Speech language pathology is the study and treatment of human communication and its disorders. These specialists work with the full range of human communication including speech, language and hearing disorders. Speech language pathologists work to prevent, assess, diagnose, and treat speech, language, social communication, cognitive-communication, and swallowing disorders in children and adults (ASHA, 2017).
Speech language pathologists also provide rehabilitation services to patients who are deaf or have hearing difficulties and augmentative and alternate communication systems for individuals with severe expressive and/or language comprehension disorders, such as autism spectrum disorder or progressive neurological disorders (ASHA, 2017). They also work with people who do not necessarily have a disorder, but are looking to improve their communication effectiveness, such as those with an extreme accent).
These healthcare professionals also provide training and education to other health professionals and to their patients and their relatives. Counseling and consultative services are provided by speech language pathologists, in addition to training and supervising support personnel. They collaborate with physicians and health care professionals from a multitude of disciplines.
A speech language pathologist may work in a variety of settings with a variety of duties and responsibilities. Some may teach at an academic institution, work in a private practice, or work for a national, state or local government or agency. Others may focus on research to enhance knowledge about human communication processes and develop new assessment and treatment methods that may lead to more effective outcomes (ASHA, 2017).
Disorders Treated by Speech Language Pathologists
A speech pathologist evaluates and treats speech, language, social communication, cognitive communication and swallowing disorders. These disorders are defined by ASHA (2017) as:
Speech disorders occur when a person has difficulty producing speech sounds correctly or fluently (e.g., stuttering is a form of disfluency) or has problems with his or her voice or resonance.
Language disorders occur when a person has trouble understanding others (receptive language), or sharing thoughts, ideas, and feelings (expressive language). Language disorders may be spoken or written and may involve the form (phonology, morphology, syntax), content (semantics), and/or use (pragmatics) of language in functional and socially appropriate ways.
Social communication disorders occur when a person has trouble with the social use of verbal and nonverbal communication. These disorders may include problems (a) communicating for social purposes (e.g., greeting, commenting, asking questions), (b) talking in different ways to suit the listener and setting, and (c) following rules for conversation and story-telling. All individuals with autism spectrum disorder have social communication problems. Social communication disorders are also found individuals with other conditions, such as traumatic brain injury.
Cognitive-communication disorders include problems organizing thoughts, paying attention, remembering, planning, and/or problem-solving. These disorders usually happen as a result of a stroke, traumatic brain injury, or dementia, although they can be congenital.
Swallowing disorders (dysphagia) are feeding and swallowing difficulties, which may follow an illness, surgery, stroke, or injury.
The History of Speech Language Pathology
The beginnings of medicine in general dates back to ancient times. Speech language pathology as a specialty medical field can be traced back to the early 19th century. Throughout the 20th century, the field achieved significant advances in professional establishment, and speech language pathology continues to grow and develop through the 21st century and beyond.
The 19th Century
There were three trends during the 19th century that led to the development of speech language pathology as a healthcare profession. The elocution movement, the scientific revolution and the rise of professionalism all contributed to the growth of speech language pathology. Each field made its own significant contributions that led to the need for speech language pathologists.
The Elocution Movement
The first pathway, the elocution movement, was a broad movement in America where elocutionists set up practices to work with orators, politicians, singers, preachers, actors, and non-specialists who wanted to improve their speaking, orating, or singing (Duchan, 2011). Elocution refers to clear and expressive speech, especially of distinct pronunciation and articulation (Oxford, 2017). The term was first used in the early 19th century for improving speaking, reading aloud, giving oral presentations or singing.
Two notable elocutionists during this time were Andrew Comstock and Alexander Graham Bell, who both offered lessons in speech, language or hearing problems.
Andrew Comstock
Andrew Comstock (1795-1864) was a professor of elocution in Philadelphia, where he worked with students with speech difficulties. Comstock invented the phonetic alphabet, which not only helped his students improve their speech and phonics, but it was also used to transcribe documents such as the New Testament (Duchan, 2011). Comstock is thought to have a significant influence on the entire speech language pathology profession.
Comstock developed a system of speech therapy to specifically treat patients with stammering and articulation issues. He argued that people who stammer must first learn the elements or oral language, including the articulatory positions of individual sounds (Duchan, 2011). Voice exercises that emphasized pronunciation, inflection and pitch were incorporated into Comstock’s speech therapy, as well as singing and choral speaking. Practice drills focused on pitch, time and force.
Alexander Graham Bell (1847-1922)
Alexander Graham Bell’s mother suffered from severe hearing loss, which spurned his desire to design methods for teaching the deaf and those with communication difficulties (Duchan, 2011). He began educating deaf students in Boston in 1871, and he also worked with individual patients and clients, which is how he met his future wife.
In 1872, Bell opened his own school for students who were deaf, stuttered or had difficulty with articulation. Bell’s speech therapy system was known as Visible Speech. The Visible Speech system involved a phonetic alphabet, based on the position of the articulators during the production of different speech and non-speech (e.g. yawns) sounds (Duchan, 2011).
Of course, Bell is most famous for inventing the original form of long-distance verbal communication, the telephone.
The Scientific Revolution
During the 19th century, there was a dramatic shift in medicinal views from religious and philosophical to those based on science. With the introduction of Darwinism and the establishment of academic psychology programs in the United States and Europe, scientific research was becoming more widely accepted. The scientific revolution led to crucial developments in the field of speech language pathology including phonetic and brain studies, technological advances, the development of psychological testing, and the study of child welfare.
The Study of Phonetics and the Brain
Elocutionists gradually developed a scientific approach to oration and speech therapy. This included utilizing speech sounds, delivery, and phonetic categories and a framework for conceptualizing domains and elements of speech pronunciation (Duchan, 2017). Brain students were being performed by physicians who were diagnosing and treating those with aphasia and other speech language disorders (Duchan, 2017).
During this time, the different areas of the brain and their respective functions were being discovered, which led to a diagram or map of the brain centers and where the disconnections were that affected language, literacy and speech disorders. James Sonnet Greene was a laryngologist who focused on speech disorders. He used the brain diagram to identify speech “cluttering” and “agitographia”, or illegible writing due to missing letters and syllables (Duchan, 2017).
Greene associated speech language disorders with dysfunction of the nervous system and the brain in particular. He also identified the progression of speech and language development, where a person’s speech issues affect their ability to correctly write due to conceptual representation.
While some conditions were explained by the brain localizationists as originating from dissociations between cortical brain centers, others were seen originating from problems with or damage to a particular center (Duchan, 2011). For example, an oral language disorder was related to the brain’s auditory word center, and literacy was related to the visual word center of the brain.
Among the Americans to use these concepts to account for speech, writing, or auditory impairments in children were Samuel Torrey Orton (1925), a psychiatrist working at the University of Iowa, and Mildred McGinnis (1929), a teacher/therapist working at Central Institute for the Deaf in St. Louis. W. L. Worcester (1896), a physician providing services to institutionalized adults at Danvers State Insane Asylum near Boston, reported on 15 cases whom he diagnosed as exhibiting word deafness (Duchan, 2011).
Further advances in scientific research of the brain led to the identification of the right and left sections of the brain and how they each affect brain function. A psychiatrist by the name of Samuel Terry Orton related speech and language disorders to the dominance of one side of the brain over the other.
Technological Advances
The development of speech science led to further technological inventions and advances that improved the ability of speech language pathologists to measure various aspects of sound perception and production. Yale University established one of the first speech pathology laboratories to analyze different aspects of speech, language and hearing.
According to Duchan (2011) there were serval other notable technological advances that significantly influenced the development of speech language pathology:
Floyd Summer Muckey (1858-1930) was the first to give a working analysis of tone, to photograph a manometric flame recording and to take a photo of the vocal cords in action.
George Oscar Russell (1890-1962) invented a type of palatography—where dynamic movements of the tongue were revealed through bends in aluminum foil and developed a method for x-ray used for examining position of articulators in vowel production.
Carl Emil Seashore (1866-1949) invented and patented the following instruments: Iowa Pitch Range Audiometer, Tonoscope, Chronoscope, Time-sense apparatus, and Stimulus key.
Psychological testing
Further advances in psychological testing led to intelligence testing and quantifying one’s academic abilities. These tests included arithmetic, handwriting, spelling, drawing, reading and language ability. Although many of these tests had no actual scientific relativity to a person’s actual intelligence (not to mention racially biased), this type of testing would eventually be the basis for assessing speech language disorders and disabilities.
Child Study and Welfare
The child studies and child welfare movement led to advances in the identification and education of childhood development and the proper stages and milestones as related to speech and language development, in addition to other mental and physical developmental milestones. The University of Iowa was one of the first academic establishments focused on child development.
Rise of Professionalism
The emergence of professions in the United States also occurred in the 19th century. Standards and qualifications and the definition of the nature and scope of various medical professions were developed and organized, which led to a more structured atmosphere for speech language pathologists and other health care professions.
Speech Correction
Speech correction emerged as its own individual profession, although its professionals typically practiced in other fields such as general medicine and psychology. The American Academy of Speech Correction was established in 1926 as a group of clinical and academic elites experienced in speech correction education and therapy.
The 20th Century
In 1925-1926, the organization of speech disorder and speech correction professionals led to further establishment of the science and principles within the field. The 20th century can be broken down into the Formative Years, the Processing Period, Linguistic Era and the Pragmatics Revolution.
The Formative Years (1900-1945) involved the development of terminology and treatments for speech language and literacy disorders, in addition to the classification of alalia (language and motor speech disorders arising from cerebral lesions or motor paralysis), paralalia (articulation disorders) and dyslalia (stuttering) (Duchan, 2011). The identification of lisping as a speech disorder led to the categorization of four types: negligent, organic, neurotic and cluttering.
A multitude of treatments, exercises and therapies emerged as speech and language disorders were more fully understood. In addition, the incidence, nature and therapy methods for treating children who stutter, and children with monotonous voices, with letter substitutions (articulation disorders), idioglossia, and a lack of speech were developed (Duchan, 2011). Speech issues experienced by children were identified as being caused by one or more of the following: mental deficiency, brain injury, digestive disorders or lack of parental reinforcement of speech development.
In 1928, Sara Stinchfield was the first person in the US to receive a PhD degree in speech pathology. Her research identified five speech habits associated with speech and language development: sound bombardment, sound imitation and sound and word sequencing. She developed a motor-kinesthetic approach to speech therapy that involved muscle exercises, among other exercises and practices.
The Processing Period (1945 – 1965)
World War II led to significant advancements in all aspects of medicine and rehabilitation professions. During this period clinicians began to acknowledge that there was something else going on in speech besides perception and motor production of sounds, something variably dubbed symbol formation inner language, mediation and psycholinguistic processing (Duchan, 2011).
Kurt Goldstein was a neuropsychiatrist who studied brain injuries and aphasia as a language disorder as opposed to a speech disorder. Of particular relevance to Americans reading Goldstein were his ideas of symbol formation, his concept of concrete and abstract attitudes to account for literalness in aphasia, and his notion of inner speech, a level of language located in processing somewhere between perceived and motor speech (Duchan, 2011).
The Linguistic Era (1965 – 1975)
The Linguistic Era involved the developed of behavior medication programs dedicated to teaching language behavior, syntax assessment, and further advancements in research methodologies, articulation disorders and psycholingual advancements. With the termination of the second-world war there was a new emphasis on developing frameworks for conducting therapy with aphasic veterans, which was then gradually transferred to other patients and children with similar conditions or disorders (Duchan, 2011).
The Pragmatics Revolution (1975 – 2000)
Around 1975 emphasis began to shift from defining language in terms of form (syntax and phonology) and content (semantics) to defining language in terms of its use (Duchan, 2011). Groupings of communicative acts and functions, such as requests or greetings, and non-verbal aberrant behavior were further defined and incorporated into therapies.
Speech act theory helped to establish pragmatics as a clinical field involving structural linguistics, conversation, discourse genres, social interaction and event participation. In combination, these areas changed clinical practice so dramatically that their combined additions into assessment and intervention began to be called a "pragmatics revolution" (Duchan, 2011).
Communication therapy and the incorporation of social interactions into clinical therapies allowed for significant advances in the development of educational tools and curriculum-based therapy programs. Clinical services were now delivered in classrooms, homes and other community settings (Duchan, 2011).
How to Become a Speech Language Pathologist
An aspiring speech language pathologist must follow a specific educational path in order to become licensed to practice in this medical field. An undergraduate degree, graduate degree, and a clinical fellowship must be completed, in addition to passing a national examination for speech language pathology.
Undergraduate Degree
Some colleges and universities offer an undergraduate degree in communication science disorders, although this major is not a requirement to become a speech language pathologist. Other majors related to speech language pathology include communication, speech, or hearing sciences. It is recommended that any future speech language pathologist research accredited graduate programs to determine an appropriate undergraduate major.
Graduate Degree
Regardless of the state a speech language pathologist practices in, they must complete a graduate program in speech language pathology that is accredited by the Council on Academic Accreditation (CCA), which results in a master’s degree in speech pathology. Coursework in the graduate program may include voice articulation, phonology, literacy and neurological substrates. Some students may choose to specialize in early intervention, child and adolescent therapy or neurogenic disorders.
Also included in a speech pathology graduate program is clinical training. During the clinical education, students diagnose and treat patients under the supervision of a licensed speech language pathologist. In addition, students may choose to elect courses in a foreign language to improve their communication skills with patients who may not speak fluent English.
Fellowship
A clinical fellowship is not required for licensing in most states; however, it is required to become certified by the American Speech Language Hearing Association (ASHA). Certification is available in academic programs, clinical practice, continuing education and clinical specialty recognition.
Speech language pathologists who choose a sub-specialty field typically complete a fellowship in order to receive additional training and education to develop the required skills needed for a sub-specialty area.
Licensing and Certification
Speech language pathologists must possess a minimum of a graduate degree and pass the Praxis examination in order to become licensed in most of the United States, although the requirements may vary slightly by state. A speech language pathologist cannot legally evaluate or treat patients without a license. To become certified, a license must be maintained.
Many speech language pathologists are certified through the Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP). Some hold dual certifications in speech language pathology and audiology. To become certified, a speech language pathologist must complete a minimum of a graduate degree from an accredited college or university, pass the Praxis examination, and complete at least a 36-week clinical fellowship.
Job Prospects
Because of the high demand for speech-language pathology services, part-time, full-time, and PRN (literally, pro re nata—in medicine, on an "as needed" basis) opportunities may be available depending on location, desired facility, employment flexibility, and other factors (ASHA, 2017). Salaries for speech language pathologists range between $70,000 and $93,000, although this may vary depending on experience and location. Administrative positions may earn a higher salary as well. Hourly pathology employees are paid a rate between $40 and $76 per hour.
The Bureau of Labor Statistics (BLS) projects a job growth of 21% by the year 2024, which is more than the average of all occupations. Most recent graduates are able to find employment shortly after obtaining their license. The predicted job growth is due to a variety of factors, including a rapidly increasing aging population, medical advances, growth in academia enrollments and an increasing demand for speech language pathologists in health care and private practice settings (ASHA, 2017).
Speech-language pathology requires attention to detail, specialized knowledge and skills and intense concentration. The emotional needs of clients and their families may also be demanding. This field enjoys flexibility of schedule and a variety of daily tasks and activities.
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