speech or language impairment meaning

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Speech and Language Impairments

The Individuals with Disabilities Education Act, or IDEA, defines the term “speech or language impairment” as follows:

“(11)  Speech or language impairment  means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.” [34 CFR §300.8(c)(11]

(Parent Information and Resources Center, 2015)

Table of Contents

What is a Speech and Language Impairment?

Characteristics of speech or language impairments, interventions and strategies, related service provider-slp.

• A Day in the Life of an SLP

Assistive Technology

Speech and language impairment  are basic categories that might be drawn in issues of communication involve hearing, speech, language, and fluency.

A speech impairment is characterized by difficulty in articulation of words. Examples include stuttering or problems producing particular sounds. Articulation refers to the sounds, syllables, and phonology produced by the individual. Voice, however, may refer to the characteristics of the sounds produced—specifically, the pitch, quality, and intensity of the sound. Often, fluency will also be considered a category under speech, encompassing the characteristics of rhythm, rate, and emphasis of the sound produced.

A language impairment is a specific impairment in understanding and sharing thoughts and ideas, i.e. a disorder that involves the processing of linguistic information. Problems that may be experienced can involve the form of language, including grammar, morphology, syntax; and the functional aspects of language, including semantics and pragmatics.

(Wikipedia, n.d./ Speech and Language Impairment)

*It’s important to realize that a language delay isn’t the same thing as a speech or language impairment. Language delay is a very common developmental problem—in fact, the most common, affecting 5-10% of children in preschool.  With language delay, children’s language is developing in the expected sequence, only at a slower rate. In contrast, speech and language disorder refers to abnormal language development.  Distinguishing between the two is most reliably done by a certified speech-language pathologist.  (CPIR, 2015)

The characteristics of speech or language impairments will vary depending upon the type of impairment involved. There may also be a combination of several problems.

When a child has an  articulation disorder , he or she has difficulty making certain sounds. These sounds may be left off, added, changed, or distorted, which makes it hard for people to understand the child.

Leaving out or changing certain sounds is common when young children are learning to talk, of course. A good example of this is saying “wabbit” for “rabbit.” The incorrect articulation isn’t necessarily a cause for concern unless it continues past the age where children are expected to produce such sounds correctly

Fluency  refers to the flow of speech. A fluency disorder means that something is disrupting the rhythmic and forward flow of speech—usually, a stutter. As a result, the child’s speech contains an “abnormal number of repetitions, hesitations, prolongations, or disturbances. Tension may also be seen in the face, neck, shoulders, or fists.”

Voice  is the sound that’s produced when air from the lungs pushes through the voice box in the throat (also called the larnyx), making the vocal folds within vibrate. From there, the sound generated travels up through the spaces of the throat, nose, and mouth, and emerges as our “voice.”

A voice disorder involves problems with the pitch, loudness, resonance, or quality of the voice. The voice may be hoarse, raspy, or harsh. For some, it may sound quite nasal; others might seem as if they are “stuffed up.” People with voice problems often notice changes in pitch, loss of voice, loss of endurance, and sometimes a sharp or dull pain associated with voice use.

Language  has to do with meanings, rather than sounds.  A language disorder refers to an impaired ability to understand and/or use words in context. A child may have an expressive language disorder (difficulty in expressing ideas or needs), a receptive language disorder (difficulty in understanding what others are saying), or a mixed language disorder (which involves both).

Some characteristics of language disorders include:

• improper use of words and their meanings,
• inability to express ideas,
• inappropriate grammatical patterns,
• reduced vocabulary, and
• inability to follow directions.

Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate. These symptoms can easily be mistaken for other disabilities such as autism or learning disabilities, so it’s very important to ensure that the child receives a thorough evaluation by a certified speech-language pathologist.

(CPIR, 2015)

• Use the (Cash, Wilson, and DeLaCruz, n.d) reading and/or the [ESU 8 Wednesday Webinar] to develop this section of the summary. 

Cash, A, Wilson, R. and De LaCruz, E.(n,d.) Practical Recommendations for Teachers: Language Disorders. https://www.education.udel.edu/wp-content/uploads/2013/01/LanguageDisorders.pdf 

[ESU 8 Wednesday Webinar] Speech Language Strategies for Classroom Teachers.- video below

Video: Speech Language Strategies for Classroom Teachers (15:51 minutes)’

[ESU 8 Wednesday Webinars]. (2015, Nov. 19) . Speech Language Strategies for Classroom Teachers. [Video FIle]. From https://youtu.be/Un2eeM7DVK8

Most, if not all, students with a speech or language impairment will need  speech-language pathology services . This related service is defined by IDEA as follows:

(15)  Speech-language pathology services  include—

(i) Identification of children with speech or language impairments;

(ii) Diagnosis and appraisal of specific speech or language impairments;

(iii) Referral for medical or other professional attention necessary for the habilitation of speech or language impairments;

(iv) Provision of speech and language services for the habilitation or prevention of communicative impairments; and

(v) Counseling and guidance of parents, children, and teachers regarding speech and language impairments. [34 CFR §300.34(c)(15)]

Thus, in addition to diagnosing the nature of a child’s speech-language difficulties, speech-language pathologists also provide:

• individual therapy for the child;
• consult with the child’s teacher about the most effective ways to facilitate the child’s communication in the class setting; and
• work closely with the family to develop goals and techniques for effective therapy in class and at home.

Speech and/or language therapy may continue throughout a student’s school years either in the form of direct therapy or on a consultant basis.

A Day in the Life of an SLP

Christina is a speech-language pathologist.  She works with children and adults who have impairments in their speech, voice, or language skills. These impairments can take many forms, as her schedule today shows.

First comes Robbie.  He’s a cutie pie in the first grade and has recently been diagnosed with childhood apraxia of speech—or CAS. CAS is a speech disorder marked by choppy speech. Robbie also talks in a monotone, making odd pauses as he tries to form words. Sometimes she can see him struggle. It’s not that the muscles of his tongue, lips, and jaw are weak. The difficulty lies in the brain and how it communicates to the muscles involved in producing speech. The muscles need to move in precise ways for speech to be intelligible. And that’s what she and Robbie are working on.

Next, Christina goes down the hall and meets with Pearl  in her third grade classroom. While the other students are reading in small groups, she works with Pearl one on one, using the same storybook. Pearl has a speech disorder, too, but hers is called dysarthria. It causes Pearl’s speech to be slurred, very soft, breathy, and slow. Here, the cause is weak muscles of the tongue, lips, palate, and jaw. So that’s what Christina and Pearl work on—strengthening the muscles used to form sounds, words, and sentences, and improving Pearl’s articulation.

One more student to see—4th grader Mario , who has a stutter. She’s helping Mario learn to slow down his speech and control his breathing as he talks. Christina already sees improvement in his fluency.

Tomorrow she’ll go to a different school, and meet with different students. But for today, her day is…Robbie, Pearl, and Mario.

Assistive technology (AT) can also be very helpful to students, especially those whose physical conditions make communication difficult. Each student’s IEP team will need to consider if the student would benefit from AT such as an electronic communication system or other device. AT is often the key that helps students engage in the give and take of shared thought, complete school work, and demonstrate their learning. (CPIR, 2015)

Project IDEAL , suggests two major categories of AT computer software packages to develop the child’s speech and language skills and augmentative or alternative communication (AAC).

Augmentative and alternative communication  ( AAC ) encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language. Augmentative and alternative communication may used by individuals to compensate for severe speech-language impairments in the expression or comprehension of spoken or written language. AAC can be a permanent addition to a person’s communication or a temporary aid.

(Wikipedia, (n.d. /Augmentative and alternative communication)

Center for Parent Information and Resources (CPIR)  (2015), Speech and Language Impairments, Newark, NJ, Author, Retrieved 4.1.19 from https://www.parentcenterhub.org/speechlanguage/

Wikipedia (n.d.) Augmentative and alternative communication. From https://en.wikipedia.org/wiki/Augmentative_and_alternative_communication 

Wikipedia, (n.d.) Speech and Language Impairment. From  https://en.wikipedia.org/wiki/Speech_and_language_impairment 

Updated 8.8.23

Understanding and Supporting Learners with Disabilities Copyright © 2019 by Paula Lombardi is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Language and Speech Disorders in Children

Helping children learn language, what to do if there are concerns.

• Detecting problems

Children are born ready to learn a language, but they need to learn the language or languages that their family and environment use. Learning a language takes time, and children vary in how quickly they master milestones in language and speech development. Typically developing children may have trouble with some sounds, words, and sentences while they are learning. However, most children can use language easily around 5 years of age.

Parents and caregivers are the most important teachers during a child’s early years. Children learn language by listening to others speak and by practicing. Even young babies notice when others repeat and respond to the noises and sounds they make. Children’s language and brain skills get stronger if they hear many different words. Parents can help their child learn in many different ways, such as

• Responding to the first sounds, gurgles, and gestures a baby makes.
• Repeating what the child says and adding to it.
• Talking about the things that a child sees.
• Asking questions and listening to the answers.
• Looking at or reading books.
• Telling stories.
• Singing songs and sharing rhymes.

This can happen both during playtime and during daily routines.

Parents can also observe the following:

• How their child hears and talks and compare it with typical milestones for communication skills external icon .
• How their child reacts to sounds and have their hearing tested if they have concerns .

Learn more about language milestones .  Watch milestones in action.

  Top of Page

Some languages are visual rather than spoken. American Sign Language uses visual signals, including gestures, facial expressions, and body movement to communicate.

Some children struggle with understanding and speaking and they need help. They may not master the language milestones at the same time as other children, and it may be a sign of a language or speech delay or disorder.

Language development has different parts, and children might have problems with one or more of the following:

• Not hearing the words (hearing loss).
• Not understanding the meaning of the words.
• Not knowing the words to use.
• Not knowing how to put words together.
• Knowing the words to use but not being able to express them.

Language and speech disorders can exist together or by themselves. Examples of problems with language and speech development include the following:

• Difficulty with forming specific words or sounds correctly.
• Difficulty with making words or sentences flow smoothly, like stuttering or stammering.
• Language delay – the ability to understand and speak develops more slowly than is typical
• Aphasia (difficulty understanding or speaking parts of language due to a brain injury or how the brain works).
• Auditory processing disorder (difficulty understanding the meaning of the sounds that the ear sends to the brain)

Learn more about language disorders external icon .

Language or speech disorders can occur with other learning disorders that affect reading and writing. Children with language disorders may feel frustrated that they cannot understand others or make themselves understood, and they may act out, act helpless, or withdraw. Language or speech disorders can also be present with emotional or behavioral disorders, such as attention-deficit/hyperactivity disorder (ADHD) or anxiety . Children with developmental disabilities including autism spectrum disorder may also have difficulties with speech and language. The combination of challenges can make it particularly hard for a child to succeed in school. Properly diagnosing a child’s disorder is crucial so that each child can get the right kind of help.

Detecting problems with language or speech

If a child has a problem with language or speech development, talk to a healthcare provider about an evaluation. An important first step is to find out if the child may have a hearing loss. Hearing loss may be difficult to notice particularly if a child has hearing loss only in one ear or has partial hearing loss, which means they can hear some sounds but not others. Learn more about hearing loss, screening, evaluation, and treatment .

A language development specialist like a speech-language pathologist external icon will conduct a careful assessment to determine what type of problem with language or speech the child may have.

Overall, learning more than one language does not cause language disorders, but children may not follow exactly the same developmental milestones as those who learn only one language. Developing the ability to understand and speak in two languages depends on how much practice the child has using both languages, and the kind of practice. If a child who is learning more than one language has difficulty with language development, careful assessment by a specialist who understands development of skills in more than one language may be needed.

Treatment for language or speech disorders and delays

Children with language problems often need extra help and special instruction. Speech-language pathologists can work directly with children and their parents, caregivers, and teachers.

Having a language or speech delay or disorder can qualify a child for early intervention external icon (for children up to 3 years of age) and special education services (for children aged 3 years and older). Schools can do their own testing for language or speech disorders to see if a child needs intervention. An evaluation by a healthcare professional is needed if there are other concerns about the child’s hearing, behavior, or emotions. Parents, healthcare providers, and the school can work together to find the right referrals and treatment.

What every parent should know

Children with specific learning disabilities, including language or speech disorders, are eligible for special education services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) external icon and Section 504 external icon , an anti-discrimination law.

Get help from your state’s Parent Training and Information Center external icon

The role of healthcare providers

Healthcare providers can play an important part in collaborating with schools to help a child with speech or language disorders and delay or other disabilities get the special services they need. The American Academy of Pediatrics has created a report that describes the roles that healthcare providers can have in helping children with disabilities external icon , including language or speech disorders.

More information

CDC Information on Hearing Loss

National Institute on Deafness and Other Communication Disorders external icon

Birth to 5: Watch me thrive external icon

The American Speech-Language-Hearing Association external icon

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Speech and Language Impairments

• En español | In Spanish
• See fact sheets on other disabilities

Table of Contents

A Day in the Life of an SLP

Christina is a speech-language pathologist. She works with children and adults who have impairments in their speech, voice, or language skills. These impairments can take many forms, as her schedule today shows.

First comes Robbie. He’s a cutie pie in the first grade and has recently been diagnosed with childhood apraxia of speech—or CAS. CAS is a speech disorder marked by choppy speech. Robbie also talks in a monotone, making odd pauses as he tries to form words. Sometimes she can see him struggle. It’s not that the muscles of his tongue, lips, and jaw are weak. The difficulty lies in the brain and how it communicates to the muscles involved in producing speech. The muscles need to move in precise ways for speech to be intelligible. And that’s what she and Robbie are working on.

Next, Christina goes down the hall and meets with Pearl in her third grade classroom. While the other students are reading in small groups, she works with Pearl one on one, using the same storybook. Pearl has a speech disorder, too, but hers is called dysarthria. It causes Pearl’s speech to be slurred, very soft, breathy, and slow. Here, the cause is weak muscles of the tongue, lips, palate, and jaw. So that’s what Christina and Pearl work on—strengthening the muscles used to form sounds, words, and sentences, and improving Pearl’s articulation.

One more student to see—4th grader Mario , who has a stutter. She’s helping Mario learn to slow down his speech and control his breathing as he talks. Christina already sees improvement in his fluency.

Tomorrow she’ll go to a different school, and meet with different students. But for today, her day is…Robbie, Pearl, and Mario.

  Back to top

There are many kinds of speech and language disorders that can affect children. In this fact sheet, we’ll talk about four major areas in which these impairments occur. These are the areas of:

Articulation | speech impairments where the child produces sounds incorrectly (e.g., lisp, difficulty articulating certain sounds, such as “l” or “r”);

Fluency | speech impairments where a child’s flow of speech is disrupted by sounds, syllables, and words that are repeated, prolonged, or avoided and where there may be silent blocks or inappropriate inhalation, exhalation, or phonation patterns;

Voice | speech impairments where the child’s voice has an abnormal quality to its pitch, resonance, or loudness; and

Language | language impairments where the child has problems expressing needs, ideas, or information, and/or in understanding what others say. ( 1 )

These areas are reflected in how “speech or language impairment” is defined by the nation’s special education law, the Individuals with Disabilities Education Act, given below. IDEA is the law that makes early intervention services available to infants and toddlers with disabilities, and special education available to school-aged children with disabilities.

Definition of “Speech or Language Impairment” under IDEA

The Individuals with Disabilities Education Act, or IDEA, defines the term “speech or language impairment” as follows:

Development of Speech and Language Skills in Childhood

Speech and language skills develop in childhood according to fairly well-defined milestones (see below). Parents and other caregivers may become concerned if a child’s language seems noticeably behind (or different from) the language of same-aged peers. This may motivate parents to investigate further and, eventually, to have the child evaluated by a professional.

______________________

More on the Milestones of Language Development

What are the milestones of typical speech-language development? What level of communication skill does a typical 8-month-old baby have, or a 18-month-old, or a child who’s just celebrated his or her fourth birthday?

You’ll find these expertly described in How Does Your Child Hear and Talk? , a series of resource pages available online at the American Speech-Language-Hearing Association (ASHA): http://www.asha.org/public/speech/development/chart.htm

Having the child’s hearing checked is a critical first step. The child may not have a speech or language impairment at all but, rather, a hearing impairment that is interfering with his or her development of language.

It’s important to realize that a language delay isn’t the same thing as a speech or language impairment. Language delay is a very common developmental problem—in fact, the most common, affecting 5-10% of children in preschool. ( 2 ) With language delay, children’s language is developing in the expected sequence, only at a slower rate. In contrast, speech and language disorder refers to abnormal language development. ( 3 )  Distinguishing between the two is most reliably done by a certified speech-language pathologist such as Christina, the SLP in our opening story.

Characteristics of Speech or Language Impairments

The characteristics of speech or language impairments will vary depending upon the type of impairment involved. There may also be a combination of several problems.

When a child has an articulation disorder , he or she has difficulty making certain sounds. These sounds may be left off, added, changed, or distorted, which makes it hard for people to understand the child.

Leaving out or changing certain sounds is common when young children are learning to talk, of course. A good example of this is saying “wabbit” for “rabbit.” The incorrect articulation isn’t necessarily a cause for concern unless it continues past the age where children are expected to produce such sounds correctly. ( 4 ) ( ASHA’s milestone resource pages , mentioned above, are useful here.)

Fluency refers to the flow of speech. A fluency disorder means that something is disrupting the rhythmic and forward flow of speech—usually, a stutter. As a result, the child’s speech contains an “abnormal number of repetitions, hesitations, prolongations, or disturbances. Tension may also be seen in the face, neck, shoulders, or fists.” ( 5 )

Voice is the sound that’s produced when air from the lungs pushes through the voice box in the throat (also called the larnyx), making the vocal folds within vibrate. From there, the sound generated travels up through the spaces of the throat, nose, and mouth, and emerges as our “voice.”

A voice disorder involves problems with the pitch, loudness, resonance, or quality of the voice. ( 6 )   The voice may be hoarse, raspy, or harsh. For some, it may sound quite nasal; others might seem as if they are “stuffed up.” People with voice problems often notice changes in pitch, loss of voice, loss of endurance, and sometimes a sharp or dull pain associated with voice use. ( 7 )

Language has to do with meanings, rather than sounds. ( 8 )  A language disorder refers to an impaired ability to understand and/or use words in context. ( 9 ) A child may have an expressive language disorder (difficulty in expressing ideas or needs), a receptive language disorder (difficulty in understanding what others are saying), or a mixed language disorder (which involves both).

Some characteristics of language disorders include:

• improper use of words and their meanings,
• inability to express ideas,
• inappropriate grammatical patterns,
• reduced vocabulary, and
• inability to follow directions. ( 10 )

Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate. These symptoms can easily be mistaken for other disabilities such as autism or learning disabilities, so it’s very important to ensure that the child receives a thorough evaluation by a certified speech-language pathologist.

What Causes Speech and Language Disorders?

Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, intellectual disabilities, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. Frequently, however, the cause is unknown.

Of the 6.1 million children with disabilities who received special education under IDEA in public schools in the 2005-2006 school year, more than 1.1 million were served under the category of speech or language impairment. ( 11 ) This estimate does not include children who have speech/language problems secondary to other conditions such as deafness, intellectual disability, autism, or cerebral palsy. Because many disabilities do impact the individual’s ability to communicate, the actual incidence of children with speech-language impairment is undoubtedly much higher.

Finding Help

Because all communication disorders carry the potential to isolate individuals from their social and educational surroundings, it is essential to provide help and support as soon as a problem is identified. While many speech and language patterns can be called “baby talk” and are part of children’s normal development, they can become problems if they are not outgrown as expected.

Therefore, it’s important to take action if you suspect that your child has a speech or language impairment (or other disability or delay). The next two sections in this fact sheet will tell you how to find this help.

Help for Babies and Toddlers 

Since we begin learning communication skills in infancy, it’s not surprising that parents are often the first to notice—and worry about—problems or delays in their child’s ability to communicate or understand. Parents should know that there is a lot of help available to address concerns that their young child may be delayed or impaired in developing communication skills. Of particular note is the the early intervention system that’s available in every state.

Early intervention is a system of services designed to help infants and toddlers with disabilities (until their 3rd birthday) and their families. It’s mandated by the IDEA. Through early intervention, parents can have their young one evaluated free of charge, to identify developmental delays or disabilities, including speech and language impairments.

If a child is found to have a delay or disability, staff work with the child’s family to develop what is known as an Individualized Family Services Plan , or IFSP . The IFSP will describe the child’s unique needs as well as the services he or she will receive to address those needs. The IFSP will also emphasize the unique needs of the family, so that parents and other family members will know how to support their young child’s needs. Early intervention services may be provided on a sliding-fee basis, meaning that the costs to the family will depend upon their income.

To identify the EI program in your neighborhood  | Ask your child’s pediatrician for a referral to early intervention or the Child Find in the state. You can also call the local hospital’s maternity ward or pediatric ward, and ask for the contact information of the local early intervention program.

Back to top

Help for School-Aged Children, including Preschoolers

Just as IDEA requires that early intervention be made available to babies and toddlers with disabilities, it requires that special education and related services be made available free of charge to every eligible child with a disability, including preschoolers (ages 3-21). These services are specially designed to address the child’s individual needs associated with the disability—in this case, a speech or language impairment.

Many children are identified as having a speech or language impairment after they enter the public school system. A teacher may notice difficulties in a child’s speech or communication skills and refer the child for evaluation. Parents may ask to have their child evaluated. This evaluation is provided free by the public school system.

If the child is found to have a disability under IDEA—such as a speech-language impairment—school staff will work with his or her parents to develop an Individualized Education Program , or IEP . The IEP is similar to an IFSP. It describes the child’s unique needs and the services that have been designed to meet those needs. Special education and related services are provided at no cost to parents.

There is a lot to know about the special education process, much of which you can learn at the Center for Parent Information and Resources (CPIR). We offer a wide range of publications and resource pages on the topic. Enter our special education information at: http://www.parentcenterhub.org/repository/schoolage/

Educational Considerations

Communication skills are at the heart of the education experience. Eligible students with speech or language impairments will want to take advantage of special education and related services that are available in public schools.

The types of supports and services provided can vary a great deal from student to student, just as speech-language impairments do. Special education and related services are planned and delivered based on each student’s individualized educational and developmental needs.

Most, if not all, students with a speech or language impairment will need speech-language pathology services . This related service is defined by IDEA as follows:

(15) Speech-language pathology services includes—

(i) Identification of children with speech or language impairments;

(ii) Diagnosis and appraisal of specific speech or language impairments;

(iii) Referral for medical or other professional attention necessary for the habilitation of speech or language impairments;

(iv) Provision of speech and language services for the habilitation or prevention of communicative impairments; and

Thus, in addition to diagnosing the nature of a child’s speech-language difficulties, speech-language pathologists also provide:

• individual therapy for the child;
• consult with the child’s teacher about the most effective ways to facilitate the child’s communication in the class setting; and
• work closely with the family to develop goals and techniques for effective therapy in class and at home.

Speech and/or language therapy may continue throughout a student’s school years either in the form of direct therapy or on a consultant basis.

Assistive technology (AT) can also be very helpful to students, especially those whose physical conditions make communication difficult. Each student’s IEP team will need to consider if the student would benefit from AT such as an electronic communication system or other device. AT is often the key that helps students engage in the give and take of shared thought, complete school work, and demonstrate their learning.

Tips for Teachers

— Learn as much as you can about the student’s specific disability. Speech-language impairments differ considerably from one another, so it’s important to know the specific impairment and how it affects the student’s communication abilities.

— Recognize that you can make an enormous difference in this student’s life! Find out what the student’s strengths and interests are, and emphasize them. Create opportunities for success.

—If you are not part of the student’s IEP team, a sk for a copy of his or her IEP . The student’s educational goals will be listed there, as well as the services and classroom accommodations he or she is to receive.

— Make sure that needed accommodations are provided for classwork, homework, and testing. These will help the student learn successfully.

— Consult with others (e.g., special educators, the SLP) who can help you identify strategies for teaching and supporting this student, ways to adapt the curriculum, and how to address the student’s IEP goals in your classroom.

— Find out if your state or school district has materials or resources available to help educators address the learning needs of children with speech or language impairments. It’s amazing how many do!

— Communicate with the student’s parents . Regularly share information about how the student is doing at school and at home.

Tips for Parents

— Learn the specifics of your child’s speech or language impairment. The more you know, the more you can help yourself and your child.

— Be patient. Your child, like every child, has a whole lifetime to learn and grow.

— Meet with the school and develop an IEP to address your child’s needs. Be your child’s advocate. You know your son or daughter best, share what you know.

— Be well informed about the speech-language therapy your son or daughter is receiving. Talk with the SLP, find out how to augment and enrich the therapy at home and in other environments. Also find out what not to do!

— Give your child chores. Chores build confidence and ability. Keep your child’s age, attention span, and abilities in mind. Break down jobs into smaller steps. Explain what to do, step by step, until the job is done. Demonstrate. Provide help when it’s needed. Praise a job (or part of a job) well done.

— Listen to your child. Don’t rush to fill gaps or make corrections. Conversely, don’t force your child to speak. Be aware of the other ways in which communication takes place between people.

— Talk to other parents whose children have a similar speech or language impairment. Parents can share practical advice and emotional support. See if there’s a parent nearby by visiting the Parent to Parent USA program and using the interactive map.

— Keep in touch with your child’s teachers. Offer support. Demonstrate any assistive technology your child uses and provide any information teachers will need. Find out how you can augment your child’s school learning at home.

Readings and Articles

We urge you to read the articles identified in the References section. Each provides detailed and expert information on speech or language impairments. You may also be interested in:

Speech-Language Impairment: How to Identify the Most Common and Least Diagnosed Disability of Childhood http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2491683/

Organizations to Consult

ASHA | American Speech-Language-Hearing Association Information in Spanish | Información en español. 1.800.638.8255 | [email protected] | www.asha.org

NIDCD | National Institute on Deafness and Other Communication Disorders 1.800.241.1044 (Voice) | 1.800.241.1055 (TTY) [email protected] | http://www.nidcd.nih.gov/

American Cleft Palate and Craniofacial Association (ACPA) 1.800.242.5338 | https://acpacares.org/

Childhood Apraxia of Speech Association of North America | CASANA http://www.apraxia-kids.org

National Stuttering Foundation 1.800.937.8888 | [email protected] | http://www.nsastutter.org/

Stuttering Foundation 1.800.992.9392 | [email protected] | http://www.stuttersfa.org/

1 | Minnesota Department of Education. (2010). Speech or language impairments . Online at: http://education.state.mn.us/MDE/EdExc/SpecEdClass/DisabCateg/SpeechLangImpair/index.html

2 | Boyse, K. (2008). Speech and language delay and disorder . Retrieved from the University of Michigan Health System website: http://www.med.umich.edu/yourchild/topics/speech.htm

4 | American Speech-Language-Hearing Association. (n.d.). Speech sound disorders: Articulation and phonological processes . Online at: http://www.asha.org/public/speech/disorders/speechsounddisorders.htm

5 | Cincinnati Children’s Hospital. (n.d.). Speech disorders . Online at:  http://www.cincinnatichildrens.org/health/s/speech-disorder/

6 | National Institute on Deafness and Other Communication Disorders. (2002). What is voice? What is speech? What is language? Online at: http://www.nidcd.nih.gov/health/voice/pages/whatis_vsl.aspx

7 | American Academy of Otolaryngology — Head and Neck Surgery. (n.d.).   About your voice . Online at:  http://www.entnet.org/content/about-your-voice

8 | Boyse, K. (2008). Speech and language delay and disorder . Retrieved from the University of Michigan Health System website: http://www.med.umich.edu/yourchild/topics/speech.htm

9 | Encyclopedia of Nursing & Allied Health. (n.d.). Language disorders . Online at: http://www.enotes.com/nursing-encyclopedia/language-disorders

10 | Ibid .

11 | U.S. Department of Education. (2010, December). Twenty-ninth annual report to Congress on the Implementation of the Individuals with Disabilities Education Act: 2007 . Online at: http://www2.ed.gov/about/reports/annual/osep/2007/parts-b-c/index.html

Special Education Guide

Speech and Language Impairments

The  Individuals with Disabilities Education Act (IDEA) officially defines speech and language impairments as “a communication disorder such as stuttering, impaired articulation, a language impairment, or a voice impairment that adversely affects a child’s educational performance.” Each point within this official definition represents a speech and language subcategory. “A communication disorder such as stuttering” provides an example of a fluency disorder; other fluency issues include unusual word repetition and hesitant speech. “Impaired articulation” indicates impairments in which a child experiences challenges in pronouncing specific sounds. “A language impairment” can entail difficulty comprehending words properly, expressing oneself and listening to others. Finally, “a voice impairment” involves difficulty voicing words; for instance, throat issues may cause an abnormally soft voice.

Common Traits

Speech and language impairments tend to emerge at a young age, and the earlier a child is diagnosed and receives services accordingly, the more likely that child can outgrow the disability. Speech-language pathologists work with children with speech and language impairments, as well as with parents and teachers. For example, a speech-language pathologist might work with a child with impaired articulation to help him or her learn to pronounce “s” and “z” sounds correctly.

If a child fails to meet the  speech and language milestones  set by  American Speech-Language-Hearing Association (ASHA) , he or she might have a speech and language impairment.The  National Dissemination Center for Children with Disabilities , commonly referred to as NICHCY, notes that parents are usually the first to suspect that a child might possess such an impairment. However, it’s important to note that hearing issues, autism and a number of other disabilities can masquerade as speech and language impairments, and a child with a suspected impairment should be evaluated by a speech-language pathologist to avoid misdiagnosis.

Educational Challenges

The obstacles created by speech and language impairments vary by the specific case, but because communication is at the core of education, these impairments can impact a student’s entire educational experience. Some of these challenges might involve:

• Communicating effectively with classmates and teachers
• Understanding and/or giving oral presentations
• Participating in classroom discussions
• Attaining normalcy within a group

Tips for Teachers and Parents

NICHCY recognizes early intervention as a helpful tool for children with speech and language impairments, and working with a speech-language pathologist during the preschool years can be a game changer. Addressing issues, such as stuttering and articulation impairments, early can lessen potential communication difficulties later in a child’s educational career.

It’s worth mentioning that speech and language impairments requiring long-term attention generally remain manageable. A school’s speech-language pathologist should work with both teachers and parents to discuss a child’s needs and how to best meet them.

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Comprehenisve Overview of Speech and Language Impairments

Comprehensive overview of speech and language impairments.

Speech and language disorders refer to problems in communication and related areas such as oral motor function. These delays and disorders range from simple sound substitutions to the inability to understand or use language or use the oral-motor mechanism for functional speech and feeding. Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, mental retardation, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. Frequently, however, the cause is unknown.

More than one million of the students served in the public schools’ special education programs in the 2000-2001 school year were categorized as having a speech or language impairment. This estimate does not include children who have speech/language problems secondary to other conditions such as deafness. Language disorders may be related to other disabilities such as mental retardation, autism, or cerebral palsy. It is estimated that communication disorders (including speech, language, and hearing disorders) affect one of every 10 people in the United States.

Characteristics

A child's communication is considered delayed when the child is noticeably behind his or her peers in the acquisition of speech and/or language skills. Sometimes a child will have greater receptive (understanding) than expressive (speaking) language skills, but this is not always the case.

Speech disorders refer to difficulties producing speech sounds or problems with voice quality. They might be characterized by an interruption in the flow or rhythm of speech, such as stuttering, which is called dysfluency. Speech disorders may be problems with the way sounds are formed, called articulation or phonological disorders, or they may be difficulties with the pitch, volume or quality of the voice. There may be a combination of several problems. People with speech disorders have trouble using some speech sounds, which can also be a symptom of a delay. They may say "see" when they mean "ski" or they may have trouble using other sounds like "l" or "r." Listeners may have trouble understanding what someone with a speech disorder is trying to say. People with voice disorders may have trouble with the way their voices sound.

A language disorder is an impairment in the ability to understand and/or use words in context, both verbally and nonverbally. Some characteristics of language disorders include improper use of words and their meanings, inability to express ideas, inappropriate grammatical patterns, reduced vocabulary and inability to follow directions. One or a combination of these characteristics may occur in children who are affected by language learning disabilities or developmental language delay. Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate.

Educational Implications

Because all communication disorders carry the potential to isolate individuals from their social and educational surroundings, it is essential to find appropriate timely intervention. While many speech and language patterns can be called "baby talk" and are part of a young child's normal development, they can become problems if they are not outgrown as expected. In this way an initial delay in speech and language or an initial speech pattern can become a disorder which can cause difficulties in learning. Because of the way the brain develops, it is easier to learn language and communication skills before the age of 5. When children have muscular disorders, hearing problems or developmental delays, their acquisition of speech, language and related skills is often affected

Speech-language pathologists assist children who have communication disorders in various ways. They provide individual therapy for the child; consult with the child’s teacher about the most effective ways to facilitate the child’s communication in the class setting; and work closely with the family to develop goals and techniques for effective therapy in class and at home. The speech-language pathologist may assist vocational teachers and counselors in establishing communication goals related to the work experiences of students and suggest strategies that are effective for the important transition from school to employment and adult life.

Technology can help children whose physical conditions make communication difficult. The use of electronic communication systems allow nonspeaking people and people with severe physical disabilities to engage in the give and take of shared thought.

Vocabulary and concept growth continues during the years children are in school. Reading and writing are taught and, as students get older, the understanding and use of language becomes more complex. Communication skills are at the heart of the education experience. Speech and/or language therapy may continue throughout a student’s school years either in the form of direct therapy or on a consultant basis.

Specific Types of Communication Disorders

What is aphasia.

Aphasia is a language disorder that results from damage to portions of the brain that are responsible for language. For most people, these are parts of the left side (hemisphere) of the brain. Aphasia usually occurs suddenly, often as the result of a stroke or head injury, but it may also develop slowly, as in the case of a brain tumor. The disorder impairs both the expression and understanding of language as well as reading and writing. Aphasia may co-occur with speech disorders such as dysarthria or apraxia of speech, which also result from brain damage.

What causes aphasia?

Aphasia is caused by damage to one or more of the language areas of the brain. Many times, the cause of the brain injury is a stroke. A stroke occurs when, for some reason, blood is unable to reach a part of the brain. Brain cells die when they do not receive their normal supply of blood, which carries oxygen and important nutrients. Other causes of brain injury are severe blows to the head, brain tumors, brain infections, and other conditions of the brain.

How is aphasia diagnosed?

Aphasia is usually first recognized by the physician who treats the individual for his or her brain injury. Frequently this is a neurologist. The physician typically performs tests that require the individual to follow commands, answer questions, name objects, and converse. If the physician suspects aphasia, the individual is often referred to a speech-language pathologist, who performs a comprehensive examination of the person's ability to understand, speak, read, and write.

What Is Apraxia of Speech?

Apraxia of speech, also known as verbal apraxia or dyspraxia, is a speech disorder in which a person has trouble saying what he or she wants to say correctly and consistently. It is not due to weakness or paralysis of the speech muscles (the muscles of the face, tongue, and lips). The severity of apraxia of speech can range from mild to severe.

What Are the Types and Causes of Apraxia?

There are two main types of speech apraxia: acquired apraxia of speech and developmental apraxia of speech. Acquired apraxia of speech can affect a person at any age, although it most typically occurs in adults. It is caused by damage to the parts of the brain that are involved in speaking, and involves the loss or impairment of existing speech abilities. The disorder may result from a stroke, head injury, tumor, or other illness affecting the brain. Acquired apraxia of speech may occur together with muscle weakness affecting speech production (dysarthria) or language difficulties caused by damage to the nervous system (aphasia).

Developmental apraxia of speech (DAS) occurs in children and is present from birth. It appears to affect more boys than girls. This speech disorder goes by several other names, including developmental verbal apraxia, developmental verbal dyspraxia, articulatory apraxia, and childhood apraxia of speech. DAS is different from what is known as a developmental delay of speech, in which a child follows the "typical" path of speech development but does so more slowly than normal.

The cause or causes of DAS are not yet known. Some scientists believe that DAS is a disorder related to a child's overall language development. Others believe it is a neurological disorder that affects the brain's ability to send the proper signals to move the muscles involved in speech. However, brain imaging and other studies have not found evidence of specific brain lesions or differences in brain structure in children with DAS. Children with DAS often have family members who have a history of communication disorders or learning disabilities. This observation and recent research findings suggest that genetic factors may play a role in the disorder.

What Are the Symptoms?

People with either form of apraxia of speech may have a number of different speech characteristics, or symptoms. One of the most notable symptoms is difficulty putting sounds and syllables together in the correct order to form words. Longer or more complex words are usually harder to say than shorter or simpler words. People with apraxia of speech also tend to make inconsistent mistakes when speaking. For example, they may say a difficult word correctly but then have trouble repeating it, or they may be able to say a particular sound one day and have trouble with the same sound the next day. People with apraxia of speech often appear to be groping for the right sound or word, and may try saying a word several times before they say it correctly. Another common characteristic of apraxia of speech is the incorrect use of "prosody" -- that is, the varying rhythms, stresses, and inflections of speech that are used to help express meaning.

Children with developmental apraxia of speech generally can understand language much better than they are able to use language to express themselves. Some children with the disorder may also have other problems. These can include other speech problems, such as dysarthria; language problems such as poor vocabulary, incorrect grammar, and difficulty in clearly organizing spoken information; problems with reading, writing, spelling, or math; coordination or "motor-skill" problems; and chewing and swallowing difficulties.

The severity of both acquired and developmental apraxia of speech varies from person to person. Apraxia can be so mild that a person has trouble with very few speech sounds or only has occasional problems pronouncing words with many syllables. In the most severe cases, a person may not be able to communicate effectively with speech, and may need the help of alternative or additional communication methods.

How Is It Diagnosed?

Professionals known as speech-language pathologists play a key role in diagnosing and treating apraxia of speech. There is no single factor or test that can be used to diagnose apraxia. In addition, speech-language experts do not agree about which specific symptoms are part of developmental apraxia. The person making the diagnosis generally looks for the presence of some, or many, of a group of symptoms, including those described above. Ruling out other contributing factors, such as muscle weakness or language-comprehension problems, can also help with the diagnosis.

To diagnose developmental apraxia of speech, parents and professionals may need to observe a child's speech over a period of time. In formal testing for both acquired and developmental apraxia, the speech-language pathologist may ask the person to perform speech tasks such as repeating a particular word several times or repeating a list of words of increasing length (for example, love, loving, lovingly). For acquired apraxia of speech, a speech-language pathologist may also examine a person's ability to converse, read, write, and perform non-speech movements. Brain-imaging tests such as magnetic resonance imaging (MRI) may also be used to help distinguish acquired apraxia of speech from other communication disorders in people who have experienced brain damage.

How Is It Treated?

In some cases, people with acquired apraxia of speech recover some or all of their speech abilities on their own. This is called spontaneous recovery. Children with developmental apraxia of speech will not outgrow the problem on their own. Speech-language therapy is often helpful for these children and for people with acquired apraxia who do not spontaneously recover all of their speech abilities.

Speech-language pathologists use different approaches to treat apraxia of speech, and no single approach has been proven to be the most effective. Therapy is tailored to the individual and is designed to treat other speech or language problems that may occur together with apraxia. Each person responds differently to therapy, and some people will make more progress than others. People with apraxia of speech usually need frequent and intensive one-on-one therapy. Support and encouragement from family members and friends are also important.

In severe cases, people with acquired or developmental apraxia of speech may need to use other ways to express themselves. These might include formal or informal sign language, a language notebook with pictures or written words that the person can show to other people, or an electronic communication device such as a portable computer that writes and produces speech.

Auditory  Preocessing Disorder (APD)

What is auditory processing.

Auditory processing is a term used to describe what happens when your brain recognizes and interprets the sounds around you. Humans hear when energy that we recognize as sound travels through the ear and is changed into electrical information that can be interpreted by the brain. The "disorder" part of auditory processing disorder means that something is adversely affecting the processing or interpretation of the information.

Children with APD often do not recognize subtle differences between sounds in words, even though the sounds themselves are loud and clear. For example, the request "Tell me how a chair and a couch are alike" may sound to a child with APD like "Tell me how a couch and a chair are alike." It can even be understood by the child as "Tell me how a cow and a hair are alike." These kinds of problems are more likely to occur when a person with APD is in a noisy environment or when he or she is listening to complex information.

APD goes by many other names. Sometimes it is referred to as central auditory processing disorder (CAPD). Other common names are auditory perception problem, auditory comprehension deficit, central auditory dysfunction, central deafness, and so-called "word deafness."

What causes auditory processing difficulty?

We are not sure. Human communication relies on taking in complicated perceptual information from the outside world through the senses, such as hearing, and interpreting that information in a meaningful way. Human communication also requires certain mental abilities, such as attention and memory. Scientists still do not understand exactly how all of these processes work and interact or how they malfunction in cases of communication disorders. Even though your child seems to "hear normally," he or she may have difficulty using those sounds for speech and language.

The cause of APD is often unknown. In children, auditory processing difficulty may be associated with conditions such as dyslexia, attention deficit disorder, autism, autism spectrum disorder, specific language impairment, pervasive developmental disorder, or developmental delay. Sometimes this term has been misapplied to children who have no hearing or language disorder but have challenges in learning.

What are the symptoms of possible auditory processing difficulty?

Children with auditory processing difficulty typically have normal hearing and intelligence. However, they have also been observed to

• Have trouble paying attention to and remembering information presented orally
• Have problems carrying out multistep directions
• Have poor listening skills
• Need more time to process information
• Have low academic performance
• Have behavior problems
• Have language difficulty (e.g., they confuse syllable sequences and have problems developing vocabulary and understanding language)
• Have difficulty with reading, comprehension, spelling, and vocabulary

How is suspected auditory processing difficulty diagnosed in children?

You, a teacher, or a day care provider may be the first person to notice symptoms of auditory processing difficulty in your child. So talking to your child's teacher about school or preschool performance is a good idea. Many health professionals can also diagnose APD in your child. There may need to be ongoing observation with the professionals involved.

Much of what will be done by these professionals will be to rule out other problems. A pediatrician or a family doctor can help rule out possible diseases that can cause some of these same symptoms. He or she will also measure growth and development. If there is a disease or disorder related to hearing, you may be referred to an otolaryngologist--a physician who specializes in diseases and disorders of the head and neck.

To determine whether the child has a hearing function problem, an audiologic evaluation is necessary. An audiologist will give tests that can determine the softest sounds and words a person can hear and other tests to see how well people can recognize sounds in words and sentences. For example, for one task, the audiologist might have the child listen to different numbers or words in the right and the left ear at the same time. Another common audiologic task involves giving the child two sentences, one louder than the other, at the same time. The audiologist is trying to identify the processing problem.

A speech-language pathologist can find out how well a person understands and uses language. A mental health professional can give you information about cognitive and behavioral challenges that may contribute to problems in some cases, or he or she may have suggestions that will be helpful. Because the audiologist can help with the functional problems of hearing and processing, and the speech-language pathologist is focused on language, they may work as a team with the child.

Developmental Dyspraxia

What is developmental dyspraxia.

Developmental dyspraxia is a disorder characterized by an impairment in the ability to plan and carry out sensory and motor tasks. Generally, individuals with the disorder appear "out of sync" with their environment. Symptoms vary and may include poor balance and coordination, clumsiness, vision problems, perception difficulties, emotional and behavioral problems, difficulty with reading, writing, and speaking, poor social skills, poor posture, and poor short-term memory. Although individuals with the disorder may be of average or above average intelligence, they may behave immaturely.

Is there any treatment?

Treatment is symptomatic and supportive and may include occupational and speech therapy, and "cueing" or other forms of communication such as using pictures and hand gestures. Many children with the disorder require special education.

What is the prognosis?

Developmental dyspraxia is a lifelong disorder. Many individuals are able to compensate for their disabilities through occupational and speech therapy.

Landau-Kleffner Syndrome

What is landau-kleffner syndrome.

Landau-Kleffner syndrome (LKS) is a childhood disorder. A major feature of LKS is the gradual or sudden loss of the ability to understand and use spoken language. All children with LKS have abnormal electrical brain waves that can be documented by an electroencephalogram (EEG), a recording of the electric activity of the brain. Approximately 80 percent of the children with LKS have one or more epileptic seizures that usually occur at night. Behavioral disorders such as hyperactivity, aggressiveness and depression can also accompany this disorder. LKS may also be called infantile acquired aphasia, acquired epileptic aphasia or aphasia with convulsive disorder. This syndrome was first described in 1957 by Dr. William M. Landau and Dr. Frank R. Kleffner, who identified six children with the disorder.

What are the signs of Landau-Kleffner syndrome?

LKS occurs most frequently in normally developing children who are between 3 and 7 years of age. For no apparent reason, these children begin having trouble understanding what is said to them. Doctors often refer to this problem as auditory agnosiaor "word deafness." The auditory agnosia may occur slowly or very quickly. Parents often think that the child is developing a hearing problem or has become suddenly deaf. Hearing tests, however, show normal hearing. Children may also appear to be autistic or developmentally delayed.

The inability to understand language eventually affects the child's spoken language which may progress to a complete loss of the ability to speak (mutism). Children who have learned to read and write before the onset of auditory agnosia can often continue communicating through written language. Some children develop a type of gestural communication or sign-like language. The communication problems may lead to behavioral or psychological problems. Intelligence usually appears to be unaffected.

The loss of language may be preceded by an epileptic seizure that usually occurs at night. At some time, 80 percent of children with LKS have one or more seizures. The seizures usually stop by the time the child becomes a teenager. All LKS children have abnormal electrical brain activity on both the right and left sides of their brains.

Laryngeal Papillomatosis

What is laryngeal papillomatosis.

Laryngeal papillomatosis is a disease consisting of tumors that grow inside the larynx (voice box), vocal cords, or the air passages leading from the nose into the lungs (respiratory tract). It is a rare disease caused by the human papilloma virus (HPV). Although scientists are uncertain how people are infected with HPV, they have identified more than 60 types of HPVs. Tumors caused by HPVs, called papillomas, are often associated with two specific types of the virus (HPV 6 and HPV 11). They may vary in size and grow very quickly. Eventually, these tumors may block the airway passage and cause difficulty breathing.

Laryngeal papillomatosis affects infants and small children as well as adults. Between 60 and 80 percent of cases occur in children, usually before the age of three. Because the tumors grow quickly, young children with the disease may find it difficult to breathe when sleeping, or they may experience difficulty swallowing. Adults with laryngeal papillomatosis may experience hoarseness, chronic coughing, or breathing problems.

How is laryngeal papillomatosis disagnosed?

There are several tests to diagnose laryngeal papillomatosis. Two routine tests are indirect and direct laryngoscopy. An indirect laryngoscopy is done in an office by a speech-language pathologist or by a doctor. To examine the larynx for tumors, the doctor places a small mirror in the back of the throat and angles the mirror down towards the larynx. A direct laryngoscopy is performed in the operating room under general anesthesia.

This procedure is usually used with children or adults during lengthy examinations to minimize discomfort. It involves looking directly at the larynx. Direct laryngoscopy allows the doctor to view the vocal folds and other parts of the larynx under high magnification and samples of unusual tissue lesions that may be in the larynx or other parts of the throat.

Spasmodic dysphonia

What is spasmodic dysphonia.

Spasmodic dysphonia (or laryngeal dystonia) is a voice disorder caused by involuntary movements of one or more muscles of the larynx or voice box. Individuals who have spasmodic dysphonia may have occasional difficulty saying a word or two or they may experience sufficient difficulty to interfere with communication. Spasmodic dysphonia causes the voice to break or to have a tight, strained or strangled quality. There are three different types of spasmodic dysphonia.

What are the types of Spasmodic Dysphonia?

The three types of spasmodic dysphonia are adductor spasmodic dysphonia, abductor spasmodic dysphonia and mixed spasmodic dysphonia.

What are the features of spasmodic dysphonia?

In adductor spasmodic dysphonia, sudden involuntary muscle movements or spasms cause the vocal folds (or vocal cords) to slam together and stiffen. These spasms make it difficult for the vocal folds to vibrate and produce voice. Words are often cut off or difficult to start because of the muscle spasms. Therefore, speech may be choppy and sound similar to stuttering. The voice of an individual with adductor spasmodic dysphonia is commonly described as strained or strangled and full of effort. Surprisingly, the spasms are usually absent while whispering, laughing, singing, speaking at a high pitch or speaking while breathing in. Stress, however, often makes the muscle spasms more severe.

In abductor spasmodic dysphonia, sudden involuntary muscle movements or spasms cause the vocal folds to open. The vocal folds can not vibrate when they are open. The open position of the vocal folds also allows air to escape from the lungs during speech. As a result, the voices of these individuals often sound weak, quiet and breathy or whispery. As with adductor spasmodic dysphonia, the spasms are often absent during activities such as laughing or singing.

Mixed spasmodic dysphonia involves muscles that open the vocal folds as well as muscles that close the vocal folds and therefore has features of both adductor and abductor spasmodic dysphonia.

(For other types of Communication Disorders and further information on this topic, , use NASET's table of hundreds of links to Speech and Language Impairments. This table will be found when you close out of this window.)

Brice, A. (2001). Children with communication disorders (ERIC Digest #E617). Arlington, VA: ERIC Clearinghouse on Disabilities and Gifted Education. (Available online at: http://ericec.org/digests/e617.html )

Charkins, H. (1996). Children with facial differences: A parents' guide. Bethesda, MD: Woodbine House. (Telephone: 800.843.7323. Web: www.woodbinehouse.com )

Cleft Palate Foundation. (1997). For parents of newborn babies with cleft lip/cleft palate. Chapel Hill, NC: Author. (Telephone: 800.242.5338. Also available online at: www.cleftline.org )

Gruman-Trinker, C. (2001). Your cleft-affected child: The complete book of information, resources and hope. Alameda, CA: Hunter House. (Web: www.hunterhouse.com )

Hamaguchi, P. M. (2001). Childhood speech, language, & listening problems: What every parent should know (2nd ed.). New York: John Wiley & Sons, Inc. (Telephone: 800.225.5945. Web: www.wiley.com )

Organizations

Alliance for Technology Access 2175 E. Francisco Boulevard, Suite L San Rafael, CA 94901 800.455.7970; 415.455.4575 Email: [email protected] Web: www.ataccess.org

American Speech-Language-Hearing Association (ASHA) 10801 Rockville Pike Rockville, MD 20852 301.897.5700 (V/TTY); 800.638.8255 Email: [email protected] Web: www.asha.org

Childhood Apraxia of Speech Association of North America (CASANA) 123 Eisele Road Cheswick, PA 15024 412.767.6589 Email: [email protected] Web: www.apraxia-kids.org

Cleft Palate Foundation 104 South Estes Drive, Suite 204 Chapel Hill, NC 27514 800.242.5338; 919.933.9044 Email: [email protected] Web: www.cleftline.org

Easter Seals--National Office 230 West Monroe Street, Suite 1800 Chicago, IL 60606 312.726.6200 312.726.4258 (TTY) 800.221.6827 Email: [email protected] Web: www.easter-seals.org

Learning Disabilities Association of America (LDA) 4156 Library Road Pittsburgh, PA 15234-1349 412.341.1515 Email: [email protected] Web: www.ldaamerica.org

Scottish Rite Foundation Southern Jurisdiction, U.S.A., Inc. 1733 Sixteenth Street, N.W. Washington, DC 20009-3199 202.232.3579 Web: www.srmason-sj.org/web/index.htm

Trace Research and Development Center University of Wisconsin-Madison 1550 Engineering Dr. 2107 Engineering Hall Madison, WI 53706 608.262-6966; 608.263.5408 (TTY) Email:

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Speech or Language Impairment

Our nation’s special education law, the Individuals with Disabilities Education Act (IDEA) defines Speech or Language Impairment as …

“… a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.”

[34 Code of Federal Regulations § 300.8(c) (11)]

There are many kinds of speech and language disorders that can affect children. Disorders may occur in articulation, fluency, voice, and language. ASHA lists the following types of disorders:

• Childhood Apraxia of Speech
• Orofacial Myofunctional Disorders
• Speech Sound Disorders: Articulation and Phonological Processes
• Voice (vocal cord nodules and polyps, vocal cord paralysis, paradoxical vocal fold movement, spasmodic dysphonia)

Language Disorders

• Preschool Language Disorders
• Learning Disabilities (Reading, Selling, and Writing)
• Selective Mutism

Medical and Developmental Conditions

• Attention Deficitit/Hyperactivity Disorder
• Autism (Autism Spectrum Disorders)
• Cleft Lip and Palate
• Right Hemisphere Brain Injury
• Traumatic Brain Injury

More information regarding types can be found on ASHA’s website:  https://www.asha.org/public/speech/disorders/ChildSandL/

(American Speech-Language-Hearing Association, ASHA, 2019)

FACTS AND STATS

In Fall, 2016, of the more than 6.1 children with disabilities who received special education under IDEA in public schools in the Fall, more than 1.1 million were served under the category of speech or language impairment. The percentage of students (16.8%) is the second most common disability category. This estimate does not include children who have speech/language problems secondary to other conditions such as deafness, intellectual disability, autism, or cerebral palsy. Because many disabilities do impact that individual's ability to communicate, the actual incidence of children with speech-language impairment is undoubtedly much higher.

(U.S. Department of Education, Office of Special Education and Rehabilitative Services, Office of Special Education Programs, 40th Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act, 2018). http://www.ed.gov/about/reports/annual/osep

Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, intellectual disabilities, drug abuse, physical impairments (cleft lip or palate), and vocal abuse or misuse. Frequently, however, the cause is unknown.

(Center for Parent Information and Resources, CPIR, 2015)

Having your child’s hearing and speech checked regularly at a local clinic or school are important prevention strategies to monitoring speech and language development. Talking, reading, and playing with a child every day can help children to learn sounds and words by hearing and seeing them. Take care that your child’s teeth and mouth are healthy and cared for can be a preventative for speech sound disorders. Allowing a child the time to talk without interruption may also help for those who stutter. Voice disorders in childhood and adulthood are prevented by taking care of the voice through the avoidance of shouting and screaming; drinking plenty of water; avoiding alcohol, caffeine, chemical fumes (i.e. some cleaning products); and smoking. Seeing a doctor about allergies or sinus/respiratory infections can also help protect the health of the voice.

(ASHA, 2019)

CHARACTERTISTICS

The characteristics of speech or language impairments will vary depending upon the type of impairment involved. There may also be a combination of several problems. ASHA’s speech and language milestone resource pages are useful to refer to when observing your child’s speech, language, and hearing development. https://www.asha.org/public/speech/development/chart.htm

When a child has an articulation disorder, he or she has difficulty making certain sounds. These sounds may be left off, added, changed, or distorted, which makes it hard for people to understand the child. Leaving out or changing certain sounds is common when young children are learning to talk, of course. A good example is saying “wabbit” for “rabbit.” The incorrect articulation isn’t necessarily a cause for concern unless it continues past the age where children are expected to product such sounds correctly.

Fluency refers to the flow of speech. A fluency disorder means that something is disrupting the rhythmic and forward flow of speech - usually, a stutter. As a result, the child's speech contains an abnormal number of repetitions, hesitations, prolongations, or disturbances. Tension may also be seen in the face, neck, shoulders, or fists.

Voice is the sound that's produced when air from the lungs pushes through the voice box in the through, making the vocal folds within vibrate. From the the sound generated travels up through the spaces of the throat, nose, and mouth, and emerges as our voice. A voice disorder involves problems with the pitch, loudness, resonance, or quality of the voice. The voice may be hoarse, raspy, or harsh. For some, it may sound quite nasal; others might seem as if they are stuffed up. People with voice problems often notice changes in pitch, loss of voice, loss of endurance, and sometimes a sharp or dull pain associated with voice use.

Language has to do with meanings, rather than sounds. A language disorder refers to an impaired ability to understand and/or use words in context. A child may have an expressive language disorder (difficulty in expressing ideas or needs), a receptive language disorder (difficulty in understanding what others are saying, or a mixed language disorder (which involves both). Some characteristics of language disorders include: improper use of words and their meanings; inability to express ideas; inappropriate grammatical patterns; reduced vocabulary; and inability to follow directions.

Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate. These symptoms can easily be mistaken for other disabilities such as autism or learning disabilities, so it's very important to ensure that the child receives a thorough evaluation by a certified speech-language pathologist.

(CPIR, 2015)

More information about characteristics and types of disorders may also be can be found at ASHA’s website:  https://www.asha.org/public/speech/disorders/ChildSandL/

The prognosis depends on the cause and type of the disorder. Usually, speech can be improved with speech therapy. Prognosis improves with early intervention and effective use of speech-language pathology services. Children and adults with severe speech or language problems may need to find other ways to communicate. In these cases, they may use augmentative and alternative communication (AAC). Speech-language pathologists, or SLPs, can help.

EDUCATIONAL IMPLICATIONS

Communication skills are at the heart of the education experience. Most, if not all, students with a speech or language impairment will need speech-language pathology services that include: identification of children with speech or language impairments; diagnosis and appraisal of specific speech or language impairments; referral for medical or other professional attention necessary for the habilitation or prevention of communicative impairments; and counseling and guidance of parents, children and teachers regarding speech and language impairments.

In addition to diagnosing the nature of a child’s speech-language difficulties, speech-language pathologists also provide: individual therapy for the child; consultation with the child’s teacher about the most effective ways to facilitate the child’s communication in the class setting; closely working with the family to develop goals and techniques for effective therapy in class and at home.

Tips for Teachers:

• Learn as much as you can about the student's specific disability. Speech-language impairments differ considerably from one another, so it's important to know the specific impairment and how it affects the student's communication abilities.
• Find out what the student's strengths and interests are, and emphasize them. Create opportunities for success.
• If you are not part of the student's IEP team, ask for a copy of his or her IEP. The student's educational goals will be listed there, as well as the services and classroom accommodations he or she is to receive.
• Make sure that needed accommodations are provided for classwork, homework, and testing. These will help the student learn successfully.
• Consult with others (e.g., special educators, the SLP) who can help you identify strategies for teaching and supporting this student, ways to adapt the curriculum, and how to address the student's IEP goals in your classroom.
• Find out if your state or school district has material or resouces available to help educators address the learning needs of children with speech or language impairments.
• Communicate with the student's parents. Regularly share information about how the student is doing at school and at home.

Assistive technology (AT) can also be very helpful to students, especially those whose physical conditions make communication difficult. Each student's IEP team will need to consider if the student would benefit from AT such as electronic communication system or other device. AT is often the key that helps students engage in the give and take of shared thought, complete school work, and demonstrate their learning.

Children and adults with severe speech or language problems may need to find other ways to communicate. There are many types of AAC that they can use. Speech-language pathologists, or SLPs, can help. ASHA provides more information on communication options at the following sites:

• Augmentative and Alternative Communication
• Speech for People with Tracheostomies or Ventilators

ORGANIZATIONS

American Speech-Language-Hearing Association (ASHA)   https://www.asha.org   2200 Research Boulevard  Rockville, MD 20850  301.296.5700; 301.296.5650 (V/TTY); 800.638.8255

ASHA is the professional, scientific, and credentialing association for more than 123,000 members and affiliates who are speech-language pathologists, audiologists, and speech, language, and hearing scientists in the United States and internationally. The purpose of ASHA is to promote the interests of and provide the highest quality services for professionals in audiologist, speech-language pathology, and speech and hearing science, and to advocate for people with communication disabilities.

Childhood Apraxia of Speech Association of North America (CASANA)   https://www.apraxia-kids.org   Cardello Building  1501 Reedsdale Street, Suite 202  Pittsburgh, PA 15233  [email protected]

The Childhood Apraxia of Speech Association is a non-profit publicly funded charity whose mission is to strengthen the support systems in the lives of children with apraxia so that each child is afforded their best opportunity to develop speech: to provide electronic and print information to families, professionals, policy-makers and other members of the public; to support and educate parents and professionals as advocates for children with apraxia; to facilitate better public policy and services for children affected by the disorder; to provide training opportunities for families and professionals; to encourage research to further understanding about childhood apraxia and to co-sponsor a biennial scientific research symposium.

American Cleft Palate-Craniofacial Association (ACPA) Family Services   https://cleftline.org   1504 East Franklin St, Suite 102  Chapel Hill, NC 27514  (919) 933-9044

ACPA Family Services is a program of the American Cleft Palate-Craniofacial Association (ACPA). ACPA Family Services provides education, personalized support, and resources for every stage of the cleft or craniofacial journey. ACPA is dedicated to providing comprehensive resources and individualized support, with a focus on education and team care. Their mission is to create a world where people with cleft and craniofacial conditions thrive.

International Society for Augmentative and Alternative Communication (ISAAC)   https://www.isaac-online.org/english/home/   312 Dolomite Drive, Suite 216  Toronto, ON M3J 2N2  Canada  +1.905.850.6848  [email protected]

ISAAC—the International Society for AAC—works to improve the life of every child and adult with speech difficulties. ISAAC provides publications, researches, and events. It describes the many ways to help people who cannot speak or write - things like electronic talking boxes, computers, books and boards with pictures or letters, or sign language. The ISAAC website can display Bliss, PCS or Rebus symbols so that people who use one of these symbol systems instead of text, or who have learning difficulties, will be able to read it.

National Institute on Deafness & Other Communication Disorders   https://www.nidcd.nih.gov   31 Center Drive, MSC 2320  Bethesda, MD USA 20892  800.241.1044  800.241.1055 (TTY)  [email protected]

The National Institute on Deafness and Other Communication Disorders (NIDCD) is to provide new knowledge to help prevent, detect, diagnose, and treat disease and disability. NIDCD conducts research in laboratories at the NIH, and the Extramural Research Program, a program of research grants, career development awards, individual and institutional research training awards, center grants, and contracts to public and private research institutions and organizations. The Institute also conducts and supports research and research training in disease prevention and health promotion and the special biomedical and behavioral problems associated with people having communication impairments and disorders.

The Stuttering Foundation   https://www.stutteringhelp.org   P.O. Box 11749  Memphis, TN 38111  800.992.9392  901.761.0343  [email protected]

The Stuttering Foundation provides free online resources, services and support to those who stutter and their families, as well as support for research into the causes of stuttering. There are several video clips for kids, youth, and teachers. The web site is well organized kids, young, and adult with stuttering. Moreover, they provide visual and research information for teachers and parents.

International Stuttering Association   http://www.isastutter.org

ISA is a worldwide network of people who stutter, a non-profit umbrella association dedicated to close cooperation among independent national and international self-help organizations of people who stutter. ISA was founded in 1995. It is to provide people who stutter, their family and friends, speech-language pathologists, academics, students and the general public with information on stuttering resources available in world.

Last modified January 2020.

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Speech/Language Impairment or Specific Learning Disability? Examining the Usage of Educational Categories

Wendy c. georgan.

a MGH Institute of Health Professions, Boston, MA

b Program in Speech and Hearing Bioscience and Technology, Division of Medical Sciences, Harvard University, Cambridge, MA

c Department of Communication Sciences and Disorders, Northeastern University, Boston, MA

Lisa M. D. Archibald

d School of Communication Sciences and Disorders, University of Western Ontario, London, Canada

Tiffany P. Hogan

Associated data.

The data used in this study are all publicly available for download through the U.S. Department of Education's Open Data Platform ( https://data.ed.gov ). IDEA data included in this study can be found under IDEA Section 618 Data Products ( https://data.ed.gov/dataset/idea-section-618-data-products ).

Developmental language disorder (DLD) is a lifelong condition that when impacting educational performance is identified and serviced through U.S. schools as outlined in the Individuals with Disabilities Education Act. A few examples of educational categories that refer to DLD are (a) speech or language impairment (S/LI) and (b) specific learning disability (SLD). In this research note, we aim to examine trends in how these categories are assigned.

We analyzed publicly available data released by the U.S. Department of Education from six school years between 2010 and 2020. We examined the use of S/LI and SLD categories across students of different ages at the U.S. national and state levels.

We present a trend in which younger students tend to be identified with the S/LI category, whereas older students tend to be identified with the SLD category. This trend is evident in all 6 years of data analyzed at the national level, and in 49 of 50 states.

Conclusions:

We discuss these findings in the context of research on language disorders to explain this trend. We highlight the potential damaging effects of using inconsistent terminology, including affecting the services for which students with DLD qualify and causing confusion for their parents and educators.

Developmental language disorder (DLD) is a lifelong neurodevelopmental condition that affects one's ability to understand and use language in the absence of brain damage, hearing impairment, or intellectual disability ( McGregor et al., 2020 ). Its presentation is variable and can be characterized by difficulties in word learning, morphosyntactic skills, vocabulary, and discourse-level language ( Lancaster & Camarata, 2019 ). DLD is one of the most common developmental disorders, with a prevalence of around 7.5% (e.g., Norbury et al., 2016 ), and its effects carry through the life span. Children with DLD are at greater risk for having reading difficulties ( Catts et al., 2002 ), smaller social circles and greater isolation ( Chen et al., 2018 ), and higher rates of anxiety and depression ( Conti-Ramsden & Botting, 2008 ). Adults with DLD tend to leave education earlier and have less skilled employment ( Conti-Ramsden et al., 2017 ). Early identification and provision of appropriate supports and services are crucial to optimize outcomes for children with DLD (e.g., Winstanley et al., 2018 ).

Unfortunately, children with DLD tend to be identified later and with less reliability than children with other neurodevelopmental disorders, including dyslexia ( Adlof & Hogan, 2018 ) and autism ( Gupta et al., 2007 ). In a parent survey conducted as part of a DLD study, only 9%–27% of parents of children with DLD reported concerns in areas of receptive and expressive language ( Hendricks et al., 2019 ; see also Tomblin et al., 1997 ). Those children with DLD who are identified are often those with more visible comorbidities, including autism ( Dockrell et al., 2019 ) and speech sound disorder (SSD; Skeat et al., 2010 ; Zhang & Tomblin, 2000 ), or those with educational and financial resources ( Wittke & Spaulding, 2018 ). This underidentification of DLD can be attributed to several factors, one of which is the inconsistent and variable terminology used to refer to DLD by researchers, clinicians, and educational policymakers. Because DLD has been studied from psychological, linguistic, neuroscientific, and genetic perspectives, there are over 100 different terms that researchers have used to describe children with DLD ( Bishop, 2014 ). The term DLD was selected by the CATALISE Consortium, a group of 57 researchers representing six countries, of which six were speech-language pathologists from the United States ( Bishop et al., 2017 ). DLD is defined as “a language problem that endures into middle childhood and beyond and that has a significant impact on social or educational function” ( Bishop et al., 2017 ). Some debate remains among researchers about how the broader term DLD relates to the widely used, more narrowly defined specific language impairment (SLI; Volkers, 2018 ). SLI typically describes an impairment specific to language that cannot be attributed to hearing loss, neurological damage, or intellectual disability ( Leonard, 2014 , 2020 ). This final exclusion is typically defined as having a nonverbal IQ of at least 85, though there is marked variability across researchers regarding the nonverbal IQ “cutoff” score ( Gallinat & Spaulding, 2014 ). Though DLD and SLI, among other research terms, continue to be used throughout the literature, these research-oriented terms, often, do not have a direct correlation with terms used by clinicians, insurance providers, and educational policymakers, all of whom operate under different labeling systems. In the United States, clinicians across settings often refer to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition , which defines the terms language disorder and specific learning disorder . Meanwhile, insurance providers use codes outlined in the World Health Organization's International Classification of Diseases, which includes F80.1 Expressive language disorder and F80.2 Expressive and receptive language disorder. Educational policymakers and speech-language pathologists working in school settings in the United States use the broader categories defined in the Individuals with Disabilities Education Act (IDEA). This inconsistency causes further confusion and makes it difficult not only for researchers to collaborate with each other, but also for people from different sectors to communicate with each other or generate awareness of DLD ( Georgan & Hogan, 2019 ; Leonard, 2020 ; Schuele & Hadley, 1999 ). In this research note, we will focus on the usage of educational categories as defined in the IDEA that could potentially be assigned to children with DLD. It is imperative that category usage is understood to ensure that educators and parents recognize the way that these categories impact services for DLD, a lifelong condition.

Within the U.S. school system, students whose disabilities affect their educational performance will be deemed eligible for special education services under one or more categories as outlined in the IDEA. These eligibility categories are broadly defined and are not meant to be diagnostic. Additionally, a student can be found eligible for special education through multiple IDEA categories, in which case they are listed as “primary,” “secondary,” and so forth. The categories defined in the IDEA are (a) autism, (b) deaf-blindness, (c) deafness, (d) emotional disturbance, (e) hearing impairment, (f) intellectual disability, (g) multiple disabilities, (h) orthopedic impairment, (i) other health impairment, (j) specific learning disability (SLD), (k) speech or language impairment (S/LI), (l) traumatic brain injury, and (m) visual impairment. The majority of students serviced through IDEA are identified with SLD (33%) and S/LI (19%) according to the National Center for Education Statistics (2022) .

There are several categories that could potentially apply to a child who has DLD. A few likely options are (a) S/LI and (b) SLD ( Sun & Wallach, 2014 ). The following definitions are taken verbatim from IDEA Part B, Subpart A, Section 300.8: Child with a disability.

Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child's educational performance.

Specific learning disability means a disorder in one or more of the basic psychological processes involved in understanding or in using language , spoken or written, that may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations, including conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.

Considering the language-based deficits of children with DLD, it is clear that either of these two categories could be used to refer to a child with DLD. The category S/LI clearly includes “language impairment” in its definition. However, this category does not distinguish whether the child in question has a S/LI (or both). In comparison, the category SLD is much broader, encompassing disorders in reading (i.e., dyslexia), writing (i.e., dysgraphia), and math (i.e., dyscalculia), among many others. At its core, however, SLD is described as “a disorder…in using language, spoken or written” ( IDEA, 2004 ). DLD clearly falls under this description, and would likely impact a child's reading, writing, and even math ( Cross et al., 2019 ), all of which rely heavily on language ability. Notably, the descriptions of both S/LI and SLD stipulate that the child's language impairment negatively affects their academic performance in some domain.

The definitional difference between these categories is difficult to pinpoint. As Sun and Wallach (2014) point out, “Even a cursory consideration of these various definitions shows their similarity and, in many aspects, their complete overlap. By definition, a disorder of spoken or written language is a learning disability (p. 28).” Indeed, children with DLD are often identified under one or both of these categories, or “transition” from one category to another ( Sun & Wallach, 2014 ).

Study Purpose

The considerable overlap between the terms S/LI and SLD in the United States raises the question of why a child with DLD would be identified with one of these categories or the other (or both). Clinical observations have highlighted more usage of the S/LI category in ages 3–5 years than in ages 6–21 years (e.g., American Speech-Language-Hearing Association [ASHA], 2016 ). The data-driven analysis of category trends in this study may lend support to these observations. Additionally, in a white paper released by the U.S. National Center for Learning Disabilities, Horowitz et al. (2017) showed graphically that the number of 6-year-old children with SLD in 2007 increased almost 6-fold compared to the number of 10-year-old children with SLD in 2011. In the same time frame, the proportion of 6-year-old children with an S/LI label was almost three times the proportion of 10-year-old children with S/LI.

Although Horowitz et al. (2017) reported the increased use of the SLD category with older children as an indication that these children were not identified in earlier grades, it is important to note that many children who had originally been designated as S/LI may have been reclassified as SLD as they were re-evaluated through the years. Thus, the discrepancies over time in S/LI and SLD usage observed in Horowitz et al. (2017) are likely not due to true shifts in the prevalence of S/LI or underlying language impairment. We know that DLD affect individuals across the life span ( Clegg et al., 2005 ), and there has been no evidence to suggest that the prevalence of such disorders changes across ages. If there is no epidemiological shift across ages, then this begs the question: Why would age affect the usage of these educational categories?

In this research note, we aim to investigate the trends in the usage of these educational categories using publicly available data released by the U.S. Department of Education as required by IDEA Section 618. Considering the fact that DLD is a life-long disorder that has impacts across the life span and manifests differently over time, we hypothesize that designations for oral language impairment (S/LI) should be identified early and remained consistent throughout the school years. Findings that this category grows in number and remains relatively stable would be consistent with this hypothesis. A pattern of decreased numbers being identified with S/LI, however, would be more consistent with a change in category use over time. Our work aims to replicate and extend the findings of Horowitz et al. (2017) and clinical observations such as those published in ASHA Leader ( ASHA, 2016 ) by investigating potential age-related differences in category usage at the national level and within individual states. We also apply robust linear models to quantify the relationship between age and category usage.

We performed data analysis on anonymized publicly available data released by the U.S. Department of Education under IDEA Section 618. All states, territories, and freely associated states of the United States supplied data about children with disabilities, aged 3 through 21 years, who received special education and related services under IDEA. We included nationwide data from the 2010–2011, 2011–2012, 2016–2017, 2017–2018, 2018–2019, and 2019–2020 school years. Between 2012 and 2015, the Department of Education released IDEA data that did not include disability category by age, so the data were incomplete for our analysis. We also analyzed state-level data from 2011–2012, the most recent year for which state-level disability category data for every age between 3 and 21 years were available. We then examined the assignment of the S/LI and SLD categories across ages at the aggregate national level, as well as within individual states.

Participants

Data from children (aged 3–21 years) with disabilities who were serviced under IDEA were included for six school years. Though data were available for the number of children designated to each of the 13 disability categories of IDEA, we only examined the number of children with S/LI or SLD and the number of children with any disability across ages. As mentioned before, a student can be identified with multiple categories under IDEA; the data analyzed reported only the primary category assignment in these cases. The total number of children who were classified by age and disability category for each school year can be found in Table 1 . Due to the nature of the data, we were unable to track an individual child over multiple years to see whether his or her category changes, which would be the ideal way to investigate the S/LI to SLD shift. However, by investigating disability category by age within individual states and nationwide, we are able to report whether such trends exist at the aggregate level and perform a more holistic analysis of general trends in the use of IDEA categories.

Number of students with speech or language impairment (S/LI), specific learning disability (SLD), and total across all disabilities for each school year of data analyzed in the United States.

Data Analysis

We downloaded Comma Separated Value (.csv) files from the IDEA Section 618 Data Products website (available at https://data.ed.gov/dataset/idea-section-618-data-products as of February 1, 2022; previous web address: https://www2.ed.gov/programs/osepidea/618-data/index.html ). We used the free, open-source software R ( R Core Team, 2021 ) for data cleaning and analysis.

For both nationwide and state-level analysis, we investigated how the number of children who are classified as S/LI or SLD changes across ages. Nationwide analyses included data from the 50 states (including Washington D.C.), U.S. territories (American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands), and freely associated states (the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau [Palau]). State-level analysis included only data from the 50 states (excluding Washington D.C.). If there was a shift in whether more children were classified as S/LI or SLD as age increased, then the mean “age of shift” was calculated. By “age of shift,” we mean the age at which there was a change in the primary category identifying children. The data do not indicate whether or not the same children are included across consecutive years, and so cannot indicate whether individual children's categories shifted. We calculated age of shift by determining the x -value (age) of the intersection. Since data are only available for whole number ages, the age of shift was calculated by determining the two ages between which the number of S/LI children became less than the number of SLD children or vice versa. We then took the total difference in number of children between these two ages and approximated the age at which the counts would cross using the following formula:

For example, for the data in Table 2 (presented graphically in Figure 1 ), the calculated age of shift would be the x -value of the intersection, calculated as:

Example data to demonstrate age of shift calculation. S/LI = speech or language impairment; SLD = specific learning disability.

Line plot of example data ( Table 2 ) to demonstrate calculation of age-of-shift using x -value of the intersection. Blue = speech or language impairment (S/LI); orange = specific learning disability (SLD).

Mean age of shift was calculated at the nationwide level for each of the 6 years of data. Additionally, the age of shift for each individual state was calculated for the 2011–12 school year, the most recent year for which state-level disability category data for every age between 3 and 21 years were available. Descriptive statistics of the distribution of the ages of shift are presented in the results.

When plotting the state-level trends in S/LI and SLD, we calculated the percentage of all children with disabilities who were categorized as S/LI or SLD, respectively, rather than using the raw counts. This is because of the wide variation in state populations, which makes the raw numbers of children with S/LI or SLD difficult to compare across states. Proportions of S/LI and SLD were calculated as follows for each age:

Finally, we used a generalized additive model (GAM) to quantify the effect of age on proportions of S/LI and SLD across states. GAM, a type of generalized linear model, has the flexibility to model nonlinear data by assigning smooth functions to the predictors ( Hastie & Tibshirani, 1986 ; Wood, 2017 ). Interpretation of GAMs is relatively similar to interpretation of other linear models, with the exception that the smoothed predictors are not assigned a single coefficient. Instead, we report the estimated degrees of freedom (EDF), which indicates the complexity of the smooth function (i.e., an EDF = 1.0 is a linear function, EDF = 2.0 is a quadratic function, etc.). We also report the p value of the smoothed age predictor and the adjusted R 2 .

At the nationwide level, we found that across all six years, a virtually identical pattern emerged: up until around age 9 years, more children are identified with the S/LI category than the SLD category. However, around age 9 years, the prevalence shifts, with more children identified as SLD than S/LI (see Figure 2 ). This trend is robust and consistent across years, indicating an irrefutable shift in educational categories from S/LI to SLD as children get older.

Number of children in the United States (states, territories, and freely associated states) serviced under the Individuals with Disabilities Education Act with speech or language impairment (S/LI; blue) and specific learning disability (SLD; orange) by age for the 2010–2011, 2011–2012, 2016–2017, 2017–2018, 2018–2019, and 2019–2020 school years.

Using the age of shift calculation formula, the mean ages of shift from higher prevalence of S/LI to higher prevalence of SLD were calculated for each school year (see Table 3 ). In more recent years, the mean age of shift is lower than in 2010 and 2011, indicating a trend for an earlier shift to categorizing children as SLD rather than S/LI. This may be due in part to the push to identify children with specific learning disability earlier ( National Joint Committee on Learning Disabilities, 2006 ).

Mean age of shift in the United States for each school year.

At the state level, the proportion of all children with disabilities who were categorized as S/LI or SLD is presented for the 2011–12 school year (see Figure 3 ). Visually, for almost all states, there is a clear trend in that the use of the S/LI category decreases as the use of SLD increases, with a clear crossing point around age 9 years. To quantify the effect of age on category usage, we fit a GAM to estimate the effect of a smoothed age predictor on the proportion of S/LI and SLD identifications across all states (see Figure 4 ). The model generated two smoothed age terms, one for each category, denoted as s (Age)|S/LI and s (Age)|SLD. The EDF for s (Age)|S/LI was 8.647, and the EDF for s (Age)|SLD was 7.204. The smoothed age predictor was significant for predicting the proportion of S/LI usage ( p < .001) and SLD usage ( p < .001), with an overall adjusted R 2 of .705. This means that the age variable explained 70.5% of the variance in S/LI and SLD category usage.

A U.S. map showing the proportion of children in the 50 states serviced under the Individuals with Disabilities Education Act with speech or language impairment (S/LI; blue) and specific learning disability (SLD; orange) by age for the 2011–2012 school year. Dotted lines indicate the intersection of the blue and orange lines (if one exists). The age ( x -value) of this shift is denoted. Figure generated with helper code from nandeshwar.info .

Smoothed predictive curves generated by a generalized additive model, using smoothed age as a predictor of speech or language impairment (S/LI) identification (blue, left) and specific learning disability (SLD) identification (orange, right). Data points depict the raw data, which is the proportion of children with a given label in a single state.

The glaring exception to the state-level trend is the state of Iowa, in which the prevalence of S/LI hovers around 8.6% of all disabilities and that of SLD around 60.4% of all disabilities across all ages. There is no clear reason why this would be the case epidemiologically, so this discrepancy is likely due to Iowa school systems assigning the S/LI and SLD categories using different evaluation criteria than the majority of U.S. states.

We also calculated the age of shift from higher S/LI prevalence to higher SLD prevalence for each state using the 2011–2012 data set (excluding Iowa, for which there is no shift in educational categories). The mean age of shift across these 49 states was 8.81, with a median age of 8.68. Values of the age of shift ranged from 6.45 to 10.58. The age of shift in each state is presented in Table 4 . The large amount of variation across states is likely due to the fact that individual states have different policies regarding evaluation and classification of children with disabilities, including different eligibility criteria, response to intervention requirements and procedures, and even arbitrary caps on the percentage of students that can be classified as having a disability ( De Jesús, 2016 ; Frame & Mirfendereski, 2018 ). The distribution of the values of the age of S/LI to SLD shift is presented as a box plot and histogram in Figure 5 .

The age of shift in each U.S. state as calculated from the 2011–2012 data set.

Note.  N/A indicates that the state did not exhibit a trend such that an age of shift could be calculated.

Distribution of the age at which proportion of speech or language impairment (S/LI) becomes less than proportion of specific learning disability (SLD). (A) Box plot indicates median (dark line), with each dot representing an individual state's age of shift. (B) Density histogram of the distribution of ages of shift, mean indicated by dotted line.

The purpose of this study was to investigate the usage of the S/LI and SLD educational categories across ages at statewide and nationwide levels in the United States. We found a clear nationwide trend in which a higher proportion of younger children are identified with the S/LI category than the SLD category and that these proportions shift toward higher SLD categorization in children older than the age of 9 years. This pattern was evident in all 6 years of data included in this study. Additionally, the state-level data from the 2011–2012 school year showed that in 49 out of 50 states, this same terminological shift from S/LI to SLD occurs. These findings reveal a robust and pervasive trend in the use of educational categories involving a shift from the use of S/LI in younger children to SLD in older children. Understanding what factors may contribute to this shift is essential for accurately identifying and providing services for children with language impairments.

Decrease of the S/LI Category: Possible Explanations

A clear trend that was observed across all years of data was the decrease in the usage of the S/LI category from younger to older students. There are several possible explanations for this shift that are not necessarily exclusive of each other. The first explanation relates to a shift in academic demands. Both word decoding and oral language skills predict reading comprehension ( Hoover & Gough, 1990 ; Kendeou et al., 2009 ). However, the relative contributions of each of these components to reading comprehension begins to shift around third to fourth grade (~age 9 years), as children transition from learning to decode lower level text to reading complex texts with advanced language. This shift from “learning to read” to “reading to learn” has been well-documented ( Language and Reading Research Consortium, 2015 ; Wolf & Stoodley, 2007 ) and explains why children with weak oral language skills may seem to suddenly struggle with reading in later grades. As reading is fundamental not only for English Language Arts classes but also for science and history classes, children with language impairments such as DLD may not be identified until around age 9 years, when they begin to struggle academically ( Nation et al., 2004 ). Chall (1983) describes this seemingly sudden decline in reading ability as the “fourth-grade slump” (see also Leach et al., 2003 ). The timeline of the shift from S/LI to SLD that we determined in this research note aligns well with what would be predicted from the change in reading level that occurs around age 9 years.

Additionally, this terminological shift could be related to the higher demands on oral language than word-level skills in more competent readers. As reported in Catts et al. (2005) , there is a shift in the predictive value of the two components of reading comprehension across age. In a longitudinal study, examining the contributions of word-level decoding and oral language skills to reading comprehension in second, fourth, and eighth grade, Catts et al. (2005) found that the amount of unique variance predicted by oral language skills increased from 9% to 21% to 36% across the three grades. The amount of unique variance predicted by word-level decoding skills decreased from 27% to 13% to 2% within the same time frame. It is within this critical period of dynamic change in the contribution of the components of reading comprehension that we see a shift in the terminology used to describe children whose language impairment begins to affect their reading ability. Older children with DLD struggle most visibly with reading ( Botting, 2020 ), an area of potential deficit specifically listed in the IDEA definition of SLD, but not in that of S/LI. This is a potential explanation for why children with DLD tend to be categorized as SLD rather than S/LI at older ages.

Another explanation for the decrease in the S/LI category is that the category represents a variety of disorders, some of which are more prevalent in younger children, such as SSDs ( Sharp & Hillenbrand, 2008 ). It would stand to reason that these children would no longer be identified as S/LI or be eligible under IDEA once these speech patterns have resolved. The fact that SSD and DLD fall under the same broad educational disability category makes it difficult to tease them apart by analyzing IDEA categories. This points to the larger issue of how IDEA categories are defined and the purpose of educational disability categories as opposed to clinical diagnostic labels. Although this falls outside the scope of this research note, future work is needed to determine the potential positive effects of creating more narrowly defined IDEA categories, such as in the case of autism spectrum disorder (e.g., Pennington et al., 2014 ). Overall, changing academic demands and resolved SSD, along with other possible explanations, should be explored in future studies in a longitudinal sample of children who are initially qualifying for services as S/LI as they matriculate through elementary school.

DLD Is a Lifelong Condition

One additional explanation for the current findings could be that children transition in their disability categories. Although longitudinal data would be necessary to determine if a given child is assigned different categories at different years of age, the present results would be consistent with that possibility. Transitioning in categories could be problematic for a number of reasons, including putting stress on the family and contributing to a lack of understanding of the child's underlying areas of need. Further research is needed to investigate whether children's categories change over time.

The patterns we observed are consistent with the possibility that children with DLD experience a shift in eligibility categories as they get older. It is crucial to point out the fact that this terminological shift is not necessarily indicative of a shift in underlying deficit or true diagnosis. Children with DLD who are identified early on as having S/LI have language difficulties that manifest in different ways depending on the learning demands. At older ages, the impairment may affect key areas of learning, resulting in something that looks like SLD, but the child's underlying impairment is still in oral language skills. In fact, Sun and Wallach (2014) propose that “the majority of learning disabilities are language disorders that have changed over time. SLD is not a ‘new’ and distinct condition that arrives when children enter school (p. 34).” It is troubling when one considers the fact that children who are identified as S/LI early on may undergo treatment and seem to improve in language skills, only to later on be identified as SLD when the language demands of the classroom increase. This “illusory recovery” ( Scarborough & Dobrich, 1990 ) in which children are discharged under S/LI, only to be re-identified with SLD, can mean that children who require continued language services may go through periods of receiving little to no support.

The redundancy of the definitions of S/LI and SLD raises the question of how important these educational categories are for the treatment of children who are categorized as one or the other. Children with language impairment who are categorized as S/LI versus SLD often have the same types of language deficits ( Bishop, 2009 ; Casby, 1989 ; Sun & Wallach, 2014 ), and the use of varied terminology only serves to be confusing for parents and educators. The use of different categories is further complicated by the way services are provided in schools. Oral language deficits, like those underlying DLD, are primarily serviced by speech-language pathologists, whereas academic difficulties in reading, writing, and math are addressed by reading specialists or special education teachers. For children with DLD, regardless of the label used to qualify for services and regardless of who provides those services, appropriate supports should be in place with no breaks or gaps. Speech-language pathologists are in the unique—albeit challenging—position of being able to ensure continued language support and facilitate smooth transitions to academic services for these children.

Limitations and Conclusions

The aim of this study was to explore how IDEA categories are assigned and to identify factors (such as age) that affect category usage. Due to the exploratory nature of this study, our findings are not meant to advocate for changes in the IDEA categories. Future work is needed to study the effects of broad categories and definitions on the treatment and services students receive through IDEA.

One limitation of this study is that the available data were cross-sectional in nature. Though we identify a clear shift in category usage over age, this trend can only be described at the aggregate level. An important future direction will be to follow children longitudinally to examine how categories are assigned and change over time in individuals. Additionally, the available data included only the primary disability category that a student was identified with; if a student was found eligible under multiple categories, these secondary categories were not accounted for in the data. Therefore, it is possible that some students could have been identified under both the S/LI and SLD categories, with one being the primary category. Because of the lack of data on secondary categories, the trends observed for shifts in primary category usage of S/LI and SLD do not consider potential interactions with other IDEA categories. Future work is needed to understand how primary and secondary IDEA categories affect services. Also, due to the nature of our data set, we were unable to investigate other factors that could potentially impact the choice to use S/LI or SLD, such as setting (schools vs. private clinics), state and local determinations of eligibility criteria, school culture, and financial considerations, such as funding for special education departments and insurance company policies ( Murza & Ehren, 2020 ). This study also did not investigate how workplace policies or practices limit diagnostic decisions ( Girolamo et al., 2022 ; Selin et al., 2019 , 2022 ). Future work on the complexities involved in assigning IDEA categories is needed. Finally, it should be noted that findings related to trends in IDEA category usage are specific to the United States and do not include international variations of educational disability categories. 1

Ultimately, the findings of this study reveal a terminological shift from S/LI to SLD that occurs around the age of 9 years. This shift occurs in almost every individual state but varies state-to-state due to differences in state-level special education policies. Understanding why this shift occurs and the significance of changing categories is crucial for improving the early diagnosis and treatment of children with language impairment.

Data Availability Statement

Acknowledgments.

The National Institute on Deafness and Other Communication Disorders Institutional Training Grant 5T32DC000038-28 was awarded to Harvard University and supported Wendy C. Georgan during their work on this research note. The Research Supplements to Promote Diversity in Health-Related Research, R01 DC016895, was awarded to Wendy C. Georgan with Tiffany P. Hogan as the recipient of the parent R01.

Funding Statement

1 However, there is potential that similar trends are occurring in other countries besides the United States. For example, in a document published by the Department for Education in England in 2019, it was noted that the use of the category “Speech, Language and Communications Needs” decreased with older students, while the use of “Specific Learning Difficulty” increased with age ( Data Insight and Statistics Division, Data Group, Department of Education, 2019 ). An intersection is observed between ages 9 and 10 years. This trend seems to be consistent with the findings described in this study for U.S. educational categories.

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