When most people think about speech-language pathologists, also known as speech therapists, the first thing that often comes to mind is lisps. And yes, speech therapists do help people who have a lisp. But that's just the tip of the iceberg!
Speech-language pathology is a field of clinical practice that is performed by certified speech-language pathologists. These clinicians are qualified experts and work to prevent, evaluate, diagnose, and treat a range of issues, including speech, language, social communication, cognitive communication, voice, feeding and swallowing, and more.
In this article, we’re going to answer all your questions about speech therapists: what they treat, where they work, their credentials, and everything in between.
What are the qualifications of a speech-language pathologist?
As you can imagine, there is a lot of education, training, and certification that goes into becoming a speech therapist.
It often starts by obtaining an undergraduate degree with an emphasis on communication. This entails coursework such as biology, statistics, and the fundamentals of communication, which are all prerequisites for graduate school.
In addition, all certified speech therapists are required to have at least a master’s degree in order to practice. This includes extensive internship placements working with both children and adults, followed by certification exams. While requirements vary by state, a speech therapist is often required to also have a teaching certificate in order to work in an academic setting.
The first year of a speech therapist’s career includes a clinical fellowship, in which they work independently to serve clients while being supervised by a fully certified speech-language pathologist. Once enough clinical hours are achieved, the speech therapist can apply for their full certification.
The scope of practice in speech therapy is surprisingly large. It requires a dedication to client progress as well as continuing education, as new research is always occurring and the profession continues to expand.
What do speech therapists treat?
While the word “speech” is in the title “speech therapist,” it’s a bit misleading. As mentioned, speech therapy is an extremely wide scope of practice that goes far beyond speech and includes many aspects of growing and rehabilitating a person’s communication abilities. Speech therapists work with every population and across all ages, from birth to death.
While speech therapists are certified to treat this range of issues, in practice many specialize in certain conditions and populations. For example, not every speech therapist that works with toddlers to promote language acquisition is specialized or comfortable working with an older individual experiencing communication-related challenges due to a traumatic brain injury.
This is why when searching and choosing a speech therapist, it’s important to find someone who’s experienced in your area of need.
A few of areas that speech therapists commonly treat or work on include:
- Speech delay: Not reaching typical speech milestones expected for a child's age
- Language disorders: Difficulty using, processing, or understanding language
- Speech sound disorders: Trouble producing sounds and words typical for a child’s age. This includes articulation challenges, which is the ability to coordinate mouth functions to accurately pronounce sounds, as well as phonological challenges, where a person has trouble distinguishing certain sounds and putting them together to produce intelligible words
- Stuttering and disfluency: A disruption in the natural flow of speech
- Lisps: Most commonly characterized by making a /th/ sound when trying to say a /s/ or /z/ sound
- Apraxia of speech: A neurological condition that makes it difficult to produce accurate sounds and speak with normal speed and rhythm
- Social communication disorder: Struggling to use communication appropriately in social situations (also called pragmatic language impairment)
- Voice disorders: Affects the pitch, volume, or quality of a person’s voice
Additional areas of coverage that speech-language pathologists work on include aphasia, dysarthria, oral, swallowing, and feeding issues, communication challenges related to autism spectrum disorder, gender-affirming voice training, and so much more.
What is early intervention?
Just as the name implies, early intervention focuses on the development of children aged 0-3. While some parents and caregivers may feel like this is too early to address speech and language needs, research clearly indicates that these are crucial years of development and that therapy enhances important skills during this stage. Speech therapists that focus on early intervention cover a variety of concerns, such as feeding, language development, play skills, attention, and speech.
Feeding therapy can begin in infancy and help with the transition from bottle feeding to table foods, especially for a child that has a cleft palate. An early intervention therapist can also help increase a child’s tolerance for oral feeding as they transition from tube feeding, such as a nasogastric tube.
Speech therapists also work with families to develop their child’s attention and play skills. While it might look like the therapist is simply playing with your child, purposeful play is essential to helping expand a child’s language skills, improve their ability to express their wants and needs, and more. Therapists use targeted play, and teach families how to incorporate these techniques at home, to develop necessary skills such as turn-taking, sharing, and using words and gestures to communicate.
Where do speech therapists work?
Speech-language pathologists work in a variety of settings. Here are a few of the most common:
Academic settings: Many schools offer speech therapy, which is where a large portion of speech therapists work. Speech therapists who work in education are required to maintain both their clinical and teaching certifications.
An academic speech therapist can work in a variety of school-based settings, from preschool all the way through high school. They may have a varied caseload that can include feeding and sensory issues, hearing loss, stuttering, language and pragmatics, and articulation and phonology.
These speech therapists frequently assess and chart the progress of students and, depending on the setting, can work with children ages 3 to 21 within the same day! Often speech therapists in school settings will conduct private or group sessions and will "push in" during class to help a child better participate in school.
Medical settings: There are many different medical settings and environments that a speech therapist can choose to work, from acute care to rehabilitation to outpatient care. A medical speech therapist may prefer to work in neonatal with an emphasis on newborn feeding, or choose to work with adults at end of life.
For those working in a medical settings, a wide scope of knowledge is required. A medical speech therapist often conducts swallowing studies, such as a modified barium swallowing study (MBSS) or fiberoptic endoscopic evaluation of swallowing (FEES). These tests enable them to determine the level of safety for feeding and swallowing for a patient, as well as develop a treatment plan.
A medical speech therapist may also conduct bedside evaluations for patients upon admission to a hospital to determine their level of cognition and ability to safely chew and swallow. Often, medical speech therapists treat a multitude of diagnoses, including stroke rehabilitation, traumatic brain injury, progressive diseases such as Parkinson’s disease, and cancer. They offer critical feeding and speech therapy to those currently on a ventilator or patients coming off a ventilator.
This setting also encompasses outpatient services for those discharged from the hospital, home care for those unable to attend sessions at a clinic, as well as skilled nursing facilities where patients live full-time and receive therapeutic services. Often a speech therapist will work in multiple settings if employed by a hospital network and rotate between settings.
Online speech therapy: Online speech therapy has been exploding in popularity in recent years, even before the onset of the COVID-19 pandemic. More families, individuals, and speech therapists are choosing to deliver and receive speech therapy virtually, given its many advantages.
The majority of speech, language, and communication disorders can be effectively treated online, from early child development, to articulation issues, fluency, post-stroke rehabilitation, and so much more. With that said, there is a small subset of issues, such as feeding and swallowing, that may be better suited to the tactile, hands-on approach of in-person settings. Speaking with a speech therapist can help you make the best choice based on your needs.
Beyond being more affordable and convenient (no more long commutes!), there are many benefits to receiving private, 1-on-1 speech therapy online. Research has shown that the more parents are involved and active participants in their child’s care, the more progress children make toward their communication goals. Online speech therapy allows caregivers to easily schedule appointments around their lifestyle, and attend sessions alongside their child. This helps foster strong parent-therapist relationships and ensures that techniques taught in therapy are reinforced and practiced at home for faster progress. Plus, children often learn best in their natural home environment, surrounded by the people and things they love most.