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Speak Out June 2013 25
SPA online update and profile
• “How foetuses learn language” (9 May)
• A virtual speech pathologist is being
developed in America. Any thoughts? (2 May)
• A study of 900 pre-schoolers has found
half of those with communication issues
are neglected (29 April)
• Friday afternoon food for thought: How
the Brain Speaks Two Languages (25 April)
• Speech pathology is 12th best job in
2013 according to Wall St Journal (22 April)
• Tasmanian member Holly Puckering on
ABC Breakfast this morning speaking about
Tounge Tie (18 April)
• Gelada baboons calls may help to reveal more
about the origins of human speech (9 April)
• One in five kindy children are likely to struggle
(4 April)
Join in the conversation and follow
Speech Pathology Australia on Twitter:
@SpeechPathAust
Speech Pathology Australia Facebook highlights
from April to May included...
Thumbs up for a great effort!
SPA Twitter update
Links to recent newsworthy articles tweeted and/or re-tweeted on our Twitter feed in April-May included:
The Speech Pathology
Australia Facebook
site has now reached
an impressive 2,816
followers at the time this
issue of Speak Out went
to print – this number
exceeds half of our total membership!
As a member you can help us spread the
news about the important work of our
profession by ‘Liking’ us on Facebook, and if
you see an article, photo and/or link posted
on our page that piques your interest, please
feel free to ‘like’ this and share it with your
colleagues and wider Facebook network –
the more the merrier!
What isaSpeechPathologist?
Speechpathologists
study,diagnose and treatcommunicationdisorders, includingdifficulties
with speech, language, swallowing,fluencyand voice.
Theyworkwithpeoplewhohavedifficultycommunicatingbecauseofdevelopmentaldelays,stroke,brain injuries, learningdisability, intellectualdisability,cerebralpalsy,dementiaand
hearing loss,aswellasotherproblems that canaffect speechand language.
Peoplewhoexperiencedifficulties swallowing foodanddrink safelycanalsobehelpedby
a speechpathologist.
Using assessment tools, speech
pathologists are able todiagnose
eachperson’s specificproblem and
devise a treatmentplan thatbest
suits their needs.
Speechpathologists are specialists
whowork cross
their entire adult
might visit a speechpathologist to
help them understand and find the
rightwords to use after a stroke,
while a childmight need treatment
to help their expressive language
(puttingwords together andbeing
understood)or receptive language
(understanding instructions and
meanings).Speechpathologists
alsoworkwithAugmentative and
AlternativeCommunication (AAC),
devices that helppeoplewho
find itdifficult to speakorwrite to
communicatemore easily. This
can include ‘unaided systems’
like signing and gesturesor ‘aided
systems’ likepicture charts,books
and special computers ordevices.
What iscommunication?
Communication involves speaking,hearing, listening,understanding, social skills, reading,writingand
using voice.
What is communication impairment?
Peoplewhohavedifficultycommunicatingmay require assistancewith:
Speech: involves saying the sounds inwords so thatpeoplecanunderstandwhat is
being said.For example, a childwhodoesn’t saywordsclearlyor anadultwho slurs their speechafteran accident.
Language:involves theexchangeof ideasusingwords,usually in spokenorwritten form.
For example,a childwhohas troubleunderstanding and following instructionsoranadultwhocan’t
find the rightwords after a stroke.
Literacy:involves reading,understandingwhat is read andcommunicating inwritten form.
SocialCommunication:ishowwecommunicateand involves interpreting the
contextof aconversation,understandingnon-verbal informationand the social rulesof
communication thatareneeded todevelop a relationshipwithanotherperson.
Voice:using the vocal cordsor voicebox toproduce speech.Forexample,apersonwho frequently
loses their voiceorapersonwhohashad surgery for throatcancer.
Fluency:commonly knownas stuttering.Thisproblem isusuallyfirstnoticedwhenachild starts
putting sentences togetherbutcan continue intoadulthood.
•Childrenwithautism,Down
Syndrome,andCerebralPalsy
oftenbegintheirlifewitha
communicationimpairment
•
20%offouryearoldchildren
havedifficultyunderstandingor
usinglanguage
• 14%of15yearoldshaveonly
basicliteracyskills
• 28%ofteacherstaketimeoff
workeachyearbecauseof
voiceproblems
•Atleast30%ofpeoplepost-stroke
sufferlossoflanguage(aphasia)
• 85%ofthosewithParkinson’s
diseasehavevoice,speechand/
orswallowingdifficulties
• 13,000Australiansuse
electroniccommunicationaids
togettheirmessageacross
•Childrenwithalanguage
impairmentaresixtimesmore
likelytohaveareadingproblem
thanchildrenwithout
• 46%ofyoungAustralianoffenders
havealanguageimpairment
• Thereisahighcorrelation
betweencommunication
difficultiesandpoormentalhealth
• Threeinevery1,000newborns
havehearingloss,whichwithout
interventioncanaffecttheir
speech,languageandliteracy.
Indigenouschildrenhavethree
timesmorehearingproblems
thannon-Indigenouschildren
Communication impairment ismorecommon than you think...
Communication impairment
inAustralia
Stutteringisaspeechdisorder thatcauses interruptions in the rhythmorflowofspeech.
These interruptionsmay include
repeated sounds (
c-c-can), syllables (da-da-daddy
),words (and-and-and) orphrases (Iwant-Iwant-Iwant
). Repetitionsmighthappenonce (
b-ball, can-can)ormultiple times (
I-I-I-I-Iwant, m-m-m-m-m-m-mummy
).Stuttering mayalso includeprolongations,
where soundsorpartsof theword are stretchedout (
caaaaan Igo)and blocks.Blocksareoften silentandare
seenwhen it looks like theperson is
stuck, trying to speakwithno sound
comingout.Thereareoften secondary
behaviourswhichaccompany stuttering.
Thesemaybe verbaland includegrunts,
smallnon-speech sounds, fillerwords
(um/er)orpauses.Theycanalsobe
non-verbal likegrimacing,blinkingor bodymovements.
Theexactcauseof stuttering is
unknown.Speechdisordersare thought
tobecausedbydifferences inbrain
activity related to speechproduction.
Thismeans that stuttering isnotusuallycausedor triggeredbyanevent,person,
experience, stressoranxiety.Some
people inheritapredisposition to stutter.
Whodoesstutteringaffect?
Stuttering can affect children,
adolescents and adults.Around1%
of thepopulation experiences stuttering
at anygiven time and asmany as
5% across a life time.Stuttering
usually starts in early childhood,
oftenby the age of three. Itmay startgraduallyoverdays,weekormonths,
or it canbe sudden, over hours or a
day.Stutteringmay change in type or
frequencyover time. Itmaydecrease
or seem to go away forperiods of time.
Recent research inAustralia
indicates that8.5%of3 yearold
childrenexperience stuttering.
Stuttering
What isAAC?
AugmentativeandAlternativeCommunication (AAC) isany typeofcommunicationstrategy forpeoplewitha rangeofconditionswhohavesignificantdifficultiesspeaking.
Thereare twomain types
ofAAC –aidedAACand
unaidedAAC.
AidedAACis any external item used
to aid communication (e.g. object
symbols, communicationboards,books,
key-ringmini-cards,wallets, speech
generatingdevice, computer,mobilephone, tablet).AidedAAC includesboth
high technology systems and low/light
technology systems.
UnaidedAACrefers to communication
techniques thatdo not require the use
of an external aid. That is, theperson
useswhatever is available to them,
generally their ownbody.Examples
of unaidedAAC include using eye
contact, facial expression,body
language,gestures andmanual sign.
Whymightsomeoneneed to
useAAC?
If aperson is not able speak theymay
need a variety ofdifferent typesofAAC
systems to communicate.
Somepeople also needAAC systems
and strategies to understand another
person’smessage.
Peoplewho havedifficulties speaking
often needboth high technology sytems,
low technology systems and unaided
AACdepending onwhere they are and
withwhom they are communicating.
OneAAC system or strategymay notbe
sufficient tomeet all of their needs, allof
the time.
Augmentativeand
AlternativeCommunication
Language is fundamental to yourbaby’sdevelopment.Everybaby learns to speakby
listening,playingwith soundsand talking toothers.
Babiesbegin to learn from themoment theyareborn – first receptive language skills
(understandingwhat theyhear), then expressive language skills (speaking).
You canhelpdevelopboth kindsof language skillsby talking,watching, listening,playing and
sharingbookswith yourbaby.
Talking
• Talktoyourbabyoften,speaking
slowly,clearlyandsimply
• Emphasisewordsfortheobjects
mostcommonlyusedinyour
baby’sworld
•Useavarietyofwordstodescribe
whatishappeningaroundyou,not
justthenamesofthings
•Repeatwords–yourbabywill
begintounderstandthemeaning
ofthemiftheyhearthemoften
• Imitatethesoundsyourbaby
makesorsaythewordthey
maybetryingtouse
•Commentonthesoundsyou
heartodrawyourbaby’sattention
tothesound
• Taketurnswhenyoutalkand
play,pausingtolistenandspeak
justlikeyouwouldinanadult
conversation
Playing
•Babieslearnabouttalkingand
listeningthroughplay,soit’s
importanttosetasidetimetoplay
withyourbabyeachday
•Createopportunitiesforyourbaby
toplaywithotherchildrenby
joiningaplaygrouportoylibrary,
orspendingtimewithpeople
whoalsohaveyoungchildren
•Watchyourbabyandcopytheir
actionsandsounds.Showthem
newactionsandactivities •Choosegamesandtoys
appropriatetoyourbaby’sage
thatencourageexploration,
problemsolvingandinteraction
betweenyouandyourbaby.
•Fingergames,softdollsand
stuffedtoys,balls,blocksand
activityboardsallhelptodevelop
yourbaby’sfingersandhands,
aswellaslisteningandlearning
skills
•Buildarepertoireofsongsand
rhymes.Singingthesamewords
overandoveragainwillhelpyour
babylearnlanguageandrhythm
Sharebooks
Earlyreadingpromotesgood
languageandthinkingskills,preparing
childrenforlearningtoreadandwrite.
•Readtoandwithyourbabyfrom
birth–makebookspartofyour
dailyroutine
•Choosebookswithlarge,bright
pictures.Babieslovepicturesof
otherbabiesandphotosoftheir
family
• Pointtoandnameobjects,animals
orpeople–eventuallyyourbaby
willrespond
Helping yourbaby to talk
Learning to speakis a crucialparof a child’sdevelopmentand themost intensiveperiod
of speechand languagedevelopmenthappens in the first three yearsof life.
Even though children vary in theirdevelopmentof speech and language, thereare certain
‘milestones’ thatcanbe identifiedas a roughguide tonormaldevelopment.Typically, these
skillsmustbe reachedatcertain agesbeforemorecomplex skillscanbe learned.These
milestoneshelp speechpathologistsdetermine ifa childmayneed extrahelp to learn to speak
oruse language.
Babies:0-1 year
During their first year, childrendevelop the ability to hear and recognise the
sounds of theirparents’ language. They experimentwith soundsbybabbling
(e.g. “baba”, “babamada”), andover time, theirbabblingbegins to soundmore
andmore like realwords.
What canmostbabiesdo?
•Between 0-3monthsbabies communicateby crying, cooing, smiling, and
making eye contact
•Between 3-6monthsbabies communicateby crying, cooing, smiling,
making eye contact,pointing,blowing raspberries and laughing
•Between6-9monthsbabies communicatebybabbling, using sounds
madewith the lips (e.g.b andm) in sequences like “baba” and later
“bamada”
•Between 9-12monthsbabies communicatebybabbling, usingmore
sounds (e.g.d,m, n, h,w, t)
• Around 12monthsbabiesbegin to usewords
Whatdomanybabies still finddifficult?
Babies can’t saywords the sameway as adultsdo andoften simplifywords
(e.g.biscuitbecomes “bi”).
How canparentshelp?
Childrenwhodo notprogress through this stageof “playingwith sounds” are
at riskof speechdifficulties later.Parents can helpby talking to their infants and
responding to any attemptsby their infants to communicate (e.g.by copying
theirbabbling). For information about helping yourbaby to talk, see the
“Helping yourbaby to talk”fact sheet.
TheSoundofSpeech:0 to3 years
Theagesand stagesofchildren’s
speechdevelopment
Learning to speak
is acrucialpartofa child’sdevelopmentandprogressmade in thepreschool
and early school years is crucial tomastering the rulesof language.
Even thoughchildrenvary in theirdevelopmentofspeechand language, therearecertain ‘milestones’
thatcanbe identifiedasa roughguide tonormaldevelopment.Typically, theseskillsmustbe
reachedatcertainagesbeforemorecomplexskillscanbe learned.Thesemilestoneshelpspeechpathologistsdeterminewhetherachildmayneedextrahelp to learn to speakoruse language.
Preschoolchildren:3 to5 years
Preschool children start to usemuch longer sentences, yet their speech should
stillbe understoodby unfamiliarpeople (outsideof the family) about75%of the
5 years of age, anyone (including unfamiliar listeners) shouldbe able to
understand the child’s speech in conversation 95-100% of the time.
What canmostchildrendo?
•
By4 years, children can saymost sounds correctly (e.g.,m, n, h,w,p,b,
t,d, k,g, ng, f, y, s, z, ch, j, sh, l). They can usemany consonant clusters,
which are combinations of twoormore sounds (e.g., tw, sp, gl).Children
may use clusters at the start (e.g.,blue) or endofwords (e.g., hand).Also,
childrenwill saymost vowel sounds inwords correctly (e.g., ay, oh, ee).
•
Between4-5 years,preschool children start todevelop skills thatwillbe
important for learning to read andwrite (called “pre-literacy skills”).They
become aware that spokenwords can rhyme (e.g., cat –bat), and canbe
broken into syllables/beats (e.g., am-bu-lance).
Whatdomanychildren still finddifficult?
• Some sounds are later todevelop and childrenmay still havedifficultywith
them at this age. For instance,preschool children commonly havedifficulty
with “r” (e.g., saying “wed” for red), “v” (e.g., saying “berry” for very), and “th”
(e.g., saying “fank you” for thank you)
• Some children are stilldeveloping the ability to use consonant clusters (e.g.,
scribble and strawberry),or to say all the sounds correctly in longerwords
(e.g., caterpillar and spaghetti).Some childrenmay stillproduce “s” as “th”
(e.g., a lisp)
Whatcanparentsdo tohelp?
Ifparentsareconcernedabout theirchild’sspeechdevelopment, theyareadvised to
have theirchild’shearingcheckedbyanaudiologistashearing is important in learning
how tosaysoundscorrectly.Also,parentscan visitaspeechpathologist ifconcerned
about theirchild’sspeechdevelopment. Inparticular,a visit to thespeechpathologist
is recommended ifchildrencannotbeunderstood, if theyare frustratedwithattempts
tocommunicate, if theirspeechappears veryeffortful, if theyareusing very few
words,or if theyarenotusingsoundsat thestartofwords (e.g.,saying “ish” for fish).
TheSoundofSpeech:
preschooland schoolagedchildren
Theagesand stagesofchildren’s speech
development
•2.4%oftheAustralianpopulation(455,000)isIndigenous
•Morethan50%oftheIndigenouspopulationliveinremoteareas
•84%ofIndigenouspeoplelivinginremoteareasdonotspeakAustralianEnglishathome
•21%ofIndigenousAustraliansdon’tuseAustralianEnglish
Indigenouschildrenhave a higher
riskof health andotherproblems
thanotherAustralian children.Theyare twice as likely tobebornwith
lowbirthweightwhich can lead to
communicationdifficulties. Indigenous
children have extremely high ratesof
middle eardisease (around 70%of all
children in remote communities),which
can lead to conductive hearing loss.
Hearing loss from early in life can affect
thedevelopmentof listening, speech
and language skills, aswell as literacy
development.
AboriginalEnglish
80%of IndigenousAustralians speak
‘Kriol’or adialectof ‘Aboriginal
English’ andmanypeoplewho hear it
spokenwrongly assume it tobe “pidgin
English”. In fact,most Indigenouschildren in remote areas know threeor
four complex languages anddialects
and it’s these they’vegrown upwith,
not standardAustralianEnglish.
AboriginalEnglish varies across
Australia,butdiffers toStandard
AustralianEnglish in its sound system,
grammar, story structure and in the
way it’s used –wordsoften have
differentmeanings and take into
account the rich linguistic heritageof
Indigenous culture.
It is important that speechpathology
services aredelivered from the
Speechpathologyand
Indigenouschildren
Mentalhealth
Mentalhealth is related topromotionofwell-being andprevention, treatment and rehabilitation
ofpeople affectedbymentalhealthdisorders.Mentalhealthdisorders affect aperson’s social,
emotional and/orbehavioural functioning and canbe influencedbyanumberof individual and
environmental factors includingbiological,psychologicaland social factors.
Communication impairment
Communicationdisordersmay involvedifficulties inoneormoreof the following:
•Speechproduction•Understandingwhatotherpeople are saying
• Formulating ideas intowords to talk toor respond toothers
•Having the social skills required to interactappropriatelywithothersacross the lifespan ina
varietyof situations
Communication impairmentcan impact
onaperson’sability toparticipate in
schoolandeducation,getand keepa
joband socialisewith their family, friends
andcommunity.This limits theway they
form friendshipsand relationshipsas
wellasaffecting thedevelopmentof
appropriatecommunication skills.
Communicationandmental
healthdisorders
Communicationdisordersoftenco-
occur in individualswithmentalhealth
issues,withsomepeopleexperiencing
mentalhealthproblems related to
pre-existingcommunicationconditions
(e.g. they feeldepressedoranxious
about theircommunicationdifficulties).
Communicationand/orswallowing
difficultiescanalsobepartofaperson’s
mentalhealthdisorder (e.g.disordered
speechand languagecanbe features
ofschizophrenia,andswallowing
difficultiesaspartofdementia).
Swallowingdisorders inmentalhealth
oftenoccurasasideeffectofmedication
orasa resultofsubstanceabuseor
acquiredbrain injury.
Adultsandchildrenwith speechand
language impairmentsaremore likely
tohavementalhealthproblems than
thosewithout.There isalsoa strong
linkbetweenaperson’scommunication
skillsand theirmentalhealth status.
The roleof speechpathologists
inmentalhealth
Speechpathologistsaim to improvea
person’scommunicationandswallowing
skillsso theycan function ineveryday
life.Thegoalofspeechpathology
intervention is to improveaperson’s
ability to functionphysically,sociallyand
mentallyathome, in theclassroom, in
theworkplace, insocialsituationsand in
mentalhealth treatmentprograms.
Speechpathologistsarean important
partof thementalhealth team that
assessespeoplewithmentalhealth
issues,as they identifycommunication
difficultiesanddevelopappropriate
treatment targets.Aspartofamental
health team, speechpathologistsplay
an important role indiagnosingcertain
mentalhealthconditions, likedementia,
schizophrenia,autism spectrum
Speechpathology in
mentalhealth services
(Clockwise from top left) Our
shelves at National Office began
filling up quickly with 2013
Book of the Year contenders;
we launched the new suite of
fact sheets with much positive
feedback received; SPA
showed support for important
initiatives such as World Autism
Awareness Day (2 April) and
World Voice Day (April 16).
Remember to join the discussion at the 2013 National Conference! #SPAConf2013