Speech, Language and Learning

Frequently Asked Questions

FAQs About the Professions

1. What's the difference between a "speech pathologist" and a "speech therapist"?
There isn't a difference, but often the term "speech pathologist" is used in medical facilities or clinics, while "speech therapist" is used by those of us who work in schools or other educational settings.

2. Is there a difference between a speech therapist and a speech-language therapist?
No. We all have essentially the same training. However, some of us specialize more in aspects of speech: articulation (pronunciation), voice, and fluency (stuttering) while others of us focus more on the language aspects of communication such as vocabulary, syntax (grammar and sentence-formulation), and discourse or "pragmatics" (conversation and social communication).

3. What training do speech-language therapists have?
A Master's Degree in speech-language pathology is required for us to be considered fully qualified clinicians. Most of us also complete a Clinical Fellowship Year after we receive our Master's degrees in order to qualify for the Certificate of Clinical Competence from the American Speech-Language-Hearing Association.

4. What is an educational therapist?
An educational therapist works one-on-one with individuals who have learning differences or disorders. An educational therapist provides intensive intervention for academic problems such as dyslexia, ADD, disorganization and poor study skills, low motivation and poor self-concept related to education. Educational therapists focus on utilizing a client's strengths to address his or her academic weaknesses.

5. What training to educational therapists have?
Educational therapists have Master's degrees in Educational Therapy or a related field such as Special Education, Speech-Language Pathology, School Psychology, or Family Therapy. Becoming a certified educational therapist requires 2500 hours of experience with individuals who have learning differences or disorders. Board certification in educational therapy requires acceptance by the Certification Board of the Association of Educational Therapists of an extensive case study.

FAQs About Speech and Language Development

1. What's the difference between "speech" and "language"?
"Speech" is the physical movements of the lips, tongue, lungs and vocal cords to produce words. "Language" is the words-in-our-heads. We use language to express ourselves through speech, writing, singing or signing. We understand language when we listen, read or watch someone sign.

2. How do babies develop speech?
First, of course, babies need to hear accurately to begin to learn to speak. In addition to normal hearing, learning to speak requires coordinated movement of the lungs, vocal cords, lips, tongue and "soft palate." (The soft palate is an area at the back of the throat which moves up and down to either close off or open the nasal passages.)

Babies begin practicing the movements required for speaking even before they are born. After birth, speech development is expected to occur in a particular sequence. First, babies "coo" using vowel sounds, gurgles and squeals: "ooo," "ah" "eeeee!" Then they combine vowels with consonants ("ma" "ba" "da") and a little later they begin "babbling," using chains of sounds ("mama" "dada" "baba").

By the end of their first year, many babies are producing a few recognizable words, and by 3 years old a child should be about 80% understandable even to strangers. The process of developing speech sounds goes roughly like this:

Age	Sounds produced correctly
3	m, n, ng, p, f, h, w
3-1/2	Consonant y (as in "yep")
4	k, b, d, g, r
4-1/2	s, sh, ch
6	t, v, l, th (as in "thin")
7	z, zh (as in "measure"), th (as in "father"), j

3. How Does Language Develop?
Babies communicate without using words from the time they are born, and formal language development begins when a baby first recognizes words and then begins to use them. Most babies recognize their own names by about 8 months and begin to use a few words by a year old. Understanding words and sentences is called "receptive language." Using words and sentences is called "expressive language." Receptive language usually develops more quickly than expressive language.

The sequence of expected language development after a baby is a year old looks (again roughly) like this:

Age	Features
18 months	Able to use 10 to 20 words; understands considerably more
2 years	Understands about 200 words; Produces 2-word phrases
2-1/2 years	Understands about 300 words (primarily nouns and verbs)
3 years	Understands about 900 words - Average sentence length: 3 words
4 years	Understands and uses 900 to 1500 words; Should be nearly 100% understandable; Uses grammatically accurate compound and complex sentences
5 years or entering Kindergarten	Understands and uses 2000+ words; Follows 2- and 3-step directions; Average sentence length: 4+ words; Able to name upper and lowercase letters; Is able to rhyme

About 85% of children who are delayed in verbal language development as pre-schoolers go on to have reading problems in school. A speech-language pathologist can identify the types of speech and language problems which are indicators of later academic difficulty. "Kids Health for Parents" recommends: "Don't Wait to Evaluate!" Appropriate early intervention can help save kids and their families from years of struggle.

Language development continues during elementary and middle school and is refined throughout our lives. New research on "brain plasticity" indicates that it is never too late to build language skills or even to re-acquire some speech and language abilities after stroke or brain injury.

4. What causes a speech or language delay?
The most obvious cause of delayed speech or language development is hearing impairment, of course. Many states now provide newborn hearing screenings, and babies can be fitted with hearing aids as early as 3 months of age. The earlier a hearing impairment is recognized and addressed, the better the outcome for speech and language acquisition. Risk factors for hearing loss in infants include complications during pregnancy or birth: rubella, low birthweight, and loss of oxygen during the birth process. Babies and toddlers are at risk for temporary hearing loss due to ear infections, and older children can sustain longterm hearing impairment by exposure to loud noise. Another hearing-related cause of speech and language delay is Auditory Processing Disorder.

5. What is an Auditory Processing Disorder?
Auditory processing is essentially the way the brain interacts with the ears. When a person has an auditory processing disorder (APD), his ears work fine, but the connection between ears and brain doesn't work smoothly or quickly enough. As a result, the person with APD will have difficulty following directions, understanding and participating in conversations, ignoring background noise, or remembering what she has heard. Additionally, and perhaps most importantly, children who have APD may have trouble learning vocabulary and grammar as well as having difficulty "hearing" differences among similar sounds in words: "cat" may sound like "cap," for instance. This significantly complicates their ability to learn to read and spell since they aren't able to clearly understand the sound-to-letter relationship.

6. What does APD look like from the outside?
People who have APD may seem to "tune out" in situations where they need to listen for periods of time. They may have difficulty knowing the direction a voice is coming from or they may complain about background noise. They may not be able to follow directions easily, especially when instructions are given quickly or if several are given at once. People with APD often misunderstand conversation and have a tendency to mishear and misspeak by confusing similar sounding words. APD is not a matter of lower intelligence, but because it interferes with both understanding and expression, it certainly has a negative impact on educational performance and self-concept.

Recommended reading about APD:

• Like Sound Through Water by Karen Foli
• When the Brain Can't Hear by Teri James Bellis

7. Besides hearing impairment and APD, what causes language delay?
Often there is no obvious cause of language delay, although many times another family member has experienced similar development. Again, a language delay does not necessarily indicate lower intelligence, but it can lead to problems learning to read and spell. Some language delays do involve cognitive deficits, however. For instance, severe delays in language development are part of autism, Down Syndrome and other forms of mental retardation, cerebral palsy or other physical disabilities which keep children from exploring the environment in typical ways.