Speech-language pathology is a field of expertise practiced by a clinician known as a speech-language pathologist (SLP) or a speech and language therapist, both of whom may be known by the shortened description, speech therapist. SLP is considered a "related health profession" or "allied health profession" along with audiology, optometry, occupational therapy, rehabilitation psychology, physical therapy, behavior analysis and others. SLPs specialize in the evaluation, diagnosis, and treatment of communication disorders (speech disorders and language disorders), cognitive-communication disorders, voice disorders, and swallowing disorders. SLPs also play an important role in the diagnosis and treatment of autism spectrum disorder (often in a team with pediatricians and psychologists).
Speech-language pathologists (SLPs) provide a wide range of services, mainly on an individual basis, but also as support for individuals, families, support groups, and providing information for the general public. SLPs work to prevent, assess, diagnose, and treat speech, language, social communication, cognitive-communication, voice, fluency, and swallowing disorders in children and adults. Speech services begin with initial screening for communication and swallowing disorders and continue with assessment and diagnosis, consultation for the provision of advice regarding management, intervention, and treatment, and providing counseling and other follow up services for these disorders. Services are provided in the following areas:
Speech, language, and swallowing disorders result from a variety of causes, such as a stroke, brain injury, hearing loss, developmental delay, a cleft palate, cerebral palsy, or emotional issues.
A common misconception is that speech-language pathology is restricted to the treatment of articulation disorders (e.g. helping English speaking individuals enunciate the traditionally difficult "r") and/or the treatment of individuals who stutter but, in fact, speech-language pathology is concerned with a broad scope of speech, language, literacy, swallowing, and voice issues involved in communication, some of which include:
The components of speech production include: (i) phonation (producing sound), (ii) resonance, (iii) fluency, (iv) intonation, (iv) pitch variance; (v) voice (including aeromechanical components of respiration).
The components of language include: (i) Phonology (manipulating sound according to the rules of a language); (ii) Morphology (understanding components of words and how they can modify meaning); (iii) Syntax (constructing sentences according to the grammatical rules of a target language), (iv) semantics (interpreting signs or symbols of communication such as words or signs to construct meaning); (v) Pragmatics (social aspects of communication).
Primary pediatric speech and language disorders include: (i) receptive and (ii) expressive language disorders, (iii) speech sound disorders, (iv) childhood apraxia of speech (CAS), (v) stuttering, and (vi) language-based learning disabilities. Speech pathologists work with people of all ages.
Swallowing disorders include difficulties in any system of the swallowing process (i.e. oral, pharyngeal, esophageal), as well as functional dysphagia and feeding disorders. Swallowing disorders can occur at any age and can stem from multiple causes.
SLPs collaborate with other health care professionals, often working as part of a multidisciplinary team. They can provide information and referrals to audiologists, physicians, dentists, nurses, nurse practitioners, occupational therapists, rehabilitation psychologists, dietitians, educators, behavior consultants (applied behavior analysis) and parents as dictated by the individual client's needs. For example, the treatment for patients with cleft lip and palate, often requires multidisciplinary collaboration. Speech-language pathologists can be very beneficial to help resolve speech problems associated with cleft lip and palate. Research has indicated that children who receive early language intervention are less likely to develop compensatory error patterns later in life, although speech therapy outcomes are usually better when surgical treatment is performed earlier. Another area of collaboration relates to auditory processing disorders, where SLPs can collaborate in assessments and provide intervention where there is evidence of speech, language, and/or other cognitive-communication disorders.
SLPs work in a variety of clinical and educational settings. SLPs work in public and private hospitals, private practices, skilled nursing facilities (SNFs), long-term acute care (LTAC) facilities, hospice, and home healthcare. SLPs may also work as part of the support structure in the education system, working in both public and private schools, colleges, and universities. Some SLPs also work in community health, providing services at prisons and young offenders' institutions or providing expert testimony in applicable court cases.
Following the American Speech-Language-Hearing Association's (ASHA's) 2005 approval of the delivery of speech/language services via video conference or telepractice, SLPs in the United States have begun to use this service model.
SLPs conduct research related to communication sciences and disorders, swallowing disorders, or other upper aerodigestive functions.
In the United States, speech-language pathology is a Master's entry-level professional degree field. Clinicians must hold a master's degree in Communicative Disorders/Speech-Language Pathology (e.g. M.A., M.S., or M.Ed.) that is from a university that holds regional accreditation and from a communication sciences and disorders program that is accredited by the American Speech-Language-Hearing Association (ASHA), the profession's national governing body as well as individual state's governing board. Programs that offer the M.Ed. degree are often housed within a university's College of education, but offer the same education and training as programs with a M.A. or M.S. degree. Beyond the master's degree, some SLPs may choose to earn a clinical doctorate in Speech-Language Pathology (e.g. CScD or SLPD), or a doctoral degree that has a research and/or professional focus (e.g., Ph.D., or Ed.D.). All degrees must be from a university that holds regional accreditation, but only the master's degree is accredited by the American Speech-Language-Hearing Association (ASHA).
All clinicians are required to complete 400 clinical hours (25 observation hours often completed during the undergraduate degree and 375 hours of graduate Clinical Practicum). They must pass multiple comprehensive exams also called Knowledge and Skills Acquisition (KASA) exams.
After all the above requirements have been met during the SLP's path to earning the graduate degree, SLPs must state licensure and national certification by:
Maintaining licensure through continuing education:
Continuing education and training obligations:
Salaries of SLPs in the United States depend on a variety of factors including educational background, work experience, and location. The ASHA 2016 Schools Survey revealed that SLPs received a median academic year salary of $62,000, which is a 2% increase from the latest Schools Survey done in 2014. The 2015 SLP Health Care Survey placed the median salary for SLPs working within the health care industry at $75,000. However, salaries can range from $60,570–97,770. In Australia, the basic salary that a Graduate SLP would earn is estimated at AU$59,500 and around AU$55,000 for a Private SLP.
For many parents, the decision of whether or not to enroll students into school-based speech therapy or privately practiced therapy is challenging. Speech Pathologists work as part of a team alongside teachers, counselors, social workers and parents when in a school setting. Because school-based speech therapy is run under state guidelines and funds, the process of assessment and qualification is more strict. To qualify for in-school speech therapy, students must meet the state's criteria on language testing and speech standardization. Due to such requirements, some students may not be assessed in an efficient time frame or their needs may be undermined by criteria. For a private clinic, students are more likely to qualify for therapy because it is a paid service with more availability.
Speech-language pathologists work with clients and patients who may present with a wide range of issues.
In the US, some children are eligible to receive speech therapy services, including assessment and lessons through the public school system. If not, private therapy is readily available through personal lessons with a qualified Speech-Language Pathologist or the growing field of telepractice. Teleconferencing tools such as Skype are being used more commonly as a means to access remote locations in private therapy practice, such as in the geographically diverse south island of New Zealand. More at-home or combination treatments have become readily available to address specific types of articulation disorders. The use of mobile applications in speech therapy is also growing as an avenue to bring treatment into the home.
In the UK, children are entitled to an assessment by local NHS Speech and Language Therapy teams, usually after referral by health visitors or education settings, but parents are also entitled to request an assessment directly. If treatment is appropriate, an educational plan will be drawn up. Speech therapists often play a role in multi-disciplinary teams where a child has speech delay or disorder as part of a wider health condition. The Children's Commissioner for England reported in June 2019 that there was a postcode lottery. £291.65 a year per head was spent on services in some areas, while the budget in some areas was £30.94 or less. In 2018, 193,971 children in English primary schools were on the special educational needs register needing speech therapy services.