speaking Strategy : Create and practice speaking strategies, such as using pauses or emphasizing certain words to improve speech flow and reduce pressure during speaking. British Stammering Association has resources for developing effective communication strategies.

Seek Professional Guidance : Work with a speech pathologist for personalized strategies and therapy sessions tailored to the individual's needs. Speech pathologists can provide specific exercises and feedback to improve speech fluency. American Speech-Language-Hearing Association (ASHA) offers a directory to find professionals.

Engage in Regular Practice : Consistent practice is key to improving speech fluency. Engage in daily exercises and real-life conversation practice to build confidence and skills. Toastmasters International can be a valuable platform for practicing public speaking and communication skills in a supportive environment.

Remember, improving fluency is a process that requires time, practice, and sometimes professional intervention for significant progress.

How to Display Fluency Skills on Your Resume

5. AAC (Augmentative and Alternative Communication)

AAC (Augmentative and Alternative Communication) encompasses methods and devices designed to supplement or replace spoken or written language for individuals with communication impairments, facilitating their ability to express needs, thoughts, and ideas effectively.

AAC is crucial as it provides individuals with speech or language impairments a means to express themselves, enhancing their ability to communicate, participate in social interactions, and improve their overall quality of life. It allows Speech Pathologists to tailor communication methods to each individual's needs, promoting independence and inclusion.

How to Improve AAC (Augmentative and Alternative Communication) Skills

Improving Augmentative and Alternative Communication (AAC) strategies involves a multi-faceted approach focusing on the customization of AAC systems, fostering communication partnerships, and staying updated with technology advancements. Here’s a brief guide for Speech Pathologists:

Assessment and Customization : Begin with a comprehensive assessment of the individual's communication needs, preferences, and abilities. Tailor the AAC system to match the individual's skills and lifestyle for maximum effectiveness. ASHA provides guidelines on assessment.

Training and Support : Offer continuous training for users and their communication partners. Focus on the functionality of AAC devices and strategies to incorporate them into daily life. The AAC Institute offers resources and training programs.

Incorporate Multimodal Communication : Encourage the use of multiple modes of communication (e.g., gestures, facial expressions, speech) alongside AAC devices to enhance expressiveness and engagement. PrAACtical AAC shares strategies for multimodal communication.

Engagement and Motivation : Select topics and activities that interest the user to encourage participation. Incorporating personal interests increases motivation and engagement.

Stay Updated with Technology : Continually explore new AAC technologies and features. Attend workshops, webinars, and conferences. Websites like ISAAC (International Society for Augmentative and Alternative Communication) provide updates on AAC technology and research.

Collaborate with Families and Teams : Work closely with families and other professionals (OTs, PTs, educators) to ensure a holistic approach to communication. The Hanen Centre offers resources on how to effectively involve families.

Focus on Literacy : Develop literacy skills alongside AAC use. Literacy opens up further communication opportunities and independence. LiteracyAAC has resources focused on developing literacy in AAC users.

By adopting these strategies, Speech Pathologists can enhance the effectiveness of AAC interventions, promoting better communication outcomes for individuals with complex communication needs.

How to Display AAC (Augmentative and Alternative Communication) Skills on Your Resume

6. Dysphagia

Dysphagia is a condition characterized by difficulty in swallowing, which may involve problems with any phase of the swallowing process, from oral preparation and transit to pharyngeal and esophageal stages. Speech pathologists assess, diagnose, and treat dysphagia to improve swallowing function and ensure safe nutrition and hydration.

Dysphagia is important for a Speech Pathologist because it involves the assessment and management of swallowing disorders, which are crucial for ensuring safe and effective oral intake, preventing malnutrition, dehydration, and aspiration pneumonia, thereby improving the patient's quality of life and health outcomes.

How to Improve Dysphagia Skills

Improving dysphagia involves a multidisciplinary approach, including assessment and intervention by a speech pathologist. Here are concise steps and strategies:

Assessment : Conduct a comprehensive evaluation to identify the type and severity of dysphagia. This may involve a clinical swallow examination and instrumental assessments like a Videofluoroscopic Swallow Study (VFSS) or a Fiberoptic Endoscopic Evaluation of Swallowing (FEES) .

Diet Modification : Adjust the texture of foods and thickness of liquids to ensure safety and ease of swallowing. The IDDSI framework provides guidelines on food and liquid consistency.

Swallowing Exercises : Implement exercises designed to strengthen the muscles involved in swallowing. These can include exercises for improving tongue strength, laryngeal elevation, and oropharyngeal coordination. ASHA provides resources and guidance on specific exercises.

Positioning Techniques : Teach and encourage the use of specific swallowing positions or maneuvers that can help manage dysphagia symptoms, such as the chin tuck or head turn techniques.

Stimulation Techniques : Use thermal-tactile stimulation or other sensory techniques to improve swallow function. These methods can help increase the swallow response.

Patient and Caregiver Education : Educate patients and caregivers about safe swallowing strategies and signs of aspiration to prevent complications. ASHA offers resources that can be used for education.

Regular Monitoring and Adjustment : Continuously monitor the patient’s progress and adjust the treatment plan as necessary to ensure the best outcomes.

Collaboration with other healthcare professionals, such as dietitians, occupational therapists, and medical personnel, is crucial for a holistic approach to managing dysphagia.

How to Display Dysphagia Skills on Your Resume

7. Phonology

Phonology is the study of the sound system of languages, focusing on the patterns, rules, and structures of speech sounds and how they are used to convey meaning in communication. For a speech pathologist, it involves analyzing, diagnosing, and treating phonological disorders to improve speech clarity and intelligibility.

Phonology is crucial for a Speech Pathologist because it helps in diagnosing and treating speech sound disorders by understanding the patterns and rules of sound use in a specific language, enabling targeted interventions for clearer communication.

How to Improve Phonology Skills

Improving phonology, particularly from a speech pathologist's perspective, involves targeted strategies and techniques designed to enhance an individual's ability to produce and understand the sounds of their language. Here's a concise guide:

Assessment and Analysis : Begin with a comprehensive phonological assessment to identify specific patterns of sound errors. Tools like the Goldman-Frisoe Test of Articulation are commonly used.

Phonological Awareness Skills : Enhance phonological awareness through activities that focus on sound identification, manipulation, and segmentation. The Reading Rockets website offers resources and activities to support phonological awareness.

Minimal Pairs Therapy : Use minimal pairs (words that differ by only one phoneme) to help the individual discriminate between sounds and correct phonological errors. This Speech And Language Therapy Guide provides a step-by-step approach to minimal pairs therapy.

Metaphon Therapy : Focus on increasing the individual's meta-phonological awareness, helping them to think about and manipulate sounds. The Metaphon Resource Pack offers materials and activities designed for this approach.

Maximal Oppositions Approach : Use contrasts between error sounds and target sounds that are maximally different to highlight the differences in sounds. This approach is discussed in various speech pathology resources, though direct links to specific maximal oppositions resources may be less readily available online.

Auditory Discrimination Training : Improve the individual's ability to hear and differentiate sounds through listening activities. Resources such as Hearing First provide tools and strategies to support auditory development.

Technology and Apps : Incorporate technology, such as apps designed for speech therapy, to make practice engaging. Apps like Articulation Station offer interactive ways to practice sounds.

Regular Practice and Feedback : Consistent practice, coupled with immediate and constructive feedback, is crucial for phonological development. Tailor feedback to the individual's needs and progress.

Remember, a tailored approach that considers the unique needs of each individual will be most effective. Collaboration with other professionals and continuous professional development can also enhance a speech pathologist's phonological intervention strategies.

How to Display Phonology Skills on Your Resume

8. Language Development

Language development refers to the process by which individuals acquire and refine their ability to communicate through spoken, written, or gestural means. For speech pathologists, it encompasses understanding, assessing, and facilitating the growth of vocabulary, grammar, syntax, and social use of language in individuals across different ages and abilities.

Language development is crucial for effective communication, cognitive development, academic success, and social-emotional well-being. For a speech pathologist, understanding and supporting language development is essential to diagnose, treat, and prevent communication disorders, enabling individuals to participate fully in their daily lives.

How to Improve Language Development Skills

Improving language development involves a multifaceted approach focusing on enhancing comprehension, expression, and practical use of language. Here are concise strategies tailored for a Speech Pathologist:

Early Identification and Intervention : Recognize and address language delays early on. Early intervention programs are crucial. ASHA provides guidelines on early detection.

Engage in Interactive Reading : Foster language skills through shared book reading, asking questions, and encouraging predictions about the story. The Hanen Centre offers strategies for interactive reading.

Use of Multisensory Approaches : Incorporate visual, auditory, and kinesthetic-tactile pathways to enhance language learning. Understood outlines the benefits of multisensory learning.

Promote Play-Based Learning : Facilitate language development through play, including role-play and games that stimulate language use and social interaction. Pathways provides examples of play-based activities.

Incorporate Technology and Apps : Utilize apps and software designed for language development, ensuring they are interactive and educational. Speech Blubs is one example of an app designed to improve speech and language skills.

Parent and Caregiver Education : Educate parents and caregivers on effective communication strategies and the importance of a language-rich environment. The Hanen Centre offers resources for parents and professionals.

Targeted Speech Therapy Techniques : Apply specific strategies suited to the individual's needs, such as articulation therapy, language intervention activities, and augmentative and alternative communication (AAC) as needed. ASHA provides resources on various therapy techniques.

By utilizing these strategies, Speech Pathologists can effectively support and enhance language development across different age groups and needs.

How to Display Language Development Skills on Your Resume

9. Voice Disorders

Voice disorders are conditions that affect the quality, pitch, volume, or duration of the sound produced by the vocal cords, interfering with communication. Speech pathologists assess, diagnose, and treat these disorders to improve vocal function and health.

Voice disorders are crucial for Speech Pathologists to address because they can significantly impact an individual's communication, social interaction, emotional well-being, and professional opportunities. Effective management is essential for improving quality of life and enabling effective verbal communication.

How to Improve Voice Disorders Skills

Improving voice disorders generally involves a combination of behavioral therapy, vocal exercises, and sometimes medical treatment, depending on the cause. Here are concise steps a Speech Pathologist might take:

Assessment : Conduct a comprehensive voice evaluation to identify the type of voice disorder. ASHA Guidelines .

Vocal Hygiene : Educate the patient on vocal hygiene practices to reduce strain and promote healing. This includes staying hydrated, avoiding yelling, and taking vocal naps. Vocal Hygiene Tips.

Voice Therapy : Implement voice therapy techniques tailored to the patient's specific needs. Techniques might include breath support exercises, pitch range expansion exercises, and relaxation techniques. Voice Therapy Techniques.

Resonant Voice Therapy : Teach resonant voice techniques to help the patient produce voice with less effort and strain. Resonant Voice Therapy .

Lee Silverman Voice Treatment (LSVT) LOUD® : For patients with Parkinson’s disease or other neurological conditions, LSVT LOUD® can be effective. It focuses on increasing vocal loudness. LSVT LOUD.

Medical Referral : In cases where a structural abnormality or neurological condition is suspected, refer the patient for medical evaluation. This might involve seeing an otolaryngologist or neurologist.

Monitoring and Adjustment : Regularly monitor the patient's progress and adjust the therapy plan as needed to ensure optimal outcomes.

For more detailed guidance and resources, Speech Pathologists can refer to the American Speech-Language-Hearing Association (ASHA) website and specific voice disorder treatment guidelines.

How to Display Voice Disorders Skills on Your Resume

10. CAS (Childhood Apraxia of Speech)

Childhood Apraxia of Speech (CAS) is a motor speech disorder where children have difficulties making accurate movements when speaking due to the brain's inability to properly plan and coordinate the muscle movements necessary for speech.

Childhood Apraxia of Speech (CAS) is important for a Speech Pathologist to identify and treat because it involves a significant difficulty in planning and producing the precise movements necessary for speech. Early and specialized intervention is crucial to improve communication skills, thereby enhancing the child's overall development and quality of life.

How to Improve CAS (Childhood Apraxia of Speech) Skills

To improve Childhood Apraxia of Speech (CAS), a Speech-Language Pathologist (SLP) can employ several strategies, including:

Intensive Practice : Engage the child in frequent, intensive speech therapy sessions focusing on the precise articulation of sounds and sequences ( ASHA ).

Multi-Sensory Approaches : Utilize tactile feedback techniques, visual aids, and auditory feedback to enhance motor planning and execution skills (Apraxia Kids).

Individualized Treatment Plans : Tailor therapy to the child’s specific needs, strengths, and weaknesses, adjusting approaches based on progress and response to therapy.

Parent and Caregiver Involvement : Train parents and caregivers in techniques to support practice at home, enhancing the frequency and consistency of practice ( CASANA ).

Use of Technology : Incorporate apps and software designed for speech therapy to provide engaging, interactive practice opportunities.

For further reading and resources, visiting professional associations like the American Speech-Language-Hearing Association ( ASHA ) and Apraxia Kids ( Apraxia Kids ) can provide valuable information, guidance, and support for professionals working with CAS.

How to Display CAS (Childhood Apraxia of Speech) Skills on Your Resume

11. SLP Software (e.g., SLP Toolkit)

SLP software, such as SLP Toolkit, is a digital tool designed for Speech-Language Pathologists (SLPs) to streamline assessment, planning, and documentation processes. It aids in managing caseloads, tracking progress, and creating individualized therapy plans for clients with speech, language, and communication needs.

SLP software, such as SLP Toolkit, is crucial for Speech-Language Pathologists as it streamlines assessment, planning, and documentation processes, enhancing therapy effectiveness and efficiency while ensuring individualized patient care.

How to Improve SLP Software (e.g., SLP Toolkit) Skills

Improving SLP Software like SLP Toolkit involves enhancing user experience, functionality, and integrating evidence-based practices. Here are concise strategies:

User-Centric Design : Focus on intuitive user interfaces. Conduct user testing with speech pathologists to identify pain points and areas for improvement. Nielsen Norman Group offers resources on usability.

Customizable Content : Allow speech pathologists to customize assessments and therapy materials to meet individual client needs. Providing templates that can be modified can increase the software's utility. Customization in Software offers insights.

Evidence-Based Practices : Incorporate the latest research and evidence-based strategies into the software’s recommendations and content. The American Speech-Language-Hearing Association (ASHA) provides a wealth of resources on evidence-based practices.

Integration Capabilities : Ensure the software can easily integrate with other tools and platforms commonly used in educational and healthcare settings, such as electronic health record systems. HealthIT.gov provides guidelines on software interoperability.

Accessibility Features : Make the software accessible to all users, including those with disabilities. Consider features like text-to-speech, adjustable font sizes, and high-contrast modes. Web Content Accessibility Guidelines (WCAG) outline key principles for accessibility.

Continual Feedback Loop : Establish a system for collecting and acting on feedback from speech pathologists. This could include regular surveys, a forum for suggestions, and a transparent roadmap of future updates. UserVoice is an example of a platform for gathering user feedback.

Professional Development : Offer resources and training for speech pathologists to get the most out of the software, such as online tutorials, webinars, and customer support. LinkedIn Learning has courses on various software and professional skills.

By focusing on these areas, SLP Software like SLP Toolkit can significantly improve, becoming more effective and user-friendly for speech pathologists.

How to Display SLP Software (e.g., SLP Toolkit) Skills on Your Resume

12. Teletherapy Platforms (e.g., Zoom, TheraPlatform)

Teletherapy platforms, such as Zoom or TheraPlatform, are digital tools that enable speech pathologists to provide therapy services remotely through video conferencing, interactive activities, and secure communication channels, facilitating accessible and flexible speech therapy sessions.

Teletherapy platforms are crucial for speech pathologists as they provide a flexible and accessible means to deliver therapy services remotely, ensuring continuity of care and expanding access to clients who may face geographical, physical, or logistical barriers to in-person sessions.

How to Improve Teletherapy Platforms (e.g., Zoom, TheraPlatform) Skills

Improving teletherapy platforms like Zoom or TheraPlatform, particularly for Speech Pathologists, involves addressing specific needs for therapy delivery, enhancing user experience, and ensuring high standards of security and privacy. Here are concise suggestions:

Customizable Interfaces : Tailor the interface to suit the therapy session's needs, allowing Speech Pathologists to adjust layouts, tools, and features easily. TheraPlatform offers customizable features tailored for therapists.

Interactive Tools : Integrate interactive tools such as whiteboards, real-time document editing, and specific speech therapy activities. This enhancement facilitates a more engaging and effective session. Zoom allows for screen sharing and annotation, which can be used creatively for these purposes.

Accessibility Features : Ensure platforms include speech-to-text, closed captioning, and customizable font sizes to accommodate clients with diverse needs, making sessions more accessible.

Enhanced Security and Privacy : Implement advanced encryption and comply with healthcare regulations like HIPAA to protect client information. Both Zoom for Healthcare and TheraPlatform have features aimed at ensuring privacy and security.

High-Quality Video and Audio : Prioritize clear, lag-free communication by supporting high-definition video and superior audio quality, crucial for accurately assessing and treating speech disorders.

Integration with Scheduling and Documentation : Streamline the therapy process with features for appointment scheduling, reminders, and progress note-taking within the platform to save time and keep organized. TheraPlatform offers such integrated features .

Training and Support : Provide comprehensive training materials and responsive technical support for therapists to navigate the platform effectively, ensuring that technology enhances rather than hinders the therapy process.

By focusing on these enhancements, teletherapy platforms can offer more efficient, engaging, and effective tools for Speech Pathologists, ultimately leading to better outcomes for their clients.

How to Display Teletherapy Platforms (e.g., Zoom, TheraPlatform) Skills on Your Resume

Related Career Skills

• Speech Language Pathologist
• Speech Therapist
• Pathologist Assistant
• Pathologist

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Home » Blog » General » Creating Effective Pragmatic Language Goals: Strategies for Speech Language Pathologists

Creating Effective Pragmatic Language Goals: Strategies for Speech Language Pathologists

As a Speech Language Pathologist (SLP), one of the key responsibilities is to help individuals develop effective communication skills. Pragmatic language, also known as social language, plays a crucial role in social interactions and is essential for successful communication. In this blog post, we will explore the importance of pragmatic language goals in speech therapy and discuss strategies for writing effective goals.

Understanding Pragmatic Language Goals

Pragmatic language refers to the social use of language, including the ability to understand and use verbal and nonverbal cues, initiate and maintain conversations, take turns, and interpret humor or sarcasm. These skills are vital for building relationships, making friends, and navigating social situations.

When setting pragmatic language goals, it is essential to be specific and target the specific skills that need improvement. By setting clear objectives, both the SLP and the individual receiving therapy can work towards a common goal.

Key Components of Effective Pragmatic Language Goals

1. Identifying the target skills:

When writing pragmatic language goals, it is crucial to identify the specific skills that need improvement. Some common target skills include:

• Understanding nonverbal cues: This involves interpreting facial expressions, body language, and tone of voice.
• Initiating and maintaining conversations: This includes starting conversations, staying on topic, and appropriately ending conversations.
• Taking turns during conversations: This involves waiting for a pause before responding and not interrupting others.
• Understanding and using appropriate body language: This includes maintaining eye contact, using appropriate gestures, and understanding personal space.
• Interpreting and responding to sarcasm or humor: This involves understanding figurative language, jokes, and sarcasm.

2. Setting measurable objectives:

Effective pragmatic language goals should be measurable, allowing progress to be tracked over time. To make goals measurable, consider:

• Using specific language: Clearly define the desired skill or behavior that needs improvement.
• Incorporating observable behaviors: Specify how progress will be observed or measured.
• Defining the desired level of proficiency: Set a clear expectation for the level of skill mastery.

3. Considering individual needs and abilities:

Each individual has unique strengths and weaknesses when it comes to pragmatic language skills. It is important to assess the student’s current abilities and tailor goals to meet their specific needs. By considering individual needs, goals can be more personalized and effective.

Strategies for Writing Pragmatic Language Goals

1. Using the SMART framework:

The SMART framework is a useful tool for writing effective goals. SMART stands for:

• Specific: Clearly define the target skill or behavior.
• Measurable: Establish how progress will be measured or observed.
• Achievable: Set goals that are realistic and attainable.
• Relevant: Ensure that the goals are relevant to the individual’s needs and abilities.
• Time-bound: Set a specific timeframe for achieving the goal.

2. Incorporating evidence-based practices:

Stay updated with current research and utilize evidence-based interventions when setting pragmatic language goals. By incorporating practices that have been proven effective, you can increase the likelihood of success.

3. Considering the student’s environment:

Pragmatic language skills are most effective when they can be applied in real-life situations. Collaborate with teachers and parents to identify relevant social contexts and incorporate them into the goals. This collaboration ensures consistency across different environments and maximizes the opportunities for practice.

Examples of Pragmatic Language Goals

Here are a few examples of pragmatic language goals:

Goal 1: The student will demonstrate understanding of nonverbal cues by correctly interpreting facial expressions in 8 out of 10 opportunities.

Goal 2: The student will initiate and maintain a conversation by asking at least two open-ended questions during a group discussion.

Goal 3: The student will take turns during conversations by waiting for a pause before responding in 9 out of 10 opportunities.

Effective pragmatic language goals are crucial for helping individuals develop the necessary skills for successful social communication. By understanding the key components of effective goals and implementing strategies such as the SMART framework and evidence-based practices, SLPs can make a significant impact on their clients’ communication abilities.

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​How can a speech-language pathologist help?

May 1, 2023

Written By Lea Rose Markham, MS, CCC-SLP, and Derek Palmer, MA, CCC-SLP, BCS-S

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Communication is a pivotal part of making connections and experiencing the world around us. When people lose the ability to adequately express themselves or understand those around them, they are often left feeling as though a part of them is missing. May is Better Hearing and Speech Month and a perfect time to bring communication to the forefront.

What do speech-language pathologists do?

Our ability to hear and understand those around us, as well as express our thoughts, feelings, and ideas can be impacted by a variety of disorders experienced from infancy into adulthood and old age. Speech-language pathologists (SLPs) help people with communication disorders in a variety of ways. Articulation therapy focuses on shaping appropriate pronunciation of the sounds used to form words (e.g. getting rid of a lisp or saying “r” correctly). Stuttering is treated by teaching strategies to improve the fluency of speech, and voice therapy targets disorders of the vocal cords and other body parts that are needed to speak with a clear voice.

Comprehension of language can also be a focus of speech therapy, whether it be developmental, following placement of a cochlear implant to restore hearing, or as the result of a stroke. Although some patients receiving speech therapy services have the ability to communicate, some can have a difficult time using appropriate communication skills. These difficulties range from to playing their friends and forging relationships, due to issues related to autism, or successfully returning to a job, for example, after a traumatic brain injury. SLPs work to foster development of social communication skills and improve an individual’s ability to carry out tasks necessary for successful daily living.

Some people with communication disorders may not be able to use their own voice, gestures, facial expressions, or writing to express their ideas. SLPs work to find other ways to bring the power of communication to all, based on each person's unique situation. Some of these approaches include using a communication board with pictures of different toys a child can select from while playing, a device to restore voice after placement of a tracheostomy tube, a computer that can recognize eye movements for a person with Amyotrophic Lateral Sclerosis’s (ALS) to allow them to tell a loved one their wants and needs, or an alternate means of voice production after having the voice box (larynx) surgically removed.

How can we improve our communication with others?

Difficulties with communication happen to everyone from time to time. It is important to remember that there are individuals in our communities who struggle to simply talk to family members on the phone, play with a friend, or place an order at a restaurant every day. Reducing background noise and distractions, using simple language with an age-appropriate tone of voice, allowing extra time to respond, repeating yourself as needed, and, most importantly, putting yourself in the other person’s shoes can help establish a strong relationship and allow for a better communication experience.

A team approach to care

At the  University of Chicago Medicine , we take a specialized approach to serving patients with communication difficulties. Our speech-language pathologists work alongside audiologists, occupational and physical therapists, nurses, and physicians as part of a multidisciplinary team to provide optimal communication during critical periods, such as after a cochlear implant placement or following a stroke. In addition to communication, speech-language pathologists focus heavily on the diagnosis and treatment of swallowing difficulties (oropharyngeal dysphagia).

Effective communication enhances our ability to express our basic needs and desires, to create, play, work, and love, and it prevents isolation, misunderstandings, and confusion. During Better Hearing and Speech Month, we are all reminded to use the gift of communication and help those who are working hard towards developing their voice in this world.

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How Speech Pathologists Help With Social Skills 

Today’s post is all about the social communication and how Speech Pathologists can help with social skills and build your child’s confidence. But first, let’s pause and take a minute to picture yourself in the following situations:  

A friend comes over for afternoon tea.   Your child sees your friend reach for a biscuit and says, “Better not take those, or you’ll get even bigger”.   You can’t believe your child could say something so rude!

As you talk with your teenage neighbour about his new car, he has trouble staying on topic.   The conversation quickly shifts to focus on his favourite TV show.   He doesn’t maintain eye contact or laugh at your jokes. He continues to talk even when you look at your watch and comment on the time. You finally leave and are relieved that the conversation is over.

What’s going on in these situations!?  

Both your child and neighbour speak well.   Their ideas are clear and the sentences they use make sense. What they may have trouble with is social communication.   Speech Pathologists often refer to this as pragmatics. These are the rules of a conversation; what we follow when we talk. In many instances, knowing and using these rules makes it easier to communicate.  

What are Social Communication Skills?  

Social communication includes three major skills:

1. Using language for different reasons or purposes , such as:  

– Greeting  

– Informing  

– Demanding  

– Negotiation  

– Requesting and Questioning (the list goes on…)

2. Changing language according to the listener or situation .  

For example, talking differently to a baby than an adult or School Principal.   Changing the words you use and way you talk at home and at work. You may also give more information to someone who does not know the topic.

3.  Following rules for conversations and storytelling , such as:  

– Taking turns when you talk

– Letting others know the topic  

– Staying on topic  

– Using gestures and body language (e.g., eye contact, appropriate physical distancing) that match what it is you’re saying and makes the listener feel comfortable.  

How Speech Pathologists Can Help with Social Skills:  

A child or young person with social communication problems may appear to say the wrong thing or act the wrong way when talking.   They may also use language in limited ways.  

It’s important to recognise that all children may break some of these rules as they learn.   However, if your child has particular difficulty mastering these skills even after explicit guidance from you, they may have a social communication disorder.  

A Speech Pathologist helps children and young people with social communication problems. Our team at Active Speech Pathology is well-equipped to assess and support children to learn how to use language flexibly and confidently with a range of different people in different situations. We provide individual as well as group therapy options. You can find out more information about our groups here.

Social Communication Tips  

Parents, here are 5 helpful ways to encourage social language learning everyday.  

• Use everyday situations.   Give your child chances to practice good social communication across the day. Practice staying on topic by talking about school.   Have your child ask others what they want to eat for dinner to practice asking questions. Let your child ask for what they need to get ready for bed.  
• Role play conversations.   Pretend to talk to different people in different situations. For example, have your child explain the rules of a game to different people. Demonstrate how he would talk to a child or adult, family member or a stranger.  
• Practice messages. Ask your child what he would say if he wanted something.   Talk about different ways to present a message, such as polite vs impolite (“Can I please go to the party?” vs “I’m going to the party”) and indirect vs direct (“That music is loud” vs “Turn off the music”  
• Show how non-verbal cues are important.   You can look at pictures of faces, and talk about how the person might feel.   Talk about what it means when a person’s face doesn’t match what they say. For instance, when someone smiles as they say, “No way!”
• Say something about the topic of conversation before talking about it .   This may help your child stay on topic and change topics more easily.   Get them to talk more about a topic by asking questions or adding information.  

If you would like to know more information about how Speech Pathologists can help with social skills or have a question to ask regarding your child’s social communication skills, please get in touch with us by phone or emailing hello@activespeechpathology.com.au  

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About the author: jane rosenlund.

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Speech and language therapy to improve the communication skills of children with cerebral palsy

The production of speech, language and gesture for communication is often affected by cerebral palsy. Communication difficulties associated with cerebral palsy can be multifactorial, arising from motor, intellectual and sensory impairments. Children with this diagnosis can experience mild to severe difficulties in expressing themselves. They are often referred to speech and language therapy (SLT) services to maximise their communication skills and help them to take as independent a role as possible in interaction activities. Therapy can include introducing augmentative and alternative communication (AAC) systems, such as symbol charts or communication aids with synthetic speech, as well as treating children's natural forms of communication. Various strategies have been used to treat the communication disorders associated with cerebral palsy, but evidence of their effectiveness is limited.

To determine the effectiveness of SLT that focuses on the child or their familiar communication partners, as measured by change in interaction patterns. To determine if individual types of SLT intervention are more effective than others in changing interaction patterns.

Search methods

Searches were conducted of MEDLINE, CINAHL, EMBASE, PsycINFO, LLBA, ERIC, WEB of SCIENCE, Scopus, NRR, BEI, SIGLE (to January 2011). A previous version of this review included studies up to the end of 2002. References from identified studies were examined and relevant journals and conference reports were handsearched.

Selection criteria

Any experimental study containing an element of a control was included in this review. This includes non‐randomised group studies and single case experimental designs in which two interventions were compared or two communication processes were examined.

Data collection and analysis

All authors searched for and selected studies for inclusion. L Pennington (LP) assessed all papers for inclusion, J Goldbart (JG) and J Marshall (JM) independently assessed separate random samples, each comprising 25% of all identified studies. Two review authors independently abstracted data from each selected study. Disagreements were settled by discussion between the three review authors.

Main results

Sixteen studies were included in the review. Nine studies evaluated treatment given directly to children, seven investigated the effects of training for communication partners. Participants in the studies varied widely in age, type and severity of cerebral palsy, cognitive and linguistic skills. Studies focusing directly on children suggest that this model of therapy delivery has been associated with increases in treated speech and communication skills by individual children. However, methodological flaws and small sample sizes prevent firm conclusions being made about the effectiveness of the therapy. In addition, maintenance of these skills was not investigated thoroughly. The studies targeting communication partners used small exploratory group designs which often contained insufficient detail to allow replication, although more recent studies have improved in this area. Overall, the studies of indirect intervention have very low power and cannot provide evidence of effectiveness of this type of treatment.

Authors' conclusions

Firm evidence of the positive effects of SLT for children with cerebral palsy has not been demonstrated by this review. However, positive trends in communication change were shown. No change in practice is recommended from this updated review. Further research is needed to describe this client group, and its possible clinical subgroups, and the methods of treatment currently used in SLT. Research is also needed to investigate the effectiveness of new and established interventions and their acceptability to families. Rigour in research practice needs to be extended to enable firm associations between therapy and the communication change to be made. There are now sufficient data to develop randomised controlled studies of dysarthria interventions and group parent training programmes. Such research is urgently needed to ensure clinically effective provision for this group of children, who are at severe risk of social and educational exclusion.

Plain language summary

Speech and language therapy for children with cerebral palsy might improve their communication skills, but more research is needed.

Cerebral palsy (CP) is a movement disorder caused by damage to the brain before, during or soon after birth. The ability for people with CP to communicate effectively is often impaired by problems with speech and also gestures usually used in communication. Speech and language therapy aims to help people with CP maximise their communication skills. This can include ways of enhancing natural forms of communication, introducing aids such as symbol charts or devices with synthetic speech, and training communication partners. The review found some weak evidence that speech and language therapy might help children with CP, but more research is needed.

Cerebral palsy describes a "group of persistent disorders of the development of movement and posture, causing activity limitation, that are attributed to non‐progressive disturbances that occurred in the developing fetal or infant brain" ( Bax 2005 ). Subgroups of cerebral palsy have been classified according to the clinical signs of spastic, ataxic and dyskinetic syndromes, plus mixed forms ( SCPE 2000 ).

The prevalence of cerebral palsy is approximately 2.5 per 1000 live births in countries with neonatal intensive care facilities ( Colver 2000 ; Yeargin‐Allsopp 2008 ; Himmelmann 2010 ). Prevalence is higher in children born with very low birth weight. However, a decline in prevalence in this group from 60.6 (99%CI 37.8‐91.4) per 1000 live births in 1980 to 39.5 (28.6‐53.0) per 1000 in 1996 has recently been observed in Europe ( Platt 2007 ). Communication difficulties can be associated with any type of cerebral palsy and may relate to limitations in the production of movements for speech, gesture and facial expression; receptive or expressive language; hearing; vision; or a combination of limitations in these functions. Speech impairments are estimated to affect approximately 36% of children with cerebral palsy and communication difficulties are observed in around 42% ( Parkes 2010 ). Prevalence of speech, language and communication impairment increases with severity of motor and intellectual impairment ( Kennes 2002 ; Bax 2006 ; Parkes 2010 ; Sigurdardottir 2010 ). Children may experience communication difficulties from early infancy and, as cerebral palsy is a persistent condition, communication impairments are chronic and children may require long term intervention. In a review of speech and language therapy caseloads in the UK, Enderby 1986 estimated that cerebral palsy was the sixth most common medical cause of speech disorder, and the proportion of referrals of children with this diagnosis remains static ( Petheram 2001 ).

Speech and language therapists (also known as speech therapists, speech‐language pathologists) assess, diagnose and treat the communication disorders associated with cerebral palsy. The aim of treatment is to maximise children's ability to communicate, through speech, gesture and supplementary means such as communication aids, to enable them to become independent communicators. As the problems experienced by children with a diagnosis of cerebral palsy are wide in range there is no single, universally appropriate form of treatment. Intervention can focus directly on spoken output, expressive or receptive language development, or helping children to develop conversation skills such as asking questions and repairing conversation when misunderstandings occur (for example Letto 1994 ). Work to develop children's language or communication skills could involve children using any method of communication. Intervention can also involve children's familiar conversation partners, such as their families, friends and teaching staff ( Culp 1988 ; Pennington 1996 ). Such indirect therapy aims to teach people who are in close contact with children with cerebral palsy, to facilitate their communication development by creating opportunities for them to use new skills in conversation. Effective indirect intervention would lead to changes in conversation style for both the familiar conversation partners and the children.

Speech and language therapy may be delivered in a range of settings, including clients' homes, community clinics, hospitals and schools ( RCSLT 1999 ). It is usual for speech and language therapists to liaise with families and teaching staff regarding therapy to ensure that intervention goals are incorporated into daily life, where possible ( Calculator 1991 ). Therapy may be delivered on an individual basis or in groups. Interventions may also vary in duration and intensity.

Speech and language therapy for this group of children is often long term, requiring significant health service resources. The effectiveness of speech and language therapy has been called into question ( Enderby 1997 ). For this client group it is necessary to know if changes that occur in children's communication are a result of SLT intervention or other factors, such as maturation. If it is demonstrated that speech and language therapy is effective, information about the effectiveness of different kinds or components of therapy is needed for children from different clinical subgroups to ensure appropriate use of resources.

In 2001 we set out to conduct an exploratory systematic review of studies of speech and language therapy for children who have communication disorders associated with cerebral palsy. This initial, broad review investigated the forms of SLT currently used to remediate different types and severities of communication disorders associated with cerebral palsy, and their relative effectiveness, with a view to providing directions for future research. As little evidence was found in the original review, this current updated review remains exploratory in nature investigating all areas of speech and language therapy intervention.

1 To assess whether direct intervention aimed at improving the communication skills of children with cerebral palsy is more effective than no intervention at all.

2 To assess whether intervention aimed at changing the conversational style of the familiar communication partners of children with cerebral palsy is more effective than no intervention at all in: (i) changing partners' conversational style, and (ii) developing communication skills of children with cerebral palsy.

3 To assess whether individual types of intervention are more effective than others in improving the communication skills of children with cerebral palsy.

4 To assess whether one particular type of intervention is more effective than others in changing the conversation style of the familiar communication partners of children with cerebral palsy.

Criteria for considering studies for this review

Types of studies.

To provide an overview of the evidence for speech and language therapy interventions provided to a diverse client group we included any controlled study of interventions aimed at improving communication skills, reported in any language, in this review. Translations were sought, when necessary. Controlled studies included group and single case experimental designs. Group studies were included if participants were allocated to different interventions or acted as their own control, receiving the novel intervention following usual treatment. Single case experimental designs were included if communication behaviours were allocated to treatment or control and both behaviours were measured at baseline, intervention and follow‐up phases, thereby allowing causal inference. Observational studies which used an AB design replicated across participants were excluded from this review.

Types of participants

Any child or individual under 20 years of age with any communication disorder associated with cerebral palsy, including dysarthria, dyspraxia, ataxia and mixed syndromes; or their communication partners. No exclusions were made on the basis of additional impairments (intellectual or sensory impairments, the presence of epilepsy) or prior receipt of speech and language therapy. This age range was selected as people who have identified special needs are entitled to statutory education provision up to 19 years of age in England, which could specify speech and language therapy.

Types of interventions

Any therapy aimed at improving communication skills whether provided individually or in groups; in the child's home, school or health service settings. Exceptions were therapies provided as part of a holistic approach (for example, in conductive education).

1. Therapies given directly to the child with the aim of developing the child's communication skills.

These are distinguished from the following. 2. Therapies given to familiar communication partners (families, teachers, teaching assistants, peers) with the aim of changing the communication partners' conversation style to help them facilitate children's communication development.

Types of outcome measures

1. Measures of communication:

a) World Health Organisation International Classifcation of Functioning, Disabiltiy and Health (ICF) body function level outcomes: children's expressive and receptive language skills, speech production;

b) ICF activity level outcomes: conversation and pragmatic skills, intelligibility, communicative competence;

c) ICF environmental level outcomes: partners' communication and interaction strategies.

Measures used may be, for example: rating scales, language tests, coding schemes developed for individual research studies that include validity and reliability data.

2. Family stress and coping (e.g. Questionnaire on Resources and Stress, Carer Strain Index).

3. Children's quality of life.

4. Children's particpation.

5. Satisfaction of patient and family with treatment.

6. Noncompliance with treatment.

Search methods for identification of studies

1. The review is based on the following search strategy:

a. cerebral palsy AND child b. speech OR speech disorder OR speech intelligibility OR speech therapy OR speech and language therapy c. language OR language disorders OR language development disorders OR sign language OR child language OR language therapy d. communication OR communication aids for disabled OR communication disorders OR communication methods, total OR manual communication OR nonverbal communication e. #b OR #c OR #d f. a AND e

The following electronic databases were searched (up until January 2011): MEDLINE (from 1966); CINAHL (from 1982); EMBASE (from 1980); PsycINFO (from 1967); Web of Science (from 1981); Scopus (from 2002); Language and Linguistic Behaviour Abstracts (from 1973); British Education Index (from 1986); National Research Register (completed and ongoing research); ERIC (from 1966); SIGLE (from 1980).

2. The following journals were handsearched (from their inception or from 1980 onwards): International Journal of Language and Communication Disorders; Augmentative and Alternative Communication; Child Language Teaching and Therapy; Developmental Medicine and Child Neurology; Child: Care, Health and Development and the Ambulatory Child; Journal of Child Psychology and Psychiatry and Allied Disciplines; Topics in Language Disorders; European Journal of Special Needs Education; Journal of Communication Disorders; Journal of Psycholinguistic Research; Journal of Special Education; International Journal of Rehabilitation Research; Folia Phoniatrica et Logopaedica; Applied Psycholinguistics; Journal of Speech, Language and Hearing Research; Asia Pacific Journal of Speech, Language and Hearing; International Journal of Speech‐Language Pathology; American Journal of Speech‐Language Pathology; International Journal of Disability, Development and Education, Speech, Language and Hearing in Schools. The current titles are given for journals experiencing name changes since 1980.

3. Published conference proceedings of the following organisations were checked: European Academy of Childhood Disability (1996 to 2010), International Society for Alternative and Augmentative Communication (1996 to 2010), American Speech and Hearing Association (1999 to 2002), Royal College of Speech and Language Therapists (1998 to 2009).

4. Reference lists of all studies selected for possible inclusion were checked for other possibly eligible studies.

5. Authors of included trials were contacted for unpublished studies. Calls for assistance were made via national professional associations.

One review author (LP) assessed the studies identified by the search strategies for inclusion according to specified criteria. The other two authors independently assessed separate random samples each comprising 25% of all identified studies plus any studies whose inclusion status was ambiguous. Agreement on inclusion was calculated using the Kappa statistic. The opinion of the third review author was sought if there was any disagreement regarding the inclusion of a trial.

Two review authors reviewed each identified study, abstracted data using forms developed for the review and graded the study's methodological quality. Where necessary, authors were contacted at their last known address to provide missing data for included trials.

As per the Cochrane Handbook, attention was paid to whether studies demonstrated protection from the following types of bias:

• selection bias, i.e. true random sequencing, true concealment up to the time of allocation, comparison of known confounding variables between groups, comparison of developmentally similar processes in single case experimental designs;
• performance bias, i.e. differences in types of treatment (co‐interventions) between the two groups;
• exclusion bias, i.e. withdrawal after entry to the trial;
• detection bias, i.e. 'unmasked' assessment of outcome.

Decisions regarding potential biases were recorded in the risk of bias table for each study.

The methodological quality of single case experimental designs was also rated on the description of the participant and intervention, whether baseline performance was adequately established, the duration of treatment and follow up and the frequency of measurement across the phases of the experiment.

Individual criteria were rated as 'met', 'partially met', 'unmet' or 'unclear'. Disagreements were resolved with a third review author. Agreement on methodology assessment was calculated using the Kappa statistic (K).

Information from studies meeting criteria for inclusion was entered into RevMan. Most studies that were included used single case experimental designs. Four group trials were identified but only one included randomisation and the participants were heterogeneous. Data were therefore not combined for the review and data were not analysed using RevMan.

Description of studies

Searches yielded 911 abstracts. Of these, 771 clearly did not fit the inclusion criteria for the review. Full texts of 140 papers were considered for potential inclusion. Authors agreed on 78 of the 81 papers randomly selected for reliability check, K = 0.873. Disagreements were resolved with a third review author for the other papers. Seventeen papers (reporting 16 studies) were included for full review. The main reasons for exclusion were that included participants did not have cerebral palsy or those with cerebral palsy could not be disaggregated from other participants, or the study did not include any experimental control. Most reports were written in English. Papers in other languages were read by translators who discussed the content with review authors; none were found to fit the inclusion criteria for the review.

Therapy focusing on children

Nine of the included studies evaluated therapy that focused directly on children, who varied widely in age, type and severity of cerebral palsy and additional impairments. These studies aimed to facilitate the development of pre‐intentional communication skills (behaviours such as mutual gaze, anticipation of behaviours in familiar routines that can be interpreted as communication by others, but which are not performed with the intention of conveying a message), pragmatic or communicative functions used in conversation, such as asking questions, providing information or repairing misunderstandings, speech production, expressive language structures or receptive vocabulary. The studies focusing on dysarthria are also discussed in a separate review ( Pennington 2009 ).

Pre‐intentional communication

Richman 1977 used operant teaching strategies to train a nine year old girl with severe cognitive impairment, who lived in an institution, to produce three pre‐intentional communication skills: maintaining eye contact and head control and increasing vocal imitations (ICF body functions). Forty hours of therapy were given over 20 weeks. Ten minute intervals were sampled for the presence of the three behaviours.

Communicative functions

Five studies focused on the production of nonverbal messages, teaching children to use individual communicative functions (ICF activity level outcomes). Hunt 1986 , Pinder 1995 and Sigafoos 1995 taught children to use requests for objects or actions. Hunt 1986 included one seven year old girl with cerebral palsy who had severe cognitive impairment and multiple disabilities in a multiple probe multiple baseline across participants design. Other participants did not have cerebral palsy. The subject was taught to request four objects or events by eye pointing to line drawings symbolising the object or action. Operant teaching methods were used, including interrupted chain training. Treatment was given twice daily, with 55 sessions in total. Requests were probed across the treatment sessions. Pinder 1995 taught four infants with cerebral palsy to produce either requests for objects or requests for more of an activity using micro teaching techniques (creating a communication environment, modelling the target skill, expectant delay, prompting and reinforcement). The children were aged 11 to 13 months, had severe cerebral palsy with no independent sitting and less than 50 on the Mental Development Index. Therapy was given twice a week for up to 12 weeks. Taught and untaught requests were probed in the teaching situation and across a second familiar communication situation. Sigafoos 1995 reported the training of a six year old boy with severe cerebral palsy and moderate cognitive impairment to request three items using micro‐teaching strategies, requests were probed throughout treatment. Three sessions were given per week, with 19 sessions in total.

Davis 1998 taught two children to produce responses to statements made by others in conversation. One of the participants was a 15 year old boy with severe cerebral palsy who usually communicated by yes/no responses only but who had access to a voice output communication device with pre‐stored phrases and spelling for novel words. Communication partners provided structured opportunities for the boy to respond to statements in conversation with further information that maintained the interaction. These elicitations were added to the conversation of three partners in succession. Responses to statements were recorded across the treatment sessions with the three partners. Therapy was given two to three times per week, 36 sessions in total.

Hurlbut 1982 trained three teenage boys with severe cerebral palsy and cognitive impairments to label objects using Blissymbols or iconic line drawings using micro‐teaching strategies. The duration and frequency of therapy sessions was not stated. The proportion of Blissymbols and iconic symbols used to label taught and untaught items was calculated before and throughout training.

Speech production

One study focused on speech production ( Pennington 2009b ), training children to control the loudness of their speech and maintain their respiratory effort for speech. Sixteen children aged 12 to 18 years, 15 of whom had cerebral palsy and one who had Worster Drought Syndrome, were taught to control their speech rate and loudness. Individual sessions, lasting 35 to 40 minutes took place three times per week over 6 weeks. Speech intelligibility in single words and connected speech to familiar and unfamiliar listeners was measured at six weeks before, one week before, one week after and six weeks after intervention (ICF activity level outcomes).

Receptive vocabulary

Dada 2009 taught three children with cerebral palsy aged 8 to 12 years to understand 24 spoken words (ICF body function level outcome), using an aided language stimulation programme which involved pairing a spoken word with a graphic symbol. Eight vocabulary items were taught in one activity carried out five times in one week (each activity lasting 15 to 25 minutes). In the second week a different activity with eight new vocabulary items was used and the activity and vocabulary items were changed again in the third week, so that 24 vocabulary items were taught in total. Teaching comprised repeated pairing of spoken word and visual symbols representing the target vocabulary. The proportion of items correctly selected when named was measured three times a week prior to and across the three week intervention period.

Expressive language

Campbell 1982 used operant training techniques to teach a 10 year old boy with severe cerebral palsy and moderate language delay to produce "is/are" in three linguistic structures (ICF body function level outcome). Two 15 minute therapy sessions were given each day, with 155 sessions in total. Frequency of correct "is/are" production in each of the three target structures was measured during each training session.

Therapy focusing on parents or other conversation partners

Eight papers investigated the success of training communication partners to facilitate the communication development of children with cerebral palsy, measuring ICF environmental level outcomes ( Basil 1992 ; Hanzlik 1989 ; McCollum 1984 ; McConachie 1997 ; Olswang 2006 ; Pennington 1996a ; Pennington 2009a ; Tait 2004 ). Pennington 1996a reported the same information, but in different format, as McConachie 1997 and will be excluded from further discussion.

Participants

Children whose parents and educators received training in the seven studies appear heterogeneous. However, insufficient information was given to provide a clear picture of their overall level of functioning. They ranged from eight months of age to 17 years, had cerebral palsy classed as mild to severe and cognitive skills ranging from within normal limits to severely impaired. Hanzlik 1989 included 20 infants aged 8 to 32 months, who had cerebral palsy of different types and severity ranging from mild to severe. Mental age was at least one standard deviation below the mean, range two to 18 months. None of the infants were able to ambulate either independently or with aids. Some, although it was difficult to tell how many, fell into the category containing speech impairment. However, some of those children may not have been expected to communicate intentionally given their chronological and mental age. Levels of communication development were not specified. McCollum 1984 included one child with severe cerebral palsy, of unknown type, aged 18 months. He was reported to vocalise but to exhibit few social behaviours. No other information was given regarding his developmental level. Basil 1992 studied four Spanish children aged seven to eight years who had cerebral palsy of unstated type. They had no independent mobility and upper limb function was severely affected. One child scored 4.5 years on a test of mental development, the others did not reach baseline. These children communicated by vocalisation, eye gaze, facial expression and produced one symbol messages on their communication boards, which contained 52 to 188 symbols. McConachie 1997 included nine children aged seven to 17 years who had cerebral palsy of differing types. No information was given on the severity of their motor impairments, cognitive or sensory skills. All had symbol communication systems (six used Blissymbolics, three Rebus Symbols), with access to 175 to 1000 plus symbols. Two children also had voice output communication aids. No information was given about how the children used their communication systems or their communicative level. Olswang 2006 studied two children with cerebral palsy aged 14 and 20 months, who were unable to sit independently, had severe cognitive impairments and vision and hearing that were within normal limits. Both children were preverbal communicators, who looked at objects, but did not look back to the parents to request items. Pennington 2009a included 11 children, 10 of whom had cerebral palsy of differing types. The children were aged 19 to 36 months at the start of the study. Gross motor function was rated using the gross Motor Function Classifaction Scale ( Palisano 1997 ); most children had difficulty using their hands but could bring two hands together to act on a toy. All had severe dysarthria and were unintelligible to their parents out of context. Most children had severe receptive language delay (Preschool Language Scales mean percentile rank = 6, SD = 9) and severe intellectual impairment. Tait 2004 studied six children aged 16 to 47 months who had spastic type cerebral palsy which affected all four limbs. Two children had cortical visual impairments, one child had a mild visual impairment, one child had a hearing impairment and two children had epilepsy. Four of the children had receptive language scores that were within six months of their chronological age, one child had receptive language skills within nine months of their chronological age and one child had a profound language delay and scored at a two month developmental level.

Adult conversation partners

With the exception of McConachie 1997 , who trained teachers and education assistants, parents were the subjects of the research. Overall, very little information is provided on the people who were trained, their communication style before intervention, previous training and relationship with the participant children. None of the studies included information on parental stress and coping, which has been found to affect communication ( Dunst 1988 ). Basil 1992 trained three mothers and one father. They were compared with teachers who received no training. No information was given on prior training or other characteristics of either group other than the pre‐intervention interaction measures which showed different communication styles between the two groups. The mothers who participated in Hanzlik 1989 had completed varying levels of education, from partial high school to college graduation. Half of the families in each group had other children. The employment of parents ranged from major professionals to semi‐skilled workers. However, it was not clear if any of the mothers were employed outside the home or how social status was classified. The mother in McCollum 1984 was a single parent with a lower‐middle income, no other information was given. McConachie 1997 included nine teachers and 10 assistants in the experimental group who received training and eight teachers and six assistants who received no intervention. No other information was given on the adult participants, who volunteered to take part and who were assigned by their managers to the two groups. Authors stated that the participants and controls were matched on gender and extent of interaction with the participant children, however no supporting evidence was presented in the paper. Olswang 2006 trained two mothers. One mother had older children, was Caucasian and had been born and brought up in the USA. The other was a second generation Ukranian immigrant living in the USA with her mother (who spoke only Ukranian) and had no other children. Both mothers had graduated from high school. No other details were provided. Pennington 2009a trained 11 mothers. Two were single parents; five had completed high school education; three had received received some further education and three had completed university degrees. Five mothers worked outside the home, four on a part‐time basis. Families lived in urban and rural areas and levels of deprivation varied across the sample. All mothers were White British or White Australian. Tait 2004 trained mothers of children in their study, but no information on the mothers was provided.

Intervention

The training given all related to facilitating communication development. McCollum 1984 , Hanzlik 1989 , Olswang 2006 and Tait 2004 concentrated on pre‐verbal communication. McCollum 1984 provided direct teaching of target skills specific to the parent and child receiving therapy. In total 10 weekly home visits were made, in which target behaviours were watched on video‐tape and practiced and treated and untreated communication behaviours measured. Hanzlik 1989 gave a generic model of training to each mother, focusing either on interaction and the use of adaptive seating for the experimental group, or neurodevelopmental therapy for the control group. Training in this study was given at home in one session that lasted one hour. Olswang 2006 and Pennington 2009a used a specified training protocol in which parents were all taught to create communication opportunities, to wait for their child to communicate, to recognise their child's communication and to shape this communication into more sophisticated signals. Olswang 2006 devised training specifically for their study. Individual training took place twice per week for three weeks. Each session lasted approximately 45 minutes. The parents in Pennington 2009a received It Takes Two to Talk®, the Hanen parent program, which was delivered to groups of parents in seven or eight sessions of two and half hours over 12 to 13 weeks. In both the intervention by Olswang and It Takes Two to Talk parents also received home visits for individual coaching. Tait 2004 developed an individualised training programme for each parent‐child pair, on how to respond contingently to their child's pre‐linguistic communication and how to prompt the use of more sophisticated communication signals. A written summary of the teaching strategies was also provided for parents. Parents then implemented the teaching strategies in 6 to 12 individual sessions of 30 minutes, which comprised three types of interactions: mealtime, play with a toy and social interaction (for example peek‐a‐boo, pretend play). Parents received feedback on their use of target strategies after each practice session. Basil 1992 and McConachie 1997 both undertook group teaching to facilitate interaction with individual AAC users. Basil 1992 trained a group of parents in one session then followed this training up with three home visits to each family to individualise intervention and help parents practice techniques. McConachie 1997 trained teachers and assistants in their own school in five 90 minute workshop sessions which concentrated on one child. Both Basil 1992 and McConachie 1997 used short talks, brainstorming and videotapes in their group teaching.

Outcome measures

Each study used outcome measures developed specifically for the research project, which related to the specific aims of the therapy. Only one ( Hunt 1986 ) had information on validation. Inter‐rater reliability of use of the coding schemes was given in each paper.

Risk of bias in included studies

See Table 1 and Table 2 for ratings of the methodological quality of included studies.

It is rarely possible or advisable to blind patients and clinicians to the type and aims of intervention in trials of speech and language therapy, but this does leave them open to performance and attrition bias.

Group studies

( Basil 1992 ; Hanzlik 1989 ; McConachie 1997 ; Pennington 2009a ; Pennington 2009b )

1. Randomisation and concealment of allocation

Basil 1992 , McConachie 1997 , Pennington 2009a and Pennington 2009b did not randomly assign participants to treatment or control groups. Basil 1992 gave training to parents and compared their communication with that of teachers who received no training. Teachers and assistants who participated in the McConachie 1997 study were assigned to treatment and control group by their school managers on the basis of school timetable, as staff were released to participate in training workshops. Allocation was not concealed as the person(s) who allocated participants also decided on their eligibility. Both of the studies, therefore, had significant weakness in their allocation strategies and selection bias was likely. In both Pennington 2009a and Pennington 2009b an interrupted time series design was used in which participants acted as their own controls. In both studies participants were recruited through the researchers' speech and language therapy colleagues, who were given a list of inclusion and exclusion criteria. Referring therapists selected participants from their caseloads and thus selection bias is likely. Hanzlik 1989 recruited parents through colleagues. Parents who were willing to take part in the study were allocated to group as they were recruited by the investigator by her taking a piece of folded paper out of a bag; 20 papers were created, 10 consigned parents to control and 10 to experimental group.

2. Similarity of participants at baseline

Information on recruitment to the studies was not provided for Basil 1992 and McConachie 1997 , nor were inclusion and exclusion criteria cited. For Basil 1992 participants and controls differed in their relationship to the children; parents received training, teachers were controls and received no training. The two groups clearly differed in their pre‐intervention patterns of interaction. No information was provided on other possible confounding variables such as previous training in communicating with children who use augmentative and alternative communication (AAC), beliefs about interaction, age, education, socio‐economic status, and extent of knowledge and experience of AAC. This study was rated as inadequate on participant similarity. Participants and controls in McConachie 1997 were matched on gender, occupation and extent of contact with the target children by managers. Pre‐intervention communication ratings and information on possible confounders such as those listed above were not given. Therefore, it was not possible to detect how similar the two groups were before training. Hanzlik 1989 provided sufficient information on participants to assess the similarity of the groups and to replicate the research with similar samples. She cited inclusion criteria that related to children's locomotor, cognitive and sensory skills and excluded mothers who had received previous training in either of the intervention strategies used in the study. The gender, type and severity of cerebral palsy, extent of locomotor skills, chronological and mental age was given for the children in each group in terms of frequencies, means and SDs, with groups seeming to be equally matched. Mothers were similar across groups in education and half of those in each group had other children. The range of socio‐economic status (SES) of the households of the two groups was slightly wider for the control group, and the numbers of participant families in each SES group is not given. Pre‐intervention scores (means and SDs) for interaction behaviours were given for the mothers and infants in both groups and appear similar. Pennington 2009a provided sufficient detail on participants to allow replication. Selection criteria were chosen to reflect the population of children with cerebral palsy referred to speech and language therapy clinics. Criteria related to presence, type and extent of motor disorder; vision; hearing; communication and lack of previous parental communication training. The gender, type and severity of cerebral palsy, extent of locomotor skills, upper limb function, speech production, chronological age, receptive language, nonverbal understanding and expressive vocabulary is given for all children. The number of mothers in the group with university degrees was higher than in the general population. Pennington 2009b provided exclusion and inclusion criteria. Information was provided on group scores for type and distribution of motor disorder, severity of dysarthria, age and gender and ability to follow simple instructions. No further information was given on children's cognitive and language functioning.

3. Participant numbers

Most of the studies provided information on how the number of participants was chosen. Pennington 2009b stated that sample size was determined by feasibility, with restrictions imposed by the data collection schedule, therapy duration and by the school day and term times. Number of participants ranged from eight ( Basil 1992 ) to 20 ( Hanzlik 1989 ). With such small numbers of participants it is unlikely that the sample can reflect the population of people who regularly converse with children who have cerebral palsy. The studies also have very low chances of detecting a true effect of training.

4. Blinding

Appropriately for therapies involving training and participant co‐operation, none of the studies included the blinding of the participants or of the clinicians providing therapy. However, with the exception of Pennington 2009a and Pennington 2009b the outcomes of the interventions were inappropriately assessed by the clinicians providing the therapy, which increased the risk of detection bias. In Pennington 2009a the first coder collected the data and was aware of time at which data were collected when analysing behaviour. A second (naive) rater coded a random 20% of set of data from each participant, thereby reducing but not eliminating detection bias. In Pennington 2009b listeners heard speech recordings blind to the data collection point. In the studies in which the therapists who undertook intervention also measured outcomes bias was reduced, but not eliminated, by the inclusion of a reliability check of coding with a blind assessor. Basil 1992 checked a nonrandom sample of 12.5% sessions from before, during and after therapy, with agreement 90%, 92%, 98%. Hanzlik 1989 reported K = 0.75 to 1.0 agreement from data from each of the children, across 14 categories but did not state the amount of data on which this was calculated. In McConachie 1997 half of the data were coded by the second author, half by a blind assessor, with agreement calculated as 76% (71% to 79%) on 15% of the total data. As only small proportions of data were included in the reliability checks, each of the studies was still open to detection bias.

5. Description of the intervention

From the information given in the studies it would not be possible to replicate the intervention provided by Basil 1992 or Pennington 2009b . It was also unclear how similar the intervention was between participants within the groups. McConachie 1997 provided fuller description of the intervention and the training programme used has been published ( Pennington 1993 ), allowing replication. Hanzlik 1989 provided additional information on the treatment protocols, which would allow partial replication. Pennington 2009a followed a well known, published therapy protocol for which therapists also receive training and certification.

6. Analysis

Data were analysed in the category to which participants were originally allocated. No cross‐over was reported or could be detected in any of the three group comparison studies. Basil 1992 and Hanzlik 1989 analysed data from the very small numbers of participants as groups, using parametric tests, which were unsuitable for such a small sample size. McConachie 1997 , Pennington 2009a and Pennington 2009b used appropriate statistical tests. Hanzlik 1989 measured 14 variables from the samples of interaction, and Basil 1992 measured 10, increasing the likelihood of obtaining a statistically significant result by chance. However, this was not taken into account in the authors' conclusions. Losses to follow up occurred only in McConachie 1997 , where a high attrition rate was observed, especially for the control group. The attrition was unexplained and left the study open to attrition bias.

Single case studies

1. participant description.

For replication of single case studies and moving from hypothesis generation to hypothesis testing participants need to be described in detail. All of the studies included in the review gave the participant child's chronological age and most gave a rating of their severity of cerebral palsy (mild, moderate, severe). Some gave children's type of cerebral palsy and rated the severity of any additional cognitive impairments. Few gave information on sensory impairments ( Olswang 2006 ; Pinder 1995 ; Tait 2004 ) and epilepsy or details of children's receptive language development. Most cited children's present modes of communication and gave a very brief overview of their use of their communication skills in interaction. Only Dada 2009 was judged to include sufficient detail to select, with certainty, other participants with a similar type of cerebral palsy, level of locomotor skills, cognitive and communication development. Davis 1998 , Hunt 1986 , Hurlbut 1982 , Olswang 2006 , Pinder 1995 and Tait 2004 were judged to give a partial account of children's level of functioning. The descriptions given by Campbell 1982 , McCollum 1984 , Richman 1977 and Sigafoos 1995 were judged to be inadequate for replicating the study.

2. Equality of skills assigned to treatment and control

Intervention is deemed to have an effect if outcome measures change at the point of, or after, intervention for each child in succession but no change is observed prior to intervention. Allocation of skills to control and treatment and similarity of skills in treatment and control were judged to be not applicable for this study. When different skills are assigned to treatment and control, in order to avoid selection bias and the effect of maturation, skills need to be of similar developmental level and prognostic indication and assigned at random to treatment or control with later treatment in multiple baseline designs. Richman 1977 compared communication skills with a motor skill. Tait 2004 compared looking at an object with looking at a graphic symbol, for which the visual‐cognitive processing is quite different. Pinder 1995 and Sigafoos 1995 selected target skills that were very similar, and which may have been expected to generalise for the included participants. Therefore, an increase in control skill as well as treated skill would be expected. The other studies investigated skills of similar prognostic indication and were rated adequate in skill selection. However, none of the studies stated if skills were assigned to treatment (or a place in a sequence of treatments for multiple baseline across processes designs) or control randomly, which could introduce selection bias. All studies were rated as unclear on this criterion.

3. Description of the intervention

For single case studies to be replicated, interventions, which are often innovative in these designs, need to be described in detail. Dada 2009 , Davis 1998 , Olswang 2006 , Richman 1977 and Sigafoos 1995 were judged to describe the intervention in sufficient detail for it to be replicated. Dada 2009 , Davis 1998 , Hunt 1986 ; Olswang 2006 and Tait 2004 reported checks of treatment integrity, which show fidelity of treatment across participants and that treatment was undertaken according to the protocol. Campbell 1982 , Hunt 1986 , Hurlbut 1982 , McCollum 1984 , Pinder 1995 and Tait 2004 were judged to give only part of the information needed to replicate intervention. Information was usually provided on the frequency and duration of treatment but was lacking on the exact methods of eliciting skills from individual children. For example, incomplete information was provided on which communication situations were used to elicit particular skills, the point in an activity at which communication opportunities were provided and the methods used to teach a communication strategy to a mother.

None of the studies included blinding participants or clinicians to the aims or type of therapy. In all studies except Olswang 2006 data on outcome measures were collected by the investigators, but included checks on the reliability of coding by a second observer, which could reduce detection bias. Olswang 2006 used students who were trained to criterion on communication coding, but it was not clear if coding was undertaken blind to time of data recording. All studies except McCollum 1984 used data collected from the participants during the study. Amount of data checked ranged from 17% to 50%; only that used by Pinder 1995 was selected randomly. Most studies calculated agreement using percentage (agreement‐disagreements/total number of behaviours coded), which does not adjust for chance agreement. Agreement ranged from 75% to 100%. Pinder 1995 calculated agreement using Kappa (K), achieving more than K = 0.60 for each participant. Taking into account the amount of data checked, the selection method used and the agreement achieved, Dada 2009 , Davis 1998 , Olswang 2006 and Pinder 1995 were judged to partially meet the blinding criterion. Campbell 1982 , Hunt 1986 , Hurlbut 1982 , McCollum 1984 , Richman 1977 , Sigafoos 1995 and Tait 2004 were judged inadequate and to be at considerable risk of detection bias.

5. Duration of phases and measurement

To show that intervention leads to change in single case experiments, frequent measurements should be taken in baseline, intervention and follow up or maintenance phases, and phases should be of similar duration. Without the use of randomisation tests ( Edgington 1995 ), baseline should be adequately established with a plateau across at least three measurements or with a downward trend. If treatment is successful a clear upward trend should be observed during the intervention phase. In studies aiming for the acquisition of new skills the behaviour should continue at similar levels to the intervention phase in follow up or maintenance with no intervention.

Campbell 1982 , Dada 2009 , Davis 1998 , Hurlbut 1982 , Pinder 1995 and Richman 1977 showed baselines that were adequate, with demonstration of stable behaviours. Hunt 1986 , McCollum 1984 and Sigafoos 1995 did not demonstrate stable behaviour at baseline and were rated inadequate. Some participants in Olswang 2006 and Tait 2004 did not show a stable baseline and these studies are rated as partial. The interventions in Campbell 1982 , Dada 2009 , Hunt 1986 and Hurlbut 1982 showed a clear upward trend in target behaviour. Similar changes were partially demonstrated by Davis 1998 , Pinder 1995 and Tait 2004 with higher scores than baseline but variability. In Olswang 2006 and Sigafoos 1995 scores were higher in intervention but were variable within treatment, which should have been continued to investigate possible trends. No clear trends were demonstrated by McCollum 1984 or Richman 1977 with lots of variation in the scores. The follow‐up phases of all studies were rated as partial or inadequate due to their absence, short duration or change in target behaviours.

Measurements of all target skills were taken continuously across phases by Campbell 1982 , Dada 2009 , Olswang 2006 , Pinder 1995 , Richman 1977 and Tait 2004 . Data across sessions were aggregated by Davis 1998 , taken infrequently for control behaviours by Hunt 1986 and presented as means by Hurlbut 1982 ; partially meeting the criterion relating to measurement. McCollum 1984 and Sigafoos 1995 included one measurement only for follow up and Sigafoos 1995 measured control processes at baseline and follow up only.

6. Confounding variables

None of the studies discussed confounding variables and all were rated unclear on this criterion. It is possible that for Sigafoos 1995 and Pinder 1995 the control skill was too similar to the treated skill and would be expected to generalise without treatment for the participants.

7. Analysis

Statistical tests have been developed for single case experimental designs ( Edgington 1995 ). However they have not been widely used and none of the studies included in the review employed statistical analysis. Analysis involved visual inspection of the graphed data and subjective interpretation.

8. Replication

Dada 2009 , Hurlbut 1982 , Olswang 2006 , Pinder 1995 and Tait 2004 included replication across participants, who appeared similar in prognostic indication. Other studies included in the review did not systematically replicate their interventions to other children with cerebral palsy. Some included children with other medical diagnoses.

Effects of interventions

Studies of interventions focused on children.

The studies focusing on children aimed to facilitate different aspects of communication development. Each aspect targeted is discussed separately.

Richman 1977 aimed to increase a child's amount of eye contact, time she kept her head in an upright position and her imitative vocalisations. These behaviours were compared with control of drooling, which received no intervention. Wide variation was seen in each of the behaviours across baseline. Increases in each behaviour were observed during their individual intervention phases. Behaviours reduced during reversal and then increased again once the treatment was recommenced. However, during the second treatment phase behaviours did not reach the levels of the initial treatment phase. Follow up at one month after intervention had ceased showed similar levels to the second treatment phase for head control and imitative vocalisation. Increased scores were observed for the three behaviours at 12 month follow up.

Hunt 1986 , Pinder 1995 and Sigafoos 1995 all trained children to produce requests. Hunt 1986 taught one girl to make requests for objects or actions in a multiple baseline design. Baseline was stable, showing infrequent use of any of the requests. The first request showed a steady increase and reached criterion (three successive correctly produced requests) in 16 sessions, the second in the sequence was produced without direct teaching. The third request in the sequence also increased steadily in the intervention phase reaching criterion in 13 sessions. The final request also generalised without direct teaching. Pinder 1995 taught four children to request either an object or 'more' by looking at the adult and the object, the untaught request acted as a control. Requests were taught in play with toys and also assessed in snack time as a generalisation situation. Baselines were stable for three of the children, with requests made to less than 20% of probes. For one child, who had earlier been taught to make the same requests by actively reaching towards an object, increases in the target behaviour appear to have been made towards the end of baseline. For each of the four children increases in the production of both the taught and untaught requests were observed during intervention across both the treatment and generalisation situations. For two children increases were noted with the onset of intervention. For the other two increases in the behaviours were observed after three to four sessions of therapy. Levels of requests were maintained for four weeks after therapy had been withdrawn. Sigafoos 1995 aimed to teach a boy to use three requests for objects in a multiple baseline design. During baseline percentage correct production of the three requests (not separated) ranged from 0% to 35%. For the first request production increased to 35% to 60% with verbal prompting and increased to 80% to 100% when expectant delay was used and verbal prompts were faded. However, although requests increased from the first to the second phase of intervention they showed a downward trend in the latter part of the second phase. The other target requests were tested after intervention for the first and were correct for 65% and 30% of 17 trials, showing some generalisation. The trial was then stopped due to the school year ending.

Davis 1998 trained a boy to produce responses to statements in conversation partners in a multiple baseline design across three communication partners, by pairing obligatory requests (questions) with a nonobligatory request (statement). Prior to intervention responses to statements were rare, being produced following 0% to 20% of statements made by each of the three partners in conversation (means = 1.8%, 2.5% and 4.0%). During intervention responses immediately increased, following an average of 41.7% and 52% of statements by the first two partners. Increases were only observed with the individual partners once the treatment had started. However, there was considerable variation in frequency of responses during intervention, ranging from 0% to 60% and 20% to 80% with each partner. Intervention was not carried out with the third partner due to the child's family moving away from the area in which the research was conducted. Responses to statements with this partner remained at baseline level throughout the study.

Hurlbut 1982 trained three children to use Bliss and iconic symbols to name objects. For each child trials to criterion were faster for iconic symbols than Bliss. Each child also produced iconic symbols more frequently than Blissymbols in maintenance and generalisation probes, and named more untrained objects using iconic symbols than Bliss.

Campbell 1982 taught one child to use "is/are" in three linguistic structures in a multiple baseline design. In baseline is/are were produced correctly in 0% to 10% of wh questions, 0% to 10% of yes/no reversal questions and 0% to 35% of statements. For the first two structures baselines were stable, whereas statements seemed to show an upward trend in correct production. During intervention the percentage of correct productions rose steeply for all three targeted structures. Levels were also maintained at a much higher rate than baseline for these structures, but showed considerable variation during the maintenance phase. Generalisation to use in spontaneous speech showed increases from baseline for yes/no questions, but much lower levels than observed with intervention. Wide variation was noted for the generalisation of is/are in statements, with no clear pattern observed during baseline, treatment or maintenance phases.

Dada 2009 taught four children to select 24 graphic symbols when named. During baseline two children selected two out of the 24 items named. During intervention the percentage of correct identification rose steeply for all target items. During follow up children continued to select items from the first two sets of vocabulary items. However, follow up was not long enough to show retention of the third set of taught words.

Pennington 2009b delivered dysarthria therapy focusing on respiratory and phonatory control, and control of speech rate and phrase length. No change in percentage of words in single word utterances and connected speech that were understandable to familiar and unfamiliar adults was observed at six weeks and one week prior to treatment. Following treatment the estimated in increase in intelligibility to familiar listeners was 14.7% (95% CI 9.8 to 19.5) for single words and 12.1% (95% CI 4.3% to 20.0%) for connected speech. For unfamiliar listeners the immediate post‐therapy estimated increase was 15.0% (95% CI 11.73% to 18.17%) for single words and 15.9% (95% CI 11.8% to 20.0%) for words in connected speech. No differences were observed between post‐intervention scores and follow‐up scores taken at one and six weeks after intervention completion for either single words or connected speech when heard by either familiar or unfamiliar listeners.

Therapy focusing on communication partners

Basil 1992 , Hanzlik 1989 , McCollum 1984 , Olswang 2006 , Pennington 2009a , Tait 2004 all trained parents, with the intention of changing their interaction style and thus facilitate children's communication. Basil 1992 found no difference between the percentage of turns taken in conversation, or the proportion of responses to children's utterances by trained parents or untrained teachers before and after intervention. Parents asked fewer open questions than teachers prior to therapy, but increased these after intervention whilst teachers' use of open questions remained stable ( F (3, 1) = 8.35, P = 0.063). After one hour of instruction parents in Hanzlik 1989 changed behaviour that related to 'doing', but not that which involved verbal interaction. Mothers who received instruction on changing physical and verbal interaction used less physical guidance (F(1, 18) = 6.34, P = 0.02), more face to face contacts (F(1, 18) = 28.49, P = 0.00005) and less physical contact (F(1, 18) = 10.11, P = 0.005) than mothers in the control group who received neurodevelopmental therapy. No differences were observed in mothers' verbal directiveness, praise, questions or verbal interaction before and after instruction for either group. McCollum 1984 trained a mother to bring her face close to her child's. The behaviour increased from baseline and was maintained after intervention had finished. The mother's imitation of her child's vocalisation increased during intervention but showed a lot of variation, and a possible downward trend towards the end of treatment. The skills appeared to generalise to an untreated play situation, but were not maintained once treatment had stopped. Contrary to expectation one mother in the study by Olswang 2006 used higher rates of target behaviours at the start of each phase of the study and rates reduced during each of the three phases: baseline, intervention and withdrawal of treatment. Her child showed variable rates of engagement in interaction in each of the three phases, but a gradual increase from baseline to treatment withdrawal. The other mother showed a fairly stable baseline, increases in rates of target behaviours during the treatment phase and a reduction in rates of target behaviours when treatment was withdrawn. Her child's engagement was correspondingly stable during baseline, increased during intervention and reduced during the withdrawal phase. In Pennington 2009a no differences were observed in mothers' communication at four and one month prior to intervention. Mothers started fewer conversational exchanges in the month after therapy ( t (10) = ‐2.730, P = .011, d = ‐.823) and responded more to children's communication ( t (10) = 3.891, P = .002, d = 1.173) than in the month prior to training. In the month after intervention mothers also used fewer directives ( t (10) = ‐2.630, P = .013, d = ‐.793). The changes observed in mothers' communication were maintained without further therapy at follow up, four months after intervention completion. The complexity of mothers' language directed to their children did not change during the study, nor did their responses to the Parental Sense of Competence questionnaire.

Teachers and educational assistants

Teachers and educational assistants who received training in McConachie 1997 used more strategies to facilitate children's communication four months after training ( X 2 (4) = 15.84 P ≤ 0.01). Post hoc analysis suggested that these differences were already observable for teachers at one month post‐training, but not for assistants ( X 2 (4) 11.82, P < 0.01). Teachers and assistants who did not receive training showed no changes in their communication patterns.

Secondary outcomes for children

Basil 1992 , Hanzlik 1989 and McCollum 1984 also looked at changes in children's communication that were associated with training given to parents. In Basil 1992 prior to parent training children failed to respond to parents' interaction more often than to teachers', but increased their responses to parents after intervention (F (3, 1) = 17.94, P = 0.024). Similarly, children communicated less often using their symbol communication boards with their parents than with their teachers, but their use with parents increased after training (F (3, 1) = 16.93, P = 0.026). Hanzlik 1989 observed an increase in voluntary responsiveness (F (1, 18) = 11.53, P < 0.003) and less physically directed compliance (F (1 to 18) = 4.44, P < 0.05) but no differences in the amount of independent play for the infants whose mothers had received interaction training. The child in the study by McCollum 1984 showed an increase in vocalisation concurrent with his mother's training and increase in the frequency with which she brought her face close to her child's. The child of the mother in the study by Olswang 2006 who used higher rates of target behaviours at the start of each phase of the study but whose rates reduced during each phase showed variable rates of engagement in interaction in each of the three phases, but a gradual increase from baseline to treatment withdrawal. The child of the mother who had a fairly stable baseline, with increases in rates of target behaviours during the treatment phase and a reduction in rates of target behaviours when treatment was withdrawn, showed engagement which was correspondingly stable during baseline, increased during intervention and reduced during the withdrawal phase. The communication patterns of children in Pennington 2009a showed no differences between recordings taken at four and one month prior to parent training. Children initiated more conversations ( t (10) = 3.150, P = .005, d = .950) and used more of their turns in conversation to control the interaction and their mother's behaviour ( t (10) = 2.987, P = .007, d =.901) in the month after their parents had received training than in the month prior to training. Changes observed following therapy were maintained at four month follow‐up, during which time no further intervention was given to parents or children. Tait 2004 observed children's use of more sophisticated communication signals to make requests, make choices, protest and to show response to their name before, during and after their parents were given training in communication teaching techniques. Four children increased their use of more sophisticated communication signals in three communication activities during treatment and maintained the use of these more sophisticated signals during follow up. Two children produced more sophisticated signals for one out of three messages targeted. One of these two children may have maintained the new behaviour but one reverted to prelinguistic behaviours during follow up.

Principal findings

• This exploratory review found 17 papers (reporting 16 studies) that investigated the effects of different methods of speech and language therapy (SLT) for children with cerebral palsy, who differed in age, type and severity of motor disorder, presence and severity of intellectual impairment, or their communication partners. Nine of these studies evaluated therapy that focused on children. Seven studies concentrated on adult conversational partners (one study contained data subsumed into another trial and the larger study only is discussed). Therapy for children targeted pre‐intentional communication skills, the use of individual communicative functions, expressive language, receptive vocabulary and speech production. Training for conversational partners included parents and education workers, teaching them to facilitate the communication of individual target children, usually augmentative communication system users.
• Although the results observed suggest possible trends in communication change, the methodological quality of the studies included in the review is generally poor and this review provides insufficient evidence to support the general effectiveness of SLT for either children with cerebral palsy or their communication partners.
• Since the original review in 2003 group studies have been published and show the potential impacts of therapy on children's speech production and training for parents on parent‐child interaction patterns. These studies provide the data necessary to develop rigorous controlled investigations of the effectiveness of therapy.
• The participants of the studies included in the review are heterogeneous and are often poorly described. Consensus on the description of participants and the choice of outcome measures in research reports is needed to establish potential clinical subgroups. Children and conversational partners within subgroups may resemble those with other primary disorders, for example children with severe cognitive impairment.
• Consensus is needed on the aims and methods of standard therapies targeting different areas of communication used with clinical subgroups. Once consensus is gained, investigations of the effectiveness of standard therapies can be developed. Consensus among communities of practice could be gained through focus groups followed by a survey of SLTs working in the clinical field.
• New therapy techniques should be applied in single case experimental designs, which should be rigorously designed and reported. These need to be replicated with similar participants, from a defined clinical subgroup, and evaluated in exploratory group trials. Should they show positive findings, the intervention should be tested in pragmatic trials.
• Participants in trials of SLT interventions should be followed up to evaluate the long term impact of therapy on communication activity, participation and quality of life.
• Valid, reliable generic outcome measures are needed to assess communication activity outcomes and allow cross trial comparisons.
• The acceptability of interventions for families has not been evaluated and needs further study.

Nine studies were found that investigated the effects of therapy given directly to children. All but one ( Pennington 2009b ) used single case experimental designs to show the impact of treatment for individual children. Children included in the studies ranged in age from infancy to late teens, had moderate to severe motor impairments, mild to severe speech, language and communication disorders and intellectual impairment ranging from mild to severe. Although each of the studies has methodological flaws, the provision of therapy does seem to be associated with increases in the production of pre‐intentional communication behaviours ( Richman 1977 ), requests for objects or actions ( Hunt 1986 ; Pinder 1995 ), responses to others' communication ( Davis 1998 ) use of expressive language structures ( Campbell 1982 ) and understanding of spoken words ( Dada 2009 ) for the children studied. For three teenage children with severe cognitive impairment it appeared that iconic communication symbols were easier to acquire than Bliss symbols ( Hurlbut 1982 ). For the studies using single case methodology we can only conclude that the intervention employed in the studies may have been effective in helping the individual children involved to develop communication skills. Given the methodology employed we cannot extend the findings to other children with cerebral palsy. Replication of the studies with other participants and exploratory group studies are needed to generalise findings to possible clinical subgroups, and move from hypothesis generation to hypothesis testing. The group study by Pennington 2009b , along with others described in the systematic review by Pennington, Miller and Robson ( Pennington 2009 ), suggests that speech and language therapy targeting control of respiration and phonation for speech may be associated with gains in intelligibility to both familiar and unfamiliar listeners. Pennington 2009b provides the data necessary to develop rigorous controlled trials of the effectiveness of this type of intervention.

Training for conversation partners

The studies that focused on communication partners provided training in facilitating the communication skills of individual children for parents, teachers and education assistants. Four studies were group trials, three studies used single case experimental design. Four of the studies ( Basil 1992 ; McCollum 1984 ; McConachie 1997 ; Olswang 2006 ) have serious methodological flaws and cannot demonstrate the effects of therapy for the participants who participated. The study by Hanzlik 1989 , involved parents of infants receiving a one hour individual training session focusing on the use physical and verbal interaction techniques. Results suggest that following the short period of intervention mothers changed their interaction style using more face to face communication and less physical contact with their infants. Overall, interaction was rated as more positive following training, but use of verbal interaction strategies did not appear to change. Follow up was not included in the study, therefore it is not possible to determine if change was maintained for the participants or if children's communication development was facilitated. Replication of this study with follow up is needed to investigate the effectiveness of the training programme used. Pennington 2009a observed the effects of the group training programme It Takes Two to Talk® for a group of parents and their preschool children aged 19 to 36 months. Although this programme was not specifically designed for parents of children with motor impairments positive changes were observed in the communication patterns of mothers and their children after training. Changes were maintained four months after intervention without any further therapy. Furthermore, in a separate interview study ( Pennington 2010 ) parents reported their experiences of the programme as largely positive, although some advised that more reference to augmentative and alternative communication (AAC) should be included when using the programme with families of children with severe motor disorders. Even with this suggestion parents appeared to view the training as acceptable and effective in helping to learn more about their child's communication needs and fostering their child's communication development. The study provides the information needed to develop a pragmatic randomised control trial of the effectiveness of the training programme for parents and their young children with motor disorders. Further, more rigorous investigations are needed of the training given in the other studies, as they aimed to teach the same communication strategies, which are widely acknowledged by clinicians to affect the communication of children with speech disorders and cerebral palsy.

Methodological quality of investigations

Children with cerebral palsy who receive SLT range in age from infancy to late teens and vary widely in their functional levels of movement, learning, communication, vision and hearing. When reporting new interventions it is necessary to describe for whom they may be suitable. However, the descriptions of children and adults who participated in the studies included in this review were generally poor. It would therefore not be possible to replicate most studies or to decide whether children on clinical caseloads were similar to those in the original study and may benefit from the intervention. Descriptions of subjects should include all features that may confound studies. This includes children's chronological age, type and severity of cerebral palsy, gross and fine motor functioning, cognitive developmental level, presence, type and severity of epilepsy, sensory skills, receptive and expressive language development, educational placement and previous therapy. Valid systems now exist to classify the motor skills of children with cerebral palsy ( Eliasson 2006 ; Palisano 2007 ) and these should be routinely applied in research. Communication skills should be described in detail, and should include measures of speech intelligibility, methods of communication used and communicative functions produced in conversation. Schemes are currently being developed to classify the communication of children with cerebral palsy ( Barty 2009 ; Hidecker 2009 ) and it is hoped that in the near future they will be validated for use in research For training of conversation partners details of their relationship to target children, gender, educational level, previous training and present communication style should be given. With such descriptions it may be possible to identify clinical subgroups of children with cerebral palsy who display similar skills and who react to interventions in similar manners. However, as cerebral palsy is associated with a wide range of disorders it is possible that some children will not fit into such groups and the evaluation of interventions for them will comprise N of one trials.

The interventions investigated in the studies included in this review were generally well described and their primary features could be replicated. For therapy focusing directly on children, techniques included operant and micro‐teaching. Training for conversation partners included short talks, brainstorming, video examples, practice and feedback. Full description with examples of interaction during intervention would facilitate replication. However, some differences would still be likely to occur due to the fluid nature of conversation and effects of different communication environments and circumstances. Some studies ( Dada 2009 ; Davis 1998 ; Hunt 1986 ; Olswang 2006 ; Tait 2004 ) reported checks of treatment integrity, which should be included in study design to show constancy of treatment across participants and that treatment was undertaken according to the protocol.

Due to the nature of participation in therapy and training it is not possible to blind participants and clinicians to therapy, which leaves trials of SLT, including those in this review, open to attrition bias. People may agree to participate, but withdraw when allocated to the intervention they least support. Attempts were made in each of the studies to reduce detection bias by including checks of data coding by a second rater. To improve the rigour of studies, outcomes should be assessed by persons other than those giving the therapy, who are blind to the allocation of treatment and control.

Sample size

The group studies in the review were exploratory in nature. Some ( Pennington 2009a ; Pennington 2009b ) could be used by future researchers to calculate sample sizes reliably to test the effects of similar interventions.

Single case experimental design

It is important to show, in these hypothesis generating studies, that intervention addresses a target behaviour and that changes in behaviour are not due to maturation. This demands the establishment of an adequate baseline, with sufficient data collection points throughout the baseline, intervention and follow‐up phases, and the comparison of a treated skill with an untreated behaviour that is similar in prognostic indication. Some studies failed to show that behaviours were stable before therapy, and it is therefore possible that behaviours attributed to intervention may have developed without it. Randomisation tests may have addressed the lack of a stable baseline, but these were not used. Other studies included control behaviours that were untreated, or treated later, which were too similar to the treated behaviour and also changed, probably as a result of the intervention. One of the studies ( Richman 1977 ) used a motor skill which would not have been expected to show the same pattern of development as the treated communication skills. None of the studies included adequate follow up to show the maintenance of behaviour change, which is vital if we are seeking to show the acquisition of communication skills.

Communication

The aim of SLT is to improve communication. As such, outcome measures should relate directly to aspects of communication behaviour. Depending on the particular difficulties children experience, therapy could aim to improve a child's speech production, understanding, expressive language, voice, range of communicative functions or use of an augmentative or alternative communication system. Training for parents and other communication partners involves changing their communication patterns to give children opportunities to develop and use new communication skills. The studies involved in this review targeted different aspects of communication and used different outcome measures. Even studies that looked at similar skills, for example those targeting requests for objects and actions, used different measures to evaluate outcome. This makes replication of studies harder than if generic tools were used, as clinicians and researchers need to be trained to use the measures reliably. The use of the same outcome measures across studies would also help in the collection of a bank of information about the communication of children with cerebral palsy and their conversation partners, in the formation of clinical subgroups and in the assessment of the clinical significance of reported interventions. In addition to describing the change in the individual skills targeted it would be useful if authors examined the rate of change in other areas of communication, using well known outcome measures. This would provide rates of change for individuals and groups that may or may not be associated with intervention and which may be used to aid clinical practice and to inform future research.

Quality of life and participation

Recent research has observed an negative correlation between communication skill and both relationships with parents and participation of children with cerebral palsy ( Dickinson 2007 ; Fauconnier 2009 ). With the exception of Pennington 2009a , which had an accompanying qualitative study ( Pennington 2010 ), the studies included in this review did not examine the wider impact of therapy. In addition to investigating the change in children's communication, and that of their conversation partners, it is important to examine if children and their families find interventions acceptable and worthwhile, and if interventions are associated with children's increased quality of life and participation in social, education and family life. Such additional information could be gained by the use of published measures of participation, family stress and functioning and through interviews with both parents and children. Qualitative studies are now more prevalent ( Clarke 2001 ; Goldbart 2004 ; Lund 2007a ; Lund 2007b ; Marshall 2008 ) and some have shown unexpected results. For example in Clarke 2001 young AAC users supported a model in which children are withdrawn from classrooms to learn new communication skills, contrary to current clinical practice in which skills are taught in normal class activities. We cannot assume that parents and families involved in the studies of this review view the intervention they received positively as therapy was of short duration and with minimal follow up, making attrition due to unsuitability of treatment less likely.

Implications for practice

Considering the range of aspects of communication targeted, methods used and participants involved in the studies included in this review, and the methodological weaknesses of the studies, it is not possible to conclude at the present time that speech and language therapy focusing on children with cerebral palsy or their communication partners is more effective than no intervention at all. However, no evidence has been found of any harmful effects of SLT for children with cerebral palsy and their families, and therapy has not been shown to be ineffective. Changes in therapy provision are not warranted given current evidence.

Implications for research

This exploratory review highlights the paucity of rigorous research on the effectiveness of speech and language therapy (SLT) that aims to improve the communication skills of children with cerebral palsy. Further research is needed to define possible clinical subgroups of children with cerebral palsy and their communication partners and to investigate the most effective methods of intervention for these subgroups. To this end a bank of research evidence is needed, including the following.

• Detailed description of research participants including their age, type and severity of cerebral palsy, gross and fine motor function (e.g. Gross Motor Function Classification System, Manual Ability Classification System), cognitive level, presence and type of epilepsy, sensory skills, receptive and expressive language skills, method of communication, range of communication skills and speech intelligibility. Where possible researchers should use the same validated measures across reports. Communication partners should also be described thoroughly, including information on their relationship to the child, age, gender, educational history, employment, previous training in communication, attitudes towards augmentation and alternative communication (AAC), present communicative style.
• Development of valid and reliable generic measures of speech function and communication activity for children with motor impairments.
• Definition of the methods currently used to treat different areas of communication development for (subgroups of) children with cerebral palsy and their conversational partners, gained through focus groups and surveys.
• Randomised controlled trials of the effectiveness of dysarthria therapy focusing on respiratory and phonatory control and communication training for parents.
• Rigorous series of single case experiments to test new interventions with clients from a potential subgroup, and for clients who do not fit inclusion criteria for identified subgroups.
• Exploratory trials of new interventions with groups of children/conversational partners to investigate the feasibility of using the new therapy in typical clinical situations and of extending the therapy to a group of clients who vary more than those involved in a single case series. If positive results are achieved these studies would lead to pragmatic trials comparing new and standard therapies for subgroups of children and conversation partners.
• Follow up of participants for at least three months after therapy to investigate the maintenance of skills development.
• The inclusion of participation and quality of life measures to evaluate wider impacts of interventions.
• Qualitative research studies to investigate children's and families' perceptions of intervention techniques and the need for these interventions.

As this review has shown, SLT for children with cerebral palsy is a complex intervention. Children have complex communication disorders, associated with their varied underlying impairments, and each disorder may require a different type of treatment. In addition, children will experience different social relationships and interact with many different people in many different environments, each of which will influence communication and its treatment. It is probable that because of the heterogeneity of the children, their conversational partners and their communicative environments, and the interaction between these variables, that a broad evaluation of the effectiveness of SLT for children with cerebral palsy may not be possible. Instead, evaluations should concentrate on the effectiveness of interventions given to ameliorate disorders affecting different areas and stages of speech, language and communication development for groups of clients with particular sets of skills and needs and to facilitate children's and families' participation in chosen life situations.

Protocol first published: Issue 1, 2002 Review first published: Issue 2, 2004

This review is being partially updated and will be replaced by a new protocol, and in due course, a new review. The new review will focus on parent‐mediated interventions only.

Acknowledgements

We thank the anonymous referees who provided helpful comments on the draft of the review; Helen McConachie, Nicola Jolleff, Pam Hunt, Carol Davis, Jodie Hanzlik for providing additional information about the included studies, and all the researchers who provided information about conference reports.

Edited (no change to conclusions)

Characteristics of studies

Characteristics of included studies [ordered by study id].

(1). Blissymbols: symbol system with written words printed beneath symbol. (2). Allocation concealment: A = allocation could not be predicted, B = method of allocation not made clear, C = allocation could be predicted or circumvented, D = no random allocation of subject or process

Characteristics of excluded studies [ordered by study ID]

Contributions of authors.

All review authors devised the protocol and search strategy. L Pennington selected studies for inclusion, with reliability checks conducted by J Goldbart and J Marshall. All review authors were involved in extracting data from included studies and writing the review. L Pennington was the primary author.

Sources of support

Internal sources.

• No sources of support supplied

External sources

• Royal College of Speech and Language Therapists, UK.

Salary funding for Lindsay Pennington during update of review. This report is independent research arising from a Career Development Fellowship supported by the National Institute for Health Research. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

Declarations of interest

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Speech-Language Pathology Specializations: What You Need to Know

If you’re planning to pursue a career in speech-language pathology (SLP), you’ll have the opportunity to make a huge difference in the lives of people who are facing communication barriers ranging from speech disorders like dysarthria to language disorders such as aphasia.

The speech-language pathology field covers a wide range of disorders that impact a very diverse set of patients. That’s why many practitioners choose to further their SLP professional development by adding additional certifications and pursuing a specialization track. This allows them to hone in on a more specific set of skills and work in an area of practice they are passionate about.

Choosing the Right Specialization in the SLP Field

There are many factors to consider when choosing the right specialization. First and foremost, you should explore your reasons for wanting a career in speech-pathology.

Do you want to work with adults or children? Are you interested in language delays, stuttering, and proper speech communication? Do you want to focus on speech disorders caused by neurological conditions like aphasia? Or are you more interested in the social and communication issues that arise from autism or augmentative and alternative communication (AAC), where people cannot speak or have low language skills due to disorders?

Whether you choose to go into pediatric speech pathology or speech pathology for adults who have neurogenic communication disorders or neurological speech disorders that affect the voice, you can help meet a critical need and have a significant impact on your patients throughout your career.

The U.S. Bureau of Labor and Statistics (BLS) predicts that the job outlook for speech-language pathologists is strong, anticipating that it will grow 19% from 2022 to 20321. This is much faster than the average for all occupations. The median income for SLPs is $84,140, according to the BLS. 1

SLP specializations can further improve your employment outlook and enhance your salary. For example, the median salary for a pediatric speech pathologist is around $171,181. 2  When deciding on a career path, you should research specializations and their job opportunities in your region. It might also benefit you to seek guidance from mentors and experienced SLP professionals to see their recommendations for choosing specializations.

If you want to work with both adults and children, it is possible to be a certified specialist in both pediatric and adult neurogenic speech disorders. You must be willing and able to achieve the certifications and design your practice around serving both populations in those specialist capacities.

Many speech pathologists do not choose to specialize because they enjoy the generalist’s path of working with a diverse client base of every age with a wide range of voice disorders.

The clinical experiences that are a part of your graduate education can give you a feel for different specializations and help you figure out where your passions lie and if there’s a specific path you might want to further explore down the line.

One of the biggest advantages of an SLP career is the flexibility it offers and the opportunities to add new specializations or focus areas along the way. For example, a clinician can spend years working in a school setting, and then switch gears to work in skilled nursing facilities.

SLP Specializations

Below is a summary of popular speech-language pathology specializations you may want to pursue:

Pediatric Speech-Language Pathology  — Pediatric SLPs typically focus on communication disorders in children, such as language delays or stuttering.

There is a consistent demand for pediatric speech-language pathologists, particularly in educational settings, healthcare facilities, and private practices. The need exists because of the prevalence of speech and language disorders in children and the emphasis on early intervention. Nearly 1 in 12 (7.7%) U.S. children ages 3-17 have had a disorder related to voice, speech, language, or swallowing. 3

Conditions as varied as Down syndrome, fragile X syndrome, autism spectrum disorder, traumatic brain injury, and being deaf or hard of hearing are known to increase the potential for childhood speech and language disorders. 4

Adult Neurogenic Speech Disorders  — This specialization focuses on communication disorders caused by neurological conditions in adults such as aphasia language disorder and dysarthria speech disorder.

With an aging population, the demand for SLPs specializing in adult neurogenic speech disorders is growing in hospitals, rehabilitation centers, skilled nursing facilities, and outpatient clinics. Neurological conditions such as strokes, traumatic brain injuries, and neurodegenerative diseases contribute to this demand.

Voice Disorders  — This SLP specialization focuses on working with individuals who have voice-related challenges stemming from voice changes, including but not limited to spasmodic dysphonia, polyps, nodules or cysts on the vocal cords, precancerous and cancerous growths, and vocal cord paralysis or weakness.

SLPs specializing in voice disorders can work in hospitals, voice clinics, ENT practices, and rehabilitation centers. Areas of demand include professional voice use, vocal rehabilitation, and working with individuals facing voice challenges due to medical conditions. In a study in the National Library of Medicine, approximately 1 in 5 Americans surveyed has had a voice disorder. 5  Risk factors for voice disorders include teleconferencing technology, voice assistant use, and occupational factors.

Fluency Disorders  — This specialization focuses on treating fluency disorders such as stuttering. It utilizes techniques and interventions for individuals with fluency challenges like speech continuity, smoothness, rate, and effort in speech production. Fluency symptoms include repetitions of sounds, syllables, words, and phrases; sound prolongations; and blocks. Planning and executing stuttering interventions can play a crucial role in working with populations who are impacted by fluency disorders.

Demand for SLPs specializing in fluency disorders is high, due in part to the fact that more than three million Americans (about 1%) stutter 6 , and stuttering and related challenges affect individuals across all age groups.

Education and Professional Path Considerations for SLP Specializations

While a master’s degree is needed to become a speech-language pathologist, many SLPs choose to pursue additional training and certifications so they can build on their skillsets and better serve specific populations.

If you have determined a specialty early on, talk to your academic advisor as you select your coursework. While most master’s programs aren’t designed for individual specializations, you can begin to lean into areas of focus as part of your path to your degree that will help you when it comes time to choose a specialization and get certified.

It is also essential to create a professional network in your chosen specialization and participate in relevant conferences, workshops, and online communities to build a strong network as well as stay on the forefront of technology, resources, and research you need to be aware of to have continued success in your field. The job market values SLPs who actively engage in continued education and stay updated on the latest research and interventions in their specialty.

SLP Supplemental Certifications Recognized by ASHA

To become a licensed practitioner, most SLPs earn the Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP), a certification from the American Speech-Language-Hearing Association (ASHA), considered the national gold standard for excellence in the profession.

Additionally, the ASHA offers distinction as a Board-Certified Specialist (BCS) to a practitioner who “demonstrates advanced knowledge, skills, and experience in a specified area of practice.”

There are three types of BCS certifications for SLPs, each awarded by independent boards that the ASHA has approved:

Board Certified as a Specialist in Child Language (BCS-CL)

The American Board of Child Language and Language Disorders offers this to SLPs who demonstrate “advanced knowledge, skills, leadership, and experience in child language.” According to the ASHA, common issues in this field include:

• Selective mutism: A child does not speak in specific scenarios
• Speech sound disorders: A child has trouble saying sounds clearly
• Learning disabilities: A child has difficulty reading, writing, or spelling

A candidate for the BCS-CL must have worked as an SLP for five years and document 100 hours of continued education in child language.

Board Certified Specialist in Fluency (BCS-F)

The American Board of Fluency and Fluency Disorders offers this to SLPs who “have demonstrated in-depth knowledge of the nature and treatment of stuttering and other fluency disorders.” In addition to stuttering, these specialists often help clients with “cluttering,” when speech becomes hard to understand because of rapid speed, erratic rhythm, or poor grammar.

A candidate for the BCS-F must have 500 hours of clinical activity and document 60 hours of training in stuttering or cluttering.

Board Certified Specialist in Swallowing and Swallowing Disorders (BCS-S)

The American Board of Swallowing and Swallowing Disorders offers this to SLPs who “have distinguished themselves via research, administrative, and/or educational accomplishments” in treating dysphagia or difficulty swallowing. These specialists use medical technology to track the swallowing process as a client eats or drinks. They offer strategies involving food changes, body posture, and behavioral maneuvers that can preclude the need for surgical intervention.

The ABSSD has a three- to five-year track to receive the BCS-S that includes working under a mentor, continued education, and focusing on a specific area of swallowing disorders.

Certification in Special Techniques

SLPs can also supplement their skillsets by learning techniques that help a specific kind of client. Many of them are cost-efficient and can be completed online or in workshops.

• Certification in Augmentative and Alternative Communication:  Available through the AAC Institute, this enables you to help clients communicate through alternative means, such as sign languages and computers. These approaches are common with clients who have suffered a traumatic brain injury or had a stroke.
• Lee Silverman Voice Treatment:  Named for a woman who lived with Parkinson’s disease (PD), this method helps clients with PD or progressive supranuclear palsy use their voice at a more normal level of loudness. Through training, clients can recalibrate their perception of their voice so they know how loud they sound to other people and can speak with confidence.
• Prompts for Restructuring Oral Muscular Phonetic Targets:  This is an integrated approach to address apraxia, a neurological disorder that affects the muscle coordination needed to speak, and dysarthria, weakness in the muscles needed to speak. In addition to helping clients better use their jaw, lips, and tongue, it also considers social aspects of communication, such as the patient’s relationship with the speaker, and cognitive-linguistic aspects, such as interpreting words and how they perceive their environment.
• Picture Exchange Communication System (PECS):  Used with clients who face cognitive challenges in speaking, this system uses visual symbols to teach clients how to communicate their needs better. Clients request what they want by handing the instructor a picture symbolizing what they need, and the request is honored. They can then go on to learn more complex messaging. A key strength of PECS is its lack of verbal cues from the instructor, which helps the client learn to do things without being prompted by an instructor.

What Are the Challenges That Come with an SLP Specialization?

As with any career that requires years of advanced education and training, being a speech-language pathologist who specializes in a specific practice area can come with its own unique set of challenges. These can include:

Specialization Complexity:  The wide range of assessment and intervention approaches observed may indicate the absence of established best practice guidelines and a need for more consistency in recommended best practices within the broader field.

Collaboration:  Learning to work with interdisciplinary teams can promote more standardized clinical decision-making processes. Learning how to work closely with all stakeholders, including clinicians, caregivers, family members, and patients, can be difficult. Still, it is vital to success in this role.

Continuing Education:  Various certifications and licensures are required within any speech and language career, whether you choose to be a generalist or a specialist. Even when busy with your practice or job, you will still need to find the time to keep your licenses current and stay on top of new research and advancements in the field.

Telepractice:  Telepractice is becoming more prevalent, providing opportunities for SLPs to offer specialized services remotely. While this ultimately is and will be a benefit to your ability to practice and meet with patients more comprehensively, the technical aspect may bring a new measure of complexity to your ways of working.

Can SLPs Change Their Specialization Later in Their Careers?

Yes, speech-language pathologists can change their specialization later in their careers. SLPs can acquire additional training, certifications, and expertise to transition from one specialization to another. This adaptability allows professionals to explore different areas of speech-language pathology and respond to evolving personal interests or emerging trends. Continuous learning and professional development enable SLPs to expand their skills and knowledge, making it feasible to pursue a different specialization as their career progresses.

Get Started in Speech-Language Pathology

Becoming a speech-language pathologist or pursuing a specialty in a field such as pediatric speech-language pathology or adult neurogenic speech or voice disorders can lead you into a career where you can positively impact your patients’ lives.

Bradley University’s online Bachelor of Science in Speech Language and Communication Sciences is a great way to lay the foundation for a career in speech-language pathology and explore the profession. Contact us today to learn how an integrated, hands-on approach to learning can open up a world of opportunities.

• Bureau of Labor and Statistics – Speech and Language Pathology Job Outlook
• Salary.com – Pediatric Speech-Language Pathologist Average Salary
• National Institute on Deafness and Other Communication Disorders – Pediatric
• National Library of Medicine – Pediatric Conditions
• National Library of Medicine – Voice Disorders
• National Institute on Deafness and Other Communication Disorders – Stuttering
• #5 Among Regional Universities (Midwest) – U.S. News & World Report: Best Colleges (2021)
• #5 Best Value Schools, Regional Universities (Midwest) – U.S. News & World Report (2019)
• Bradley Ranked Among Nation’s Best Universities – The Princeton Review: The Best 384 Colleges (2019). Only 15% of all four-year colleges receive this distinction each year, and Bradley has regularly been included on the list.
• Bradley University has been named a Military Friendly School – a designation honoring the top 20% of colleges, universities and trade schools nationwide that are doing the most to embrace U.S. military service members, veterans and spouses to ensure their success as students.

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The 2024 Scaringi Lecture Series in Speech Language Pathology

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McGill’s School of Communication Sciences and Disorders is proud to be hosting a research talk on enhancing the language of adolescents with DLD and a workshop on using narratives in clinical assessment and intervention.

These events are funded by the Scaringi Lecture Series grant. This year the events are also co-sponsored by the FRQSC group on Cognitive plasticity and language acquisition.

Speaker: Victoria Joffe School of Health and Social Care, University of Essex Research Talk and Reception April 5, 2024, 5:00 to 7:00 pm Leacock, room 232 855 Sherbrooke St W, Montreal, Quebec H3A 2T7

Enhancing Language and Communication in Adolescents with Language Disorder across Levels of Service provision: Specialist, Targeted and Universal.

There is strong evidence for the pervasiveness of Developmental/Language Disorder (D/LD), and its long-term impact on academic performance, employment, socialisation and wellbeing. These difficulties persist over time and can increase during adolescence and adulthood. Adolescents and young adults with (D)/LD are a significantly under-researched and under-serviced client population. However, there is an emerging evidence base for enhancing language and communication in this group, and Speech and Language Therapy services are typically offered at three levels of service provision: universal, targeted, and specialist. The talk will describe these different service delivery models, providing evidence for the effectiveness of intervention in storytelling and vocabulary at the targeted and universal levels in the adolescent group. Consideration will be given to the factors that contribute to the selection of service provision, including severity of the disorder, school setting, staff expertise, resource allocation and staff and client perspectives. This presentation will incorporate a critical appraisal of the interplay between resource-led and needs-led components, and the current evidence base. Results from the experimental studies, and views and perspectives from speech and language pathologists, teachers, and young people in receipt of the intervention will be shared. Common themes in working with adolescents with language disorder in schools will be identified with implications for education and clinical practice. Key ingredients for success will be identified to maximize engagement in the therapy process, emphasizing needs-led provision in order to enhance long term outcomes.

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2024 Oyer Lecture highlights work of educational audiology services

On March 8, the Department of Communicative Sciences and Disorders hosted the 2024 Oyer Lecture on campus and online.  The event is named for Dr. Herbert J. and Dr. E. Jane Oyer.  Herbert J. Oyer came to Michigan State University in 1960 as director of the Speech and Hearing Clinic. 

This year’s speaker was Dr. Carrie Spangler, educational audiologist in Ohio and owner of empowEAR Audiology and Coaching , an organization supporting people who are deaf or hard of hearing, their families, educators and audiology speech language pathology professionals. 

Speaking with the aid of an American Sign Language (ASL) interpreter, Spangler described the collaboration between educational audiologists and speech language pathologists (SLP) as they serve children who are deaf or hard of hearing.   

“If you end up working in the schools or a pediatrics type of setting, you will likely run into a student sometime in your career that is hard of hearing,” Spangler said.  “How do you collaborate with the right people?  I want you to be thinking about some of the things that could negatively impact the students in a school setting and how we make sure the classroom is accessible for them.” 

Spangler referred to educational audiologists as “brain builders” for young children, noting that the brain’s auditory functions are not fully developed until about age 15. 

“So, every single student is probably at risk of not hearing appropriately in the classroom,” she said.  “About 60 to 70 percent of what we expect kids to learn is through listening in the classroom, and that doesn’t even factor in all of the visual information that they’re trying to take in and multitasking throughout the class.” 

Spangler noted that the elementary classroom of today isn’t designed like those of previous generations.  When she was growing up, Spangler said, students sat in rows of desks with the teacher standing at the front of the room.  She said, growing up with a hearing loss herself, she learned how to position herself where she knew the teacher would be standing so she could better hear and understand what was being said.   

“But when I go into the classroom now, we have a lot of different learning styles,” Spangler said.  “When we think about our hard of hearing kids, the environment is changing all the time.  Kids are moving their seats. They’re bouncing on balls. They’re standing up at high tables…there’s lots of movement happening within the classroom. When you’re thinking about deaf and hard of hearing kids, sometimes that can be a big factor.” 

Spangler also said it’s vital that parents, teachers and anyone else in the education continuum help hearing impaired students learn to advocate for their own needs.   

“One of the things that I wish I would have had more of growing up was advocacy and being more determined about who I was; to be able to make decisions that were important for me and that were autonomous (to) me,” Spangler said. “Without having knowledge of what your difference or disability or however you want to frame it is, it’s really hard to advocate.  It’s important to be able to teach a student from a young age how to advocate for their hearing needs all the way through high school and beyond.” 

By: Kevin Lavery