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Chapter Eleven
Teaching Students
with Communication
Disorders
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Introduction
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Most of us take our ability to communicate for
granted.
When communication is impaired, absent, or
qualitatively different, the simplest interactions
become different or even impossible.
Disorders in communication may result in social
problems in school.
Communication problems are often complex.
There are many different types of communication
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disorders, involving
both
speech
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Definitions of
Communication & Language
COMMUNICATION is the exchange of
information and ideas. Communication
involves encoding, transmitting, and decoding
messages. It is an interactive process requiring
at least two parties to play the roles of both
sender and receiver.
LANGUAGE is a
system used by a group
of people for giving
meaning to sounds,
words, gestures, and
other symbols to enable
communication with
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one another.
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Definition of Speech (Heward, 1995)
SPEECH is the actual behavior
of producing a language code
by making appropriate vocal
sound patterns.
Although it is not the only possible vehicle for expressing
language (gestures, manual signing, patterns, and written
symbols can also be used to convey ideas and intentions),
speech is a most effective and efficient endeavor. Speech
is one of the most complex and difficult human
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endeavors.
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Important Language
Considerations
(American Speech-Language-Hearing Association, 1982)
Language evolves within
specific historical, social,
and cultural contexts.
Language learning and use
are determined by the
interaction of biological,
cognitive, psychosocial, and
environmental factors.
Language is rule-governed
behavior.
Effective use of language
for communication requires
a broad understanding of
human interactions,
including associated factors
such as nonverbal cues,
motivation, and
sociocultural roles.
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Normal and
Disordered Communication
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According to Emerick and Haynes (1986), a
communication difference is considered
a disability when:
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the transmission or perception of messages is faulty.
the person is placed at an economic disadvantage.
the person is placed at a learning disadvantage.
the person is placed at a social disadvantage.
there is a negative impact upon the person’s emotional
growth.
the problem causes physical damage or endangers the
health of the person.
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Types of
Communication Disorders

SPEECH DISORDERS

LANGUAGE DISORDERS
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Speech Disorders

SPEECH DISORDERS
include impairments
 Voice
 Articulation
 Fluency
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Prevalence
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About 2% of the school-age population were classified as
having speech or language impairments during the 19992000 school year.
Because many other students have other conditions as
their primary disability but still receive speech-language
services, the total number of students served by speechlanguage pathologists is about 5% of all school-age
children (2/3s of these students are boys)
Students with communication disorders constitute about
20% of all students with disabilities.
Of the estimated one million students identified as speechlanguage impaired, over 90% are 6 to 12 years old.
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Identification, Assessment,
and Eligibility
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Students with speech or language impairments
are the most highly integrated of all students
with disabilities.
During the 1998-1999 school year, 88.5% of
students with communication disorders were
served in general education classrooms, and
6.5% were served in resource rooms.
The small proportion served in separate
classes most likely represents students with
severe language
delays
and disabilities.
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Types of Speech Disorders
Articulatory &
Phonological
Disorders
Voice Disorders
Fluency Disorders
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Articulatory and
Phonological Disorders
 Articulation and phonological disorders are the most
common speech disorder affecting about 10% of
preschool and school age children.
 The ability to articulate clearly and use the
phonological code correctly is a function of many
variables, including:
 Age
 Developmental History
 Oral-Motor Skills
 Culture
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Most Common Types
of Articulation Efforts
Distortions
 Substitutions
 Omissions
 Additions
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Organic & Functional Causes of
Articulatory & Phonological Disorders
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FUNCTIONAL CAUSES:
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lack of opportunities to
practice appropriate/
inappropriate speech
transient hearing loss
during early development
absence of good speech
models
differences in speech
related to culture (often
do not constitute a
speech disorder)
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ORGANIC CAUSES:
 Cleft palate
 Dental malformations
 Tumors
 Hearing loss
 Brain damage
 Other related
neurological problems
The severity of articulation disorders can vary widely,
depending in part(c) on
the
causes
of©the
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Teaching Suggestions
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Take note of how
understandable or
intelligible the student’s
speech is.
Consider how many
different errors the
student makes.
Consider whether the
errors could be due to
physical problems.
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Evaluate whether the
speech errors may have
an impact of the student’s
ability to read and write.
Observe whether the
articulation errors cause
the student problems in
socialization or
adjustment.
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Voice Disorders Defined
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VOICE DISORDERS are abnormalities of speech
related to volume, quality, or pitch.
Voice disorders are not very common in children.
It is difficult to distinguish an unpleasant voice
from one that would be considered disordered.
Two basic types of voice disorders:
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Phonation - production of sounds by the vocal folds
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EXAMPLE: Hoarseness
Resonance - hypernasality or hyponasality
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Causes of Voice Disorders
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Vocal Abuse and Misuse
Trauma to the Larynx, Nodules, or Tumors
Learned Speech Patterns
Medical Conditions or Trauma
When voice disorders are
related to a medical
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condition, the child may be
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referred to an
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otolaryngologist (ear, nose,
and throat
doctor). resulting
Most voice disorders are due to functional
problems,
from learned speech patterns.
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
Reye’s syndrome
Juvenile arthritis
Psychiatric problems
Tourette syndrome
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Questions to Ask Before Referring a
Student for a Possible Voice Disorder
Is the student’s voice having such
an unpleasant effect on others that
the student is teased or excluded
from activities?
Does the student’s voice problem
make him difficult for others to
understand?
Does the student habitually abuse
or misuse his voice?
Has there been a recent, noticeable
change in the student’s vocal
quality?
Is there a possibility that the voice
disorder is related to another
medical condition?
Might the voice quality be related to
a hearing loss?
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Fluency Disorders Defined
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FLUENCY refers to the pattern of the rate and flow of
a person’s speech.
Normal speech patterns include some interruptions in
speech flow.
When the interruptions in speech flow are so frequent
or pervasive that a speaker cannot be understood,
when efforts at speech are so intense that they are
uncomfortable, or when they draw undue attention,
then the dysfluencies are considered a problem.
Many young children exhibit dysfluencies; these
typically disappear by age 5.
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Fluency Disorders
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Fluency problems consist of blocking,
repeating, or prolonging sounds, syllables,
words, or phrases.
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The most frequent type of fluency disorder is
stuttering, which affects about 2% of the
school-age children.
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More boys than girls are affected.
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Stuttering
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In stuttering, interruptions in speech are
frequently obvious to both the speaker and
the listener.
Stuttering has received much attention, even
though it is not as prevalent as other
communication disorders.
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Causes of Stuttering
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There are many causes of stuttering.
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There is growing evidence supporting a
genetic and physiologic basic of
stuttering.
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When Fluency Disorders are
Considered a Serious Problem
Are the dysfluencies
beginning to occur more
often in the student’s
speech or beginning to
sound more effortful or
strained?
Is the student experiencing
social problems?
Is there a pattern to
situations in which the
student stutters?
Is the student concerned
about his dysfluencies?
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Classroom Accommodations for
Students with Speech Disorders
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Build a Positive Classroom Climate
Help Students Learn to Monitor Their Own
Speech
Pair Students for Practice
Teach Students Affirmations and Positive
Self-Talk
Modify Instruction and Materials
Encourage Parents to Work with Their
Children
Teach Students Their Own Strategies
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Build a Positive
Classroom Climate
Talk with the student privately about his
speech problems.
Give student chances to model and
practice appropriate speech.
Encourage the student’s family to
actively support the educational and
communication program.
Provide lots of opportunities for student
to participate in oral activities.
Work closely with the speech-language
pathologist.
Maintain eye contact when the student
speaks.
Don’t refer to students in terms of their
behaviors (“students” not “stutters”
Educate other students in the class
about speech disorders, when
appropriate.
Encourage the student.
Don’t interrupt or finish the student’s
sentence for him or her.
Be positive.
Be a good listener.
Accept the child.
Reward the student.
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Pair Students for Practice
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To master speech skills, students will
need to practice the skills taught by
the speech-language pathologist
(S/LP).
Students can practice specific
sounds using practice exercises with
a partner using a program such as
Loehr’s Read the Picture Stories for
Articulation (Loehr, 2002).
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Teach Students Affirmations
and Positive Self-Talk
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Low self-confidence and a positive
attitude are important for students with
speech disorders, especially stuttering.
Negative self-talk is common among
individuals with speech disorders.
The goal of positive self-talk is to replace
negative thought patterns.
Encourage students to mentally erase
negative ideas and immediately think of
something positive.
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Modify Instruction and Materials
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Suggestions from Pre-Referral Intervention
Manual (McCarney & Wunderlich, 1988):
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Set up a system of motivators to encourage student’s
effort.
Highlight material to identify key syllables and words in
a passage.
Give student practice listening so that they can learn to
discriminate among sounds, fluent speech patterns, and
good vocal habits.
Tape the student’s reading so that he/she can evaluate
self related to communication goals.
Reduce the emphasis on competition.
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Encourage Parents to Work
with Their Children
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There are many ways to structure practice
activities so that students can work at home with
their parents.
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One program is the book. Oral-Motor Activities for
School-Aged Children.
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This program is a series of homework activities
designed to build speech skills.
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Teach Students Their Own Strategies
Teach student to relax with
Let student practice skills
breathing exercises or mental with a friend in real situations.
energy.
Encourage student to
Allow student to record
participate in groups in which his/her own speech and listen
responses do not have to be carefully for errors.
individually generated.
Teach student to selfreinforce by recognizing
when they are doing well.
Help student come up with
strategies for dealing with
specific people or situations
that make them nervous.
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Language Disorders
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LANGUAGE is the system we use to
communicate our thoughts and ideas to other.
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Language is an integral component of students’ abilities
in reading, writing, and listening.
Disorders of language may have a serious impact on
academic performance.
In recent years, the emphasis in the field of
communication disorders has shifted away from the
remediation of speech problems to an increased focus
on language disorders.
Approximately 50% to 80% of children seen by speechlanguage pathologists
have language disorders.
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Language Disorders
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There are two modes of communication:
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Receptive Language - involves receiving and and
decoding and interpreting language
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Expressive Language - involves encoding or
production of a message
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EXAMPLE: reading and listening
EXAMPLE: writing and speaking
There is a sequence of normal language
development.
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Three Dimensions of Language
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FORM describes the rule systems used in oral
language.
CONTENT refers to the intent and meaning of
language and its rule system.
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Semantics deals with the meaning of words and
word combinations.
FUNCTION refers to the use of language in
social contexts.
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Pragmatics are the rules of social language.
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Language Form
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Involves three different rule systems:
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Phonology - rule system that governs the
individual and combined sounds of a language
(e.g., vowel sounds)
Morphology - rule system controlling the
structure of words (e.g., prefixes and suffixes)
Syntax - rule system that governs the ordering of
words (e.g., verb tense, questions)
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Content Of Language
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Semantics - deals with the meaning of words
and word combinations.
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When students fail to comprehend concrete
and abstract meanings of words, inferences,
or figurative expressions, it is difficult for
them to understand the more subtle uses of
language such as jokes, puns, similes,
proverbs, or sarcasm.
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Function Of Language
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Pragmatics - language that is used in various
social contexts.
If children are to build and maintain
successful relationships with others, they
need to understand and effectively use
language skills that are appropriate to the
context.
Students from different cultural backgrounds
may be particularly challenged in this area.
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Types of
Language Disorders
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Absence of Verbal Language
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Qualitatively Different Language
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Delayed Language Development
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Interrupted Language Development
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Indicators of
Language Impairment
PRIMARY GRADES
Problems in Following Verbal Directions
Difficulty with Preacademic Skills
Phonics Problems
Poor Word Attack Skills
Difficulties with Structural Analysis
Problems Learning New Material
INTERMEDIATE GRADES
MIDDLE AND HIGH
SCHOOL GRADES
Inability to Understand
Abstract Concepts
Problems Understanding
Multiple Word Meanings
Difficulties Connecting
Previously
Learned Information to New
Material that Must Be Learned
Independently
Widening Gap in Achievement
When Compared to Peers
Word Substitutions
Inadequate Language Processing
and Production that Affects
Reading Comprehension and
Academic Achievement
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Classroom Adaptations for
Students with Language Disorders
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Teach Some Prerequisite Imitation Skills
Increase Comprehension in the Classroom
Give Students Opportunities for Facilitative Play
Encourage Students to Talk with Their Teachers and
Peers
Use Naturalistic Techniques and Simulated Real-Life
Activities to Increase Language Use
Encourage Students’ Conversational Skills Through
Story Telling
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Classroom Adaptations for
Students with Language Disorders
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Use Music and Play Games to Improve Language
Arrange Your Classroom for Effective Interactions
Use Challenging Games with Older Students
Modify Strategies to Develop Students’ Learning
Tools
Work Collaboratively with the Speech-Language
Pathologist
Use Storytelling and Process Writing
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Language Differences
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Children’s patterns of speech and language
reflect their culture and may be different from
that of some of their peers.
It is important not to mistake a language
difference for a language disorder.
Cultural variations in family structure,
childrearing practices, family perceptions and
attitudes, and communication style can each
influence students’ communication.
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Relationship Between
Communication Style and Culture
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Culture has a strong influence on the style of
communication.
Communication style can be affected by factors
such as:
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Gender
Age
Status
Communication differences in style can be
manifested through nonverbal means such as:
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Gestures
Facial expressions
Physical space
Use of silence
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Multicultural
Considerations in Assessment
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Observation is an important form of assessment,
particularly when students are linguistically diverse.
Considerations for assessment personnel who work with
students having cultural and linguistic differences include:
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Selection of tests that have valid items
Using procedural modifications (e.g., lengthening time limit)
Assess whether the linguistically or diverse child has had
access to the information
Consider scoring the test in two ways, first as the manual
indicates, then allowing credit for items considered correct in
the child’s language system.
Focus on what the child does well rather than what he or she
cannot do.
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Augmentative and
Alternative Communication (AAC)
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AUGMENTATIVE
COMMUNICATION
denotes techniques that
supplement or enhance
communication by
complementing whatever
vocal skills the
individual already has.
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ALTERNATIVE
COMMUNICATION are
techniques used by
individuals who must
employ techniques that
serve in place of
speech.
AAC is a multimodal system consisting of four components:

symbols

aids

techniques

strategies
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Aided and Unaided
Communication Techniques
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AIDED communication techniques require a
physical object or device to enable the
individual to communicate (e.g., charts,
communication boards).
UNAIDED communication techniques do
not require any physical object or device to
enable the individual to communicate (e.g.,
speech, manual signs or gestures, facial
communication).
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and Bacon 2004
Examples
of
Communication
Aids
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Non-Electronic Aids
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Communication Boards
Charts, Frames or Books
Electronic Aids
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Voice Output Communication Aids
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Facilitated Communication

Facilitated communication is a process
involving having someone (a facilitator)
support the arm or wrist of the student with
autism, who then points to letters on a
keyboard. The keyboard is often connected
to a computer so that the student’s words
can be displayed or printed.

Efficacy research on facilitated
communication
has
mixed results.
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2004Copyright © Allyn
and Bacon 2004
Promoting Inclusive
Practices for Students
with Communication Disorders

In years past, pullout models were used for
students requiring speech-language services.

Today, the trend is toward the provision of
speech-language services in the general
education classroom.

Collaboration between classroom teachers
and speech-language pathologists is
essential.
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and Bacon 2004
Future Trends
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In addition to providing services in the more
traditional area of oral communication skills,
speech-language pathologies now are called
upon to have expertise in areas such as:
Addressing swallowing disorders

Medicaid billing
Selecting AAC systems
Providing interventions for children with TBI

Promoting and enhancing literacy skills


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Future Trends
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There is an increasing demand for services,
especially in the area of language disorders.
The traditional “pull-out” model will still be offered,
but the trend is toward a more collaborative and
consultative framework.
To address personnel shortages, alternate methods
might include:
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Employment of SLP assistants
Flexible scheduling
Cross-disciplinary service provision
Increased use of natural supports
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Future Trends

Another area of change is the expected
continuation of technological advances.
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This means that students with severe
communication disorders will have increased
opportunities to participate in ways that seemed
impossible several years ago.
Distance learning and telehealth services will
become more commonplace.
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