In recent years as more parents choose to send their children to mainstream schooling, speech pathologists are dealing with more complex cases of students with significant disabilities, Mala Ferdinando writes.
It is not uncommon for schools to choose to employ their own speech pathologist in order to meet the diverse needs of schools and students. In many states in Australia, once a student is at school, a school based service is the only free speech pathology service the student can access. While not saying a/th sound correctly may not necessarily affect spelling, it can still limit a student’s potential if untreated.
A stutter may not limit a student’s ability to learn in the classroom but may lead to social isolation and anxiety and other long term mental health issues. Most school vision statements include a focus on more than just the student’s learning outcome. Schools generally include a comment about fostering self worth and enabling students to achieve their full potential and become engaged and responsible members of the local and global community. Good communication skills are essential in this. It is therefore vital that comprehensive speech pathology supports are readily available in a school context.
The work of a speech pathologist in schools is engaging, rewarding, challenging and diverse. Speech pathologists work with a range of student needs including articulation, voice, fluency social skills, language and literacy. The role may involve directly working with students and parents as well as training and planning with teachers and learning support officers (LSOs). The focus of a school based speech pathology service is often on improving student learning outcomes however the social and future potential outcomes for each student should also be considered. Communication disorders can have lifelong implications so intervention for students with speech and language disorders is vital.
Areas needing intervention
Articulation can be as simple as a child not being able to say a/th sound correctly or as complex as Childhood Apraxia of Speech (CAS) where there is a challenge to coordinate muscle movements with air flow to produce and sequence the sounds of speech (Tukel et al, 2015). A child with severe CAS may have little or no functional verbal communication and alternative forms of communication such as signing or using a device may be required. In the early years of schooling with intensive speech therapy and support, these children often make good gains though progress is usually slow. A speech pathologist working with a child with CAS would also monitor receptive and expressive language skills as well as literacy supports. It is important to ensure that a child’s inability to articulate sounds does not limit progression with language or literacy development.
There are a number of common voice disorders seen by a speech pathologist working in schools. A hoarse or husky voice can be a result of vocal abuse such as yelling or frequent throat clearing. In these instances a speech pathologist would liaise with the student’s family doctor to organise a referral to an Ear Nose and Throat (ENT) Specialist to ensure that no nodules or other abnormal pathology is contributing to the presenting voice concerns. The speech pathologist may then commence a vocal hygiene program with the student, parent and the school to try and decrease or eliminate the behaviours causing nodules. If these behaviours are controlled then the nodules will fade and surgery would not be required. Alternative ways of correctly projecting voice may also be introduced. Prevalence data on voice disorders varies, however one study in Turkey found up to 30% of children had vocal nodules (Akif Kilic et al, 2004). Interestingly, teachers are also often prone to voice disorders as they are considered professional voice users.
Fluency is the absence of stuttering. Fluency in a school context is important. Even though it may not directly impact on student outcomes with reading and writing, it does affect the listening and speaking domains of learning. More importantly however is the fact that young people who stutter are significantly more at risk of developing social anxiety disorders as an adult (Smith et al, 2014). The long term prognosis for someone who stutters is greatly improved by early intervention.
Social skills support is often required for students with Autism Spectrum Disorders (ASD) and may take the form of social groups promoting use of eye contact, turn taking and use of greetings and farewells. A variety of other social skills such as recognition of non literal language and understanding of humour are sometimes also required.
The important role strong oral language skills play in the development of early literacy is often overlooked. Studies have shown the high incidence of low oral language functioning of youth incarcerated in the juvenile justice system. The most effective outcome to support students with difficulty in language and learning is prevention (Snow et al, 2012).
Focus on holistic school based approaches
As the role of the school based speech pathologist is becoming more and more classroom focused, linked to learning outcomes, the clinical role in areas such as voice and fluency and simple articulation should not be overlooked as part of a holistic school based speech pathology service. Combining shared skills and knowledge of professionals who are actively involved with supporting students is an effective way to identify areas of concern, use data to plan, implement appropriate supports and then monitor results to assist with future planning. This ensures optimum outcomes for the student. The role of the speech pathologist in the school is more than improving student learning outcomes in isolation and making recommendations for teachers to implement. Collaboration between teachers and speech pathologists needs to be comprehensive and holistic in order to help students achieve their full potential and become engaged participants in the world around them.