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6 Speak Out April 2013 Speech Pathology Australia
Association News
T he long-awaited updated
set of fact sheets is now
available!
You can now access the 11 revised or
brand-spanking new fact sheets, with
another four on the way soon.
Thank you to everyone who provided
their expertise to make this project
happen.
Now available from the ‘Information
for the Public’ section of the website
are:
• What is a speech pathologist?
• Communication impairment
in Australia
• Stuttering
• AAC
• Helping your baby to talk
• The sound of speech:
0 to 3 years
• The sound of speech: preschool
and school aged children
• Communication impairment
following stroke
• Speech pathologists working
with older people
• Speech pathology and
Indigenous children
• Speech pathology in
mental health services
Coming soon: Speech, Language,
Swallowing and Voice.
If you think we should develop
a fact sheet for a certain topic,
please email your suggestion to
marketing@speechpathology
Introducing
our new suite
of fact sheets!
T he Laryngectomy Clinical Guideline has
been developed in response to requests from the
Speech Pathology Australia (SPA) membership for
the development of a clinical guideline for laryngectomy
management.
The Laryngectomy Clinical Guideline provides
speech pathologists with comprehensive information
about the management of individuals who have had a
laryngectomy from the pre-operative phase through to
the long-term/ongoing management phase.
The topics and content of the laryngectomy guideline
address all aspects of communication and swallowing,
and other important rehabilitation areas of focus; such as
humidification and olfaction.
It is anticipated that the clinical guideline will assist
clinicians and employers in identifying the knowledge,
skills and resources required to work in the area of
laryngectomy.
Stacey Baldac
Practice Document Coordinator
Clinical guideline developed for management
of laryngectomy
What isaSpeechPathologist?
Speechpathologistsstudy,diagnose and treatcommunicationdisorders, includingdifficulties
with speech, language, swallowing,fluencyand voice.
Theyworkwithpeoplewhohavedifficultycommunicatingbecauseofdevelopmentaldelays,
stroke,brain injuries, learningdisability, intellectualdisability,cerebralpalsy,dementiaand
hearing loss,aswellasotherproblems thatcan affect speech and language.
Peoplewho experiencedifficulties swallowing food anddrink safely canalsobehelpedby
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 andgesturesor ‘aided
systems’ likepicture charts,books
and special computersordevices.
What iscommunication?
Communication involves speaking,hearing, listening,understanding, social skills, reading,writing and
using voice.
What iscommunication impairment?
Peoplewhohavedifficultycommunicatingmay require assistancewith:
Speech:involves saying the sounds inwords so thatpeople canunderstandwhat is
being said.For example,achildwhodoesn’t saywords clearlyor anadultwho slurs their speech
after anaccident.
Language:involves the exchangeof ideasusingwords,usually in spokenorwritten form.
For example, achildwhohas troubleunderstandingand following instructionsor an adultwhocan’t
find the rightwordsafter a stroke.
Literacy:involves reading,understandingwhat is read and communicating inwritten form.
SocialCommunication:ishowwecommunicate and involves interpreting the
contextof a conversation,understandingnon-verbal information and the social rulesof
communication thatareneeded todevelop a relationshipwith anotherperson.
Voice: using the vocalcordsor voicebox toproduce speech.Forexample, apersonwho frequently
loses their voiceor apersonwhohashad surgery for throat cancer.
Fluency: commonly known as stuttering.Thisproblem isusually firstnoticedwhen a child starts
putting sentences togetherbutcancontinue into adulthood.
• 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 isnotusually
causedor 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 start
graduallyoverdays,weekormonths,
or it canbe sudden, over hoursor a
day.Stutteringmay change in type or
frequencyover time. Itmaydecrease
or seem togo away forperiodsof time.
Recent research inAustralia
indicates that8.5%of3 yearold
childrenexperience stuttering.
Stuttering
What isAAC?
AugmentativeandAlternativeCommunication (AAC) isany typeofcommunicationstrategy forpeople
witha 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,mobile
phone, 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 theirownbody.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 varietyofdifferent types ofAAC
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
AACdependingonwhere 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 fundamentalto yourbaby’sdevelopment.Everybaby learns to speakby
listening,playingwith sounds and talking toothers.
Babiesbegin to learn from themoment they areborn – first receptive language skills
(understandingwhat theyhear), thenexpressive language skills (speaking).
Youcanhelpdevelopboth kindsof language skillsby talking,watching, listening,playingand
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 crucialpar of a child’sdevelopmentand themost intensiveperiod
of speechand languagedevelopmenthappens in thefirst three yearsof life.
Even thoughchildren vary in theirdevelopmentof speechand language, thereare certain
‘milestones’ thatcanbe identifiedasa roughguide tonormaldevelopment.Typically, these
skillsmustbe reachedat certainagesbeforemorecomplex skillscanbe learned.These
milestoneshelp speechpathologistsdetermine if achildmayneed extrahelp to learn to speak
oruse language.
Babies:0-1 year
During their first year, childrendevelop the ability to hear and recognise the
soundsof theirparents’ language. They experimentwith soundsbybabbling
(e.g. “baba”, “babamada”), andover time, theirbabblingbegins to soundmore
andmore like realwords.
Whatcanmostbabiesdo?
• Between0-3monthsbabies communicateby crying, cooing, smiling, and
making eye contact
• Between3-6monthsbabies communicateby crying, cooing, smiling,
making eye contact,pointing,blowing raspberries and laughing
• Between 6-9monthsbabies 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 stillfinddifficult?
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 to 3 years
Theagesand st gesofchildren’s
speechdevelopment
Learning to speakis a crucialpartof a child’sdevelopment andprogressmade in thepreschool
and early school years iscrucial tomastering the rulesof language.
Even thoughchildrenvary in theirdevelopmentofspeechand language, therearecertain ‘milestones’
thatcanbe identifiedasa roughguide tonormaldevelopment.Typically, theseskillsmustbe
reachedatcertainagesbeforemorecomplexskillscanbe learned.Thesemilestoneshelpspeech
pathologistsdeterminewhetherachildmayneed extrahelp to learn to speakoruse language.
Preschoolchildren: 3 to 5 years
Preschool children start to usemuch longer sentences, yet their speech should
stillbe understoodby unfamiliarpeople (outsideof the family) about75%of the
time.By5 years of age, anyone (including unfamiliar listeners) shouldbe able to
understand the child’s speech in conversation95-100%of the time.
What canmost childrendo?
• 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 end ofwords (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).
Whatdomany children 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
Indigenouschildren have a higher
riskof health andotherproblems
thanotherAustralian children. They
are 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
thedevelopment of listening, speech
and language skills, aswell as literacy
development.
AboriginalEnglish
80% of IndigenousAustralians speak
‘Kriol’ or adialect of ‘Aboriginal
English’ andmanypeoplewho hear it
spokenwrongly assume it tobe “pidgin
English”. In fact,most Indigenous
children in remote areas know three or
four complex languages anddialects
and it’s these they’ve grown upwith,
not standardAustralianEnglish.
AboriginalEnglish varies across
Australia,butdiffers toStandard
AustralianEnglish in its sound system,
grammar, story structure and in the
way it’s used –words often 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, treatmentand rehabilitation
ofpeopleaffectedbymentalhealthdisorders.Mentalhealthdisordersaffectaperson’s social,
emotional and/orbehavioural functioning and canbe influencedby anumberof individualand
environmental factors includingbiological,psychologicaland social factors.
Communication impairment
Communicationdisordersmay involvedifficulties inoneormoreof the following:
• Speechproduction
• Understandingwhatotherpeopleare saying
• Formulating ideas intowords to talk toor respond toothers
• Having the social skills required to interactappropriatelywithothersacross the lifespan in a
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.
Communication andmental
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