By Sari Pietikäinen, FinlandAlexandra Jaffe, Long BeachHelen Kelly-Holmes, and Nikolas Coupland
Sociolinguistics from the Periphery "presents a fascinating book about change: shifting political, economic and cultural conditions; ephemeral, sometimes even seasonal, multilingualism; and altered imaginaries for minority and indigenous languages and their users."
Review of The Handbook of Language and Speech Disorders
‘The Handbook of Language and Speech Disorders’ (hereafter referred to as ‘The Handbook’), edited by Jack Damico, Nicole Müller & Martin Ball, presents 26 chapters that are grouped into four parts. Part I, “Foundations”, consists of six chapters discussing issues that are described as germane to all areas of language and speech disorders, whereas Parts II, III, and IV are more disorder specific chapters relating to “Language Disorders”, “Speech Disorders”, and “Cognitive and Intellectual Disorders”, respectively.
To present a brief summary review of each of the 26 chapters would be lengthy and also unnecessary for the current review. Therefore, chapters from Part I will be reviewed in more individual depth as these chapters are the most representative of The Handbook's unique contribution to the field of speech, language and communication disorders. This is not to underestimate the value of the chapters in Parts II, III, and IV, but rather merely to say that for the majority of these chapters, the content is fairly transparent from the chapter titles (i.e. the reader knows what to expect).
This review will proceed with more in-depth description and review of Part I, followed by more general description and review of Parts II, III, and IV.
Part I: Foundations
Chapter 1, ''The social and practical considerations in labeling'', by Jack Damico, Nicole Müller, and Martin Ball, discusses the drivers and potential impact of assigning diagnostic 'labels' to persons with speech, language and communication disorders. The authors claim that the primary aim of initial clinical encounters is for the clinician to establish a diagnostic label to attach to the individual in front of them. The authors then go on to discuss potentially positive and negative consequences of such labeling behavior. Labeling is described within a social constructivist framework and the authors present specific examples of how the social construction of certain disorders has evolved over time. For example, the authors discuss how senility was previously perceived as a normal consequence of aging whereas now it is seen as a disorder that can be differentiated from the norm. A further example discussed is that of autistic spectrum disorders and how it is commonly perceived that identification of children with autistic spectrum disorders is perpetually increasing following, among other factors, changes in diagnostic criteria from the third to the fourth evolutions of the ‘Diagnostic and Statistical Manual of Mental Disorders of the American Psychological Associations’. Concluding this thought-provoking chapter is the assertion that clinicians working with such populations need to consider the individual within the context, whilst also attempting to “discover the reality behind the label and the individuality of each client's condition” (p. 28).
Chapter 2, ''Diversity consideration in speech and language disorders'', by Brian Goldstein and Ramonda Horton-Ikard, discusses issues surrounding the increasingly recognised issue of culturally and linguistically diverse speakers. The chapter discusses issues relating to language variation and the notions of language difference versus language disorder before moving on to highlighting issues of multilingualism and how this may impact on clinical practice. For example, the chapter discusses the known difficulties of conducting speech and language assessments with speakers from culturally and linguistically 'different' groups such as the frequent lack of available standardized and published assessment resources for such speakers. However, the chapter does then also describe some of the more commonly practiced adaptations that clinicians may consider in order to gather some data to inform clinical decision-making (e.g. repeating test instructions, providing cues to elicit target behaviors, adding practice items, and so on). The chapter concludes by arguing that clinicians need to demonstrate cultural competence in order to successfully provide services for culturally and linguistically diverse/different populations. Cultural competence is achieved through awareness of how various “cognitive, linguistic, social, and cultural factors interact to influence the language learning behaviors” (p. 51), and occurs through the processes of: i) increasing awareness; ii) increasing knowledge; and iii) increasing skills. From the outset of the chapter, the authors do acknowledge that the majority of issues are contextualized using research and observation within the US context, with numerous examples of African American English speakers, almost exclusively in pediatric settings; however, the authors do extract out salient principles that could be applied to other culturally and linguistically diverse groups, thus making this chapter useful more generally.
Chapter 3, ''Intervention for children with auditory or visual sensory impairments'', by Laura Kretschmer and Richard Kretschmer, presents a comprehensive review of research concerning speech and language acquisition and development in children with primary hearing and/or primary visual impairments. This includes a discussion surrounding issues of early identification and early intervention, the effects of such impairments on parent-child interactions, the acquisition of spoken language, and the acquisition of signed languages (in the case of hearing impaired children). The chapter argues that for speech and language pathology clinicians to play an effective role in intervention for such children, they need to be fully knowledgeable of typical speech and language development in addition to being knowledgeable about the potential impact that the implementation of technologies (e.g. cochlear implants) and alternative communication modes (e.g. encouraging use of sign) may have with such children.
Chapter 4, ''Intelligibility impairments'', by Megan Hodge and Tara Whitehill, discusses the concept of intelligibility and the applications of obtaining measurements of intelligibility. A principle application of intelligibility measurements is presented as a measure of severity of speech impairment, and furthermore, as a measure of communication impairment. The authors carefully differentiate ‘intelligibility’ (i.e., the reflection of “a talker's ability to convert language to a physical signal (speech) and a listeners' ability to perceive and decode this signal” (p. 99)) from the related, and often easily confused, concepts of ‘comprehensibility’ (i.e. the ability for the speech message to be understood within a particular communicative context) and ‘acceptability’ (i.e. roughly speaking, the extent to which a person's speech is acceptable according to individual perceptions and social norms). Intelligibility is described as a multi-faceted phenomenon that can be influenced by one or a combination of inadequacies in a person's speech (e.g. articulation, voice, loudness, prosody) and/or language (e.g. semantics, morphosyntax, discourse). The chapter discusses various factors that should be considered by the clinician when measuring intelligibility and determining the impact of reduced intelligibility (e.g. characteristics associated with the speaker, characteristics associated with the listener, characteristics of the elicitation/speech task, characteristics associated with the speaking environment, and so on). The authors go on to present the application of speech intelligibility in relation to how it can inform the need for intervention, how it can inform decisions regarding the type of intervention to provide, and also in terms of how repeated pre- and post- measures of intelligibility can be gathered in order to measure the effectiveness of intervention.
Chapter 5, ''Genetic syndromes and communication disorder'', by Vesna Stojanovik, presents rationales for why researchers and clinicians in speech and language disorders should be familiar with developments in our understanding of genetic syndromes and the impact that syndromes may have on communication. It is argued that the study of speech and language in clients with genetic syndromes has increasing potential to inform our theoretical understanding of language development within the broader context of cognitive development. For example, citing previous research, Stojanovik argues that the investigation of genetic syndromes allows naturalistic insight into how development of language and other cognitive functions can dissociate and seemingly follow different developmental trajectories. While the chapter makes it clear that speech and language are unlikely to be totally dissociable from other aspects of cognitive development (due to the influence that different aspects of cognition have on each other), the general principles of dissociability are illustrated through specific discussions of three syndromes (i.e. Williams syndrome, Downs syndrome, and Fragile-X syndrome) that highlight different patterns of speech and language development. The author concludes by stating that while research has progressed in terms of understanding individual syndromes, there is a desperate need for more comparative studies (especially longitudinal studies) that investigate cognitive and language development over time in such conditions. Also, in order for studies to fully inform theories of language and cognitive development, it is imperative that such research consider development as close to birth as possible.
Chapter 6, ''Principles of assessment and intervention'', by Bonnie Brinton and Martin Fujiki, begins by presenting the reader with a scenario whereby a newly graduated speech pathologist is dropped into a preschool classroom situation surrounded by children of varying, and often complex, needs. The reader is then encouraged to empathize with this speech pathologist, who is likely to experience self-doubt and feelings of being overwhelmed. The authors go on to provide reassurance that such feelings of being overwhelmed are natural (even for clinicians with more experience who may be moving into unfamiliar clinical areas) and then offers advice by presenting several principles of assessment and intervention that are valid across different clinical contexts that clinicians can use to offer a kind of structured decision-making process. Some principles that are presented and discussed include (among others): beginning with the end in mind (i.e. going into intervention with a clear understanding of what the 'ultimate' aim of intervention is likely to be, from a long-term perspective, i.e., not only focusing on short-term goals); the fact that good intervention relies on good assessment; the need to focus on what is truly important in order to achieve functional and authentic goals; and, the appreciation that intervention is most likely going to involve a substantial amount of time and effort from both the clinician's and the client's behalf. Throughout the chapter, as well as in its conclusion, there is recognition that services for clients are unlikely to always be 'perfect', whether they be in relation to periods of intervention, or even within the context of an individual clinical session. However, it is argued that by following guiding principles and reflecting on previous experiences, speech pathology clinicians will be able to “contribute to an improved quality of life for the individuals … [they] serve” (p. 148).
Chapters within Parts II, III, and IV generally attempt to follow the 'prototypical' structure of presenting sections (not necessarily in this order) covering: definitions of the disorder in question; historical development; incidence and prevalence data; causes; subtypes and classifications within the disorder; theoretical underpinnings; assessment and evaluation; and intervention. As may be expected, this consistent structure is more easily achieved for some topics than others. This is affirmed by the fact that no single chapter presents all of the above mentioned sections and that some chapters present a unique structure in order to more effectively present the content.
Part II: Language Disorders
This part consists of eight chapters discussing language disorders from a mix of both developmental and acquired perspectives: (7) “Autism spectrum disorders: The state of the art” (John Muma and Steven Cloud); (8) “Delayed language development in preschool children” (Deborah Weiss and Rhea Paul); (9) “Specific language impairment” (Sandra Gillam and Alan Kamhi); (10) “Pragmatic impairment” (Michael Perkins); (11) “Learning disabilities” (Robert Reid and Laura Jacobson); (12) “Reading and reading impairments” (Jack Damico and Ryan Nelson); (13) “Substance abuse and childhood language disorders” (Truman Coggins and John Thorne); and (14) “Aphasia” (Chris Code).
Part III: Speech Disorders
This part presents eight chapters focused on speech disorders, again, from varying perspectives: (15) “Children with speech sound disorders” (Sara Howard); (16) “Dysarthria” (Hermann Ackermann, Ingo Hertrich and Wolfram Ziegler); (17) “Apraxia of speech” (Adam Jacks and Donald Robin); (18) “Augmentative and alternative communication: An introduction” (Kathryn Drager, Erinn Finke and Elizabeth Serpentine); (19) “Fluency and fluency disorders” (John Tetnowski and Kathy Scaler Scott); (20) “Describing voice disorders” (Richard Morris and Archie Bernard Harmon); (21) “Orofacial anomalies” (Jane Russell); and (22) “Speech disorders related to head and neck cancer: Laryngectomy, glossectomy, and velopharyngeal and maxillofacial deficits” (Tim Bressmann).
Part IV: Cognitive and Intellectual Disorders
This final part presents four chapters that discuss situations where speech and language disorders may be more secondarily related to primary disorders of cognitive functioning: (23) “ADHD and communication disorders” (Carol Westby and Silvana Watson); (24) “Communication deficits associated with right hemisphere brain damage” (Margaret Lehman Blake); (25) “Traumatic brain injury” (Jennifer Mozeiko, Karen Lé and Carl Coelho); and (26) “Dementia” (Nicole Müller).
Overall, The Handbook continues the tradition of linguistics related handbooks published under the Wiley-Blackwell name by presenting a comprehensive and contemporary discussion of the state of the area/s under discussion. This is a notable challenge within the field of speech and language disorders, as discussed by the editors in the Introduction chapter. For one, the field has expanded rapidly over the last 15-20 years to include more disorders that fall within the remit of researchers and clinicians working within the field. Secondly, there has been, and continues to be, a fairly extensive paradigm shift within many sub-disciplines within the field of speech and language disorders, which follows a more global move in healthcare professions toward working according to principles of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. This has led to a situation where the impairment as such is no longer the sole focus of assessment and intervention and greater emphasis is given to investigating the actual impact of the impairment on the patient’s/client’s/student’s ability to participate in activities of daily living and within the environment/s in which they operate (e.g. home, work, school, etc.). . However, despite this expansion and paradigm shift, The Handbook rises to the challenge and presents a consistent message across all chapters, achieving an appropriate balance between description of disorders and appropriate contextualization (i.e., the consequences of disorders for the individual). Therefore, the editors should be commended for compiling The Handbook, as it will surely stand as a significant work for a period of time.
In terms of the overall content, while Part I presents The Handbook’s unique conceptual contribution to the field of speech and language sciences, it is important to highlight that all chapters presented within Parts II, III, and IV are successful in presenting overviews of specific subject matter, including an integration of up-to-date and quality research as appropriate. The majority of chapters also effectively present how the understanding of disorders has developed over time, either by explicitly describing the historical development of attitudes and the understanding of the disorders in question and/or by describing the underlying theoretical literature on which current understanding is based. Therefore, there is a successful blend of both seminal and current research woven through chapters in these Parts – as would be expected in an effective handbook.
With regards to the target audience of this handbook, it is quite clearly directed towards clinicians and researchers working with speech, language and communication disorders. For this audience, the Handbook is successful in providing an overview of the current state of knowledge in relation to the topics covered. The Handbook as a whole would be a difficult recommendation to make for early students of speech, language and communication disorders, as it does generally assume a fair amount of background knowledge in most of the areas covered. While some chapters offer a broad, non-specialist introduction to the subject matter, other chapters may be less accessible to students, given their highly specialised nature and the tendency for the subject matter to not receive a great deal of attention (relatively speaking) within speech pathology courses (outside of the United States at least; e.g. Chapters 13, on substance abuse and childhood language disorders, and Chapter 21, on orofacial anomalies). However, more advanced students (i.e. later stage undergraduates and research level students) could still stand to benefit from reading The Handbook as a whole or from reviewing individual chapters, as needed.
The majority of the chapters’ authors are well respected academics based in institutions in the United States. This in itself is not an issue, however, there is perhaps a US-centric perspective in terms of the research literature that is presented within The Handbook. This is also evident when topics are placed within the context of ‘the healthcare system’. As an initial example, Chapter 1 ''Social and practical considerations in labeling” is quick to suggest that a primary aim for clinicians within an initial session with a client is to establish a clinical diagnosis, as this will open or close therapy options within an insurance-based healthcare system. Chapter 2, “Diversity considerations in speech and language disorders”, successfully acknowledges a US-centric view, with much of the research presented being derived from work with African American English speakers. However, it also attempts to extract key themes that emerge that may generalise to clinicians and researchers working within other contexts. In comparison, Chapter 11 “Learning disabilities”, fails to acknowledge that the term 'learning disabilities' is itself used differently in different English-speaking countries. The chapter is explicit in defining 'learning disability' within the US context and is consistent with the definition adhered to by the American Speech- Language -Hearing Association (ASHA, 1991), which considers disorders that are exclusive of intellectual impairment. However, 'learning disability' as used in the United Kingdom and Australia tends to be more inclusive of intellectual impairment, and as such, the term 'language-learning disability' would be more commonly recognised (e.g. Royal College of Speech and Language Therapists, 2006). This omission is somewhat ironic, considering the chapter spends significant time discussing the development of the definitions of 'learning disability' within the US context. It should be stressed, however, that this is a minor issue, as the chapter itself is very explicit and specific with its intended use of terminology.
As a minor remark, while not necessarily fitting with the primary focus of the Handbook, it is a notable omission that there is no chapter regarding disorders of swallowing. Considering that speech and language clinicians, who would be within the target audience for this Handbook, working across a number of settings encounter dysphagia in tandem with communication disorders. This may have been a useful addition to Part I Foundations.
As a further minor remark, the current reviewer feels that Chapter 18, “Augmentative and alternative communication: An introduction”, by Kathryn Drager, Erinn Finke and Elizabeth Serpentine, may have been more effectively situated within Part I of The Handbook. This suggestion acknowledges that augmentative and alternative communication (AAC) methods are not solely applied within speech disorders but are, in reality, a consideration across all areas of practice in which a clinician may work. However, having made this suggestion, it is easy to see how AAC may be traditionally viewed within the domain of speech disorders.
As already discussed, it is an extraordinary and rare task to attempt to compile a comprehensive handbook to cover all areas of speech and language disorders. It is therefore fortunate that the field of speech and language disorders has received this handbook and is soon to receive The Cambridge Handbook of Communication Disorders, edited by Louise Cummings (Nottingham Trent University, UK), which looks to be another exciting attempt to provide a comprehensive overview of this field of research and clinical practice. It will be interesting to conduct a thorough comparison between these two publications, however, a conclusion of whether either of these offerings is to be considered more effective than the other is a moot point, as the field of speech and language disorders as a whole will no doubt benefit from both attempts to provide a comprehensive description of the current state of the field.
American Speech-Language-Hearing Association. (1991). Learning disabilities: issues on definition [Relevant Paper]. Available from www.asha.org/policy
Cummins, L. (Ed). The Cambridge Handbook of Communication Disorders. Cambridge: Cambridge University Press. Forthcoming 2013.
RCSLT. (2005). Royal College of Speech & Language Therapists Clinical Guidelines. Bicester: Speechmark Publishing Ltd.
ABOUT THE REVIEWER:
Christopher Plant holds a Ph.D. in Speech and Language Sciences from Newcastle University, UK (2012). His Ph.D. research focused on investigating the semantic representations of nouns and verbs and their implications for conducting speech and language intervention for people with aphasia. He is currently a lecturer in speech pathology at James Cook University, Australia and continues to be interested in research investigating the cognitive-neuropsychology of language processing and implications for assessment and intervention in speakers with acquired disorders of communication. He can also be found on Twitter @ChrisSPlant