Speech–language pathology (or speech and language pathology) is a field of expertise practiced by a clinician known as a speech–language pathologist (SLP) or a speech and language therapist, both of whom may be known by the shortened description, speech therapist. Speech–language pathology is considered[by whom?] a "related health profession" or "allied health profession",[clarification needed] along with audiology, optometry, occupational therapy, rehabilitation psychology, physical therapy, behavior analysis and others.
SLPs specialize in the evaluation, diagnosis, and treatment of communication disorders (speech and language impairments), cognitive-communication disorders, voice disorders, and swallowing disorders. SLPs also play an important role in the diagnosis and treatment of autism spectrum disorder (often in a team with pediatricians and psychologists).
Speech–language pathologists (SLPs) provide a wide range of services, mainly on an individual basis, but also as support for individuals, families, support groups, and providing information for the general public. SLPs work to prevent, assess, diagnose, and treat speech, language, social communication, cognitive-communication, voice, fluency, and swallowing disorders in children and adults. Speech services begin with initial screening for communication and swallowing disorders and continue with assessment and diagnosis, consultation for the provision of advice regarding management, intervention, and treatment, and providing counseling and other follow-up services for these disorders. Services are provided in the following areas:
- cognitive aspects of communication (e.g., attention, memory, problem-solving, executive functions).
- speech (phonation, articulation, fluency, resonance, and voice including aeromechanical components of respiration);
- language (phonology, morphology, syntax, semantics, and pragmatic/social aspects of communication) including comprehension and expression in oral, written, graphic, and manual modalities; language processing; preliteracy and language-based literacy skills, phonological awareness.
- augmentative and alternative communication, for individuals with severe language and communication impairments.
- swallowing or other upper aerodigestive functions such as infant feeding and aeromechanical events (evaluation of esophageal function is for the purpose of referral to medical professionals);
- voice (hoarseness, dysphonia), poor vocal volume (hypophonia), abnormal (e.g., rough, breathy, strained) vocal quality. Research demonstrates voice therapy to be especially helpful with certain patient populations; individuals with Parkinson's Disease often develop voice issues as a result of their disease.
- sensory awareness related to communication, swallowing, or other upper aerodigestive functions.
Speech, language, and swallowing disorders result from a variety of causes, such as a stroke, brain injury, hearing loss, developmental delay, a cleft palate, cerebral palsy, or emotional issues.
A common misconception is that speech–language pathology is restricted to the treatment of articulation disorders (e.g. helping English-speaking individuals enunciate the traditionally difficult r) and/or the treatment of individuals who stutter but, in fact, speech–language pathology is concerned with a broad scope of speech, language, literacy, swallowing, and voice issues involved in communication, some of which include:
- Word-finding and other semantic issues, either as a result of a specific language impairment (SLI) such as a language delay or as a secondary characteristic of a more general issue such as dementia.
- Social communication difficulties involving how people communicate or interact with others (pragmatics).
- Language impairments, including difficulties creating sentences that are grammatical (syntax) and modifying word meaning (morphology).
- Literacy impairments (reading and writing) related to the letter-to-sound relationship (phonics), the word-to-meaning relationship (semantics), and understanding the ideas presented in a text (reading comprehension).
- Voice difficulties, such as a raspy voice, a voice that is too soft, or other voice difficulties that negatively impact a person's social or professional performance.
- Cognitive impairments (e.g. attention, memory, executive function) to the extent that they interfere with communication.
The components of speech production include: (i) phonation (producing sound), (ii) resonance, (iii) fluency, (iv) intonation, (iv) pitch variance; (v) voice (including aeromechanical components of respiration).
The components of language include: (i) Phonology (manipulating sound according to the rules of a language); (ii) Morphology (understanding components of words and how they can modify meaning); (iii) Syntax (constructing sentences according to the grammatical rules of a target language), (iv) semantics (interpreting signs or symbols of communication such as words or signs to construct meaning); (v) Pragmatics (social aspects of communication).
Primary pediatric speech and language disorders include: (i) receptive and (ii) expressive language disorders, (iii) speech sound disorders, (iv) childhood apraxia of speech (CAS), (v) stuttering, and (vi) language-based learning disabilities. Speech pathologists work with people of all ages.
Swallowing disorders include difficulties in any system of the swallowing process (i.e., oral, pharyngeal, esophageal), as well as functional dysphagia and feeding disorders. Swallowing disorders can occur at any age and can stem from multiple causes.
SLPs collaborate with other health care professionals, often working as part of a multidisciplinary team. They can provide information and referrals to audiologists, physicians, dentists, nurses, nurse practitioners, occupational therapists, rehabilitation psychologists, dietitians, educators, behavior consultants (applied behavior analysis) and parents as dictated by the individual client's needs. For example, the treatment for patients with cleft lip and palate often requires multidisciplinary collaboration. Speech–language pathologists can be very beneficial to help resolve speech problems associated with cleft lip and palate. Research has indicated that children who receive early language intervention are less likely to develop compensatory error patterns later in life, although speech therapy outcomes are usually better when surgical treatment is performed earlier. Another area of collaboration relates to auditory processing disorders, where SLPs can collaborate in assessments and provide intervention where there is evidence of speech, language, and/or other cognitive-communication disorders.
SLPs work in a variety of clinical and educational settings. SLPs work in public and private hospitals, private practices, skilled nursing facilities (SNFs), long-term acute care (LTAC) facilities, hospice, and home healthcare. SLPs may also work as part of the support structure in the education system, working in both public and private schools, colleges, and universities. Some SLPs also work in community health, providing services at prisons and young offenders' institutions or providing expert testimony in applicable court cases.
Following the American Speech–Language–Hearing Association's 2005 approval of the delivery of speech/language services via video conference or telepractice, SLPs in the United States have begun to use this service model.
SLPs conduct research related to communication sciences and disorders, swallowing disorders, or other upper aerodigestive functions.
Education and training
In the United States, speech–language pathology is a Master's entry-level professional degree field. Clinicians must hold a master's degree in communicative disorders / speech–language pathology (e.g., MA, MS, or MEd) that is from a university that holds regional accreditation and from a communication sciences and disorders program that is accredited by the American Speech–Language–Hearing Association (ASHA), the profession's national governing body as well as individual state's governing board. Programs that offer the MEd degree are often housed within a university's College of education, but offer the same education and training as programs with a MA or MS degree. Beyond the master's degree, some SLPs may choose to earn a clinical doctorate in speech–language pathology (e.g., CScD or SLPD), or a doctoral degree that has a research and/or professional focus (e.g., PhD, or EdD). All degrees must be from a university that holds regional accreditation, but only the master's degree is accredited by the ASHA.
All clinicians are required to complete 400 clinical hours (25 observation hours often completed during the undergraduate degree and 375 hours of graduate Clinical Practicum). They must pass multiple comprehensive exams also called Knowledge and Skills Acquisition (KASA) exams.
After all the above requirements have been met during the SLP's path to earning the graduate degree, SLPs must state licensure and national certification by:
- Passing the National Speech–Language Pathology Board examination (praxis).
- Successfully complete a clinical fellowship year (CFY) as a clinical fellow (CF) under the mentorship of a fully licensed mentor clinician. The CFY is no less than 36 weeks of full-time experience, totaling a minimum of 1260 hours. During the CFY, the CF cannot earn CFY hours unless they work more than 5 hours in a week and cannot earn any CFY hours beyond 35 hours in a week.
- Receive American Speech–Language–Hearing Association (ASHA) Certificate of Clinical Competence (CCC) and full state licensure to practice, following successful completion of clinical fellowship year(CFY).
- States are responsible for licensure of clinicians and other professionals and, as far as the new SLP, these requirements are often similar to that of the CFY. Following the state licensure procedures and national certification requirements are usually done simultaneously.
To maintain licensure, SLPs are required to participate in periodic earning of Continuing Educational Units (CEU). Continuing education and training obligations:
- Educate, supervise, and mentor future SLPs.
- Participate in continuing education.
- Educate and provide in-service training to families, caregivers, and other professionals.
- Train, supervise, and manage speech–language pathology assistants (SLPA) and other support personnel.
- Educating and counseling individuals, families, co-workers, educators, and other persons in the community regarding acceptance, adaptation, and decisions about communication and swallowing.
- Credentials of a clinical fellow typically read as: MA, MS, or MEd, CF-SLP (e.g.: Jane Doe, MA, CF-SLP).
- Credentials of a fully licensed SLP commonly read as: MA, MS, or MEd, CCC-SLP (e.g.: Jane Doe, MA, CCC-SLP), indicating a practitioner's graduate degree and successful completion of the fellowship year/board exams to obtain the "three Cs" the Certification of Clinical Competence, in speech–language pathology.
Salaries of SLPs in the United States depend on a variety of factors including educational background, work experience, and location. The ASHA 2016 Schools Survey revealed that SLPs received a median academic year salary of $62,000, which is a 2% increase from the latest Schools Survey done in 2014. The 2015 SLP Health Care Survey placed the median salary for SLPs working within the health care industry at $75,000. According to the Bureau of Labor Statistics in 2019, the median salary for SLP in the US is $79,120. In Australia, the basic salary that a Graduate SLP would earn is estimated at AU$59,500 and around AU$55,000 for a private SLP.
Methods of assessment
For many parents, the decision of whether or not to enroll students into school-based speech therapy or privately practiced therapy is challenging. Speech Pathologists work as part of a team alongside teachers, counselors, social workers and parents when in a school setting. Because school-based speech therapy is run under state guidelines and funds, the process of assessment and qualification is more strict. To qualify for in-school speech therapy, students must meet the state's criteria on language testing and speech standardization. Due to such requirements, some students may not be assessed in an efficient time frame or their needs may be undermined by criteria. For a private clinic, students are more likely to qualify for therapy because it is a paid service with more availability.
Clients and patients
Speech–language pathologists work with clients and patients who may present with a wide range of issues.
Infants and children
- Infants with injuries due to complications at birth, feeding and swallowing difficulties, including dysphagia
- Children with mild, moderate or severe:
- Genetic disorders that adversely affect speech, language and/or cognitive development including cleft palate, Down syndrome, DiGeorge syndrome
- Attention deficit hyperactivity disorder
- Autism spectrum disorders, including Asperger syndrome
- Developmental delay
- Feeding disorders, including oral motor deficits
- Cranial nerve damage
- Hearing loss
- Craniofacial anomalies that adversely affect speech, language and/or cognitive development
- Language delay
- Specific language impairment
- Specific difficulties in producing sounds, called articulation disorders, (including vocalic /r/ and lisps)
- Pediatric traumatic brain injury
- Developmental verbal dyspraxia
- Cleft palate
In the US, some children are eligible to receive speech therapy services, including assessment and lessons through the public school system. If not, private therapy is readily available through personal lessons with a qualified speech–language pathologist or the growing field of telepractice. Teleconferencing tools such as Skype are being used more commonly as a means to access remote locations in private therapy practice, such as in the geographically diverse south island of New Zealand. More at-home or combination treatments have become readily available to address specific types of articulation disorders. The use of mobile applications in speech therapy is also growing as an avenue to bring treatment into the home.
In the UK, children are entitled to an assessment by local NHS speech- and language-therapy teams, usually after referral by health visitors or education settings, but parents are also entitled to request an assessment directly. If treatment is appropriate, an educational plan will be drawn up. Speech therapists often play a role in multi-disciplinary teams when a child has speech delay or disorder as part of a wider health condition. The Children's Commissioner for England reported in June 2019 that there was a postcode lottery; £291.65 a year per head was spent on services in some areas, while the budget in some areas was £30.94 or less. In 2018, 193,971 children in English primary schools were on the special educational needs register needing speech-therapy services.
Children and adults
- Adults with mild, moderate, or severe eating, feeding and swallowing difficulties, including dysphagia
- Adults with mild, moderate, or severe language difficulties as a result of:
- Adults seeking transgender-specific voice training, including voice feminization and voice masculinization
- All India Institute of Speech and Hearing (AIIMS)
- American Speech–Language–Hearing Association
- Applied linguistics
- Auditory processing disorder
- Augmentative and alternative communication
- Communicative disorders assistant
- Esophageal speech
- Frenkel exercises
- Language delay
- List of university speech–language pathology departments
- List of voice disorders
- Motor theory of speech perception
- Oral myology
- Origin of speech
- Specific language impairment
- Speech acquisition
- Speech and language pathology in school settings
- Speech perception
- Speech processing
- Speech repetition
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