17. The History of Speech Pathology

Categories of Disability

The creation of IDEA legislation imposed on school speech-language pathologists a formal system of education disability categories. Clinical certification only partly prepared them for their new role. 

Categories

SLPs were obliged to understand category criteria and differentiate among them. The number of categories rose to 14 in 1990 when traumatic brain injury and autism were added to the list.  Speech Language Impairment (SLI) was selected as the category for placement and treatment of communication disorders of all kinds.  

SLPs were involved with the category system in two ways, as evaluators for the SLI category, and as therapists for all other disability categories. 

In IDEA 2004 regulations indicated SLPs were one of three principal evaluators for the reauthorized law. SLPs were given significant national recognition in evaluating at-risk children for special education placement, treatment and retention.  On the other hand, they provided supplemental services in support of IEPs.  Medical doctors, psychologists and IEP teams requested speech therapy services for cases where SLPS were not primary evaluators. They evaluated the treatment plan, goals and procedures for the speech and language component of IEPs.  

Quality of Judgment

Adoption of the special education category system meant SLPs faced greater complexity of judgment and different assumptions for disability determinations. Disability judgment required two-way assessments of the extent to which a primary disability affected educational performance. Here is the relevant definition of  SLI:” Speech or Language Impairment…means a communication disorder such as stuttering, impaired articulation, a language impairment, or a voice impairment that adversely affects a child’s educational performance” (Nichcy, 2011). 

“You may have noticed that the phrase “adversely affects educational performance” appears in most of the disability definitions. This does not mean, however, that a child has to be failing in school to receive special education and related services. According to IDEA, states must make a free appropriate public education available to “any individual child with a disability who needs special education and related services, even if the child has not failed or been retained in a course or grade, and is advancing from grade to grade” [§300.101(c)(1)]  (Nichcy, 2011). 

Beyond the ambiguous cases mentioned, two-fold assessment is subtle as to the ways in which the two levels of judgment are interwoven in application.  SLPs have a federal obligation to follow assessment procedures which include how pupils are progressing in the general curriculum through appropriate instruction.  For example, how is the pupil using speech and language in the classroom to participate in teacher-guided lessons? Or does a brilliant child with a voice problem qualify for special education? 

Faulty Judgments

Critics agree categories of disability hold a natural place in education dating back centuries.  Further, they agree the present system has been studied and validated to a reasonable degree given the short history of federal laws requiring them.  However, it is complicated and invites many areas of misjudgment affecting the children involved:

“Special education has also been validly criticized for the way in which students with disabilities are identified. In the early nineteenth century, physicians and educators had difficulty making reliable distinctions between different disability categories. In fact, the categories of mental retardation and behavioral disorders are inseparably intertwined. Many of the disability categories overlap to the extent that it is hard to differentiate one from the other. Additionally, some of the categories – learning disabilities and behavioral disorders, for example – are defined by the exclusion of other contributing disabilities. Thus, at the beginning of the twenty-first century, much work remains on the identification of students with disabilities.”

(http://www.answers.com/topic/history-of-special-education, PAUL ACKERMAN, ROBERT JAEGER, ANNE SMITH)

Preparation

Close inspection of the new skills required after 1975 indicates they are outside of the scope of the traditional communication disorders curriculum.

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