Communication Science Disorders

Definition

The discipline of communication science disorders (CSD) is comprised of two related fields known as speech language pathology and audiology and in both cases involves the diagnosis and treatment of client-patients. The governing scientific body that regulates and supports the profession is ASHA or the American Speech-Language-Hearing Association.

Unlike various other professions that also collaborate with biomedicine, the discipline of communication science disorders [is a unique interdisciplinary field] that encourages researchers to involve [the afflicted or "disabled"] in developing research questions, designing methods and analyzing data.[1]

The field of speech language pathology (or therapy) focuses on helping individuals regain lost communication skills through rehabilitation services and includes knowledge of:
  • Speech and language development
  • Problems of language
  • Anatomy, physiology and neurology
  • Intervention and remediation strategies for treating communication disorders

A related field, audiology is a profession that deals with:
  • Measurement of hearing and hearing impairment
  • Study of the nervous system, how we process auditory information, and the testing and analysis of auditory disorders
  • Use of hearing aids, cochlear implants, and other assistive listening devices to enhance hearing capabilities in individuals with hearing loss or other disorders of the auditory system.[2]

While biopolitics and "the biotechnical embrace" (Good, 2010) have exerted a powerful influence in medicine and ventured into the field of communication science disorders, the growing trend within communication science is to engage in reflexive practices and to borrow from ethnographic methods used in anthropology. The incorporation of ethnography into clinical practice has been called a critical ingredient to the profession of communication science disorders.[3] What appears evident is that besides medicine, communication science professionals and ASHA strongly promote: (1) A holistic perspective of the human body, and (2) the right to voice the afflicted can exercise towards "self-determination."[4]

In the United States, for nearly two decades, renown speech pathologists, Damico and Simmons-Mackie have suggested that clinicians need to train in the "flexible" methods of applied ethnography which include observation, analysis of artifacts, interviews and recorded diaries, but also underscore the practical relevance of obtaining continual feedback on the relationship between patient and practitioners.[5] Likewise, in Britain, the influential Royal School of Speech and Language Pathology has incorporated a strong vein of social medicine and qualitative practice into the profession's preparative curriculum.[6]

Perhaps because anthropology and communication science are young and interdisciplinary professions with strong leanings towards the humane, crossover research is becoming both inevitable and desirable. To date, overall evidence suggest that communication science and anthropology are two disciplines that have much to gain through research collaborations. In both professions, the following topics have taken center stage:

  • The power of the medical system in our lives
  • The role of policy development and social change
  • Analysis of social harm and restrictions that impede well-being for the afflicted
  • The critical need for transdisciplinary research collaborations
  • Stigma and marginalization
  • The experience of identity for the afflicted or "disabled"
  • Cross-cultural sensitivity and improving quality of life for the afflicted or "disabled"
  • Emphasis on practitioner reflexivity rather than strict bio-objectivity
  • Effective dual-language assessment, intervention and management practices for non-English speakers
  • Social and communicative acts rather than impairment-based interventions
  • Bioethics can be borrowed as the new middle ground.[7] [8] [9]


Among communication disorders that have become relevant in research anthropology, aphasia, autism and deafness stand out:
  • In aphasia, linguistic anthropologist, Charles Goodwin has done significant research on the signification of adaptive modes of communication in post-stroke patients and corroborated the endurance of language, social life and identity despite illness (see Wiki entry for aphasia).[10]
  • For autism, Solomon and Bagatell (psychological anthropologists), recently lassoed an interdisciplinary team of scholars to: (1) Rethink research on autism and its intersubjectivity, (2) move from biomedical pathology to the experience of living with autism (a phenomenological and ethnographic combination), (3) reenvision social interaction and participation for people with autism, and (4) consider the psychological importance and autistic individual's experience in society.[11]
  • Regarding deafness, from early research efforts focused on pathology, victimhood and stigma, recent studies in anthropology are uncovering culturally meaningful and complex sociocultural perspectives such as: (1) community identity and the right to claim the historical role of deaf roots, (2) formation and maintenance of deaf identity, (3) group ideology towards language and education, (4) the emic experience, and (5) how issues surrounding deaf language and culture articulate with those of hearing society.[12]

In all three cases described above, communication science specialists would generally agree with anthropologists, but would argue potentially antagonistic differences of opinion in the following ways:
  • Communication disorder specialists are not physicians or necessarily agree with biomedical model implications
  • The focus for communication science professionals is not to advance bio-strict pathology on hearing and language disorders or promote specific cures to allay perceived "disabilities"
  • Client-patient values are far from trivial
  • The unique characteristics of individuals are prioritized
  • Evidence of any disorder is interpreted within the context of each individual case
  • Methodologies are considered imperfect
  • Evidence-based practice is not about state-of-the-art practice but matching "best" evidence with client-patient values
  • Evidence-based clinical philosophy is a practical necessity given the current inadequacies of the quality and scope of research studies on which systematic reviews are built
  • Evidence-based practice (highest quality evidence) is considered a reliable and ethical standard to use in clinical decision-making. What would be a better substitute?[13]

The simplest observation to make is that anthropology and communication sciences are gaining a lot of ground in understanding human health but research collaborations are needed. However, given the current climate of post-modern ambivalence among anthropologists in general, it remains to be seen whether or not medical anthropologists can accept the practical scientific gains that have been achieved in the highly complex field of communication science disorders. The reality is that much medical anthropology research surrounding communication disorders has been non-inclusive of communication science researchers, and that chasm is not ideal for the production or propagation of knowledge.

Establishment of the Field

The ancients were known to emphasize the ability to speak well and communicate in society, but contingent on prevailing cultural values and attitudes, treatment of the speech and hearing impaired varied greatly even in antiquity. According to professor emerita, Dr. Judith Duchan (CCC-SLP), while the Romans ostracized the handicapped and Spartans condemned the disabled to die, Egyptians offered job placement and were socially supportive. Depending on the disability, various ancient cultures adopted specific methods of rehabilitation:
  1. Memorization exercises were used to train Babylonian bards
  2. Greeks and Babylonians resorted to prayer and sacrifice to gods considered responsible for infirmities
  3. Physical exercise, baths and fresh air were considered palliatives to both treat and prevent illness
  4. To elevate the condition of citoyen, Graeco-roman society prioritized education and mastery in rhetorical skills
  5. To remediate speech problems, Demosthenes developed speech exercises involving the tongue and voice.[14]

As Dr. Duchan explains in various parts, several movements and ideological trends that sprung during the 19th century created the modern profession of speech pathology. In the 19th century, the preliminary stage was set by (1) the elocution movement founded on progressive European politics and freedom of expression ideologies (John Thelwall: British,1764-1834), (2) the shift from religion to science, and (3) the rise of professionalism. During the 20th century, at least four periods account for the development of ideology, theory and practice in speech pathology:
  1. 1900-1945: The "formative period" that established cannons of clinical practice separate from medicine but aligned to medical and educational therapy of speech production
  2. 1945-1965: Focus on the internal process of language
  3. 1965-1975: Focus on behavior and goal-oriented methods
  4. 1975-today: Emphasis on outreach clinical practice[15]

Multimedia



Communication Science Disorders: The multifaceted world of hearing science professionals
in 60 seconds or less


MRI of the Speech Mechanism: Without using any technical language, real-time MRI imaging gives
a fairly complex view of all that must physically happen for the speech and speaking mechanism to take place


Process of Hearing Animation: A fascinating visit to the inner working and wonders of the human ear


Movie trailer of The King's Speech, winner of the 83rd Academy Award Oscar for Best Foreign Picture. After the scandalous abdication of Edward VIII, the film is based on the true story of how George VI (father of Elizabeth II) rose to the throne (1936-1952), overcame a profound stutter with the help of a maverick speech pathologist, and helped lead Britain through WWII.

Into the 21st Century


By 1992, communication science experts, McDonald and Caroll emerged as a team of researchers who explored the relationship of "social interaction" and "event participation" between clients and speech language pathologists.[16] Just what are the "partners in health" doing together? According to Dr. Duchan, what is true for ethnography in anthropology can also work in speech pathology: Assessment and intervention approaches built around events and social participation must involve clinicians as ethnographic observers who act on behalf and support client-patients in their "natural habitats."[17]

Concomitant with how communication science professionals are stepping step away from the strict bio-objectivity of biomedicine, the advent of the 21st century has brought a micro model to speech language pathology that is descriptive-developmental, is not medicalized in nature, and has the following characteristics:
  1. It is not always possible to know the cause of a language disorder, and diagnostic categories may not always explain or predict language behavior
  2. The most important information for the language clinician to collect is a detailed profile of a child (or individual's) skills in each of the relevant areas of language function
  3. The what and how in a language intervention program is determined by how close or how far the individual lives in the zone of normal human speech and language development
  4. Takes into account client setting and context, chronological age and levels of communicative function
  5. The model makes no assumptions but focuses on the on the manifestations of the language disorder that require intervention.[18]

Intervention Approaches


In speech language pathology, the three intervention approaches used for children with developmental language disorders are:
  • Clinical-behaviorist model (applied behavior or ABA analysis)
  • Social-pragmatic model (DIR/RDI/Floortime)
  • Hybrid model (a combo) [19] [20] [21]

Typically, the three styles of intervention therapy get matched to individual developmental disorders and fall under the micro-theoretical model of a descriptive-developmental and non-medicalized persuasion. All approaches prioritize the child and his/her individual needs.

Description of Intervention Approaches


Clinical-behaviorist (child-directed) model:
  • Clinician manipulates material, context, and clinical exchange to maximize opportunities for a child to use new forms
  • Clinician is able to target, develop plans and is able to measure outcome sooner
  • Clinician generally obtains above average results through drill and behavioral reinforcement
  • Is a method that has been repeatedly proven to work and is not a fad

Disadvantages of the clinical-behaviorist (child-directed) model:
  • Client-practitioner exchange is less natural because the clinician controls context and communication language
  • The model is less efficient incorporating new language forms into settings outside the clinic

The Social-pragmatic (child-centered) model:
  • Clinicians choose material and arrange activity for child
  • Achieve indirect language stimulation through facilitative but non-directed play
  • Target responses as a natural part of play
  • React to child's behavior placing it in a communicative context and giving it linguistic mapping
  • Gives child opportunity to see how new forms are used in real communication

Disadvantages of the Social-pragmatic (child-centered) model:
  • The spontaneous nature of the exchange can delay structured progress of forms
  • Plans and targets for specific problems less efficiently
  • Because it is a less structured environment, requires above average levels of clinical training and experience
  • Can be a very lengthy (two year) and costly process to learn
  • Anyone surrounding child for extended periods (parents, teachers, etc.) must be trained.[22]

The hybrid model is a combination curriculum of clinical and pragmatic styles and is highly flexible but requires great expertise and time to perfect. In any intervention, it is best to focus on intervention techniques that work rather than slipping into a theoretically divisive trap.

For competent clinicians in speech language pathology, ethnography plays a significant role: Any therapeutic assessment or intervention should be built around events and social participation where clinicians can act as ethnographic insiders willing to support and act on behalf of their client-patients in their natural states and surroundings or "habitats."[23]

Autism


The best case-in-point in the debate over which intervention model works best, is to apply it to children classified with autism or related spectral disorders. While the debate rages on, many appear inclined to agree that the ideal approach for autism interventions is the one that works best in any given context. Combination intervention styles are typically very useful, but according to Dr. Arbel (CCC-SLP) at USF, clinical-behaviorist approaches have been shown to work extremely well. Nonetheless, the general consensus is that any of the three approaches will boost developmental growth and advance communication and social skills and can be fairly well tailored to meet the specific needs of individual children. That said, heavyweight researchers such as Lovaas (e.g., ABA), Greenspan (e.g., DIR/Floortime) and Gutstein et al. (RDI) have demonstrated that many autistic individuals indeed benefit from intervention therapy.

For communication science professionals, the foundation for intervention is deliberately humane, and makes extensive use of the Zone of Proximal Development.[24] ZPD techniques stem from Vygotsky's ideas that learning can be propitiated when the target zone is subjected to a process where the individual is kept between comfortable and uncomfortable of knowledge. The strategy is effectively used by speech pathologists but not fully accepted by a research anthropologist like Charles Goodwin (2004) who wrote about ZPD in his study on the cognitive education and verbal output of the aphasic patient, Chil.


Autism: Clinical-behaviorist approach (ABA)


Autism: Social-pragmatic approach (DIR/RDI and Floortime)

Perhaps the most complex aspect inherent to autism is whether or not people believe autism and related spectral disorders exist, need to be "treated" or should be classified as a developmental disability. The question is of significant concern since according to the Centers for Disease Control and Prevention the current rate of incidence for autism and related disorders in the United States is estimated to be 1:110. With those numbers, autism can seem too commonplace. Some researchers will agree the numbers are relevant, while others will contest them and call the percentage of autism-affected individuals, biomedical constructs.

Psychological anthropologists Solomon and Bagatell, have committed research to explain their vision of autism as a social constructed across institutional, ideological, sociohistorical, and social-interactional contexts [that] demarcate a new interdisciplinary domain of inquiry that examines autism as a contestable and contested sociocultural as well as biomedical construct.[25] Their empirical position is one which reflects on autism as a way of being rather than a medical condition and encourages families, healthcare providers and educational policy makers to think along the same lines.

As an anthropologist diagnosed with adult-diagnosed Asperger (considered an autism spectrum disorder), Dawn Eddings Prince illustrates "the different way of being" and moves beyond pathological classification. In her story, Prince shares her emic and deeply human point-of-view, and illuminates not the disability of autism, but the reward of the struggle and the gifts that are part of a different way of being.[26] (No multimedia appears to be yet available.)

From the perspective of communication science disorders, accepting a diagnosis of autism and subsequent interventions exist in relation to the following: (1) what can be done to improve quality of life for the autistic child? (2) the importance of teaching the social skills that ignite an autistic individual's desire to live and contribute to the world, and (3) assist in the individual counseling process. For speech pathologists in particular, interventions are about locating a healing threshold for autistic children, friends, and community.

In combination thinking, communication science professionals would argue that autism is both a clinical and sociological phenomenon. The evidence used by communication science professionals stems from research in communication science disorders, from being exposed to doing extensive work with varying types of autistic children, and from some of the following medical research findings:
  • Neurology and biology: (a) autism shows brain enlargement and brain tissue differences, (b) is primarily genetic, (c) shows interference in protein signaling that mediates normal development of language, social interaction and cognitive motor responses, (d) show a slightly higher risk for seizure disorders over a lifetime, (e) is a heterogeneous disorder likely to have multiple possible etiologies, and (f) core autism deficits are largely resistant to pharmacological treatments
  • Is defined by the Autism Society of America as a complex developmental disability that cause problems with interaction and communication with symptoms that start before age three and can cause serious delay problems
  • Presents with deficits in communication, abnormal social interactions, and restrictive, repetitive behavior
  • Can range from low-to-high functioning (there is an "autism spectrum" range)
  • Is generally called a PDD (pervasive developmental disorder), but is specifically referred to as ASD (autism spectrum disorder) and related to another group of similar disorders (Asperger, Rhett, and PDD/NOS or developmental disorders not otherwise specified, etc.)
  • Demonstrably improves with intervention: Early interventions lessen further mal-development[27] [28]


Much like anthropologist Dawn Eddings Prince, on the side of communication science disorders and dipping into her animal science background, self-identified autistic person, Dr. Temple Grandin, recounts her life story and takes us into her difficult world of sensorineural loss. In a moving yet humorous account, Dr. Grandin offers incredible insight as both diagnostee and subject expert.


HBO original film trailer of Temple Grandin's life from autistic child in the 1960s to brilliant doctoral
candidate who became professor of animal science at Colorado State University


Temple Grandin advises parents of autistic children


Possibly, the most intriguing perspective is anthropologist Richard Grinker's notion that the autism "epidemic" is more "a sign of how much the world has achieved in promoting autism awareness education." Father-cum-anthropologist with an autistic child himself (Isabel), Grinker argues that the shift in how we view autism [and its spectral disorders] is part of a [much] broader societal shift, such as changing attitudes about mental illness, the growth of child psychiatry and special education, and the rise of parent advocacy.[29]


Movie clip of Rainman used by Grinker to explain autism

Related terms


Logopedics, phoniatrics, oral myology, speech processing disorders, speech science, accent fluency, speech developmental disorders, autism, asperger, augmentative and alternative communication, auditory processing disorders, audiometry, tympanometry, cochlea, sensoryneural hearing loss, conductive bone hearing loss, presbycusis, hearing impairment, deafness, noise-induced hearing loss, tinnitus, otitis, Eustachian tubes, hearing aids

Online Resources


ASHA (American Speech-Language-Hearing Association)
National Student-Speech-Language-Hearing Association
Audiology on-line
American Academy of Audiology
The National Center for Voice and Speech
Forum supporting Voice Disorders
U.S. National Library of Medicine
Autism Resources
National Institute on Deafness
Unstrange minds
Dr.Temple Grandin

Further Reading


  • Eldridge, M. (1968). A history of the treatment of speech disorders. Edinburgh, Scotland: E. & S. Livingstone.
  • Gelfand, S. (2009). Essentials of audiology. (3rd ed.). New York, NY: Thieme Medical Publishers
  • Goldstein, K. (1948). Language and language disturbances. New York, NY: Grune and Stratton.
  • Good, M. (2010). The medical imaginary and the biotechnical embrace: Subjective experience of clinical scientists and patients. In Byron Good, Michael M.J. Fischer, Sarah S. Willen, & Mary-Jo Delvecchio Good (Eds.), A reader in medical anthropology: Theoretical trajectories, emergent realities (272-283). Malden, MA: Wiley-Blackwell.
  • Grinker, R.R. (2007). Unstrange minds: Remapping the worlds of autism. Cambridge, MA: Basic Books.
  • Kjaer, B.E. (2005). Terminology and conception of the profession. Advances in Speech-Language Pathology, 7 (2), 98-10
  • Jerger, J. (2009). Audiology in the USA. San Diego, CA: Plural Publishing
  • Justice, L. M. (2010). (2nd ed.) Communication sciences and disorders: A contemporary perspective. Columbus, OH: Allyn & Bacon.
  • Moeller, D. (1975). Speech pathology and audiology: Iowa origins of a discipline. Iowa City: University of Iowa Press.
  • O'Neill, Y. V. (1980). Speech and speech disorders in Western Thought before 1600. Westport, CO: Greenwood Press.
  • Rockey, D. (1977). The logopaedic thought of John Thelwall, 1764-1834: First British speech therapist. British Journal of Disorders of Speech, 12, 83-95.
  • Sonninen, A. & Damsté, P.H. (1971). An international terminology in the field of logopedics and phoniatrics. Folia Phoniatrica and Logopaedica, 23, 1-32
  • Wollock, J. (1997). The noblest animate motion: Speech physiology and medicine in pre-Cartesian linguistic thought. Philadelphia, PA: John Benjamins.

References


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