This chapter discusses individuals with speech and language impairments. Speech (the expression of language with sounds) is differentiated from language (a rule-based method of communication involving the comprehension and use of signs and symbols by which ideas are represented) and communication (the exchange of ideas, information, thoughts, and feelings). Definitions of speech and language impairments from the American Speech-Language-Hearing Association and IDEA are presented. Classification and differentiation of speech, language, and central auditory processing (CAPD) disorders are discussed. The history of working with individuals with speech and language impairments is reviewed. Speech and language impairments, a high-incidence disability and many students in special education receive services for speech and language impairments, predominantly in the general education classroom. Functional and organic and congenital, developmental, and acquired etiologies of speech and language impairments are explained. Strategies for preventing these disabilities are presented. Characteristics of individuals with speech and language impairments are detailed as is the assessment of speech and language impairments. Services for young children such as early intervention services are profiled as are services for adolescents and adults. The need to involve families as partners in services provided to children and technology that can serve as alternative or augmentative communication devices are presented.  Future trends and issues include appropriately identifying diverse students and the increased use of technology with this population. Controversy still swirls around the etiologies of certain speech and language disorders as well as the neurophysiological basis of these disorders.

Learning Objectives:

• Define speech, language, and communication.
• Identify the five components of language.
• List three different types of speech impairments and five forms of language disorders.
• Define central auditory processing disorder.
• Distinguish between functional and organic causes of speech and language impairments.
• Explain the differences between receptive and expressive language impairments.
• Describe procedures used for assessing speech and language impairments.
• Explain the function of augmentative and alternative communication devices.

Lecture Outline:

1. Nature of Speech, Language, and Communication
   
   1. Speech: expression of language with sounds
   2. Language: rule-based method of communication
      
      1. Phonology: The sounds characteristic of a language, rules governing their distribution and sequencing, and the stress and intonation patterns that accompany sounds
      2. Morphology: The rules governing how words are formed from the basic element of meaning
      3. Semantics: Rules for how to string words together to form phrases and sentences—the relationships among the elements of a sentence
      4. Syntax: The linguistic realization of what the speaker knows about the world—the meanings of words and sentences
      5. Pragmatics: The social effectiveness of language in achieving desired functions—rules related to the use of language in social contexts
   3. Communication: involves verbal and nonverbal behaviors
2. Defining Speech and Language Impairments
   
   1. The American Speech-Language-Hearing Association defines a communication disorder as “an impairment in the ability to receive, send, process, and comprehend concepts or verbal, nonverbal, and graphic symbols systems. A communication disorder may be evident in the processes of hearing, language, and/or speech.”
   2. The IDEA label for students with communication difficulties is speech and language impairment and they are eligible for special education if they have “a communication disorder such as stuttering, impaired articulation, a language impairment or a voice impairment, which adversely affect a child’s educational performance.”
3. Classifying Speech and Language Impairments
   
   1. Speech Disorders
      
      1. Articulation disorders: error in production of sound
      2. Fluency disorders: difficulties with rhythm and timing of speech
      3. Voice disorders: quality of voice is effected
   2. Language Disorders
      
      1. Phonological disorders: Difficulties organizing speech sounds into recognizable patterns
      2. Apraxia of speech: Inability to control the muscles and thoughts that produce speech
      3. Morphological disorders: Adding morphemes incorrectly to words
      4. Semantic disorders: Poor understanding of word meanings, difficulty finding correct words to use
      5. Syntactical deficits: Difficulty with word order and sentence structure
      6. Pragmatic difficulties: Problems understanding and using language in different social contexts
   3. Central Auditory Processing Disorders (CAPD)
      
      1. Students with CAPD have difficulty processing (using and interpreting) sounds. CAPD occurs when the ear and brain do not work smoothly together to interpret sounds.
4. Historical Perspectives
   
   1. Rejection
   2. Objects of pity
   3. A rewarding sense of humor
5. Prevalence of Speech and Language Impairments
   
   1. High incidence disability
   2. Often occurs with other disabilities
   3. Almost 20% of children receiving special education receive services for speech and language disorders
   4. Preschoolers with speech and language disorders represent almost half of all preschoolers receiving special education
6. Etiology of Speech and Language Impairments
   
   1. May be considered functional versus organic
   2. May be classified based on the time of acquisition: before birth, developmentally during childhood, or due to injury.
7. Prevention of Speech and Language Impairments
   
   1. Children typically develop language within acceptable limits. Children who do not reach linguistic developmental milestones may be at risk for developmental language delays.
   2. Language is learned in social contexts. Language has developed within the context of social relationships in virtually every known culture.
   3. Providing early language experiences is essential for children to associate sounds with objects and concepts and to begin to process and use those sounds to communicate.
   4. Genetic testing may be warranted if hereditary factors are a consideration.
8. Characteristics of Speech and Language Impairments
   
   1. Expressive Language; may experience difficulties with:
      
      1. Limited vocabulary
      2. Incorrect grammar or syntax
      3. Excessive repetition of information
      4. Difficulty formulating questions
   2. Receptive Language; may experience difficulties with:
      
      1. Following oral directions
      2. Understanding humor or figurative language
      3. Comprehending complex sentences
      4. Responding to questions appropriately
9. Assessing Speech and Language Impairments
   
   1. Formal and informal measures
      
      1. Examples: case histories, family interviews, health assessments, observations, developmental information, family dynamics, speech and language assessments
      2. Professionals who conduct assessments: teachers, speech-language pathologists, audiologists, neurologists, physicians
10. Educational Considerations
    
    1. Predominantly served in general education classroom
    2.  
11. Services for Young Children with Speech and Language Impairments
    
    1. Early identification importance
    2. Early identification procedures
    3. Services available from birth to school age
    4. Interactions with typically developing peers
    5.  
12. Adolescents and Adults with Speech and Language Impairments
    
    1. Communication disorders may compound adolescent insecurities
    2. Transition planning in all areas of adult living
13. Family Issues
    
    1. Speech-language pathologists include families in the assessment and planning process
    2. Speech-language pathologists provide suggestions to families to assist them in helping their children with speech or language impairments
14. Issues of Diversity Children who do not speak standard or proficient English do not have speech or language impairments although some students with limited English proficiency may also have special learning needs including speech and language impairments.
15. Technology and Individuals with Speech and Language Impairments
    
    1. Assistive Technology
    2. Augmentative or Alternative Communication (AAC)
       
       1. Augmentative or Alternative Communication (AAC) is considered to be Assistive Technology under IDEA.
16. Trends, Issues, and Controversies
    
    1. Early intervention
    2. Medical innovations
    3. Cultural and linguistic diversity
    4. Controversies regarding etiologies of speech and language disorders