Speak Out April 2013

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: Introducing our new suite of fact sheets!

Communication impairment inAustralia

Stuttering

What isaSpeechPathologist?

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.

Communication impairment ismorecommon than you think...

Stuttering isaspeechdisorder thatcauses interruptions in the rhythmorflowofspeech. These interruptionsmay include

13,000Australiansuse electroniccommunicationaids togettheirmessageacross impairmentaresixtimesmore likelytohaveareadingproblem thanchildrenwithout 46%ofyoungAustralianoffenders havealanguageimpairment Thereisahighcorrelation betweencommunication difficultiesandpoormentalhealth Threeinevery1,000newborns havehearingloss,whichwithout interventioncanaffecttheir speech,languageandliteracy. Indigenouschildrenhavethree timesmorehearingproblems thannon-Indigenouschildren

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• Childrenwithautism,Down Syndrome,andCerebralPalsy

Speechpathologists study,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.

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

oftenbegintheirlifewitha communicationimpairment 20%offouryearoldchildren havedifficultyunderstandingor usinglanguage 14%of15yearoldshaveonly basicliteracyskills 28%ofteacherstaketimeoff workeachyearbecauseof voiceproblems • Atleast30%ofpeoplepost-stroke sufferlossoflanguage(aphasia) • 85%ofthosewithParkinson’s diseasehavevoice,speechand/ orswallowingdifficulties

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

• Childrenwithalanguage

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Peoplewho experiencedifficulties swallowing food anddrink safely canalsobehelpedby a speechpathologist.

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(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.

Augmentativeand AlternativeCommunication

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. TheSoundofSpeech:0 to 3 years Theagesand st gesofchildren’s speechdevelopment

Using assessment tools, speech pathologists are able todiagnose eachperson’s specificproblem and devise a treatmentplan thatbest suits their needs. Speechpathologists are specialists 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 whoworkwithpeople across their entire lifespan.An adult

• Helping yourbaby to talk

( um/er )orpauses.Theycanalsobe non-verbal likegrimacing,blinkingor bodymovements. Theexactcauseof stuttering is unknown.Speechdisordersare thought

Language is fundamental to 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.

Recent research inAustralia indicates that8.5%of3 yearold childrenexperience stuttering. Learning to speak is 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.

Talking •

• 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 languageandthinkingskills,preparing childrenforlearningtoreadandwrite. • Readtoandwithyourbabyfrom birth–makebookspartofyour dailyroutine • Choosebookswithlarge,bright Sharebooks Earlyreadingpromotesgood pictures.Babieslovepicturesof otherbabiesandphotosoftheir family Pointtoandnameobjects,animals orpeople–eventuallyyourbaby willrespond

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, •

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.

What isAAC? AugmentativeandAlternativeCommunication (AAC) isany typeofcommunicationstrategy forpeople witha rangeofconditionswhohavesignificantdifficultiesspeaking.

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.

Thereare twomain types ofAAC –aidedAACand unaidedAAC. AidedAAC is 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. UnaidedAAC refers 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.

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orspendingtimewithpeople whoalsohaveyoungchildren

Speechpathologyand Indigenouschildren

Speechpathology in mentalhealth services

TheSoundofSpeech: preschooland schoolagedchildren Theagesand stagesofchildren’s speech development

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

Learning to speak is 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).

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,wit hsomepeopleexperiencing mentalhealthproblems related to pre-existingcommunicationconditions (e.g. they feeldepressedoranxious about theircommunicationdifficulties). Communicationand/orswallowing difficultiescanalsobepartofaperson’s mentalhealthdisorder (e.g.disordered speechand lan guagecanbe features

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

• 2.4%oftheAustralianpopulation(455,000)isIndigenous • Morethan50%oftheIndigenouspopulationliveinremoteareas • 84%ofIndigenouspeoplelivinginremoteareasdonotspeakAustralianEnglishathome • 21%ofIndigenousAustraliansdon’tuseAustralianEnglish

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

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

ofschizophrenia,andswallowing difficultiesaspartofdementia).

Swallowingdisorders inmentalhealth oftenoccurasasideeffectofmedication orasa resultofsubstanceabuseor acquiredbrain injury.

• What is a speech pathologist?

• Speech pathology in mental health services

• The sound of speech: preschool and school aged children

• Communication impairment in Australia

Coming soon: Speech, Language, Swallowing and Voice.

• Communication impairment following stroke

• Stuttering

• AAC

If you think we should develop a fact sheet for a certain topic, please email your suggestion to marketing@speechpathology australia.org.au

• Speech pathologists working with older people

• Helping your baby to talk

• Speech pathology and Indigenous children

• The sound of speech: 0 to 3 years

Clinical guideline developed for management of laryngectomy

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

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Speak Out April 2013

Speech Pathology Australia