NICHCY Disability Fact Sheet #11 January 2011
A Day in the Life Pearl one on one, using the same • Articulation | speech impair- of an SLP storybook. Pearl has a speech ments where the child pro- disorder, too, but hers is called duces sounds incorrectly (e.g., Christina is a speech-language dysarthria. It causes Pearl’s lisp, difficulty articulating pathologist. She works with speech to be slurred, very soft, certain sounds, such as “l” or children and adults who have breathy, and slow. Here, the “r”); impairments in their speech, cause is weak muscles of the tongue, lips, palate, and jaw. So • Fluency | speech impairments voice, or language skills. These where a child’s flow of speech impairments can take many that’s what Christina and Pearl work on—strengthening the is disrupted by sounds, forms, as her schedule today syllables, and words that are shows. muscles used to form sounds, words, and sentences, and repeated, prolonged, or First comes Robbie. He’s a improving Pearl’s articulation. avoided and where there may cutie pie in the first grade and be silent blocks or inappropri- has recently been diagnosed with One more student to see—4th ate inhalation, exhalation, or childhood apraxia of speech—or grader Mario, who has a stutter. phonation patterns; CAS. CAS is a speech disorder She’s helping Mario learn to slow down his speech and control his • Voice | speech impairments marked by choppy speech. where the child’s voice has an Robbie also talks in a monotone, breathing as he talks. Christina already sees improvement in his abnormal quality to its pitch, making odd pauses as he tries to resonance, or loudness; and form words. Sometimes she can fluency. see him struggle. It’s not that the Tomorrow she’ll go to a muscles of his tongue, lips, and different school, and meet with jaw are weak. The difficulty lies different students. But for today, in the brain and how it commu- her day is...Robbie, Pearl, and nicates to the muscles involved Mario. in producing speech. The is the muscles need to move in precise National Dissemination Center ways for speech to be intelligible. Definition for Children with Disabilities. And that’s what she and Robbie There are many kinds of are working on. NICHCY speech and language disorders 1825 Connecticut Avenue N.W. that can affect children. In this Next, Christina goes down the Washington, DC 20009 fact sheet, we’ll talk about four hall and meets with Pearl in her 1.800.695.0285 (Voice / TTY) major areas in which these third grade classroom. While the 202.884.8200 (Voice / TTY) impairments occur. These are the other students are reading in [email protected] areas of: small groups, she works with http://nichcy.org
Disability Fact Sheet #11 (FS11) • Language | language impair- ments where the child has Definition of “Speech or Language Impairment” problems expressing needs, under IDEA ideas, or information, and/or in understanding what others The Individuals with Disabilities Education Act, or IDEA, defines say.1 the term “speech or language impairment” as follows: These areas are reflected in “(11) Speech or language impairment means a communica- how “speech or language impair- tion disorder, such as stuttering, impaired articulation, a ment” is defined by the nation’s language impairment, or a voice impairment, that adversely special education law, the Indi- affects a child’s educational performance.” viduals with Disabilities Educa- tion Act (IDEA’s definition is [34 CFR §300.8(c)(11] given in the box to the right). IDEA is the law that makes early intervention services available to Having the child’s hearing the two is most reliably done by infants and toddlers with dis- checked is a critical first step. The a certified speech-language abilities, and special education child may not have a speech or pathologist such as Christina, the available to school-aged children language impairment at all but, SLP in our opening story. with disabilities. rather, a hearing impairment that is interfering with his or her Characteristics of Speech or Development of Speech development of language. Language Impairments and Language Skills It’s important to realize that a The characteristics of speech in Childhood language delay isn’t the same thing as a speech or language or language impairments will vary depending upon the type of Speech and language skills impairment. Language delay is a impairment involved. There may develop in childhood according very common developmental also be a combination of several to fairly well-defined milestones problem—in fact, the most problems. (see the box below). Parents and common, affecting 5-10% of children in preschool.2 With other caregivers may become When a child has an articula- language delay, children’s lan- concerned if a child’s language tion disorder, he or she has guage is developing in the seems noticeably behind (or difficulty making certain sounds. expected sequence, only at a different from) the language of These sounds may be left off, slower rate. In contrast, speech same-aged peers. This may added, changed, or distorted, and language disorder refers to motivate parents to investigate which makes it hard for people abnormal language develop- further and, eventually, to have to understand the child. the child evaluated by a profes- ment.3 Distinguishing between sional. Leaving out or changing certain sounds is common when young children are learning to More on the Milestones of Language Development talk, of course. A good example of this is saying “wabbit” for What are the milestones of typical speech-language development? “rabbit.” The incorrect articula- What level of communication skill does a typical 8-month-old tion isn’t necessarily a cause for baby have, or a 18-month-old, or a child who’s just celebrated his concern unless it continues past or her fourth birthday? the age where children are You’ll find these expertly described in How Does Your Child Hear and expected to produce such sounds 4 Talk?, a series of resource pages available online at the American correctly. (ASHA’s milestone Speech-Language-Hearing Association (ASHA): resource pages, mentioned above, are useful here.) http://www.asha.org/public/speech/development/chart.htm
NICHCY: 1.800.695.0285 2 Speech-Language Impairments (FS11) Fluency refers to the flow of public schools in the 2005-2006 speech. A fluency disorder school year, more than 1.1 means that something is disrupt- million were served under the ing the rhythmic and forward category of speech or language flow of speech—usually, a stutter. impairment.11 As a result, the child’s speech contains an “abnormal number This estimate does not in- of repetitions, hesitations, clude children who have speech/ prolongations, or disturbances. language problems secondary to Tension may also be seen in the • improper use of words and other conditions such as deaf- face, neck, shoulders, or fists.”5 their meanings, ness, intellectual disability, autism, or cerebral palsy. Because Voice is the sound that’s • inability to express ideas, many disabilities do impact the produced when air from the individual’s ability to communi- • inappropriate grammatical lungs pushes through the voice cate, the actual incidence of patterns, box in the throat (also called the children with speech-language larnyx), making the vocal folds • reduced vocabulary, and impairment is undoubtedly within vibrate. From there, the much higher. sound generated travels up • inability to follow directions.10 through the spaces of the throat, Children may hear or see a Finding Help nose, and mouth, and emerges as word but not be able to under- our “voice.” A voice disorder Because all communication stand its meaning. They may involves problems with the disorders carry the potential to have trouble getting others to pitch, loudness, resonance, or isolate individuals from their understand what they are trying quality of the voice.6 The voice social and educational surround- to communicate. These symp- may be hoarse, raspy, or harsh. ings, it is essential to provide toms can easily be mistaken for For some, it may sound quite help and support as soon as a other disabilities such as autism nasal; others might seem as if problem is identified. While or learning disabilities, so it’s they are “stuffed up.” People many speech and language very important to ensure that the with voice problems often notice patterns can be called “baby child receives a thorough changes in pitch, loss of voice, talk” and are part of children’s evaluation by a certified speech- loss of endurance, and some- normal development, they can language pathologist. times a sharp or dull pain become problems if they are not associated with voice use.7 outgrown as expected. What Causes Speech and Language has to do with Language Disorders? Therefore, it’s important to meanings, rather than sounds.8 take action if you suspect that A language disorder refers to an Some causes of speech and your child has a speech or impaired ability to understand language disorders include language impairment (or other 9 and/or use words in context. A hearing loss, neurological disability or delay). The next two child may have an expressive disorders, brain injury, intellec- sections in this fact sheet will tell language disorder (difficulty in tual disabilities, drug abuse, you how to find this help. expressing ideas or needs), a physical impairments such as receptive language disorder cleft lip or palate, and vocal Help for (difficulty in understanding what abuse or misuse. Frequently, Babies and Toddlers others are saying), or a mixed however, the cause is unknown. language disorder (which in- Since we begin learning volves both). Incidence communication skills in infancy, Some characteristics of it’s not surprising that parents language disorders include: Of the 6.1 million children are often the first to notice—and with disabilities who received worry about—problems or special education under IDEA in delays in their child’s ability to
NICHCY: 1.800.695.0285 3 Speech-Language Impairments (FS11) communicate or understand. There, you’ll find a school staff will work Parents should know that there is listing for early interven- with his or her parents a lot of help available to address tion under the first to develop an Individu- concerns that their young child section, State Agen- alized Education Pro- may be delayed or impaired in cies. The agency gram, or IEP. The IEP is developing communication listed will be able to similar to an IFSP. It skills. Of particular note is the put you in contact describes the child’s the early intervention system with the early unique needs and the that’s available in every state. intervention services that have program in your been designed to Early intervention is a system community. meet those needs. of services designed to help Special education infants and toddlers with dis- To learn more and related services abilities (until their 3rd birthday) about early are provided at no and their families. It’s mandated intervention, cost to parents. by the IDEA. Through early including how to intervention, parents can have write the IFSP, visit NICHCY at: There is a lot to know about their young one evaluated free of http://nichcy.org/babies/ the special education process, charge, to identify developmen- overview/ much of which you can learn at tal delays or disabilities, NICHCY, which offers a wide including speech and language Help for range of publications on the impairments. topic. Enter our special educa- School-Aged Children tion information at: http:// If a child is found to have a nichcy.org/schoolage/ delay or disability, staff work Just as IDEA requires that with the child’s family to develop early intervention be made what is known as an Individual- available to babies and toddlers Educational Considerations ized Family Services Plan, or IFSP. with disabilities, it requires that Communication skills are at The IFSP will describe the child’s special education and related the heart of the education unique needs as well as the services be made available free experience. Eligible students with services he or she will receive to of charge to every eligible child speech or language impairments address those needs. The IFSP with a disability, including will want to take advantage of will also emphasize the unique preschoolers (ages 3-21). These special education and related needs of the family, so that services are specially designed to services that are available in parents and other family mem- address the child’s individual public schools. bers will know how to support needs associated with the dis- their young child’s needs. Early ability—in this case, a speech or The types of supports and intervention services may be language impairment. services provided can vary a great provided on a sliding-fee basis, Many children are identified deal from student to student, just meaning that the costs to the as having a speech or language as speech-language impairments family will depend upon their impairment after they enter the do. Special education and related income. public school system. A teacher services are planned and deliv- may notice difficulties in a ered based on each student’s To access early intervention child’s speech or communication individualized educational and services in your area skills and refer the child for developmental needs. Consult NICHCY’s evaluation. Parents may ask to Most, if not all, students with State Resource Sheet have their child evaluated. This a speech or language impairment for your state. evaluation is provided free by the will need speech-language ••••••• public school system. pathology services. This related http://nichcy.org/ If the child is found to have a service is defined by IDEA as state-organization-search-by- follows: state disability under IDEA—such as a speech-language impairment—
NICHCY: 1.800.695.0285 4 Speech-Language Impairments (FS11) (15) Speech-language either in the form of direct student would benefit from AT pathology services in- therapy or on a consultant basis. such as an electronic communi- cludes— cation system or other device. AT Assistive technology (AT) can is often the key that helps (i) Identification of also be very helpful to students, students engage in the give and children with speech or especially those whose physical take of shared thought, complete language impairments; conditions make communica- school work, and demonstrate tion difficult. Each student’s IEP their learning. (ii) Diagnosis and team will need to consider if the appraisal of specific speech or language impairments; References
(iii) Referral for medi- 1| Minnesota Department of Education. (2010). Speech or language impair- cal or other professional ments. Online at: http://education.state.mn.us/MDE/Learning_Support/ attention necessary for Special_Education/Categorical_Disability_Information/ the habilitation of speech Speech_or_Language_Impairments/index.html or language impairments; 2| Boyse, K. (2008). Speech and language delay and (iv) Provision of speech disorder. Retrieved from the University of Michigan and language services for Health System website: http://www.med.umich.edu/ the habilitation or pre- yourchild/topics/speech.htm vention of communica- 3| Ibid. tive impairments; and
(v) Counseling and guidance of parents, Tips for Teachers children, and teachers regarding speech and —Learn as much as you can about the student’s specific disability. language impairments. Speech-language impairments differ considerably from one another, [34 CFR §300.34(c)(15)] so it’s important to know the specific impairment and how it affects Thus, in addition to diagnos- the student’s communication abilities. ing the nature of a child’s —Recognize that you can make an enormous difference in this speech-language difficulties, student’s life! Find out what the student’s strengths and interests are, speech-language pathologists and emphasize them. Create opportunities for success. also provide: —If you are not part of the student’s IEP team, ask for a copy of his or • individual therapy for the her IEP. The student’s educational goals will be listed there, as well as child; the services and classroom accommodations he or she is to receive.
• consult with the child’s —Make sure that needed accommodations are provided for classwork, teacher about the most homework, and testing. These will help the student learn successfully. effective ways to facilitate the child’s communication in the —Consult with others (e.g., special educators, the SLP) who can help class setting; and you identify strategies for teaching and supporting this student, ways to adapt the curriculum, and how to address the student’s IEP goals in • work closely with the family your classroom. to develop goals and tech- niques for effective therapy in —Find out if your state or school district has materials or resources class and at home. available to help educators address the learning needs of children with speech or language impairments. It’s amazing how many do! Speech and/or language therapy may continue through- —Communicate with the student’s parents. Regularly share informa- out a student’s school years tion about how the student is doing at school and at home.
NICHCY: 1.800.695.0285 5 Speech-Language Impairments (FS11) Tips for Parents
—Learn the specifics of your child’s —Listen to your child. Don’t rush to speech or language impairment. The fill gaps or make corrections. more you know, the more you can help Conversely, don’t force your child to yourself and your child. speak. Be aware of the other ways in which communication takes place —Be patient. Your child, like every child, between people. has a whole lifetime to learn and grow. —Talk to other parents whose children —Meet with the school and develop an have a similar speech or language impair- IEP to address your child’s needs. Be your ment. Parents can share practical advice and child’s advocate. You know your son or emotional support. Visit NICHCY’s State daughter best, share what you know. Sheets and find a parent group near you. Look in the Disability-Specific section, under —Be well informed about the speech-language “speech-language.” State Sheets are online at: therapy your son or daughter is receiving. Talk http://nichcy.org/state-organization-search-by- with the SLP, find out how to augment and state enrich the therapy at home and in other environments. Also find out what not to do! —Keep in touch with your child’s teachers. Offer support. Demonstrate any assistive —Give your child chores. Chores build confi- technology your child uses and provide any dence and ability. Keep your child’s age, information teachers will need. Find out how attention span, and abilities in mind. Break you can augment your child’s school learning down jobs into smaller steps. Explain what to at home. do, step by step, until the job is done. Demon- strate. Provide help when it’s needed. Praise a job (or part of a job) well done.
4| American Speech-Language-Hearing Association. 9| Encyclopedia of Nursing & Allied Health. (n.d.). (n.d.). Speech sound disorders: Articulation and phonologi- Language disorders. Online at: http://www.enotes.com/ cal processes. Online at: http://www.asha.org/public/ nursing-encyclopedia/language-disorders speech/disorders/speechsounddisorders.htm 10| Ibid. 5| Cincinnati Children’s Hospital. (n.d.). Speech conditions and diagnoses. Online at: http:// 11 | U.S. Department of Education. (2010, December). www.cincinnatichildrens.org/health/info/speech/ Twenty-ninth annual report to Congress on the Implemen- diagnose/speech-disorder.htm tation of the Individuals with Disabilities Education Act: 2007. Online at: http://www2.ed.gov/about/reports/ 6| National Institute on Deafness and Other Commu- annual/osep/2007/parts-b-c/index.html nication Disorders. (2002). What is voice? What is speech? What is language? Online at: http:// www.nidcd.nih.gov/health/voice/whatis_vsl.htm
7| American Academy of Otolaryngology — Head and Neck Surgery. (n.d.). Fact sheet: About your voice. Online at: http://www.entnet.org/HealthInformation/ aboutVoice.cfm
8| Boyse, K. (2008). Speech and language delay and disorder. Retrieved from the University of Michigan Health System website: http://www.med.umich.edu/ yourchild/topics/speech.htm
NICHCY: 1.800.695.0285 6 Speech-Language Impairments (FS11) Readings and Articles
We urge you to read the articles identified in the References section. Each provides detailed and expert infor- mation on speech or language impairments. Additionally, we’d also recommend:
• Speech-Language Impairment: How to Identify the Most Common and Least Diagnosed Disability of Childhood | http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2491683/
• Speech and Language (Communication) Disorders | NOAH-Health | http://www.noah-health.org/en/bns/ disorders/speech/
Organizations to Consult
ASHA | American Speech-Language-Hearing Association Information in Spanish | Información en español. 1.800.638.8255 | [email protected] | www.asha.org
NIDCD | National Institute on Deafness and Other Communication Disorders 1.800.241.1044 (Voice) | 1.800.241.1055 (TTY) [email protected] | http://www.nidcd.nih.gov/Pages/default.aspx
Cleft Palate Foundation | 1.800.242.5338 | http://www.cleftline.org
Childhood Apraxia of Speech Association of North America | CASANA http://www.apraxia-kids.org
National Stuttering Foundation | 1.800.937.8888 | [email protected] | http://www.nsastutter.org/
Stuttering Foundation | 1.800.992.9392 | [email protected] | http://www.stuttersfa.org/
If there is a primary condition that is associated with the speech-language impairment, such as autism or learning disabilities, we’d recommend visiting NICHCY and using the “search” box to identify organizations that specialize in that primary condition.
FS11—January 2011
This publication is copyright free. Readers are encouraged to copy and share it, but please credit the National Dissemination Center for Children with Disabilities (NICHCY).
This publication is made possible through Cooperative Agreement #H326N080003 between FHI 360 and the Office of Special Education Programs, U.S. Department of Education. The contents of this docu- ment do not necessarily reflect the views or policies of the Department of Education, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
NICHCY: 1.800.695.0285 7 Speech-Language Impairments (FS11)