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What do speech-language pathologists do?

Speech-language pathologists treat and assess a variety of speech, language, and communication disorders. That probably doesn't answer your question, right? Let's dive straight into this!


This article from Speech and Audiology Canada has a great summary of what we do.


It states that our jobs include screening, assessment, treatment, measurement, and consultation.


We work in a variety of clinical areas including, but not limited to the following:

Clinical areas of service may include, but are not limited to: speech sound production; resonance; voice; fluency; pre-linguistic communication; language comprehension and expression; pre-literacy and literacy skills; cognitive communication; social (pragmatic) communication; feeding and swallowing; alternative and augmentative communication; aural (re)habilitation, and accent modification;

That sounds like a lot of big words. Let's break it down further.


Speech Sound Production aka Speech Sound Disorders

This includes more typical difficulties such as a lisp or difficulties producing an "r" sound. Typically, this is in the realm of articulation disorders. Another area we work in often is phonological disorders. This is difficulty with understanding the linguistic (think rules and patterns) aspect of speech. For example, if you child has difficulties using final consonants or a class of sounds, that typically falls within the realm of phonological disorders.


Other speech sound disorders include dysarthria - difficulties with muscles executing commands to produce certain speech sounds, apraxia of speech - difficulties with creating motor plans for muscles to execute certain actions. Speech sound disorders may also result from a cleft lip/palate, structural deficits due to trauma or surgery, and/or a hearing impairment. See this ASHA document for further information.


Resonance

Resonance disorders typically arise due to too much or too little energy going through your nose. With too much energy, you sound "hypernasal". This is an example. With too little energy (think when you are sick from a cold and your nose is stuffed up so nothing is getting through there!), you sound "hyponasal". There are many reasons a resonance disorder exists. Common reasons include a cleft palate, submucous cleft palate, or certain genetic syndromes. See this ASHA document for further information.


Voice

Voice disorders typically result in differences in pitch, voice quality, and loudness when you talk. There are many reasons why a voice disorder may exist. Voice disorders fall into two categories: organic and functional. Organic voice disorders are due to a structural change or are neurogenic (changes in your brain/nervous system). Some diagnoses include: psychogenic voice disorder, paradoxical vocal fold movement, spasmodic dysphonia, tumour growth, etc. These diagnoses can result in voice differences and disorders.


Fluency

Commonly perceived to be stuttering, BUT fluency disorders also include cluttering. Cluttering "is characterized by a perceived rapid and/or irregular speech rate, atypical pauses, maze behaviors, pragmatic issues, decreased awareness of fluency problems or moments of disfluency, excessive disfluencies, collapsing or omitting syllables, and language formulation issues, which result in breakdowns in speech clarity and/or fluency." Taken from ASHA.


Pre-Linguistic Communication

This may be one of my favourite areas to work on because I really think it's often underappreciated! In essential, pre-linguistic communication are all those skills that children use to communicate with you before they even use their first words. These skills support the development of first words. For example, if a child has difficulties with paying attention to you and looking at you, imagine how hard it would be to learn words from you!


Common pre-linguistic areas that I assess and treat include, but are not limited to:

  • Eye-contact

  • Pointing

  • Gestures

  • Facial expressions

  • Imitating

  • Joint attention


Language Comprehension and Language Expression

This includes difficulties with understanding and using language. Some terminology that is used commonly includes expressive language delay/disorder, receptive language delay/disorder, and specific language impairment. The term we use now when difficulties with understanding or talking is not secondary to a medical diagnosis is developmental language disorder (DLD). For more information on DLD, please visit this website.


There are different parts of language that your child may have difficulties understanding or using.

Some typical areas that we work-on include (not comprehensive):

  • Morphology - Think those tiny parts of language such as plurals, past tense, and copula

  • Syntax - Think stringing together long sentences

  • Narrative Language - Think telling a coherent story

  • Vocabulary/Semantics - Think words, but also how words are related to one another

Pre-Literacy and Literacy Skills

I think pre-literacy skills may be my second favourite area of work! It is common for parents to want me to teach their children how to read letters in preschool, but before we are even able to read, there are some other skills that are also vital and support reading skills.


These include, but are not limited to:

Print Knowledge - Ability to identify letters, words and symbols BUT also understanding of how reading works. For example, in Canada our books read left to right and letters come together to form words. In other countries, books may read right to left or vertically.

Sound Awareness or Phonological Awareness - This is understanding that words can be broken down into syllables and sounds. For example, recognizing the first sound in a word is a phonological awareness skill.

Rhyming - This is pretty self-explanatory, but being able to tell that "cat" rhymes with "bat" is a pre-literacy skill.


Literacy is quite complicated, but the simple view of reading includes decoding, the ability to "read aloud" words, and comprehension, the ability to understand what was written.


Cognitive Communication

There is a LONG list of cognitive processes that are related to cognitive-communication.

Some examples of cognitive processes include: attention, memory, organization, problem solving/reasoning, and executive functions. Problems in these areas can affect verbal and nonverbal communication. For instance, speaking, listening, reading, writing, and pragmatic (social interaction) skills may be affected negatively. Problems with cognitive-communication can affect activities of daily living, and academic and work performance.

The above was taken from here.


Cognitive communication deficits can result from (traumatic) brain injury, right hemisphere brain damage, genetic disorders, tumour, surgery, anoxia... The list can be quite long. Both children and adults can have a cognitive communication disorder.


Social (Pragmatic) Communication

This includes all the social aspects of communication. For example, if a child can string together long sentences, do they use it to communicate with you for different reasons? You can communicate to request, ask for help, greet, make a choice, comment, show...the list is endless, but those are some early communicative functions we work on.


Other areas of social communication include communicating for social purposes that are appropriate for the situation, using literal and figurative language, understanding what was said and not said explicitly, following rules of communication etc. My third favourite area of work is probably running social groups with preschoolers all the way to teenagers. There are so many social skills that can be learned in groups! I really like incorporating Social Thinking concepts into my practice.


Feeding and Swallowing

A swallowing disorder is called dysphagia. This can occur in adults or children. Other difficulties include picky eating, sensory preferences, or difficulties with self-feeding. Feeding and swallowing is probably one of the most interdisciplinary area that we practice in. We typically collaborate with occupational therapists, pediatricians, and dietitians when it comes to feeding and swallowing disorders. Feel free to read more about it here.


Alternative and Augmentative Communication (AAC)

AAC includes any other means besides verbal speech to communicate. Some common AAC devices include iPads, eye-trackers, and communication boards, but did you know that writing in a notebook, using gestures, or even facial expressions is also considered to be AAC? We use AAC in our EVERYDAY lives.


The myths are AAC is endless, but using an AAC device or method of communication DOES NOT inhibit your child from talking. In fact, AAC supports verbal speech development. For a further read, visit this link.


Aural (Re)habilitation

This is an area that I do not currently have experience treating, I'll be honest! I will send you to this link to read further about it. In summary, aural rehabilitation assesses and manages deficits due to hearing loss.


Accent Modification

Let me start with this - EVERYONE has an accent. It is not wrong to have an accent, in fact, it is NORMAL. Speech is naturally different in different areas of the world which is why we have British English, Canadian English, American English and within each of those categories there are regional differences. Additionally, if you learn a second language later in life, it is quite normal to have an accent as you learn to hear the differences between speech sounds at a younger age and there are critical periods (a certain window of time) for learning these differences. You can still learn them as an adult, but it's much harder. Infants breeze through it.


If you would like to work on your accent or change it, for whatever reason, speech-language pathologists have a specialized skillset that can help you modify it. For example, prosody, stress, speech sounds, and language all contribute to an accent and we are experts in these areas.



I did not expect this to be 10000 words long, but there is so much that we treat and diagnosis! When choosing a speech-language pathologist, it is important to consider what they specialize in. Since our scope of practice is so wide, there is no way we are going to be an expert at everything.


Areas that I specialize in include autism, social communication, early intervention (0-5) and treating bilinguals that may have a communication disorder. I have a strong interest in pre-literacy skills and teaching children how to decode to read.


If you have questions about my blog posts, I can be contacted at cassie@startnowspeech.com.