Prevalence, Definitions, and Characteristics

Individuals classified with speech or language impairments make up 18.6% of all students ages 6–21 served under IDEA, and represent 1.65% of the school-age population. Speech is the system of forming and producing sounds that are the basis of language, while language is considered the system of communicating ideas. Most students receiving speech and language therapy work individually or in small groups with a specialist for brief sessions several times a week and usually spend the remainder of their day in general education classes. In some schools, speech and language teachers may conduct therapy sessions in the general education classroom (Owens, Metz, & Haas, 2003).

Some students with speech and language disorders may have another primary disability area, such as a learning disability, cerebral palsy, traumatic brain injury, or other severe disabilities. The latter groups are more likely to be using Alternative and Augmentative Communication (AAC) devices to help them communicate.

Examples and Characteristics of Speech Disorders

Speech disorders may exist as voice, articulation, or fluency disorders. Voice disorders affect volume, pitch, flexibility, and quality of voice and affect about 3% to 6% of school-age children (Owens, Metz, & Haas, 2003). Examples of voice disorders include speech that is chronically strained, hoarse, breathy, or nasal. In the most severe instances, voice is not present at all.

Articulation disorders represent the largest subgroup of communication disorders (about 75%), and include difficulty pronouncing words, including omissions (“libary” for “library”), additions (“terribubble” for “terrible”), distortions (such as lisping), and substitutions (e.g., “tram” for “clam”). A child with articulation problems might say, “wabbits aw fuwwy animals.”

Fluency disorders are interruptions in the natural flow or rhythm of speech. A common fluency disorder is stuttering, “an involuntary repetition, prolongation or blockage of a word or part of a word that a person is trying to say” (Curlee, 1989, p. 8). Most people who stutter begin stuttering before age 5, but only after they have begun to speak in sentences (Curlee, 1989).

Examples and Characteristics of Language Disorders

Language disorders are problems in using or comprehending language, either expressive (using language) or receptive (understanding language of others). Language disorders may involve difficulties with phonology, morphology, syntax, semantics, or pragmatics. Phonology involves the ability to blend and segment the sounds that individual letters or groups of letters make to form words. For example, it may be difficult for students to identify the final sound in the words cap and cat if they have a phonological problem. Morphology involves the meaningful structure of words, as expressed in morphemes, the smallest units of language that carry meaning or function. For example, the word swimmer contains two morphemes: a free morpheme (can stand alone as a word) (swim), and a bound morpheme (depends on other words) (-er). Syntax is the grammatical structure of language and is concerned with such things as word order and noun-verb agreement. Semantics refers to the meanings of words used in language. For example, the sentence, ”Walk can I take?” may convey a semantic meaning but is not syntactically correct. Pragmatics refers to the use of language in the context of social situations. For example, students typically speak to teachers in a different manner than they would speak to classmates (Owens, Metz, & Haas, 2003).

One of the most severe language disorders is aphasia, which refers to difficulties speaking (expressive aphasia) or comprehending (receptive aphasia) language. Aphasia often accompanies brain injuries, and individuals may experience difficulty retrieving words that they knew before the injury (Owens, Metz, & Haas, 2003).

In the most severe communication disorders, individuals cannot speak and must learn to rely on alternative and augmentative communication devices (Lloyd, Fuller, & Arvidson, 1997).

Causes of Speech or Language Impairments

In most cases, specific causes of speech and language disorders are unknown. Some children have severe language delays during early childhood development, but reasons for the delay are unknown. Voice disorders can be caused by growths, infections, or trauma to the larynx (structure containing the vocal cords); infections of the tonsils, adenoid glands, or sinuses; or physical disorders such as cleft palate, in which the upper part of the oral cavity is split (Moore & Hicks, 1994). The cause of stuttering is presently unknown (Conture, 1989; Owens, Metz, & Haas, 2003).

Issues in Identification and Assessment of Communication Disorders

Parents are usually the first to identify a potential speech or language problem, when, for example, their 2-year-old has not begun to develop language. Primary school teachers may be the first to refer a child for a speech and language evaluation when they notice problems with speech or language. Frequently administered tests include articulation tests, auditory discrimination tests, language development tests, vocabulary tests, and language samples taken from a variety of social contexts.

Classroom Adaptations for Students with Speech or Language Impairments

It is important to provide an open, accepting classroom environment to promote acceptance, decrease anxiety, and minimize opportunities for ridicule.

Adapt the Physical Environment

Place students with communication disorders near the front of the room for easier listening. This will also enable easier access if they need help or if you have devised a special cueing system with them for responding orally in class. The following In the Classroom feature provides a checklist for considerations for adaptations in the physical environment.

Adapt Materials

Allow students to use any technology that may help them with their disability area. For example, perhaps they can prerecord aniticpated responses on audiotapes, videotapes, or computers, and then play that recording for the class.

Use Alternative or Augmentative Communication. Adaptive communication methods are referred to as Alternative and Augmentative Communication (AAC) techniques. AAC symbols and techniques fall into two broad categories—aided and unaided. Aided communication involves the use of some external device, such as simple handmade materials, a picture board, or more sophisticated computer-assisted devices. Unaided communication does not involve any apparatus other than the individual’s own body. Examples include manual signing, making physical gestures, miming, pointing, and moving the eyes (Lloyd, Fuller, & Arvidson, 1997).

Alternative communication techniques involve the use of communication boards to assist communication. Communication boards contain pictures or words of commonly asked questions and responses to questions. When asking or responding to questions, students can point to the picture that communicates what they mean. Pointing devices that attach to the head can be used for students who have difficulty pointing with their hands or fingers. When the AAC user is unable to point, a communication partner can help identify the correct symbol. Some commercially available boards, such as the Touch Talker or LightTalker available from the Prentke Romich Company, produce speech output when the corresponding symbol or picture is touched (Lloyd, Fuller, & Arvidson, 1997).

More recent advances in technology have also incorporated the use of synthesized speech sounds when using some alternative communication devices. Students can type information into computers, and computers will produce the speech output for them using a variety of tones.

Adapt Instruction

Effective teaching practices, including clear, well-organized presentations and activities, will help meet the needs of students with speech and language disorders in your classroom. Appropriate pace of instruction and maximized student engagement—including frequent questioning and feedback—can help ensure academic success.

Facilitate Verbal Responding. Allow sufficient time for students with communication disorders to speak when responding. Do not impose time pressures on oral responses. When a student finishes, repeat the response for the entire class to hear. For example, Mr. Lee allowed Natalie, a student with a speech and language disorder, sufficient time to respond, and then said, “Natalie, that was a good answer. Natalie said, ‘The numbers 11 and 23 are both prime numbers.’”

A high school history teacher, Mrs. Stobey, met at the beginning of the school year, with Micky, a student who stuttered. Together they decided that if Micky raised his hand, then he felt comfortable trying to participate in the discussions and only then would Mrs. Stobey call on him to talk.

Initially, ask a student who stutters questions that can be answered in just a few words. If you are going to ask everyone in class to answer a question, call on the student who stutters relatively early, to allow less time for anxiety to develop (Stuttering Foundation of America, 1997).

Monitor your pace of instruction, especially when introducing new vocabulary to students with receptive language disorders. Use language cards containing representational pictures and illustrations depicting the definitions. Whenever possible, use concrete examples, rather than lengthy verbal descriptions, to illustrate new concepts.

Practice Oral Presentations. If oral presentations are mandatory, practice alone with students first and provide feedback. Consider allowing students to present with partners or in small groups, such that each group member has a different role during oral presentations.

Adapt Evaluation

Some students may require extended time periods to complete class tests. Others may require the assistance of readers, scribes, or communication boards and communication partners while taking tests.

In the Classroom: Sample Environmental Adaptation Considerations

Seating Position

_____ near teacher

_____ near peer assistant

_____ near paraprofessional

_____ near board

_____ near front of room

_____ alone

_____ quiet space

_____ other

Seating Planned for

_____ lunchroom

_____ assemblies

_____ bus

_____ all classes

_____ other

Rearrange Physical Space

_____ move desks

_____ move class displays

_____ other

Reduce Distractions

_____ visual

_____ auditory

_____ movement

_____ other

Provide Daily Structure

_____ first thing to do when entering class

_____ second thing

_____ third thing

_____ being prepared

_____ other

Provide Designated Places

_____ in boxes

_____ out boxes

_____ other

Provide Orderly Models

_____ organized desks

_____ organized lockers

_____ other