Objectives: The purposes of this study were to (a) examine children’s access to services for their speech and language disorders during their lifetimes; (b) identify any child, disorder, and family characteristics associated with access to services; and (c) describe the speech and language service providers among children who received care. Study design: Data from the 2012 National Health Interview Survey were used for this retrospective cohort study. Our sample included 491 children (ages 3;0–17;11 [years;months]) with speech disorders and 333 children with language disorders. We measured the receipt of services for speech or language difficulties (main outcome) and the type of professional providing services (secondary outcome). We examined associations between services and child, disorder, and family characteristics. Results: Approximately 75% of children with speech and language disorders had ever received services for their difficulties. Privately insured children and children with co-occurring conditions were more likely to receive services than their peers who were uninsured (speech: 6.1 [1.7,21.3]; language: 6.6 [1.3,32.9]) and had no co-occurring conditions (speech: 2.1 [1.2,3.9]; language: 2.9 [1.5,5.5]). Speech-language pathologists (SLPs) were the most commonly reported provider of services (speech: 68%, language: 60%) followed by early interventionists. Conclusions: Most children with speech and language disorders received services. However, disparities existed by race/ethnicity, health insurance type, co-occurring diagnoses, and disorder duration (speech only). Most children who received services were being provided with care by the experts of speech and language: SLPs. Updated population-based data and implementation studies are needed to document speech and language screening, referral, and access to services.

Supplemental Material S1. Age of datasets from previously published studies on treatment access in speech and language disorders.

Davidson, M. M., Alonzo, C. N., & Stransky, M. L. (2022). Access to speech and language services and service providers for children with speech and language disorders. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2022_AJSLP-21-00287

Purpose: A retrospective review of speech-language pathology graduate school applications was conducted to identify ways in which the application process may act as barriers to admission for three populations of underrepresented students: students who are Black, Indigenous, and people of color; first-generation college students; and students with low socioeconomic status.Method: Graduate school applications were analyzed to identify application components that act as barriers to admission. The data set included application data from one program that uses composite cutoff scores and demographics in admissions decisions. Quantitative methods were used to probe for evidence of three types of barriers: barriers to application, group differences, and differential predictive validity. Applicants from underrepresented populations were compared to applicants from overrepresented populations.Results: Applicants from underrepresented populations were more likely to submit late or incomplete applications. Group differences were found for grade point averages (GPAs) and Graduate Records Examination (GRE) percentiles, but not for letters of recommendation or personal statements. All application components made significant contributions to decisions about initial application results. Differential predictive validity was found in the analysis of initial application results. For letters of recommendation, GPAs, and personal statements, group-specific regression lines with the same slopes were found for applicants from underrepresented populations and applicants from overrepresented populations. For GRE percentiles, group-specific regression lines had different slopes.Conclusions: This barrier assessment found quantitative evidence of several barriers to admission for applicants from underrepresented populations. These barriers help perpetuate the lack of diversity in the profession. Actionable steps to mitigate barriers are proposed.Supplemental Material S1. Instructions, scoring tables, and scoring rubrics for graduate school application components used by the Department of Communication Sciences and Disorders in the 2017–2018, 2018–2019, and 2019–2020 application cycles.Kovacs, T. (2022). Assessing barriers to graduate school admission for applicants from underrepresented populations in a master’s level speech-language pathology program. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2021_AJSLP-21-00124

Purpose: For many individuals with aphasia, gestures form a vital component of message transfer and are the target of speech-language pathology intervention. What remains unclear are the participant variables that predict successful outcomes from gesture treatments. The authors examined the gesture production of a large number of individuals with aphasia—in a consistent discourse sampling condition and with a detailed gesture coding system—to determine patterns of gesture production associated with specific types of aphasia.Method: The authors analyzed story retell samples from AphasiaBank (TalkBank, n.d.), gathered from 98 individuals with aphasia resulting from stroke and 64 typical controls. Twelve gesture types were coded. Descriptive statistics were used to describe the patterns of gesture production. Possible significant differences in production patterns according to aphasia type were examined using a series of chi-square, Fisher exact, and logistic regression statistics.Results: A significantly higher proportion of individuals with aphasia gestured as compared to typical controls, and for many individuals with aphasia, this gesture was iconic and was capable of communicative load. Aphasia type impacted significantly on gesture type in specific identified patterns, detailed here.Conclusion: These type-specific patterns suggest the opportunity for gestures as targets of aphasia therapy.

Purpose: Limited evidence exists to guide the assessment and treatment of cognitive-communication disorders associated with right hemisphere stroke. The purpose of this study was to obtain information about speech-language pathologists’ (SLPs’) clinical practices and decision making for this population to understand what practices are being used and identify gaps in clinical practice.Method: A survey was distributed via online ASHA Communities for the Special Interest Groups and other social media platforms. Respondents included 143 SLPs from across the United States representing 3–50 years of experience and a wide range of practice settings. Survey questions probed assessment practices including how tests are selected, what tests are used to diagnose specific deficits, and how confident SLPs were in their diagnoses. Treatment decisions were queried for a small set of disorders.Results: SLPs routinely assess cognitive disorders using standardized tests. Communication disorders are less likely to be formally assessed. Three core right cerebral hemisphere deficits—anosognosia, aprosodia, and pragmatic deficits—are either not assessed or assessed only through observation by 80% of SLPs. Evidence-based treatments are commonly used for disorders of attention, awareness, and aprosodia.Conclusion: Communication disorders are less likely to be formally assessed than cognitive disorders, creating a critical gap in care that cannot be filled by other allied health professionals. Suggestions for free or low-cost resources for evaluating pragmatics, prosody, and awareness are provided to aid SLPs in filling this gap.Supplemental Material S1. Assessments included in the survey.Ramsey, A., & Blake, M. L. (2020). Speech-language pathology practices for adults with right hemisphere stroke: What are we missing? American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2020_AJSLP-19-00082

Purpose: In persons living with aphasia, we will explore the relationship between iconic gesture production during spontaneous speech and discourse task, spoken language, and demographic information.Method: Employing the AphasiaBank database, we coded iconic gestures in 75 speakers with aphasia during two spoken discourse tasks: a procedural narrative, which involved participants telling the experimenter how to make a sandwich (“Sandwich”), and a picture sequence narrative, which had participants describe the picture sequence to the experimenter (“Window”). Forty-three produced a gesture during both tasks, and we further evaluate data from this subgroup as a more direct comparison between tasks.Results: More iconic gestures, at a higher rate, were produced during the procedural narrative. For both tasks, there was a relationship between iconic gesture rate, modeled as iconic gestures per word, and metrics of language dysfluency extracted from the discourse task as well as a metric of fluency extracted from a standardized battery. Iconic gesture production was correlated with aphasia duration, which was driven by performance during only a single task (Window), but not with other demographic metrics, such as aphasia severity or age. We also provide preliminary evidence for task differences shown through the lens of two types of iconic gestures.Conclusions: While speech-language pathologists have utilized gesture in therapy for poststroke aphasia, due to its possible facilitatory role in spoken language, there has been considerably less work in understanding how gesture differs across naturalistic tasks and how we can best utilize this information to better assess gesture in aphasia and improve multimodal treatment for aphasia. Furthermore, our results contribute to gesture theory, particularly, about the role of gesture across naturalistic tasks and its relationship with spoken language.Supplemental Material S1. Iconic gesture examples from the gesture coding, for the Window task, and for the Sandwich task, demonstrating a variety of gesture forms used.Supplemental Material S2. Descriptive statistics of gesture type frequency for all gesture types (i.e., iconic, emblem, concrete deictic, and number) collected as a part of this study in N = 75 participants.Supplemental Material S3. Correlation table between demographic information, language information extracted from each discourse task, and iconic gestures (collapsed across subtypes; for frequency and rate) in N = 75 subjects.Supplemental Material S4. Correlation table between demographic information, language information extracted from each discourse task, and iconic gestures (collapsed across subtypes; for frequency and rate) in N = 43 subjects (subjects who gestured on both tasks).Stark, B. C., & Cofoid, C. (2021). Task-specific iconic gesturing during spoken discourse in aphasia. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2021_AJSLP-20-00271Publisher Note: This article is part of the Special Issue: Select Papers From the 50th Clinical Aphasiology Conference.

Purpose: We describe the communication challenges of four patients with a neurodegenerative disorder consistent with behavioral variant frontotemporal dementia (bvFTD), characterized by early behavioral and personality changes. By describing their clinical profiles, we identify common barriers to functional communication in this population and provide recommendations for how speech-language pathologists (SLPs) might contribute to minimizing them.Method: Four patients with bvFTD were selected from a cohort of patients with progressive communication impairments. Three of them returned for at least one follow-up visit. Case histories are presented along with the results of comprehensive speech and language, neuropsychological, and neurological testing.Results: At the time of initial evaluation, patients were between the ages of 54 and 66 years and had been experiencing symptoms for 1.5–6 years. Consistent with their bvFTD diagnoses, all patients had prominent behavioral and personality changes that impacted communication. Patients 1 and 2 also had mild aphasia at enrollment, primarily characterized by anomia and loss of word meaning. Patients 3 and 4 both had apraxia of speech and moderate-to-severe aphasia at enrollment with prominent anomia and agrammatism. All four patients had impaired executive functioning and relative sparing of visuospatial skills; episodic memory was also impaired for Patients 2 and 4. Even though functional communication was progressively limited for all patients, none of them received regular support from an SLP.Conclusions: This case series adds to a scant, but growing, literature demonstrating that patients with bvFTD have communication impairments. SLPs are uniquely positioned to identify barriers to functional communication and to provide tailored strategy training to the patients and their care partners over the course of their disease. Systematic evaluation of the efficacy of treatment in this population would be valuable.Supplemental Material S1. Supplemental tasks from the Western Aphasia Battery–Revised.Meade, G., Machulda, M. M., Clark, H. M., Duffy, J. R., Botha, H., Whitwell, J. L., Josephs, K. A., & Utianski, R. L. (2024). Identifying and addressing functional communication challenges in patients with behavioral variant frontotemporal dementia. American Journal of Speech-Language Pathology, 33(4), 1573–1589. https://doi.org/10.1044/2024_AJSLP-24-00013

Purpose: The aims of this study were, in a cohort of children with neonatal opioid withdrawal syndrome (NOWS), (a) to report 1-year neurodevelopmental outcomes and specifically characterize speech, language, and hearing outcomes and (b) to report the prevalence of cleft lip and/or cleft palate. Method: This prospective observational cohort study includes newborns with confirmed in utero opioid exposure who received pharmacological treatment for NOWS. During 1-year-old developmental visits, we administered standardized assessments (Bayley Scales of Infant and Toddler Development–Third Edition [Bayley-III] or Developmental Assessment of Young Children–Second Edition [DAYC-2]—due to COVID-19 restrictions). We compared Bayley-III scores to standardized population means using one-sample z tests. We report estimates, 95% confidence intervals, and two-sided p values. Results: We enrolled 202 infants (October 2018 to March 2020). Follow-up at 1-year was 80%. Infants with NOWS had lower Bayley-III scores at 1 year compared to published norms for cognitive, language, and motor domains. One infant with NOWS was diagnosed with isolated cleft palate and Pierre Robin sequence. All infants passed the newborn hearing screen, and 7.5% had a formal hearing evaluation after neonatal intensive care unit discharge, with 40% having abnormal or inconclusive results; middle ear effusion was the leading cause of abnormal hearing (66.7%). Ten percent of children received a speech-language pathology referral prior to 2 years of age. Infants born to mothers with mental health conditions were more likely to have Bayley-III or DAYC-2 scores below 95 in language or motor domains. Conclusions: Infants with pharmacologically treated NOWS have significantly lower cognitive, language, and motor scores on standardized developmental testing compared to population means at 1 year of age. Early speech-language pathology referral is frequently necessary to promote optimal development in this population.

Supplemental Material S1. 1-year neurodevelopmental outcomes after neonatal opioid withdrawal syndrome.

Benninger, K. L., Richard, C., Conroy, S., Newton, J., Taylor, H. G., Sayed, A., Pietruszewski, L., Nelin, M. A., Batterson, N., & Maitre, N. L. (2022). One-year neurodevelopmental outcomes after neonatal opioid withdrawal syndrome: A prospective cohort study. Perspectives of the ASHA Special Interest Groups. Advance online publication. https://doi.org/10.1044/2022_PERSP-21-00270

Purpose: The purpose of this study was to evaluate the relative contribution of socioeconomic status (SES) on three grammatical measures—finite verb morphology composite (FVMC), percent grammatical utterances (PGU), and clausal density—in children between the ages of 4 and 9 years.Method: Data for this study were from the normative sample in the Edmonton Narrative Norms Instrument. For 359 children, hierarchical linear regression was performed to evaluate the amount of variance in FVMC, PGU, and clausal density that was uniquely explained by SES after accounting for child chronological age and language status (typical, impaired).Results: After child age and language status were controlled, SES was a significant predictor of PGU and clausal density scores, but not of FVMC scores. SES uniquely accounted for 0.5% of variance in PGU scores and 0.8% of variance in clausal density scores.Conclusions: Consistent with maturational accounts of children’s development of tense markers, results of this study offer evidence that, among grammatical measures, FVMC is uniquely robust to variation in SES. Although significant, the variance of PGU and clausal density scores uniquely accounted for by SES was close to minimum. Clinicians can therefore include these three grammatical measures for assessing children of different socioeconomic backgrounds.Supplemental Material S1. Mean (standard deviation) of demographic measures of children by language status and age.Supplemental Material S2. Mean (standard deviation) of grammatical measures by language status and age (N = 359). Weiler, B., Schneider, P., & Guo, L.-Y. (2021). The contribution of socioeconomic status to children's performance on three grammatical measures in the Edmonton Narrative Norms Instrument. Journal of Speech, Language, and Hearing Research. Advance online publication. https://doi.org/10.1044/2021_JSLHR-20-00576

Purpose: Health care professionals’ management and service provision for cognitive-communication disorders following pediatric acquired brain injury (ABI) are poorly understood. This retrospective medical chart review explored interprofessional cognitive-communication rehabilitation practices for children and adolescents with ABI. The aim was to describe current assessment and treatment patterns given practice overlap and the need for collaborative care among diverse health care professionals in pediatric rehabilitation. This will serve as a step toward developing practice guidelines for rehabilitation while reinforcing the critical role of speech-language pathologists (SLPs) in managing cognitive-communication disorders.Method: The retrospective review involved 30 consecutive admissions from a pediatric health care and research center in Ontario, Canada. The cohort comprised all eligible children and adolescents aged 2–17 years with ABI. Extracted variables included patient demographics, cognitive and communication assessment and treatment practices, and interprofessional collaboration.Results: Patients varied widely in age, injury mechanism, and severity. Health care professionals such as physicians, nurses, and neuropsychologists were extensively involved in managing cognitive and communication challenges, but involvement of SLPs was limited. Interprofessional collaboration was infrequent, particularly with SLPs, even though they were members of the interdisciplinary team.Conclusions: Results revealed a lack of SLP involvement in inpatient rehabilitation of children with cognitive-communication disorders, underscoring the need for enhanced interdisciplinary collaboration. These findings suggest that the impact of cognitive impairment on communication might not be well recognized in pediatric inpatient rehabilitation, highlighting the need for not only interdisciplinary collaboration but also education regarding cognitive-communication disorders and advocacy for the role of SLPs. Future research should investigate barriers and facilitators to interprofessional practice to optimize collaboration and improve patient outcomes. Ongoing dialogue and development of shared definitions for cognitive-communication disorder, alongside targeted educational initiatives and advocacy, will promote a culture of collaborative practice and ensure comprehensive care for pediatric patients with cognitive-communication disorders.Supplemental Material S1. ICD-10-CA and CCI codes (Chen et al., 2012; Colantonio, 2013) for ABI and total number (percentage) of patients per code.Perrier, M.-F., Gamm, E., McCormick, A., Turkstra, L. S., Flowers, H. L. (2025). Interprofessional cognitive-communication rehabilitation patterns for children and adolescents with acquired brain injuries: A retrospective medical chart review. American Journal of Speech-Language Pathology, 34(5), 2748–2759. https://doi.org/10.1044/2025_AJSLP-24-00143

Purpose: Listening difficulty (LiD), often classified as auditory processing disorder (APD), has been studied in both research and clinic settings. The aim of this study was to examine the predictive relation between these two settings. In our SICLiD (Sensitive Indicators of Childhood Listening Difficulties) research study, children with normal audiometry, but caregiver-reported LiD, performed poorly on both listening and cognitive tests. Here, we examined results of clinical assessments and interventions for these children in relation to research performance.Method: Study setting was a tertiary pediatric hospital. Electronic medical records were reviewed for 64 children aged 6–13 years recruited into a SICLiD LiD group based on a caregiver report (Evaluation of Children’s Listening and Processing Skill [ECLiPS]). The review focused on clinical assessments and interventions provided by audiology, occupational therapy, psychology (developmental and behavioral pediatrics), and speech-language pathology services, prior to study participation. Descriptive statistics on clinical encounters, identified conditions, and interventions were compared with quantitative, standardized performance on research tests. z scores were compared for participants with and without each clinical condition using univariate and logistic prediction analyses.Results: Overall, 24 clinical categories related to LiD, including APD, were identified. Common conditions were Attention (32%), Language (28%), Hearing (18%), Anxiety (16%), and Autism Spectrum Disorder (6%). Performance on research tests varied significantly between providers, conditions, and interventions. Quantitative research data combined with caregiver reports provided reliable predictions of all clinical conditions except APD. Significant correlations in individual tests were scarce but included the SCAN Composite score, which predicted clinical language and attention difficulties, but not APD diagnoses.Conclusions: The variety of disciplines, assessments, conditions, and interventions revealed here supports previous studies showing that LiD is a multifaceted problem of neurodevelopment. Comparisons between clinical- and research-based assessments suggest a path that prioritizes caregiver reports and selected psychometric tests for screening and diagnostic purposes.Supplemental Material S1. Assessment codes allocated to electronic medical records (EMR; Epic) and the number of children receiving each code (Cases). All Hospital divisions.Supplemental Material S2. Summary assessments (from codes in Supplemental Material S1).Supplemental Material S3. Speech/Language Pathology Intervention codes. Here, and in Supplemental Materials S4–S6, the types of intervention in the EMR, either recommended or delivered, by each Hospital division, and the number of children receiving each code are listed.Supplemental Material S4. Audiology (see Supplemental Material S3 for further details).Supplemental Material S5. Psychology (see Supplemental Material S3 for further details).Supplemental Material S6. Occupational Therapy (see Supplemental Material S3 for further details).Supplemental Material S7. Summary of interventions and the four most common interventions for each Division.Moore, D. R., Lin, L., Bhalerao, R., Caldwell-Kurtzman, J., & Hunter, L. L. (2025). Multidisciplinary clinical assessment and interventions for childhood listening difficulty and auditory processing disorder: Relation between research findings and clinical practice. Journal of Speech, Language, and Hearing Research, 68(6), 2978–2991. https://doi.org/10.1044/2025_JSLHR-24-00306

Purpose: The purpose of this study was to determine the degree to which the executive functions of attention switching and inhibition predicted performance on language subtests from the Temple Assessment of Language and (Verbal) Short-Term Memory in Aphasia (TALSA; N. Martin, Minkina, Kohen, & Kalinyak-Fliszar, 2018) across 3 interval conditions (no delay, 5-s delay, and 5-s filled delay), which was designed to add a memory and executive load to language tasks.Method: This study was a post hoc experimental design. Participants included 27 people with aphasia who were administered 5 subtests from the TALSA (Naming, Word Repetition, Nonword Repetition, Category Judgment, and Rhyming Judgment), which were selected to evaluate input and output levels of processing in the 3 interval conditions listed above. Three executive tasks were administered to evaluate inhibition (Simon and Flanker tasks) and attention switching (number–letter shifting).Results: Independent variables were proportion correct on each TALSA task in 3 separate time conditions, and predictor variables were efficiency on the Simon task and number–letter shifting task. Linear regression modeling was completed, which revealed that inhibition was a significant predictor of proportion correct for Word Repetition and Category Judgment in the 5-s filled interval condition.Conclusions: Our findings indicate that inhibition plays a role in completing tasks that require lexical and/or semantic processing in cognitively demanding conditions. Attention switching was not a significant predictor for any task. These results are an important step toward creating methods to evaluate executive skills in the context of language production.Supplemental Material S1. Control demographic data. Supplemental Material S2. Supplemental Material S2. Average control (n = 5) performance on temple assessment of language and (verbal) short term memory tasks.Supplemental Material S3. Means and standard deviations of reaction time for executive function measures in control participants (n = 5).Obermeyer, J., Schlesinger, J., & Martin, N. (2019). Evaluating the contribution of executive functions to language tasks in cognitively demanding contexts. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2019_AJSLP-CAC48-18-0216Publisher Note: This article is part of the Special Issue: Select Papers From the 48th Clinical Aphasiology Conference.

Objectives: The aim of this study was to determine whether college students build their vocabularies by playing a serious game that incorporates principles of learning and memory.Design: This study used a single-site, prospective, randomized trial with 2 branches: immediate and delayed treatment. Outcome measures were obtained after a 1-month intervention and, for the immediate group only, after a 1-month retention interval.Setting: College students from the University of Iowa were recruited via mass e-mail. The intervention took place in the participants’ homes; the testing took place in a university laboratory.Participants: Forty undergraduates (32 women, 8 men) who planned to take the Graduate Record Examinations (GRE; Educational Testing Service, 2018) within the year following the treatment participated in the study. Participants were allocated to 1 of the 2 treatment branches via biased coin randomization.Intervention: The treatment consisted of vocabulary training on Vocabulary.com for a minimum of 20 min (dose) 4 times per week (frequency) for 4 weeks (treatment duration), for a total cumulative treatment intensity of 320 min.Outcome Measures: The prespecified primary outcome measures of word learning were the number of words mastered during Vocabulary.com play and the percentage of mastered words accurately defined. The depth of information included in the definitions was a secondary outcome. The prespecified primary outcome measure of functional impact was change in the verbal GRE practice test scores from pre- to posttreatment. The examiners scoring the definitions were blind to treatment assignment. All other outcomes were measured automatically by the relevant computer program so blinding was moot.Results: The participants averaged 5.33 hr of play during the treatment interval and mastered 124 words. Amount of play and mastery were highly correlated. Accuracy of definitions was 55% or 59% (depending on treatment branch) after treatment and 55% 1 month later, an insignificant decline. The game itself did not result in GRE gains, but participants who mastered more words per minute of play had higher GRE scores than other participants.Conclusion: Vocabulary.com, an evidence-based game, showed promise as a way to build vocabulary knowledge, but at the intensity of treatment provided, it did not result in gains in high-stakes test performance.Trial Registration: This trial was not preregistered.Supplemental Material S1. Raw data including demographics, descriptive information about gaming and GRE preparation and outcomes associated with the randomized controlled trial.McGregor, K. K., Marshall, B. A., Julian, S. K., & Oleson, J. (2019). Learning while palying: A randomized trial of serious games as a tool for word mastery. Language, Speech, and Hearing Services in Schools, 50, 596–608. https://doi.org/10.1044/2019_LSHSS-VOIA-18-0121Publisher Note: This article is part of the Forum: Vocabulary Across the School Grades.