°-o SPEECHCORRECTION An Introduction to Speech Pathology and Audiology N I N T H E D I T I 0 N CHARLESVAN RIPER Late of Western Michigan University ROBERT L. ERICKSON Western Michigan University Allyn and Bacon Boston London Toronto Sydney Tokyo Singapore Series Editor: Kris Farnsworth Editorial Assistant: Christine Svitila Senior Marketing Manager: Kathy Hunter Editorial-Production Administrator: Joe Sweeney Editorial-Production Service: Walsh Associates Composition Buyer: Linda Cox Manufacturing Buyer: Megan Cochran Cover Administrator: Linda Knowles APPO h Copyright© 1996, 1990, 1984 by Allyn & Bacon A Simon & Schuster Company Needham Heights, MA 02194 All rights reserved. No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyrightholder. Library of Congress Cataloging-in-Publication Data Van Riper, Charles Speech correction : an introduction to speech pathology and audiology / Charles Van Riper, Robert L. Erickson. —9thed. p. cm. Includes bibliographical references and index. ISBN 0-13-825142-8 1. Speech disorders. 2. Speech therapy. 3. Audiology. I. Erickson, Robert L.II. Title. [DNLM: 1. Speech Disorders. 2. Voice Disorders. 3. Speech Therapy. WM 475 V274s 19951 RC423.V35 1995 61&85'5—dc2O DNLM/DLC for Library of Congress 95—41718 CIP Printed in the United States of America 10 9 8 7 6 5 4 3 2 1 00 99 98 97 96 95 To Catharine Flull Van Riper, aka Katy, "The Earth Mother" (1909—1984) to Jackie, Doug, Chuck, and Deanna, to our clients, and to our students and their future clients, and to the memory of Charles "Cully" Gage Van Riper, the man from Michigan's Upper Peninsula who, followingS the comple- tion of his doctoral studies at the University of Iowa, came to Western State Normal College in 1936 to begin a speech clinic and to establish one of the country's earliest educational programs for the preparation of "speech correctionists." For decades to follow, Charles Van Riper played a pioneering and dominant role in the developing profession of speech- language pathology. Doctor Van Riper was destined to become part of the very fiber of generations of students and practitioners throughout the world, even as he also was to become a source of strength, hope, inspiration, under- standing, and help for countless persons with communication disabilities. "Doctor Van" lived, and urged his students and his colleagues to live, in ways intended to have positive and enduring effects. He sought to teach us that, "although we are specks at the intersection of the two infinities of time and space," we are able to erect a perpendicular at that point. "Every time you help a person to have a better life," he reminds us still, "and every time you've made this earth a bit more beautiful, you add another unit to your perpendicular." Through word and deed he impacted in many ways on myriad lives. He relished the notion thus of "playing bil- liards with eternity." It is in his spirit, and now in remembrance of him, that you are in- vited to explore in these pages the miracle of human speech and hearing, the devastations wrought by their malfunctions, and the still-evolving pro- fessions of speech-language pathology and audiology. CONTENTS Prefacexi Acknowledgments xii Introduction u I History of the Disabled 5 How the Disabled Person Reacts 8 Current Attitudes toward Disability 8 Communicating with the Communicatively ImpairedI 0 A Brief Look at the Professions I I Basic Components of Speech 2 and Language 25 7 TheSpeech Mechanism 29 Language 45 Speech Acoustics 5 5 - Development of Speech and Language is 3 /Prerequisitesfor Speech Development 76 ,'The First Words 85 ,Syntax:Learning to Talk in Sentences 9 I Phonological Development 97 Semantics: The Development of MeaningI 0 I Prosody and Pragmatics I 05 CONTENTS 4 SpeechDisorders 109 Definition I I 0 Disorder Classification I II Articulation Disorders I I 3 Fluency Disorders I I 8 VoiceDisorders I 23 Language Disorders I 3 3 5 EmotionalAspects of Communication 141 Components of the Emotional Fraction I 43 Role of the Speech-Language Pathologist I 57 6DevelopmentalLanguage Disorders 165 Nonverbal Children I 67 Children with Delayed or Deviant Language 169 Deterrents to Language Acquisition I 72 Experience Deprivation I 85 Assessing the Child's Language I 87 Language Therapy I 9 I 7Articulation and Phonological Disorders 207 t-:- Dialect Differences 2 I 0 Types and Causes of Articulatory Disorders 2 I 2 Analyzing Misarticulations 222 Correcting Misarticulations 23 I CONTENTS Vii Fluency Disorders 253 8 \'Vhat is Stuttering? 2 54 Development of the Disorder 260 TheTreatmentof Stuttering 268 Treatment of the Child 'NhoHas Become Aware of Stuttering 293 Cluttering 297 /c'oice Disorders 303 9 Disorders of Loudness 305 Pitch Disorders 3 I 4 Disorders of Vocal Quality 322 Laryngectomy 332 Cleft Palate 343 I0 incidence and Types of Clefts 344 Causes of Clefts 350 The Oral Cleft Team 351 Surgery for Clefts 3 54 Prostheses 356 Communication Problems Associated with Cleft Palate 3 58 Aphasia and Related Disorders 375 II The Disorder 376 Causes of Aphasia 38 I Aphasia Tests 385 CONTENTS Physical andPsychosocial Elements 387 Prognosis 388 Treatment 389 12 CerebralPalsy and OtherNeuropathologies 403 Varietiesof Cerebral Palsy 405 Classificationby Body Parts 407 Causesof Cerebral Palsy 407 Impactof Cerebral Palsy 408 SpeechTherapy 409 MotorSpeech Disorders 4I 2 TheSeverely lmpaird 4I 3 I 3 Hearingand Hearing Impairment 423 TheHeanng Mechanism 424 Detectionand Evaluation of Hearing Loss 427 Typesof Hearing Loss 435 HearingRehabilitation 457 14 TheSpeech and Hearing Professions 472 Originsof the Speech and Hearing Professions 472 Organizationsand Standards 479 SomeLegal and Ethical Considerations 483 CareerOptions 485 FutureTrends 487 SomeConcluding Comments 49I CONTENTS ix Appendix A: American SpeechLanguage.Hearing Association Codeof Ethics 497 AppendixB: American Academy of Audiology Codeof Ethics 503 Appendix C: Scope ofPractice: Speech-Language Pathology andAudiology507 AppendixD:Organizations.Agencies,andSupport Groups Related toCommunication Sciences and Disorders 5 I I !ossy L5_- Index527 PRE FACE As were its eight previous editions, this book is intended primarily for un- dergraduate students of human communication sciencesand disorders; however, it also should be of interest to students of elementaryand pre- primary education, music therapy, nursing, occupational therapy, physical therapy, special education, psychology, and social work. Predentistryand premedicine students also may find in this text usefuloverviews of many of the disability types that they eventually will encounter in their practices. In an introductory textbook it is impossible, of course, to reflectad- equately the ever-expanding roles and responsibilitiesof today's speech- language pathologists and audiologists, so studentswho plan to enter either of these professions will be well advised to supplement theirstud- ies with readings from current journals and specialized texts. Towardthat end we have suggested various sources of more detailed information when our own discussion necessarily is foreshortened. In this ninth edition we have maintained the clinical focus that has helped to make the book uniquely readable, relevant, andinformative for many generations of students. As in previous editions,we have used ac- tual client examples to illustrate and clariFy text material. However, some of the detailed discussions of specific therapy procedures found in earlier editions have been either condensed or eliminated. Chapter 8 is an ex- ception in this regard, representing as it does the seniorauthor's final writ- ings on the treatment of stuttering. In addition to updating information, we have included far more com- prehensive coverage of normal communication processes,and we have expanded considerably our consideration of hearing problemsand audiol- ogy. Some materials have been reorganized (for example,emotional prob- lems associated with speech disorders are discussed in a separate chapter, and alaryngeal speech has been combined with voice disorders in a single chapter); and materials related to professional ethics and scopesof prac- tice have been added as appendices. Among the other new features of this edition are the inclusion of study questions in each chapter and the mar- ginal definition of highlighted glossary terms throughoutthe book. We trust that such changes as well as the improved layout of thisedition will enhance its usefulness to students and instructors alike. ACKNOWLEDGMENTS Thank you to the reviewers of various versions of this edition—Donald Fucci, Ohio University; Nancy K. O'Hare, Ph.D., James Madison Uni- versity; Arthur M. Guilford, Ph.D., University of South Florida; and Bonnie Lucido, Brigham Young University—and to the many faculty col- leagues at Western Michigan University have provided generous advice and other forms of assistance during the preparation of this revision. Among those at WMU, Harold L. Bate, James M. Hillenbrand, Gary D. Lawson, Donna B. Oas, and Karen K. Seelig were particularly helpful. Their interest and support have been very much appreciated. Gratitude also is extended to John M. Hanley for having afforded me sufficient workload flexibility to ensure completion of the project. Kris Farnsworth of Allyn and Bacon has been especially patient, considerate, and persistent