How speech and hearing professionals help us communicate across a lifetime

Note: This interview was originally published in Doing Well, a health news outlet from ASU Media Enterprise and ASU Learning Enterprise. Subscribe to Doing Well to get interviews with health experts delivered to your inbox weekly.

By Mel Moore

Remember those hearing screenings in elementary school? As a kid, you probably didn't think much about it — but those screenings are a part of a national effort to intervene when support is needed for hearing difficulties.

The health professionals behind this effort are audiologists and speech language pathologists (SLPs) — professionals who work to diagnose and treat communication challenges.

Speech, language and hearing disorders are common. Around 1 in 10 adults report trouble hearing, and 1 in 12 children aged 3 to 17 has a disorder related to voice, speech, language or swallowing. These challenges can take many forms — hearing loss or delay; aphasia; stuttering; lisps; and communication challenges related to stroke, ALS, autism spectrum disorder and Parkinson’s, among other examples. Speech and language therapy can help manage many of these conditions.

To better understand the tools we have to support communication throughout our lives and diagnose and treat speech, language and hearing disorders, Doing Well spoke to Victoria Clark, a speech language pathologist and professor at the ASU College of Health Solutions.

Note: This conversation has been lightly edited for length and/or clarity.

Question: How do speech and language disorders develop?

Answer: A lot of speech and language issues run in families. Stuttering is an example where if you have someone in your family who stuttered in the past, it increases the risk for other family members. We usually ask during an evaluation: Has anyone in your family been diagnosed with any kind of communication difficulty?

SLPs also diagnose acquired communication challenges. It might be a traumatic brain injury, possibly a stroke, that causes a communication issue, so we ask about hospitalizations and anything that might cause damage to the brain, nerves or muscles involved with communication.

There are also a number of progressive conditions like Parkinson’s, MS or ALS that cause speech and language deficits.

Q: How do hearing disorders develop?

A: Hearing disorders might be present at birth, and it’s been a huge help for newborn hearing screenings to become pretty standard across the nation, because that helps catch any deafness or hard-of-hearing condition in young children.

Our field is building awareness of the importance of starting sign language early. We often recommend that people start learning and using American Sign Language as soon as possible, because infants should be exposed to language as soon as possible. Some kids have progressive hearing loss that is developing over time, so there are regular hearing screenings for all public school children to identify undiagnosed hearing deficits.

A big cause of hearing loss or delay in language is kids who have repeated ear infections. Because those infections cause fluid in the middle ear, they’re hearing everything like it’s underwater, and they might not be talking on time. Sometimes the eardrum fills with fluid and gets perforated because there’s an infection that has swollen and burst the eardrum. Addressing the ear infections and fluid behind the eardrums will allow children to hear speech sounds clearly so they can progress in their comprehension and speech.

Then there is acquired hearing loss for different reasons. Sometimes, a sudden loud noise right next to the ear could cause temporary or permanent hearing loss, and repeated exposure to loud noise can also cause damage over time.

Q: What are some of the most common hearing disorders?

A: Hearing disorders are classified into two categories. One is in the inner ear, called sensorineural hearing loss. That’s anything that’s happening in the cochlea and up into the neural pathways to the brain.

The other type would be the middle ear or the outer ear. Those tend to be more treatable with medication or surgery. You can repair the middle ear disorders that might be due to an infection, accident or a burst eardrum.

Q: Is there a reason that some children are “late talkers” or struggle to meet the usual speech or language benchmarks?

A: There are a group of late talkers that simply start talking a little bit later, and they end up catching up. Other kids need specific support. When they’re not talking on time, you don’t know which group they belong to, so we really want to catch all of those kids and give them support. I would recommend parents go to the American Speech-Language-Hearing Association (ASHA) website — there are developmental, social and communication milestones there.

I always encourage parents, if they are concerned about their child’s communication development, to get some kind of consultation or evaluation to rule out any concerns, because it will always be better to start earlier on therapy if it’s needed — the earlier you start, the less the child may need.

Q: Are there any other signs to look out for that may indicate a need for professional evaluation?

A: Not saying recognizable words at about 12 months — when most children start saying words that are recognizable to other people. Before that, there’s a lot of babble that’s happening, and you should hear a lot of sounds within the child’s babble. I get really encouraged when I’m evaluating a child with a language delay if I see them using gestures like pointing, shrugging their shoulders, or waving hello and goodbye. Having that nonverbal communication is a really good sign that they are taking in quite a bit of the language around them.

The number one thing I would recommend is engaging with books with kids. You don’t even have to read the text on the page, just talking about the pictures starts to expose them to a rich variety of vocabulary, and it sets up face-to-face time with an adult that is essential for language.

I would caution parents about depending on TV shows or videos as language stimulation. Even if it’s just 10 minutes a day that caregivers can sit and read with their child, that will be powerful.

Q: Sometimes parents can be discouraged from speaking a language other than English to their children, because they worry that the children might be confused. What does the research say about children’s ability to learn and distinguish between two different languages?

A: Research shows parents should continue exposing their child to any languages that are relevant to their family needs or environment. That actually becomes a building block and a basis for learning English later. We always encourage families to continue to speak their first language with their child. I’ve seen kids with severe communication disabilities be very functional in two languages, and they’re able to participate in the communities that are relevant to their family life, which has a huge impact on their social and emotional well-being.

Q: Are there habits that can support healthy speech and hearing as we age?

A: Making time to seek out information and help for communication concerns earlier rather than later is always recommended. For example, if you’re noticing that your voice is not working as well as it was — maybe you work in a profession where you speak a lot and you’re noticing a lot of coarseness and strain — a course of voice therapy can help you care for your voice differently and allow you to keep working.

A lot of people delay getting their hearing screened or tested if they are noticing that they’re not hearing as well as they used to, and the research shows that hearing loss is related to cognitive decline. If your brain can’t hear the difference between certain sounds, it will stop thinking it needs to, and it can be hard to recover that. More recently, research has connected hearing loss with dementia. It’s always worth getting checked out sooner rather than later, because often there are treatments or therapies that may help.

Q: What are some resources or organizations that provide assessments and care?

A: From birth to 3 years old, look at the Arizona Early Intervention Program or an early intervention program in your state. Three to age 18, or even up to 22, schools offer an evaluation, and parents can request in writing if they have concerns about their child’s communication or progress in school.

Once you get into adult services, a referral might be available through your doctor. You can always look to things like the Division of Developmental Disabilities or the ALTCS program in Arizona. This would be for people with impactful disabilities that are continuing throughout their life, and they can often get therapies, free or low-cost, to support that communication. And then sometimes you’re just approaching a private clinic and saying, "This is my concern; I would like more support." Many times insurance does cover speech and language therapy.

Q: How can we create inclusive and accessible environments for people with speech or hearing differences?

A: I’ve started to see communication boards in playgrounds — symbols that kids can point to that help them communicate some things about their play. Within schools, having students with disabilities that are part of the general education classrooms or activities has helped bring a better awareness to the public about the presence of people with all different types of abilities as part of our community.

People should not hesitate to do advocacy on an individual basis. Although we have laws that require that things be accessible, there’s no substitute for an individual speaking up and saying, "This looks like it would be hard for someone to participate in." Also, if there aren’t any people with disabilities participating in something — a sports team, a Scout troop, a theatrical production — ask: "Are there no people with disabilities here because they can’t access it? And if so, I wonder what would help them access it?"